Weight and Shape Concern Impacts Weight Gain Prevention in the SNAP Trial: Implications for Tailoring Intervention Delivery

Evaluating the effect of targeting body shape concerns on long-term weight change

OBJECTIVE

The goal of this follow-up to a randomized proof-of-concept study was to determine if targeting body shape concern (BSC) has a clinically significant impact on long-term weight change among adult women of higher body weight with BSC. A secondary aim was to observe the maintenance of body image improvements during follow-up.

METHOD

In the original 4-week trial, women were randomized to behavioral weight loss recommendations alone (control; n = 15) or combined with the evidence-based body project intervention (n = 17). All participants were directed to continue monitoring diet and exercise through Week 8. The current analysis focused on follow-up data collected on weight, BSC, internalized weight bias, internalized thin ideal, and body appreciation at 8 weeks, 6 months, and 12 months. Percent weight change was calculated from baseline and compared against clinical milestones of -2.5% and -5%. An intent-to-treat approach was used for individuals lost to follow-up (n = 11).

RESULTS

Body project participants achieved the clinically significant target of -2.5% weight loss by 12 months. Control participants did not reach the milestone and regained lost weight at 12 months. Neither condition reached the 5% clinical target. Both groups experienced improved body image, but body project participants maintained a greater magnitude of improvement in all measures except internalized thin ideal at 12 months.

CONCLUSION

The current study provides preliminary evidence that targeting BSC among women with BSC who want to lose weight may improve long-term weight loss. Further intervention development and testing are warranted.

PUBLIC SIGNIFICANCE

The results of this study suggest that targeting negative body image among adult women with high BSC might be a pathway to improve long-term weight loss in behavioral weight management. This is aligned with precision medicine priorities to optimize weight-related health care.

Association of weight and shape concern with weight change and weight-related behaviors in behavioral weight loss treatment

Weight and shape concern (WSC) is a facet of negative body image that is common among individuals with overweight/obesity seeking behavioral weight loss treatment (BWL), but remains understudied. This secondary analysis evaluates associations between WSC, weight change, and weight-related behaviors among individuals in a 24-week BWL. Adults (n = 32) with body mass index 25-50 kg/m2 completed a baseline WSC questionnaire, measured weight at 12 and 24 weeks, measured physical activity via accelerometer, and completed 24-hour dietary recalls. Adherence to self-monitoring dietary intake and weight were assessed. A series of linear mixed models were used to evaluate associations between baseline WSC and weight change, as well as weight-related behaviors. Results revealed no significant effect of WSC on weight change. There were significant WSC x time interactions, such that those rating WSC "very important" decreased self-weighing and the "low importance" group decreased their caloric intake during treatment. The "pretty important" group had greater minutes of activity than the "low importance" group. Findings indicated that WSC may impact weight-related behaviors that contribute to BWL success. This trial was pre-registered on ClinicalTrials.gov (NCT03739151).