Evaluating the utility of temporal self-regulation theory for understanding physical activity outcomes in a behavioral weight loss maintenance program.

OBJECTIVE: Physical activity (PA) is critical for weight loss maintenance (WLM) success. Clarifying mechanisms behind PA engagement may suggest new WLM intervention targets. This study examined an application of temporal self-regulation theory (TST) to enhance our understanding of PA during WLM. METHODS AND MEASURES: Participants (n = 214) who achieved a ≥ 5% weight loss during a 4-month weight loss intervention were recruited into an 18-month WLM trial. TST constructs (i.e. PA beliefs, intention, behavioral prepotency, self-regulatory capacity) were measured via self-report measures. PA was subsequently assessed over a 7-day period with waist-worn Actigraph GT9X. Robust linear regression models and generalized linear mixed models tested the association between PA beliefs and intention, and the associations between intention, behavioral prepotency, self-regulatory capacity and device-measured PA at baseline and 18-months. RESULTS: Short-term positive beliefs were associated with intention at baseline and 18-months, whereas short-term negative beliefs were associated with intention at 18-months only. Intention was associated with moderate/vigorous PA (MVPA) minutes and bouted MVPA at baseline and 18-months. The intention by self-regulatory capacity interaction was significant at baseline. CONCLUSION: Findings lend some support for the use of TST for understanding PA and suggest that short-term beliefs about PA may represent a meaningful target for intervention.

Impact of social connectedness on weight loss outcomes in an online program.

Obesity is linked to many negative health consequences. While online behavioral weight loss programs (BWL) are an effective treatment for obesity, weight losses are modest. Social connectedness has been found to improve weight loss outcomes and previous findings suggests that it may be especially important for people of color. The present study investigated the impact of social connectedness (structural connectedness, or network size; relationship quality, and functional connectedness, or social support) on weight loss outcomes in an online BWL program and whether Black race or Hispanic ethnicity moderates the relationship between social connectedness and weight loss. Participants (N = 387) enrolled in a 16-week online BWL program and completed measures of social connectedness before treatment and had their weight measured. Individuals with less structural connectedness (smaller social networks) had greater weight losses. Further, higher levels of functional connectedness (affectionate support, positive support, and relationship quality) mediated the relationship between smaller network size and better weight loss outcomes. Black race / Hispanic ethnicity did not moderate the relationship between social connectedness and weight loss. These findings suggest that the quality of one's relationships, not the size of one's social network, is important for weight loss. Future studies may examine whether online BWL programs that build relationship quality and affectionate and positive support in participants' existing social networks improve overall weight loss outcomes.

Obesity Treatment in African American Churches: Current Treatment Targets and Preferences among Parishioners.

Obesity is prevalent among African Americans, and church-based weight management programs may help address this public health issue. To develop more effective interventions, a survey was administered to members of a large, African American faith-based organization that assessed weight management intervention targets and preferences. Respondents (N = 1,439) represented the Midwestern and Southern United States. Mean body mass index was 30.8 ± 9.2 kg/m2, and 82.5% of respondents were overweight/obese. The majority (65.0%) wanted a weight management intervention conducted with the church and preferred an in-person (69.0%), group-based (68.0%) program that meets weekly for one hour or less (72%) and addresses identified barriers including access to healthy foods, childcare, and physical activity support. Church support was linked to better dietary quality and higher physical activity among parishioners (p's ≤ 0.02), suggesting church support may be important for healthy eating and exercise. This study provides a clear path forward for developing and delivering weight loss interventions within African American churches.

Small Incentives Improve Weight Loss in Women From Disadvantaged Backgrounds.

INTRODUCTION: Women from lower-income backgrounds have the highest rates of obesity. Thus, effective programs for this high-risk population are urgently needed. Evidence suggests that adding financial incentives to treatment helps to engage and promote health behavior change in lower-income populations; however, this has never been tested in women for obesity treatment. The purpose of this study was to examine whether adding small financial incentives to Internet weight loss treatment yields better weight loss outcomes in women from lower-income backgrounds compared with the same treatment without incentives. Weight losses in lower-versus higher-income women were also compared. METHODS: Data were pooled from two randomized trials in which women (N=264) received either Internet behavioral weight loss treatment (IBWL) or IBWL plus incentives (IBWL+$). Weight was objectively assessed. Data were collected and analyzed from 2011 to 2017. RESULTS: Women from lower-income backgrounds had significantly better weight loss outcomes in IBWL+$ compared with IBWL alone (6.4 [SD=4.9%] vs 2.6 [SD=4.6%], p=0.01). Moreover, a greater percentage achieved a ≥5% weight loss in IBWL+$ vs IBWL alone (52.6% vs 38.1%, p=0.01). Interestingly, the comparison between lower-income versus higher-income groups showed that, in IBWL alone, women with lower income achieved significantly poorer weight losses (3.4 [SD=4.2%] vs 4.9 [SD=4.0%], p=0.03). By contrast, in IBWL+$, weight loss outcomes did not differ by income status (5.0 [SD=5.6%] vs 5.3 [SD=3.8%], p=0.80), and a similar percentage of lower- versus higher-income women achieved a ≥5% weight loss (52.6% vs 53.8%, p=0.93). CONCLUSIONS: An Internet behavioral weight loss program plus financial incentives may be an effective strategy to promote excellent weight losses in women with lower income, thereby enhancing equity in treatment outcomes in a vulnerable, high-risk population. These data also provide important evidence to support federally funded incentive initiatives for lower-income, underserved populations.