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.

Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program.

Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions. The present study examined whether lower income predicts treatment engagement and weight loss outcomes during an online behavioral weight loss (BWL) intervention. A total of N = 260 participants (79.2% female; 50.7 ± 11.9 years of age; 60.3% non-Hispanic White) were enrolled into an online BWL program and had their income, stress, program engagement, and weight measured. Results showed that stress fully mediated the effect of income on engagement in the online program. Further, lower income predicted poorer weight loss outcomes, and this effect was partially mediated by perceived stress. This is the first study to demonstrate that lower income is associated with poorer engagement and weight loss outcomes in an online weight loss program, underscoring the need for systems-level stress reduction programs and individual level stress management tools, particularly for individuals with lower income.

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).

An exploratory component analysis of emotion regulation strategies for improving emotion regulation and emotional eating.

Emotion-focused treatments are generally efficacious for improving emotion regulation and consequently, improving clinical symptoms across numerous disorders. However, emotion-focused treatment approaches often contain numerous treatment components, limiting our ability to identify which are most efficacious. As such, the current pilot study sought to isolate three components common across a range of emotion-focused treatments (i.e. emotional awareness, emotion down-regulation, and distress tolerance) and test the impact of each component on (1) emotion regulation and (2) emotional eating behavior. Adults (N = 76) who reported four or more emotional eating episodes in the past month were assigned to attend a one-time, three-hour workshop focused on either awareness, down-regulation or tolerance of emotions, and were subsequently evaluated at one-week and two-weeks follow-up. All groups experienced equivalent improvements in emotional eating at two-weeks follow-up (F [1.47, 85.38 ] = 7.60, p < .01). However, groups showed differential patterns of change across facets of emotion regulation. Improvements in access to healthy emotion regulation strategies was moderately related to improvements in emotional eating in Down-Regulation and Distress Tolerance groups (r [18] = 0.40, r [20] = 0.63, respectively). In the Distress Tolerance group, improvements in emotional eating were moderately related to improvements in acceptance of emotions (r[20] = 0.33) and ability to refrain from impulses (r[20] = 0.41). In the Emotional Awareness group, improvements in emotional acceptance (r[20] = 0.30), awareness (r[20] = 0.38) and clarity (r[20] = 0.39) were moderately related to improvements in emotional eating. While several components of emotion-focused treatments may improve outcomes, each component may demonstrate a unique mechanism of action. Further study is needed to isolate these treatment components in fully powered clinical trials to better understand the mechanisms of action for emotion-focused treatments and ultimately develop more efficient and effective treatment approaches.

The relationship of weight suppression to treatment outcomes during behavioral weight loss.

Many adults enter behavioral weight loss (BWL) programs at a weight below their highest lifetime weight. The discrepancy between highest lifetime weight and current weight is known as weight suppression (WS). Research has yet to characterize WS during BWL or investigate its relation to weight loss outcomes or treatment acceptability. Adults (N = 272) in a 12-month BWL program were assessed. WS was calculated by subtracting measured baseline weight from self-reported highest lifetime weight. Participants with higher WS lost significantly less weight than those with lower WS during treatment, although they still had clinically meaningful weight losses (e.g., participants with WS above the median: 7.8 kg; participants with WS below the median: 12.0 kg). WS was unrelated to weight losses at 24-month follow-up. Controlling for weight loss, treatment acceptability was unrelated to WS. BWL appears appropriate for those with high WS, but future research should aim to improve outcomes in this group.

Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change.

BACKGROUND: Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program. PURPOSE: In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss. METHODS: Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states. RESULTS: Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses. CONCLUSIONS: In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.

Executive functioning and dietary intake: Neurocognitive correlates of fruit, vegetable, and saturated fat intake in adults with obesity.

Obesity is a significant public health issue, and is associated with poor diet. Evidence suggests that eating behavior is related to individual differences in executive functioning. Poor executive functioning is associated with poorer diet (few fruits and vegetables and high saturated fat) in normal weight samples; however, the relationship between these specific dietary behaviors and executive functioning have not been investigated in adults with obesity. The current study examined the association between executive functioning and intake of saturated fat, fruits, and vegetables in an overweight/obese sample using behavioral measures of executive function and dietary recall. One-hundred-ninety overweight and obese adults completed neuropsychological assessments measuring intelligence, planning ability, and inhibitory control followed by three dietary recall assessments within a month prior to beginning a behavioral weight loss treatment program. Inhibitory control and two of the three indices of planning each independently significantly predicted fruit and vegetable consumption such that those with better inhibition and planning ability consumed more fruits and vegetables. No relationship was found between executive functioning and saturated fat intake. Results increase understanding of how executive functioning influences eating behavior in overweight and obese adults, and suggest the importance of including executive functioning training components in dietary interventions for those with obesity. Further research is needed to determine causality as diet and executive functioning may bidirectionally influence each other.

Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial.

OBJECTIVE: To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT). METHODS: Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session. RESULTS: Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges. CONCLUSIONS: Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making.

Slowing down and taking a second look: Inhibitory deficits associated with binge eating are not food-specific.

Poor inhibitory control may contribute to the maintenance of binge eating (BE) among overweight and obese individuals. However, it is unknown whether deficits are general or specific to food (versus other attractive non-food stimuli), or whether observed deficits are attributable to increased depressive symptoms in BE groups. In the current study, we hypothesized that individuals with BE would display inhibitory control deficits, with more pronounced deficits occurring when food stimuli were used. Overweight or obese participants with (n = 25) and without (n = 65) BE completed a Stop Signal Task (SST) with distinct task blocks featuring food-specific stimuli, positive non-food stimuli, or neutral stimuli. The BE group exhibited poorer inhibitory control across SST stimuli types (p = .003, ηp(2)=.10), but deficits did not differ by stimuli type (p = .68, ηp(2) < .01). Including depression as a covariate did not significantly alter results. Results suggest individuals with BE display inhibitory control deficits compared to controls; however, deficits do not appear to be specific to stimuli type. Furthermore, inhibitory control deficits do not appear to be associated with mood disturbance in the BE group. Replication and further research is needed to guide treatment targets.