Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions.

Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.

Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance.

Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, ß = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, ß = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .

Factors associated with early non-response within an Internet-based behavioural weight loss program.

OBJECTIVE: While behavioural weight loss interventions are effective overall, many individuals fail to achieve a clinically significant weight loss. Given that 4-week weight loss has been shown to predict longer term outcomes, one potential strategy for improving rates of success is to provide additional support to early non-responders. To inform these early rescue efforts, it is important to first identify how they may differ from their more successful peers. METHODS: At week 4 of a 12-week Internet-delivered weight loss program, 130 adults (age: 49.8 ± 9.8 years, body mass index: 31.2 ± 4.6 kg m-2) were asked to complete an 11-item survey assessing mood and weight-related cognitions and behaviours. Participants were then categorized as early non-responders (4-week weight loss <2%) or initial responders (4-week weight loss ≥2%), and groups were compared on intervention adherence during weeks 1-4 and week 4 survey question responses. RESULTS: Early non-responders and initial responders did not differ on any intervention adherence variables (ps > 0.05). Compared to initial responders, early non-responders reported less positive mood (p = 0.011), greater boredom with weight loss efforts (p = 0.036), greater temptation to eat foods not consistent with their goals (p = 0.023), and that their eating choices were less consistent with their goals (p < 0.001). CONCLUSIONS: These findings identify important differences between early non-responders and initial responders, offering potential intervention targets for rescuing early non-responders (i.e. making it easier for individuals to choose healthier foods, reducing boredom in Internet-delivered weight loss programs and providing strategies to limit exposure to dietary temptations).

Sustaining eHealth engagement in a multi-year weight gain prevention intervention.

INTRODUCTION: Digital tools are widely used and effective in weight management interventions; however, usage declines over time. Strategies to promote continued engagement should be explored. We examined the effects of offering additional modes of weight reporting as well as periodic online campaigns to promote engagement, assessed by frequency of weight reporting, in a weight gain prevention study for young adults. METHODS: Using an observational design, self-reported weights obtained through digital tools were pooled across participants assigned to two interventions (n = 312). Analysis examined the effects before during and after introduction of an additional reporting modality (email) and for three time-limited refresher campaigns over 2 years. RESULTS: Adding a new modality to the three existing modes (SMS, web, and mobile web) increased weight reporting as well as the number of modalities participants used to report weights. The use of several modes of reporting was associated with more weights submitted (p < 0.01). Refresher campaigns did not increase the proportion of participants reporting; however, the number of weights submitted during the 4-week campaigns increased compared with the 4 weeks before the campaign (p's ≥ 0.45, <0.001, respectively). CONCLUSION: Using multiple digital modalities and periodic campaigns shows promise for sustaining engagement with weight reporting in a young adult population, and incorporating such strategies may mitigate typical declines in eHealth and mHealth interventions.

Weight self-stigma and weight loss during behavioural weight loss intervention.

OBJECTIVE: Despite the myriad negative effects of weight self-stigma, its role in weight loss intervention has not been thoroughly examined. The aim of this study was to examine the association between weight self-stigma and weight loss. METHODS: This longitudinal study examined the association between weight loss and changes in self-stigma, assessed by the Weight Self-Stigma Questionnaire, which distinguished between self-devaluation and fear of enacted stigma. Participants were adults with overweight or obesity enrolled in a 24-month weight loss intervention trial (groups were collapsed for this post hoc analysis) who were assessed at baseline, 6, 12, 18 and 24 months. RESULTS: Baseline levels of self-stigma were not associated with weight loss outcomes. However, mixed models analysis showed that reductions in one aspect of weight self-stigma, self-devaluation, was associated with greater weight loss (p = 0.01). Cross products mediation analysis showed that increases in use of weight control strategies mediated the association between reductions in self-devaluation and greater weight loss (F = 14.86, p < 0.001; CI 0.09-0.37). CONCLUSIONS: Results suggest that there may be potential for incorporating intervention methods targeting the reduction of self-stigma in order to improve weight loss outcomes.

Weight gain prevention buffers the impact of CETP rs3764261 on high density lipoprotein cholesterol in young adulthood: The Study of Novel Approaches to Weight Gain Prevention (SNAP).

BACKGROUND AND AIMS: Two weight gain prevention strategies, one targeting small changes to diet and physical activity and a second targeting large changes, significantly reduced weight gain in young adulthood. We examined whether weight gain prevention blunts genetic risk for body weight increase and/or high density lipoprotein cholesterol (HDL-C) lowering over two years. METHODS AND RESULTS: Participants were 524 male and female young adults (mean age = 28.2, SD = 4.3; mean BMI = 25.5, SD = 2.6). Obesity-related SNPs accounting for ≥ 0.04% of the variance were genotyped and combined into a genetic risk score. For HDL-C, SNPs within CETP, LIPC and FADS2 were genotyped. The obesity-related genetic risk score did not predict change in BMI independently or in interaction with treatment arm. However, consistent with the prior literature, each copy of the HDL-C risk, C, allele at CETP rs3764261 was associated with lower HDL-C at baseline. Moreover, significant interaction between SNP and treatment arm for change in HDL-C was observed (p = 0.02). In the control group, HDL-C change was dependent upon rs3764261 (p = 0.004) with C allele carriers showing a continued reduction in HDL-C. In contrast, within the two intervention groups, HDL-C increased on average with no differential effect of rs3764261 (p > 0.24). Notably, even among carriers of the CC genotype, small and large change arms were associated with increased HDL-C and the control arm a reduction (p = 0.013). CONCLUSIONS: The C allele at CETP rs3764261 is a strong risk factor for low HDL-C in young adulthood but weight gain prevention may mitigate this risk. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: clinicaltrials.gov Identifier: NCT01183689, https://clinicaltrials.gov/.

Successful weight loss initiation and maintenance among adolescents with overweight and obesity: does age matter?

Treatments for adolescents with overweight/obesity demonstrate mixed success, which may be due to a lack of consideration for developmental changes during this period. Potential developmental differences in weight loss motivations, weight maintenance behaviours and the role of parents in these efforts were examined in a sample of successful adolescent weight losers. Participants enrolled in the Adolescent Weight Control Registry (n = 49) self-reported demographic information and weight history, reasons for weight loss and weight control, weight loss approach and weight maintenance strategies, and perceived parental involvement with weight loss. Associations between age at weight loss initiation and the aforementioned factors were examined using linear and generalized regressions, controlling for highest z-BMI and sex. Adolescents who were older (≥16 years) at their weight loss initiation were more likely to report losing weight on their own (37.5% vs. 75%, P = 0.01) and reported greater responsibility for their weight loss and weight loss maintenance (P < 0.001) compared to younger adolescents. Younger age at weight loss initiation was associated with greater parental involvement (P = 0.005), whereas older age was associated with greater adolescent responsibility for the decision to lose weight (P = 0.002), the weight loss approach (P = 0.007) and food choices (P < 0.001). Findings suggest the importance of considering developmental differences in responsibility for weight loss and maintenance among adolescents with overweight/obesity.

Exploring process variables through which acceptance-based behavioral interventions may improve weight loss maintenance.

OBJECTIVE: A previously published randomized trial with individuals reporting high internal disinhibition showed significant differences in post-treatment weight change favoring Acceptance-Based Behavioral Intervention (ABBI) when compared to standard behavioral treatment (SBT). This paper examines process variables that might contribute to the observed differences in weight change. METHODS: Participants were 162 adults with overweight or obesity (mean BMI 37.6) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on process measures hypothesized to be related to outcome in ABBI and SBT and their association with weight loss outcomes using linear and non-linear mixed models methods and exploratory correlational analyses. RESULTS: Both the SBT and the ABBI groups showed significant changes over time on all process variables. The only significant between group difference was for values consistent behavior, with the ABBI group improving more as compared to SBT (t=2.45, p=.016); however, changes in values consistent behavior did not mediate weight change. Exploratory analyses suggest the possibility that changes in process variables were less associated with weight change in ABBI than in SBT after treatment was discontinued. CONCLUSIONS: Both conditions produced significant changes in process variables, however there was little difference between groups. Thus, the results do not provide an adequate process account for the observed weight change differences between ABBI and SBT, leaving important questions that need to be addressed by future research.

Weight loss and frequency of body-weight self-monitoring in an online commercial weight management program with and without a cellular-connected 'smart' scale: a randomized pilot study.

Objective: Evaluate the effects of an online commercial weight management program, with and without provision of a 'smart' scale with instructions to weigh daily and weekly tailored feedback, on weight loss and the frequency of body-weight self-monitoring. Methods: Participants (N = 92; body mass index 27-40 kg/m2) were randomized to 6 months of no-cost access to the Weight Watchers Online (WWO) platform alone, or enhanced with a cellular-connected 'smart' scale, instructions to weigh daily and weekly pre-scripted email feedback (Weight Watchers Online Enhanced [WWO-E]). The number of days that weight was self-monitored (via 'smart' scale in WWO-E and manually in WWO) was recorded automatically across the 6-month trial. Objective weight was measured at baseline, 3 and 6 months. Results: While both groups achieved statistically significant weight loss, mean ± standard error weight loss did not differ between WWO-E and WWO at 3 months (5.1 ± 0.6 kg vs. 4.0 ± 0.7 kg, respectively; p = 0.257) or 6 months (5.3 ± 0.6 kg vs. 3.9 ± 0.7 kg, respectively; p = 0.116). However, a greater proportion of WWO-E lost ≥5% of initial body weight at 3 months (52.2% vs. 28.3%; p = 0.033), but not 6 months (43.5% vs. 30.4%; p = 0.280), compared with WWO. Mean ± standard deviation days with self-monitored weight was higher in WWO-E (80.5 ± 5.6; 44.7% of days) than WWO (12.0 ± 1.0; 6.7% of days; p < 0.001) across the 6-month study period. Conclusions: This is the first study to show that provision of a 'smart' scale with weekly tailored feedback substantially increased the frequency of self-weighing and the proportion of participants achieving an initial clinically significant ≥5% weight loss (52% vs. 28%) in an online commercial weight management program. Both WWO and WWO-E produced significant weight loss over 6 months. While mean weight losses were slightly greater in the enhanced group, the difference was not statistically significant in this small sample. This study provides support for the clinical utility of online commercial weight management programs and the potential for supporting technology such as 'smart' scales to improve adherence to body-weight self-monitoring and clinical outcomes.

Characteristics of adults with overweight/obesity and high internal disinhibition: do they fit with targets for acceptance-based interventions?

OBJECTIVE: Adults with overweight/obesity reporting high levels of internal disinhibition (ID) tend to do poorly in standard behavioural weight loss programmes. The current study sought to compare a sample of individuals with overweight/obesity selected on the basis of high ID with an unselected treatment-seeking sample of adults with overweight/obesity on characteristics that might make acceptance-based treatments particularly appropriate for those with high ID. METHODS: Sample 1 included 162 treatment-seeking adults with overweight/obesity who were selected for high ID; sample 2 included 194 unselected treatment-seeking adults with overweight/obesity. First, the two samples were compared on levels of general and weight-related experiential avoidance, and values-consistent behaviour, both of which are targeted in acceptance-based treatments, and on other general psychological characteristics. Next, the unselected sample was split into two groups, those meeting criteria for high (N = 105; sample 2/high ID) vs. low (N = 89; sample 2/low ID) ID, and the three groups were compared on the same characteristics. RESULTS: Sample 1 reported higher levels of both general and weight-related experiential avoidance as well as less values-consistent behaviour than sample 2. They reported greater psychological impairment in quality of life, depression and anxiety. Within sample 2, 54% met the criteria for high ID. Both sample 1 and sample 2/high ID reported higher levels of experiential avoidance and less values-consistent behaviour than did the sample 2/low ID. The two high ID samples also reported greater psychological impairment in quality of life, depression and anxiety than sample 2/low ID. CONCLUSIONS: Adults with overweight/obesity who report high levels of ID were characterized by higher levels of experiential avoidance, lower levels of values-consistent behaviour, and more psychosocial impairment as compared with other adults with overweight/obesity. As these are important targets of acceptance-based approaches, this subgroup may benefit from the integration of such approaches into behavioural weight loss programmes.

Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health.

OBJECTIVE: The objective of this paper is to evaluate successful weight loss maintainers' use of self-monitoring technology. METHODS: National Weight Control Registry (NWCR) participants, who maintained a ≥13.6 kg weight loss for ≥1 year, completed an online survey about self-monitoring technology use. The NWCR sample (n = 794) was compared with a demographically similar subsample of 833 individuals answering the same questions in the Pew Tracking for Health Survey. RESULTS: The NWCR had higher rates of tracking weight, diet or exercise using any modality (92.8% vs. 71.3%), on a regular basis (67.4% vs. 41.3%), and frequency of updating records, compared with Pew (ps < .01). Smartphone ownership was higher in NWCR participants (80.2% vs. 52.8%, p < .001), and NWCR smartphone owners had 23.1 times greater odds for using diet, food or calorie counter apps (58.9% vs. 5.9%) and 15.5 times greater odds for using weight monitoring apps (31.7% vs. 3.0%; all ps < .01). Pew respondents more often changed their behaviour based on their tracking data (ps < .01). CONCLUSION: Use of self-monitoring technology is common in weight loss maintainers: more so than in a nationally representative sample. However, the national sample more often changed their behaviour based on tracking data, perhaps suggesting that weight loss maintainers could derive additional benefit from technology they are already using.

Effect of experimental change in children's sleep duration on television viewing and physical activity.

BACKGROUND: Paediatric observational studies demonstrate associations between sleep, television viewing and potential changes in daytime activity levels. OBJECTIVE(S): To determine whether experimental changes in sleep lead to changes in children's sedentary and physical activities. METHODS: Using a within-subject counterbalanced design, 37 children 8-11 years old completed a 3-week study. Children slept their typical amount during a baseline week and were then randomized to increase or decrease mean time in bed by 1.5 h/night for 1 week; the alternate schedule was completed the final week. Children wore actigraphs on their non-dominant wrist and completed 3-d physical activity recalls each week. RESULTS: Children reported watching more television (p < 0.001) and demonstrated lower daytime actigraph-measured activity counts per epoch (p = 0.03) when sleep was decreased (compared with increased). However, total actigraph-measured activity counts accrued throughout the entire waking period were higher when sleep was decreased (and children were awake for longer) than when it was increased (p < 0.001). CONCLUSION(S): Short sleep during childhood may lead to increased television viewing and decreased mean activity levels. Although additional time awake may help to counteract negative effects of short sleep, increases in reported sedentary activities could contribute to weight gain over time.

Internal disinhibition predicts 5-year weight regain in the National Weight Control Registry (NWCR).

BACKGROUND: Maintenance of weight loss remains elusive for most individuals. One potential innovative target is internal disinhibition (ID) or the tendency to eat in response to negative thoughts, feelings or physical sensations. Individuals high on ID do worse on average in standard behavioural treatment programmes, and recent studies suggest that disinhibition could play a significant role in weight regain. PURPOSE: The purpose of the current study was to examine whether ID was associated with weight change over 5 years of follow-up in the National Weight Control Registry, a registry of individuals who have successfully lost weight and maintained it. METHODS: From the National Weight Control Registry, 5,320 participants were examined across 5 years. Weight data were gathered annually. The disinhibition subscale of the Eating Inventory was used to calculate internal disinhibition and External Disinhibition (ED) and was collected at baseline, year 1, year 3 and year 5. Linear mixed models were used to estimate the weight loss maintained across follow-up years 1 to 5 using ID and ED as baseline and prospective predictors. RESULTS: Internal disinhibition predicted weight regain in all analyses. ED interacted with ID, such that individuals who were high on ID showed greater weight regain if they were also higher on ED. CONCLUSIONS: The ID scale could be a useful screening measure for risk of weight regain, given its brevity. Improved psychological coping could be a useful target for maintenance or booster interventions.

Frequency of self-weighing and weight loss outcomes within a brief lifestyle intervention targeting emerging adults.

BACKGROUND: Frequent self-weighing is associated with better weight loss and maintenance among adults. Emerging adults ages 18-25 rarely enroll in behavioural weight loss trials, and thus, little is known about their willingness to engage in frequent self-weighing and its association with weight loss in this age group. PURPOSE: The purpose of this study is to examine the frequency of self-weighing among 18-25-year-old over the course of a brief lifestyle intervention and to determine the association between frequent self-weighing and weight loss. METHODS: Emerging adults (EA) ages 18-25 [N = 52, 54% racial/ethnic minority, 79% female, BMI = 34.2 (5.4)] enrolled in a 3-month lifestyle intervention with structure and content modified for EA. Benefits of frequent self-weighing were presented; participants were encouraged to weigh themselves at least weekly and no more than daily. Assessments occurred at baseline and post-treatment (3 months). RESULTS: At baseline, a majority of participants (63.5%) reported self-weighing less than once a week. Frequency of self-weighing increased over treatment (p < 0.001), with 42.9% weighing weekly and 38.2% weighing several times per week or more (i.e. frequent self-weighing) at 3 months. Frequent self-weighing was associated with greater weight loss (p = 0.03) and greater likelihood of achieving 5% weight loss (p = 0.01) at post-treatment. CONCLUSIONS: Frequent self-weighing may be a viable approach to promoting self-regulation during the high-risk developmental period of emerging adulthood. Consistent with findings among other adult samples, frequent self-weighing was associated with greater weight losses.

Partial sleep deprivation impacts impulsive action but not impulsive decision-making.

Sleep deprivation may lead to increased impulsivity, however, previous literature has focused on examining effects of total sleep deprivation (TSD) rather than the more common condition, partial sleep deprivation (PSD) or 'short sleep'. Moreover, it has been unclear whether PSD impacts impulse-related cognitive processes, and specifically if it differentially affects impulsive action versus impulsive decision-making. We sought to determine if short compared to long sleep (6 vs. 9h/night) impacts impulsive action via behavioral inhibition (Go/No-Go), and/or impulsive decision-making processes of risk taking (Balloon Analogue Risk Task [BART]) and preferences for immediate over delayed rewards (Delay Discounting). In a within-subject design, 34 participants (71% female, mean age=37.0years, SD=10.54) were assigned to four consecutive nights of 6h/night (short sleep) and 9h/night (long sleep) in their own home in random counterbalanced order. Sleep was measured via wrist-worn actigraphs to confirm adherence to the sleep schedules (mean short sleep=5.9h, SD=0.3; mean long sleep=8.6h, SD=0.3, p<0.001). The Go/No-Go, BART, and Delay Discounting tasks were completed following both sleep conditions. Participants had more inhibition errors on the Go/No-Go task after short (mean false alarms=19.79%, SD=14.51) versus long sleep (mean=15.97%, SD=9.51, p=0.039). This effect was strongest in participants reporting longer habitual time in bed (p=0.04). There were no differences in performance following long- versus short-sleep for either delay discounting or the BART (p's>0.4). Overall, these results indicate that four days of PSD diminishes behavioral inhibition abilities, but may not alter impulsive decision-making. These findings contribute to the emerging understanding of how partial sleep deprivation, currently an epidemic, impacts cognitive ability. Future research should continue to explore the connection between PSD and cognitive functions, and ways to minimize the occurrence and negative consequences of short sleep.

A mixed methods approach to improving recruitment and engagement of emerging adults in behavioural weight loss programs.

OBJECTIVE: Emerging adults ages 18-25 are at high risk for obesity, but are markedly underrepresented in behavioural weight loss (BWL) programs and experience lower engagement and retention relative to older adults. PURPOSE: To utilize a mixed methods approach to inform future efforts to effectively recruit and engage this high-risk population in BWL programs. METHODS: We used a convergent parallel design in which quantitative and qualitative data were given equal priority. Study 1 (N = 137, age = 21.8 + 2.2, BMI = 30.1 + 4.7) was a quantitative survey, conducted online to reduce known barriers and minimize bias. Study 2 (N = 7 groups, age = 22.3 + 2.2, BMI = 31.5 + 4.6) was a qualitative study, consisting of in person focus groups to gain greater depth and identify contextual factors unable to be captured in Study 1. RESULTS: Weight loss was of interest, but weight itself was not a central motivation; an emphasis on overall lifestyle, self-improvement and fitness emerged as driving factors. Key barriers were time, motivation and money. Recruitment processes should be primarily online with messages tailored specifically to motivations and preferences of this age group. Preferences for a program were reduced intensity and brief, hybrid format with some in-person contact, individual level coaching, experiential learning and peer support. Key methods of promoting engagement and retention were autonomy and choice, money and creating an optimal default. CONCLUSIONS: An individually tailored lifestyle intervention that addresses a spectrum of health behaviours, promotes autonomy and emphasizes activity and fitness may facilitate recruitment and engagement in this population better than traditional BWL protocols.

Examination of whether early weight loss predicts 1-year weight loss among those enrolled in an Internet-based weight loss program.

One-month weight loss (WL) predicts posttreatment WL in face-to-face interventions; however, whether this holds true within Internet programs is unknown. This study examined whether 4-week WL predicts WL following a 12-week Internet program and at 6 and 12 months follow-up. A total of 181 participants (body mass index=33.4±5.5 kg m(-)(2); 83.1% female) received a 12-week behavior-based Internet WL program consisting of weekly video lessons. Participants were given a daily WL, calorie and physical-activity goal and asked to enter these data on the study website weekly. Personalized feedback was provided. Using 4-week WL, individuals were categorized as 'early nonresponders' (<2.0% WL) or 'early responders' (⩾2.0% WL). Early nonresponders had significantly lower WL than early responders at 3 (-1.3±3.8% vs -6.3±4.3%), 6 (-1.7±5.1% vs -5.8±5.2%) and 12 months (-0.05±6.8% vs -2.7±6.3%, P<0.05). The odds of achieving a ⩾5% WL were 8.5 (95% confidence interval (CI), 3.3-22.1), 3.4 (95% CI, 1.4-8.3) and 2.6 (95% CI, 0.93-7.4) times lower in early nonresponders, compared with early responders at 3, 6 and 12 months, respectively. Compared with early responders, early nonresponders viewed fewer video lessons and self-monitored less often across the 12-week intervention (P<0.05). This study provides initial evidence that a 4-week WL of <2.0% places an individual at an increased risk of failing to achieve clinically significant WL following an Internet program.

The role of avoidance-based coping in the psychosocial functioning of weight loss treatment-seeking adults.

OBJECTIVE: The aim of this study was to determine the role of avoidance-based coping in the psychosocial functioning of weight loss treatment-seeking persons with obesity who report high internal disinhibition. METHODS: Participants were 162 overweight or obese adults entering a behavioural weight loss intervention programme who reported high internal disinhibition at screening. We conducted multivariate regression analyses by using mental and physical quality of life and satisfaction with relationships as dependent variables and examining the association of demographic variables, experiential avoidance (avoidance-based coping) and symptoms of depression. We hypothesized that higher levels of experiential avoidance and symptoms of depression would be associated with poorer mental and physical quality of life and relationship satisfaction. Post-hoc analyses examined results relative to non-obese norms. RESULTS: Both experiential avoidance and depression were significantly and independently associated with each of the three psychosocial outcome measures. Individuals who were high on both experiential avoidance and depression scored significantly below the population mean for non-clinical samples on mental and physical quality of life and relationship satisfaction. CONCLUSION: In a sample of weight loss treatment-seeking adults with high internal disinhibition, elevated levels of experiential avoidance and psychological symptoms are prevalent. Adding intervention components specifically designed to address unhealthy coping could results in improvements in overall psychosocial functioning and possibly weight loss.

A pilot randomized controlled trial testing the effects of a routine-based intervention on outcomes in a behavioural weight loss programme.

BACKGROUND: Structured routines aimed at eating and sleep have been successfully employed in weight loss interventions for children. Although such routines are discussed in lifestyle modification programmes for adults, they are not a primary focus. PURPOSE: The purpose of this study is to determine if establishing healthy eating and sleep routines may improve outcomes in a behavioural weight loss (BWL) intervention. METHODS: Twenty-five overweight/obese participants (age = 52.4 ± 9.8; body mass index = 33.5 ± 4.1) were randomly assigned to either a 4-week routine-based intervention (ROU) targeting regular eating and sleep or an education control before beginning an 18-week BWL intervention. RESULTS: Routine-based intervention participants reported adhering to eating routines, with increased 'on-schedule' eating (p = 0.007) and decreased 'off-schedule' eating (p = 0.002) but showed no change in 'on-schedule' sleep (p = 0.74). However, contrary to our hypothesis, ROU participants lost less weight than controls after 6 weeks of BWL (2.3 ± 2.5 vs. 4.6 ± 2.6 kg, p = 0.04) and achieved only modest weight loss over the full 18 weeks (ROU: 3.2 ± 4.6 vs. education control: 5.8 ± 5.7 kg, p = 0.23). CONCLUSIONS: Focusing initially on establishing healthy sleep and eating routines led to poorer, rather than better, subsequent weight loss outcomes. Further studies using a longer initial intervention period or focusing on only sleep or eating behaviour are needed to determine whether establishing routines for eating and sleep behaviours can enhance weight loss in adults.