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.

Self-control and grit: associations with weight management and healthy habits.

Weight management requires resisting immediate temptations in one's environment (self-control) as well as the ability to persevere towards one's long-term goals despite minor setbacks (grit). This study sought to establish relationships between self-control, grit, and behavioral and health outcomes in the context of a couples-based weight management intervention. Couples (n = 64 dyads) in a behaviorally based intervention completed measures of self-control and grit at study entry and the end of treatment (6 months). Habit automaticity for self-weighing and exercise as well as objective weights were measured at baseline, 6 months, and 12 months (maintenance). Self-control and grit increased during treatment; these increases were significantly associated with greater self-weighing habit automaticity at 6 months. Baseline self-control, changes in self-control, and baseline grit were also associated with 6-month exercise automaticity. Only baseline grit was associated with weight loss maintenance. No partner effects were observed. Findings suggest that self-control and grit are malleable constructs that may play an important role in health behavior habits associated with weight management.ClinicalTrials.gov: NCT02570009, October, 7, 2015.

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.

Feasibility of online behavioral clinical trials: The future of weight management randomized clinical trials?

Objective: Behavioral weight management trials are traditionally conducted in-person. The COVID-19 shutdown halted in-person operations, forcing investigators to develop new methods for remote treatment and assessment delivery without additional funding for website development or remote equipment. This study examined the feasibility and acceptability of remote procedures from an ongoing weight management trial impacted by COVID-19. Methods: Using a quasi-experimental longitudinal design, in-person (pre-COVID) and remote (COVID) treatment and assessment procedures were used. Attendance at in-person versus remote (videoconference) treatment sessions was compared. Acceptability of treatment modalities (in-person vs. remote) was examined via self-report. Validity and reliability were assessed on bathroom scales. Attendance at remote (videoconference + mailed, scales) versus in-person assessment sessions was compared. Finally, exploratory analyses were conducted to determine whether participant characteristics moderated the effects. Results: Remote treatment attendance was significantly better than in-person. Overall, there was no significant difference in modality preference. However, Hispanic (vs. non-Hispanic) individuals had greater preference for remote options and attended more remote treatment sessions. Bathroom scales demonstrated excellent validity and reliability. Adherence to remote and in-person assessment sessions was similar. Conclusions: COVID-19 has provided an opportunity to rethink how we conduct research. Results herein establish an evidence-base to support a paradigm shift to remote clinical trial procedures. Such a shift may enhance diversity in clinical trials.

Effect of a Lifestyle Intervention on Cardiometabolic Health Among Emerging Adults: A Randomized Clinical Trial.

Importance: The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group. Objective: To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults. Design, Setting, and Participants: In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis. Interventions: Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group. Main Outcomes and Measures: The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure. Results: Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups. Conclusions and Relevance: In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics. Trial Registration: ClinicalTrials.gov Identifier: NCT02736981.

Effectiveness of "run-ins" at predicting adherence in a behavioral weight loss efficacy trial.

There is limited research on whether run-in procedures predict participant adherence during behavioral efficacy trials. This study examined whether information from behavioral run-ins (food diary completion, questionnaire completion, and staff interview) predict intervention adherence, trial retention, and trial outcomes in a behavioral weight loss trial. Using run-in data, trial staff predicted which participants would have high, moderate, or low trial adherence. Participants with predicted high or moderate adherence were randomized. Results showed that predicted high adherers had better intervention adherence (session attendance and completion of self-monitoring records) and superior trial outcomes (i.e. weight loss). Run-in data did not predict trial retention. Results suggest that run-ins may be effective at identifying participants adherent to intervention protocols, thereby enhancing internal validity of behavioral efficacy trials.

Pilot trial of QuitBet: A digital social game that pays you to stop smoking.

Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players (N = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Can Assessing Physical Activity Liking Identify Opportunities to Promote Physical Activity Engagement and Healthy Dietary Behaviors?

Improving our understanding of what physical activities are enjoyed and the factors that are associated with physical activity liking can promote participation in regular physical activity. We aimed to study physical activity (PA) liking in college women by modelling interactions between body size perception and dietary behaviors on PA liking, and by examining discrepancies between PA liking versus engagement on body size perception and dietary behaviors. Women (n = 251; 74% white) utilized an online survey to report their level of liking for PA types (scored into a PA liking index) and frequency of PA participation. They also reported their perceived body size, level of dietary restraint, and frequency of consuming foods (scored into a diet quality index). In multivariate analyses, a greater perceived body size was directly associated with lower PA liking and indirectly through greater dietary restraint but lower diet quality. Healthiest dietary behaviors were reported by women who both liked and engaged in PA. Women who reported high PA liking but low PA participation reported a higher dietary restraint and lower diet quality. These findings support the empowerment of women across all body sizes to identify physical activities that they enjoy. Health promotion efforts should encourage women to couple physical activity liking and engagement with a healthy level of dietary restraint and consumption of a healthy diet.

Using measured resting metabolic rate to derive calorie prescriptions in a behavioral weight loss program.

OBJECTIVE: Within behavioral weight loss (BWL) programs, using measured resting metabolic rate (RMR) is a more accurate-yet costlier-alternative to the standard method of assigning calorie prescriptions using baseline weight. This investigation aimed to assess differences between calorie goals prescribed using each method including demographic predictors and associations with weight loss. METHODS: This is an ancillary study to a trial comparing approaches to motivational enhancement in a 6-months BWL program designed for emerging adults age 18-25 (N = 308). RMR was measured at baseline and used to derive calorie prescriptions; standard calorie goals were retrospectively assigned for the purpose of these analyses. RESULTS: Standard calorie prescriptions were significantly higher than those derived from RMR. Sex and race were significant predictors of calorie prescription discrepancies: using the standard method, women and Black participants were assigned higher calorie goals than their RMR would indicate. Calorie goal discrepancy did not predict 6-months weight change. CONCLUSIONS: Differences in calorie prescriptions between approaches were significant; however, it remains to be determined whether measuring RMR is worth the cost, time, and participant burden. It may be the case that this consideration has greater impact for certain subgroups-namely, women and Black participants.

Behavioral weight loss in emerging adults: Design and rationale for the Richmond Emerging Adults Choosing Health (REACH) randomized clinical trial.

BACKGROUND: In the U.S., over 40% of 18-25 year olds meet criteria for overweight or obesity. Yet, no large-scale trials have targeted this age group for behavioral weight loss (BWL). Formative data revealed that existing BWL programs do not meet their unique needs and identified motivation as a fundamental barrier for weight management. The goal of the Richmond Emerging Adults Choosing Health (REACH) trial was to test the efficacy of two mHealth lifestyle interventions specifically focused on enhancing motivation, relative to adapted standard. METHODS: Participants (N = 381, 18-25 years, body mass index 25-45 kg/m2) will be randomized to 1) adapted BWL (aBWL), 2) aBWL + self-determination theory (aBWL+SDT), or 3) aBWL + behavioral economics (aBWL+BE). All arms will receive a 6-month intervention, delivered via one group session and one individual session, followed by an mHealth platform. Assessments will occur at baseline, 3-months, 6-months (post-treatment) and 12-months (following a no-contact period). The primary aim is to compare weight loss outcomes at 6 months. Secondary aims include changes at 6-months in physical and behavioral cardiometabolic risk factors, as well as psychosocial measures. We will also explore weight loss maintenance, change in hypothesized mediators, and moderators of treatment response. DISCUSSION: REACH is the first large-scale BWL trial designed specifically for emerging adults. Further, it will be the first trial to compare a lifestyle intervention grounded in self-determination theory to one rooted in behavioral economics. If clinically significant reductions in adiposity are achieved, findings could inform a scalable treatment model to meet the needs of this vulnerable population. TRIAL REGISTRATION: NCT02736981.

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.

Patient-provided e-support in reduced intensity obesity treatment: The INSPIRE randomized controlled trial.

OBJECTIVE: There are two types of patient supporters, peers (two individuals initiating health behavior change who support one another) and mentors (a previously successful patient who supports incoming patients). Social comparison theory suggests that peers and mentors may elicit social comparison processes (patients may compare their progress to that of their peer/mentor), and these social comparisons could impact treatment outcomes. This randomized controlled trial is the first to examine the differential impact of peers and mentors on obesity treatment outcomes and social comparison processes when added to reduced intensity treatment. METHOD: Participants (N = 278) were randomly assigned to reduced intensity behavioral weight loss treatment alone (rBWL), rBWL plus peer e-support (rBWL + Peer), or rBWL plus mentor e-support (rBWL + Mentor). rBWL involved periodic group sessions that decreased over time; when group sessions decreased, intensity of peer/mentor e-support increased. Weight and social comparison processes were assessed throughout the 12-month intervention. RESULTS: There was a significant treatment effect; when group sessions became less frequent and peer/mentor e-support became more frequent, rBWL + Peer had significantly greater weight loss than rBWL alone, and rBWL + Mentor was not significantly different from the other two. Social comparison processes differed by treatment arm; rBWL + Peer participants tended to report more lateral social comparisons ("my weight loss progress is 'similar' to my peer's"), whereas rBWL + Mentor participants reported more upward comparisons ("my weight loss progress is 'worse than' my mentor's"). Upward comparisons were associated with poorer weight loss outcomes. CONCLUSIONS: Peer e-support may be an effective, low-cost, sustainable method for improving longer-term weight loss outcomes in reduced intensity obesity treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Episodic future thinking, delay discounting, and exercise during weight loss maintenance: The PACE trial.

OBJECTIVES: Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance. METHOD: Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored. CONCLUSIONS: This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study.

BACKGROUND: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. OBJECTIVE: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. METHODS: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. RESULTS: In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=-0.26; P=.06). CONCLUSIONS: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244.

A Secondary Data Analysis Examining Young Adults' Performance in an Internet Weight Loss Program with Financial Incentives.

OBJECTIVE: In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss. METHODS: Participants (N = 180; BMI = 33.2 ± 6.0 kg/m2 ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes. RESULTS: Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η2 = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05). CONCLUSIONS: Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.

Behavioural weight loss treatment preferences of college students with overweight and obesity.

The college environment increases risk of weight gain in young adults with overweight/obesity. Behavioural weight loss interventions are proven effective, however, young adults' adherence to such programs is poor. The purpose of the study was to determine weight loss treatment preferences of 2- and 4-year college students for the development of population-specific interventions. Students with a BMI ≥25, between 18 and 24 years of age, and enrolled in one of four institutions were recruited. A questionnaire was developed to assess students' preferences and was administered via Qualtrics. BMI was calculated from objectively assessed height and weight measurements. Descriptive analyses, chi-square, Fisher's Exact Test, Mann-Whitney U test and Cramer's V were performed. Participants (n = 133, age = 20.2 ± 1.8) predominately identified as female (70%), non-Hispanic (68%) and Black/African American (32%) or White (32%). Fifty-five percent met criteria for obesity. Most students preferred session length of ≤1 hour (78%), for meetings to be held on a weekday (70%) and for both a peer and a professional to co-facilitate meetings (61%). Preferences for health outcomes and physical activity monitoring, type of physical activity, frequency of dietary monitoring, physical activity tracking method and interest in financial incentives to promote core treatment components differed between institutions. Heterogeneity in program preferences by college environment should be considered when designing weight loss interventions.

Meaning-making and quality of life in heart failure interventions: a systematic review.

PURPOSE: Heart failure (HF) patients often report high levels of psychological distress and diminished quality of life (QoL). As such, interventions aimed at improving their QoL and other positive psychosocial outcomes are needed. Some interventions have shown promise, but results are mixed. Interventions directed toward physical well-being (e.g., self-care behaviors, medical adherence) may be less effective at improving QoL than those aimed at improving psychological well-being (e.g., stress reduction, coping strategies). We systematically reviewed recent HF interventions and compared results of those emphasizing coping strategies related to meaning-making to those lacking meaning-making components as a possible factor in QoL discrepancies. METHODS: A systematic review of four databases produced 439 studies for potential inclusion, of which 25 qualified for review. These were coded into substantial or minimal meaning focus. RESULTS: Forty percent of all studies (n = 10) reported improved QoL due to intervention effects, while 60% reported no significant change in QoL (60%; n = 15). Fewer than one-third of minimal meaning focus studies demonstrated significant improvements in QoL (30.8%; n = 4). In contrast, half of substantial meaning focus studies demonstrated significant improvements in QoL (50%; n = 6). CONCLUSIONS: By clarifying the potential importance of promoting meaning-making in improving QoL of HF patients, we highlight its potential value in future interventions directed to this underserved, high-risk patient population.

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.

Internet-delivered obesity treatment improves symptoms of and risk for depression.

OBJECTIVE: In-person lifestyle interventions for obesity treatment yield significant improvements in depression. These improvements may be attributed to the excellent weight losses produced by in-person interventions. In contrast, Internet programs yield more modest weight losses, and their effect on depression is unknown. This study is the first to examine whether Internet-delivered obesity treatment impacts depressive symptoms. METHODS: Participants (N = 136) were randomized to either a community campaign plus Internet behavioral weight loss (IBWL) or community campaign alone (Control). IBWL did not include online social support components. A measure of depressive symptoms was administered, and weight was objectively assessed. RESULTS: Of the total sample, 24% met the clinical cutoff for elevated depression risk at baseline. IBWL participants lost more weight during treatment (P = 0.005) and experienced significantly greater improvements in depressive symptoms (P = 0.02). Among participants who met the clinical cutoff for elevated risk for depression at baseline, those assigned to IBWL had greater improvements in depressive symptoms during treatment compared to Control (P = 0.033). Consequently, at post-treatment, a smaller percentage of IBWL participants were at elevated risk for depression. CONCLUSIONS: This study is the first to show that Internet-delivered obesity treatment improves depression risk and depressive symptoms in individuals with overweight or obesity.

Effects of breakfast eating and eating frequency on body mass index and weight loss outcomes in adults enrolled in an obesity treatment program.

This study examined the effects of breakfast eating and eating frequency on objectively assessed BMI and weight loss outcomes among adults enrolled in obesity treatment. Participants completed measures of breakfast eating and eating frequency before and after treatment and had their height and weight measured. Baseline breakfast eating and eating frequency were not associated with baseline BMI (p = .34, p = .45, respectively) and did not predict weight loss during treatment (p = .36, p = .58, respectively). From pre- to post-treatment, there was no significant change in eating frequency (p = .27) and changes in eating frequency had no impact on weight loss (r = -.08, p = .23). However, increases in breakfast eating during treatment were associated with significantly better weight loss outcomes (r = .26, p < .001). Among participants who increased breakfast eating, those who had either no change or a decrease in daily eating frequency were more likely to achieve a 5% weight loss compared to those who had an increase in daily eating frequency (p = .04). These results suggest that increasing breakfast eating, while simultaneously reducing or keeping eating frequency constant, may improve outcomes in obesity treatment. Experimental studies are needed to further elucidate these effects.