1
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Parke A, Eschle T, Keatley D. Risk factors for momentary loss of control and subsequent abandonment of self-devised dietary restraint plans in adults with weight-loss goals: a behaviour sequence analysis approach. Psychol Health 2024; 39:691-709. [PMID: 35791507 DOI: 10.1080/08870446.2022.2094929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The current study aims to improve understanding of events leading to lapses of dietary restraint, and to identify pathways to perseverance or abandonment of weight loss efforts in response to lapses. In addition, Behaviour Sequence Analysis (BSA) was also evaluated as an analytical tool in dietary behaviour. DESIGN A sample of 176 adults who were engaging in self-imposed dietary restraint for weight loss were recruited to participate. MAIN OUTCOME MEASURES Participants were instructed to provide a detailed written timeline of an episode where they lapsed in their dietary restraint plan. They were instructed to report their preceding behaviours and internal states, and social and environmental contexts, leading up to and after their lapse in dietary restraint. RESULTS Lapses in dietary restraint were precipitated by negative internal states in the presence of cues for highly palatable foods. In addition, abandonment of weight loss efforts after lapsing was preceded by dichotomous thinking, whereas perseverance was preceded by a more neutral, flexible interpretation of the lapse in self-control. CONCLUSION BSA has identified that neutral evaluation of inevitable lapses in dietary restraint are predictive of continuation with weight loss efforts, highlighting the importance of individual tolerance of lapses in self-regulation.
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Affiliation(s)
- Adrian Parke
- Psychology Division, Education and Social Sciences, University of West of Scotland, Paisley, Renfrewshire, UK
- Researchers in Behaviour Sequence Analysis (ReBSA)
| | - Timothy Eschle
- Psychology Division, Education and Social Sciences, University of West of Scotland, Paisley, Renfrewshire, UK
| | - David Keatley
- Researchers in Behaviour Sequence Analysis (ReBSA)
- Murdoch University, Perth, WesternAustralia
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2
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Hagerman CJ, Ehmann MM, Taylor LC, Forman EM. The role of self-compassion and its individual components in adaptive responses to dietary lapses. Appetite 2023; 190:107009. [PMID: 37619622 PMCID: PMC10543633 DOI: 10.1016/j.appet.2023.107009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
Dietary lapses (i.e., instances of dietary non-adherence) are common during weight loss attempts, and compromise success in two ways: increasing caloric intake and demoralizing the participant, sometimes leading them to abandon their weight control goals altogether. Efforts to understand and prevent demoralization have received almost no research attention. Self-compassion has high potential to promote adaptive responses to these setbacks because it reframes "failure" and promotes self-improvement. Past research shows that when participants experience a lapse, those practicing higher self-compassion report higher self-efficacy and intentions to continue dieting. The current study extended this literature to examine whether self-compassion in response to a lapse would predict lower likelihood of a subsequent same-day lapse and greater reports of perceived control over weight management behaviors. We also examined whether the individual facets of self-compassion, including self-kindness (treating oneself the way one would a friend); common humanity (the understanding that everyone has struggles); and mindfulness (non-judgmental awareness of thoughts and feelings) are associated with these outcomes. Participants (N = 140) enrolled in a behavioral weight loss trial completed 6 ecological momentary assessment (EMA) surveys a day for seven days. Total self-compassion and each facet of self-compassion individually were all associated with less negative affect after a lapse. None of the self-compassion variables predicted the likelihood of participants reporting a lapse again that day. However, higher total self-compassion and higher self-kindness after a lapse were both associated with greater perceived self-control over weight management behaviors in the hours following. Common humanity and mindfulness, respectively, were not associated with reports of perceived control. Results suggest that self-compassion following dieting setbacks may prevent goal disengagement, and that self-kindness is the facet most strongly associated with adaptive responses to these setbacks.
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Affiliation(s)
- Charlotte J Hagerman
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Marny M Ehmann
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Lauren C Taylor
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Evan M Forman
- Department of Psychological and Brain Sciences and Center for Weight, Eating and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
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3
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Wronski ML, Hohnemann C, Bernardoni F, Bahnsen K, Doose A, Arold D, Borucki K, Holsen LM, Lawson EA, Plessow F, Weidner K, Roessner V, Diestel S, King JA, Seidel M, Ehrlich S. Explicating the role of amygdala substructure alterations in the link between hypoleptinemia and rumination in anorexia nervosa. Acta Psychiatr Scand 2023; 148:368-381. [PMID: 37688292 DOI: 10.1111/acps.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The amygdaloid complex plays a pivotal role in emotion processing and has been associated with rumination transdiagnostically. In anorexia nervosa (AN), we previously observed differential reductions of amygdala nuclei volumes (rostral-medial cluster substantially affected) and, in another study, elevated food-/weight-related rumination. Both amygdala volumes and rumination frequency correlated with characteristically suppressed leptin levels in AN. Thus, we hypothesized that amygdala nuclei alterations might be associated with AN-related rumination and potentially mediate the leptin-rumination relationship in AN. METHODS Rumination (food-/weight-related) was assessed using ecological momentary assessment for a 14-day period. We employed frequentist and Bayesian linear mixed effects models in females with AN (n = 51, 12-29 years, majority admitted to inpatient treatment) and age-matched healthy females (n = 51) to investigate associations between rostral-medial amygdala nuclei volume alterations (accessory basal, cortical, medial nuclei, corticoamygdaloid transitions) and rumination. We analyzed mediation effects using multi-level structural equation models. RESULTS Reduced right accessory basal and cortical nuclei volumes predicted more frequent weight-related rumination in AN; both nuclei fully mediated the effect of leptin on weight-related rumination. In contrast, we found robust evidence for the absence of amygdala nuclei volume effects on rumination in healthy females. CONCLUSION This study provides first evidence for the relevance of specific amygdala substructure reductions regarding cognitive symptom severity in AN and points toward novel mechanistic insight into the relationship between hypoleptinemia and rumination, which might involve the amygdaloid complex. Our findings in AN may have important clinical value with respect to understanding the beneficial neuropsychiatric effects of leptin (treatment) in AN and potentially other psychiatric conditions such as depression.
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Affiliation(s)
- Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charlotte Hohnemann
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dominic Arold
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Borucki
- Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Laura M Holsen
- Division of Women's Health, Department of Medicine/Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Diestel
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Ugwoaba UA, Carpenter CA, Arroyo KM, Scarlett CA, Ross KM. Hunger, temptation, and dietary adherence during weight management. Eat Behav 2023; 50:101754. [PMID: 37263142 PMCID: PMC10690492 DOI: 10.1016/j.eatbeh.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/07/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Preliminary evidence suggests that hunger and temptation may predict nonadherence to dietary intake goals; however, no studies have investigated the potential interaction between hunger and temptation in relation to dietary nonadherence nor have any investigated whether these associations may be different after the end of active behavioral intervention. Thus, the current study examined the week-to-week associations between hunger, temptation, and dietary adherence in 74 adults with overweight or obesity (mean ± SD age = 50.7 ± 10.4, BMI = 31.2 ± 4.5 kg/m2) enrolled in a 12-week, Internet-based weight loss program followed by a 40-week post-intervention observational maintenance period. Each week during the study, participants completed a questionnaire on which they rated their hunger, temptation, and dietary adherence on 7-point scales. Multilevel models demonstrated that higher levels of hunger and temptation were associated with lower ratings of dietary adherence during the same week, ps < 0.0001, such that 1-point higher ratings of hunger or temptation were associated with 0.2- and 0.5-point lower ratings of dietary adherence, respectively. Further, there was an interaction between hunger and temptation such that the association between temptation and dietary nonadherence was stronger when ratings of hunger were lower, p = .028. There were no differences in associations between the initial weight loss period and the maintenance period. Results suggest that hunger and temptation may serve as potential treatment targets for interventions aimed at improving adherence to dietary intake goals. Future studies should investigate whether interventions targeting hunger and temptation can improve dietary adherence and weight loss outcomes.
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Affiliation(s)
- Umelo A Ugwoaba
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Chelsea A Carpenter
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Kelsey M Arroyo
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Charlayne A Scarlett
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA.
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5
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Genes D, Sirois FM, Buckland NJ. The impact of the first COVID-19 lockdown on weight management practices in UK adults: A self-regulation perspective. Health Psychol Open 2023; 10:20551029231214058. [PMID: 37953745 PMCID: PMC10637132 DOI: 10.1177/20551029231214058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
This study aimed to identify the impact of the first UK COVID-19 lockdown on individuals' weight management attempts (WMA). A self-regulation theoretical framework was used to identify predictors of continuing with a WMA, and weight change during the lockdown. An online retrospective cross-sectional study was conducted after the first UK COVID-19 lockdown. The sample consisted of 166 UK adults (M:31.08, SD:12.15) that were trying to manage their weight before the lockdown started. The survey assessed changes in WMA and practices, and measured perceived stress, flexible/rigid restraint, uncontrolled eating, craving control, and self-compassion. Results showed that 56% of participants reported disruption to their WMA during the lockdown. Participants with lower levels of perceived stress and higher flexible restraint were more likely to continue their WMA. Flexible restraint was a significant predictor of weight change. Interventions that promote flexibility in weight management may be beneficial for at-risk individuals under lockdown conditions.
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Tonkin S, Gass J, Wray J, Maguin E, Mahoney M, Colder C, Tiffany S, Hawk LW. Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial. J Med Internet Res 2023; 25:e43826. [PMID: 37347538 PMCID: PMC10337346 DOI: 10.2196/43826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/15/2023] [Accepted: 04/20/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time. OBJECTIVE This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults. METHODS A total of 257 daily cigarette-using adults participating in a randomized controlled trial for smoking cessation completed daily smartphone EMA assessments, including 1 scheduled morning assessment and 4 random assessments per day. Weekly EMA compliance was calculated and multilevel modeling assessed the rate of change in compliance over the 9-week assessment period. Participant and study characteristics were examined as predictors of overall compliance and changes in compliance rates over time. RESULTS Compliance was higher for scheduled morning assessments (86%) than for random assessments (58%) at the beginning of the EMA period (P<.001). EMA compliance declined linearly across weeks, and the rate of decline was greater for morning assessments (2% per week) than for random assessments (1% per week; P<.001). Declines in compliance were stronger for younger participants (P<.001), participants who were employed full-time (P=.03), and participants who subsequently dropped out of the study (P<.001). Overall compliance was higher among White participants compared to Black or African American participants (P=.001). CONCLUSIONS This study suggests that EMA compliance declines linearly but modestly across lengthy EMA protocols. In general, these data support the validity of EMA for tracking health behavior and hypothesized treatment mechanisms over the course of several months. Future work should target improving compliance among subgroups of participants and investigate the extent to which rapid declines in EMA compliance might prove useful for triggering interventions to prevent study dropout. TRIAL REGISTRATION ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662.
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Affiliation(s)
- Sarah Tonkin
- Stephenson Cancer Center, Tobacco Settlement Endowment Trust Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Julie Gass
- Department of Veterans Affairs Center for Integrated Healthcare, VA Western NY Healthcare System at Buffalo, Buffalo, NY, United States
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Jennifer Wray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Ralph H Johnson VA Healthcare System, Charleston, SC, United States
| | - Eugene Maguin
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Martin Mahoney
- Departments of Internal Medicine and Health Behavior, Roswell Park Cancer Comprehensive Cancer Center, Buffalo, NY, United States
| | - Craig Colder
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Stephen Tiffany
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
| | - Larry W Hawk
- Department of Psychology, The State University of New York: University at Buffalo, Buffalo, NY, United States
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7
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Chwyl C, Crochiere RJ, Forman EM. The role of everyday activities on likelihood of dietary lapse: an ecological momentary assessment study. J Behav Med 2023; 46:532-539. [PMID: 36342563 PMCID: PMC10164199 DOI: 10.1007/s10865-022-00365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
Abstract
Developing a more nuanced understanding of factors predicting risk of dietary lapse (i.e., instances of non-adherence to a reduced calorie diet) is important, because dietary lapses contribute to suboptimal weight outcomes. The study investigated, for the first time, how various everyday activities affected likelihood of dietary lapses at two timescales-both in-the-moment, and in the hours after engaging in an activity. Participants (N = 107) with overweight/obesity in a behavioral weight loss program completed ecological momentary assessment surveys on dietary adherence and daily activities for 3 weeks at mid-treatment. Generalized estimating equations revealed that socializing predicted greater concurrent lapse risk, while work/school, doing chores, cooking, or practicing a spiritual activity/prayer/meditation were associated with reduced lapse risk. In terms of subsequent effects, cooking and indoor hobbies were associated with greater lapse risk in the next few hours, whereas spiritual activity/meditation was associated with reduced risk. Certain activities may have affected concurrent and subsequent lapse risk due to: their influence on the presence of tempting food, the compatibility of engaging in the activity and eating simultaneously, and the reward reaped from the activity (potentially reducing desire for food-related reward). Findings speak to the importance of attending to the timescale of relationships between activities and lapses, which has clinical implications for providing nuanced and optimally timed interventions for overweight/obesity.
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Affiliation(s)
- Christina Chwyl
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St, Philadelphia, PA, USA.
| | - Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, 3141 Chestnut St, Philadelphia, PA, USA
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8
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Moffitt RL, Neumann DL, Gersh HE, van Poppel EJ. A brief self-compassionate reflective writing task can manage negative reactions following an eating transgression. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2183109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Robyn L. Moffitt
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - David L. Neumann
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Hannah E. Gersh
- Psychology, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Emily J. van Poppel
- Psychology, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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9
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Roordink EM, Steenhuis IHM, Kroeze W, Hoekstra T, Jacobs N, van Stralen MM. Social Environmental Predictors of Lapse in Dietary Behavior: An Ecological Momentary Assessment Study Amongst Dutch Adults Trying to Lose Weight. Ann Behav Med 2023:7000437. [PMID: 36694372 PMCID: PMC10354841 DOI: 10.1093/abm/kaac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND When losing weight, most individuals find it difficult to maintain a healthy diet. Social environmental conditions are of pivotal importance in determining dietary behavior. To prevent individuals from lapsing, insight in social environmental predictors of lapse in dietary behavior is needed. PURPOSE Identify social environmental predictors of lapse in dietary behavior, using ecological momentary assessment (EMA) amongst Dutch adults trying to lose weight. METHODS Adults (N = 81) participated in two 7-day EMA weeks. Six times a day semi-random prompts were sent. At each prompt, participants indicated whether a lapse had occurred and responded to questions assessing social support, descriptive norm, injunctive norm, social pressure, presence of others, and current location. Generalized estimating equations were used to examine associations with lapse. RESULTS Injunctive norm (OR = 1.07, 95% CI = 1.03-1.11), descriptive norm (OR = 1.04, 95% CI = 1.02-1.07), and social pressure (OR = 1.09, 95% CI = 1.05-1.14), all toward diverting from diet plans, predicted lapses. Social support toward sticking to diet plans and presence of others did not predict lapses. When controlling for a prior lapse, all other associations became nonsignificant. Lapses occurred most often at home and gradually occurred more often during the day. CONCLUSIONS Traditional public health perspectives have mainly focused on individual choice and responsibility for overweight related unhealthy lifestyles. This study shows that there may be opportunities to enhance intervention programs by also focusing on social norms and social pressure. The involvement of partners or housemates may create more awareness of the impact of (unintentional) social pressure on risk of lapsing, and reduce the level of exerted social pressure.
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Affiliation(s)
- Eline M Roordink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, 6717 JS Ede, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Nele Jacobs
- Department of Lifespan Psychology, Faculty of Psychology, Open Universiteit, Heerlen, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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10
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Alshurafa NI, Stump TK, Romano CS, F. Pfammatter A, Lin AW, Hester J, Hedeker D, Forman E, Spring B. Rationale and design of the SenseWhy project: A passive sensing and ecological momentary assessment study on characteristics of overeating episodes. Digit Health 2023; 9:20552076231158314. [PMID: 37138585 PMCID: PMC10150430 DOI: 10.1177/20552076231158314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 05/05/2023] Open
Abstract
Objectives Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Method Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Analysis Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. Conclusions This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions.
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Affiliation(s)
- Nabil I. Alshurafa
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
- Nabil Alshurafa, Department of Preventive
Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore
Drive, Chicago, IL, USA.
| | - Tammy K. Stump
- Department of Dermatology, University
of Utah, Salt Lake City, UT, USA
| | - Christopher S. Romano
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Angela F. Pfammatter
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Annie W. Lin
- Department of Nutrition, Benedictine University, Lisle, IL, USA
| | - Josiah Hester
- Department of Electrical and Computer
Engineering, McCormick School of Engineering and
Applied Science, Northwestern University, Evanston, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences,
University of Chicago, Chicago, IL, USA
| | - Evan Forman
- Department of Psychological and Brain
Sciences, Drexel University, Philadelphia, PA, USA
- Center for Weight, Eating and Lifestyle
Sciences, Drexel University, Philadelphia, PA, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
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11
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Goldstein SP, Hoover A, Thomas JG. Combining passive eating monitoring and ecological momentary assessment to characterize dietary lapses from a lifestyle modification intervention. Appetite 2022; 175:106090. [PMID: 35598718 DOI: 10.1016/j.appet.2022.106090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 01/26/2023]
Abstract
Dietary lapses (i.e., specific instances of nonadherence to recommended dietary goals) contribute to suboptimal weight loss outcomes during lifestyle modification programs. Passive eating monitoring could enhance lapse measurement via objective assessment of eating characteristics that could be markers for lapse (e.g., more bites consumed). The purpose of this study was to evaluate if passively-inferred eating characteristics (i.e., bites, eating duration, and eating rate), measured via wrist-worn device, could distinguish dietary lapses from non-lapse eating. Adults (n = 25) with overweight/obesity received a 24-week lifestyle modification intervention. Participants completed ecological momentary assessment (EMA; repeated smartphone surveys) biweekly to self-report on dietary lapses and non-lapse eating episodes. Participants wore a wrist device that captured continuous wrist motion. Previously-validated algorithms inferred eating episodes from wrist data, and calculated bite count, duration, and rate (seconds per bite). Mixed effects logistic regressions revealed no simple effects of bite count, duration, or eating rate on the likelihood of dietary lapse. Moderation analyses revealed that eating episodes in the evening were more likely to be lapses if they involved fewer bites (B = -0.16, p < .05), were shorter (B = -0.54, p < .05), or had a slower rate (B = 1.27, p < .001). Statistically significant interactions between eating characteristics (Bs = -0.30 to -0.08, ps < .001) revealed two distinct patterns. Eating episodes that were 1. smaller, slower, and shorter than average, or 2. larger, quicker, and longer than average were associated with increased probability of lapse. This study is the first to use objective eating monitoring to characterize dietary lapses throughout a lifestyle modification intervention. Results demonstrate the potential of sensors to identify non-adherence using only patterns of passively-sensed eating characteristics, thereby minimizing the need for self-report in future studies. CLINICAL TRIALS REGISTRY NUMBER: NCT03739151.
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Affiliation(s)
- Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Adam Hoover
- Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, SC, 29634, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
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12
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Dicker-Oren SD, Gelkopf M, Greene T. The dynamic network associations of food craving, restrained eating, hunger and negative emotions. Appetite 2022; 175:106019. [PMID: 35500722 DOI: 10.1016/j.appet.2022.106019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Food craving, restrained eating, hunger, and negative emotions may predict and reinforce one another. However, less is known about how they interact together as a complex system in daily life. Therefore, we used a dynamic network approach to examine the associations between food craving, restrained eating, hunger and negative emotions in daily life. METHODS Food craving, restrained eating, hunger and negative emotions were measured using ecological momentary assessment three times a day over ten days in a community sample in Israel (n = 123). A two-step multilevel vector auto-regression network analysis was used to estimate temporal, contemporaneous and between-persons networks. RESULTS In the temporal network, restrained eating was the most central predictor of eating behaviors and negative emotions, predicting food craving and hunger as well as sadness and loneliness. Food craving was also predicted by hunger and stress, and hunger predicted loneliness. In the contemporaneous network, food craving was associated with hunger and feeling bored, and higher anger was associated with lower restrained eating. Stress and sadness were central negative emotions in the models. DISCUSSION This study suggests possible temporal and contemporaneous relationships between food craving, restrained eating, hunger and negative emotions, emphasizing their complex interactions in daily life. Restrained eating and stress should be investigated as potential targets for interventions addressing food craving and overeating.
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Affiliation(s)
- S D Dicker-Oren
- The Department of Community Mental Health, University of Haifa, Haifa, Israel.
| | - M Gelkopf
- The Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - T Greene
- The Department of Community Mental Health, University of Haifa, Haifa, Israel
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13
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Olson KL, Panza E, Lillis J, Wing RR. Association of Weight-Related Stigmas With Daily Pain Symptoms Among Individuals With Obesity. Ann Behav Med 2022; 57:269-274. [PMID: 35738017 PMCID: PMC10074027 DOI: 10.1093/abm/kaac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Individuals with obesity are disproportionately impacted by pain-related symptoms. PURPOSE This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. METHODS Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts. RESULTS IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p < .05) and muscle soreness (p < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt. CONCLUSIONS Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size.
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Affiliation(s)
- KayLoni L Olson
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Emily Panza
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Jason Lillis
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
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14
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Panza E, Lillis J, Olson K, van den Berg JJ, Tashima K, Wing RR. HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV. AIDS Behav 2022; 26:686-697. [PMID: 34396464 PMCID: PMC8840952 DOI: 10.1007/s10461-021-03428-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2-2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen Tashima
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- The Miriam Hospital Immunology Center, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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15
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Andersen CC, de Baca TC, Votruba SB, Stinson EJ, Engel SG, Krakoff J, Gluck ME. Food insecurity moderates the relationship between momentary affect and adherence in a dietary intervention study. Obesity (Silver Spring) 2022; 30:369-377. [PMID: 35088549 PMCID: PMC8820389 DOI: 10.1002/oby.23335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Negative affect and food insecurity have been proposed to impede adherence to weight loss interventions. Therefore, this study examined the role of these variables on dietary adherence using Ecological Momentary Assessment. METHODS A total of 50 participants (19 male participants; age = 49 [SD 14] years) participated in an outpatient dietary study. Lean participants (n = 22; BMI ≤ 25 kg/m2 ) received a weight-maintaining energy needs (WMEN) diet, and participants with obesity (BMI ≥ 30) were randomized to receive either a WMEN diet (n = 14) or a 35% calorie-reduced diet (n = 14). Food insecurity was measured, and, twice daily, Ecological Momentary Assessment captured real-time affect ratings and adherence. Between-person (trait-level) and lagged within-person (state-level) scores were calculated. RESULTS Greater food insecurity and trait-level negative affect were associated with reduced adherence (p = 0.0015, p = 0.0002, respectively), whereas higher trait-level positive affect was associated with greater adherence (p < 0.0001). Significant interactions between affect and food insecurity revealed an association between higher trait positive affect and increased adherence at lower levels of food insecurity. Higher trait negative affect was more strongly associated with decreased adherence in participants with greater levels of food insecurity (-1 SD: B = -0.21, p = 0.22; mean: B = -0.46, SE = 0.13, p = 0.0004; +1 SD: B = -0.71, SE = 0.17, p < 0.0001). CONCLUSIONS Trait-level affect may be crucial in predicting dietary adherence, especially in those with greater food insecurity.
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Affiliation(s)
- Coley C. Andersen
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Tomás Cabeza de Baca
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Susanne B. Votruba
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Emma J. Stinson
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | | | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Marci E. Gluck
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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16
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Review about Psychological Barriers to Lifestyle Modification, Changes in Diet Habits, and Health-Related Quality of Life in Bariatric Endoscopy. Nutrients 2022; 14:nu14030595. [PMID: 35276953 PMCID: PMC8840117 DOI: 10.3390/nu14030595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/10/2022] Open
Abstract
Obesity is an expanding disease responsible for significant deterioration in the Health-Related Quality of Life (HRQL) of those who suffer from it. Bariatric Endoscopy (BE) therapies have proven to be an effective treatment for this pathology. A multidisciplinary approach is essential for the successful therapeutic management of BE. This article addresses the multidisciplinary treatment of BE by considering the possible variables that can influence treatment. In particular, the variables that can facilitate or hinder changes in patients’ habits are discussed. These include the neuropsychological, emotional, and social implications that may influence the formation of healthy habits necessary for improvement in a patient’s quality of life; the individual and environmental psychological factors that influence the monitoring of nutritional and physical activity indications; and different psychological disorders such as depression, anxiety, or disorders related to eating. The main objective of BE treatment, except in certain special biological situations, must be to establish a long-term sustainable change in habits such that patients, once they reach a healthy weight, do not revert to the lifestyle that caused their obesity, as well as identifying and addressing major problems that may exist prior to, or arise during, treatment.
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17
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Goldstein SP, Evans EW, Espel‐Huynh HM, Goldstein CM, Karchere‐Sun R, Thomas JG. Dietary lapses are associated with meaningful elevations in daily caloric intake and added sugar consumption during a lifestyle modification intervention. Obes Sci Pract 2022; 8:442-454. [PMID: 35949281 PMCID: PMC9358737 DOI: 10.1002/osp4.587] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 01/26/2023] Open
Abstract
Objective Lapses from the dietary prescription in lifestyle modification interventions for overweight/obesity are common and impact weight loss outcomes. While it is expected that lapses influence weight via increased consumption, there are no studies that have evaluated how dietary lapses affect dietary intake during treatment. This study examined the association between daily lapses and daily energy and macronutrient intake during a lifestyle modification intervention. Methods This study used an intensive longitudinal design to observe participants throughout a 6-month lifestyle modification intervention. Participants (n = 32) were adults with overweight/obesity (body mass index 25-50 kg/m2) and a diagnosed cardiovascular disease risk factor (e.g., hypertension) with a desire to lose weight. Participants underwent a gold-standard individual in-person lifestyle modification protocol consisting of 3 months of weekly sessions with 3 months of monthly sessions. Each participant's dietary prescription included a calorie target range that was based on their starting weight. Participants completed ecological momentary assessment (EMA; repeated daily smartphone surveys) every other week to self-report on dietary lapses and telephone-based 24-h dietary recalls every 6 weeks. Results On days with EMA and recalled intake (n = 210 days), linear mixed models demonstrated significant associations between daily lapse and higher total daily caloric intake (B = 139.20, p < 0.05), more daily grams of added sugar (B = 16.24, p < 0.001), and likelihood of exceeding the daily calorie goal (B = 0.89, p < 0.05). The associations between daily lapse and intake of all other daily macronutrients were non-significant. Conclusions This study contributes to literature suggesting that dietary lapses pose a threat to weight loss success. Results indicate that reducing lapse frequency could reduce overall caloric intake and added sugar consumption.
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Affiliation(s)
- Stephanie P. Goldstein
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - E. Whitney Evans
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Hallie M. Espel‐Huynh
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Carly M. Goldstein
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Renee Karchere‐Sun
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - J. Graham Thomas
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityThe Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
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18
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Roordink EM, Steenhuis IHM, Kroeze W, Chinapaw MJM, van Stralen MM. Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study. Health Psychol Behav Med 2022; 10:22-40. [PMID: 34993004 PMCID: PMC8725894 DOI: 10.1080/21642850.2021.2014332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Preventing people from relapsing into unhealthy habits requires insight into predictors of relapse in weight loss maintenance behaviors. We aimed to explore predictors of relapse in physical activity and dietary behavior from the perspectives of health practitioners and persons who regained weight, and identify new predictors of relapse beyond existing knowledge. Methods We used concept mapping to collect data, by organizing eight concept mapping sessions among health practitioners (N=39, five groups) and persons who regained weight (N=21, three groups). At the start of each session, we collected participants’ ideas on potential predictors. Subsequently, participants individually sorted these ideas by relatedness and rated them on importance. We created concept maps using principal component analysis and cluster analysis. Results 43 predictors were identified, of which the majority belonged to the individual domain rather than the environmental domain. Although the majority of predictors were mentioned by both stakeholder groups, both groups had different opinions regarding their importance. Also, some predictors were mentioned by only one of the two stakeholder groups. Practitioners indicated change in daily structure, stress, maladaptive coping skills, habitual behavior, and lack of self-efficacy regarding weight loss maintenance as most important recurrent (mentioned in all groups) predictors. Persons who regained weight indicated lifestyle imbalance or experiencing a life event, lack of perseverance, negative emotional state, abstinence violation effect, decrease in motivation and indulgence as most important recurrent predictors. Conclusions For several predictors associations with relapse were shown in prior research; additionally, some new predictors were identified that have not been directly associated with relapse in weight loss maintenance behaviors. Our finding that both groups differed in opinion regarding the importance of predictors or identified different predictors, may provide an opportunity to enhance lifestyle coaching by creating more awareness of these possible discrepancies and including both points of view during coaching.
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Affiliation(s)
- Eline M Roordink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department Care for Nutrition and Health, School of Nursing, Christian University of Applied Sciences, Ede, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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19
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Hayes JF, Schumacher LM, Panza E, Dunsiger SI, Wing RR, Unick JL. Affective responses to overeating episodes in women participating in a behavioral weight loss program. Eat Behav 2022; 44:101599. [PMID: 35144169 PMCID: PMC8901183 DOI: 10.1016/j.eatbeh.2022.101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/03/2022] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Much research has focused on precursors to dietary lapses in weight loss programs, but less is known about how individual responses to lapses may influence future non-adherence and program success. The current study examined affective responses to overeating lapses and their influence on subsequent overeating and overall weight loss. METHODS Women (n = 60) with overweight or obesity (BMI (mean ± SD): 34.3 ± 3.9 kg/m2; age: 48.1 ± 10.1 years) participated in a 3-month group behavioral weight loss intervention (BWLI). At baseline and 3 months, participants completed anthropometric assessments and a 10-day ecological momentary assessment protocol sent 5 times per day reporting on overeating and affect (stress, shame, anxiety, and feeling good about oneself). Across time points, multilevel models were used to examine affective responses to overeating and to predict likelihood of subsequent overeating. Linear regression models were used to examine the effect of affective responses to overeating (at baseline and collapsed across time points) on weight loss. RESULTS Following self-reported overeating episodes, compared to non-overeating episodes, feeling good about oneself decreased. These decreases lessened with time from overeating. Overeating predicted subsequent overeating episodes, with decreases in feeling good about oneself following overeating marginally predicting increased likelihood (p = 0.065). Neither overeating frequency at baseline nor change in overeating frequency predicted weight loss; however, greater decreases in anxiety following overeating were associated with less weight loss. CONCLUSIONS Self-reported overeating during a BWLI was associated with negative affective responses and may have increased the likelihood of subsequent overeating, but did not affect overall weight loss in this sample.
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Affiliation(s)
- Jacqueline F. Hayes
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, United States of America,Corresponding author at: Weight Control and Diabetes Research Center at The Miriam Hospital/Brown University, 196 Richmond Street, Providence, RI 02903, United States of America. (J.F. Hayes)
| | - Leah M. Schumacher
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, United States of America
| | - Emily Panza
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, United States of America
| | - Shira I. Dunsiger
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, United States of America
| | - Rena R. Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, United States of America
| | - Jessica L. Unick
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI, United States of America
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20
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Real-time fluctuations in mindful awareness, willingness, and values clarity, and their associations with craving and dietary lapse among those seeking weight loss. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021; 22:87-92. [PMID: 34900572 DOI: 10.1016/j.jcbs.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Mindful awareness, willingness and values clarity have been examined as protective factors across a wide range of problems, including overweight/obesity. However, these variables have almost exclusively been examined at the trait-level. It is possible that these variables also fluctuate within individuals in daily life, and that these intraindividual fluctuations may in turn be related to food craving and dietary lapse. The current study used ecological momentary assessment (EMA) to examine the extent to which momentary mindful awareness, willingness, and values clarity varied within-person, and were associated with craving and likelihood of dietary lapse among weight-loss seeking individuals with overweight/obesity prior to starting a weight loss program. We also examined the extent to which craving was associated with dietary lapse. Methods Adults with overweight/obesity (N = 126) completed one week of EMA prior to enrolling in a randomized controlled trial of behavioral weight loss treatments. They responded to EMA questions assessing dietary lapses, craving, mindful awareness, willingness, and values clarity six-times per day. Results Mindful awareness, willingness, and values clarity demonstrated substantial within-person variability, and higher within-person mindful awareness, willingness, and values clarity were concurrently (but not prospectively) associated with lower craving and likelihood of dietary lapse. Higher craving was concurrently (but not prospectively) associated with higher likelihood of dietary lapse. Between-person, higher mindful awareness, willingness, and values clarity were associated with lower craving and likelihood of dietary lapse, and higher craving was associated with greater frequency of dietary lapses. Conclusion Mindful awareness, willingness, and values clarity vary substantially at the daily level, and may be important mechanisms to target to reduce craving and dietary lapses in the daily lives of individuals with overweight/obesity.
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21
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Goldstein SP, Zhang F, Klasnja P, Hoover A, Wing RR, Thomas JG. Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial. JMIR Res Protoc 2021; 10:e33568. [PMID: 34874892 PMCID: PMC8691411 DOI: 10.2196/33568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. OBJECTIVE The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. METHODS Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. RESULTS The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. CONCLUSIONS This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). TRIAL REGISTRATION ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33568.
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Affiliation(s)
- Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Adam Hoover
- Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, SC, United States
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - John Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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22
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Chwyl C, Berry MP, Manasse SM, Forman EM. Rethinking emotional eating: Retrospective and momentary indices of emotional eating represent distinct constructs. Appetite 2021; 167:105604. [PMID: 34293393 PMCID: PMC8435005 DOI: 10.1016/j.appet.2021.105604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/27/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
Emotional eating (EE) has been proposed as a key weight loss barrier. However, most investigations of EE rely on retrospective self-reports, which may have poor construct validity. This study evaluated concordance between a common self-report EE measure and a novel method for assessing momentary EE using ecological momentary assessment (EMA). We further assessed the utility of both measures for predicting both BMI and weight outcomes. Participants with overweight or obesity enrolled in a weight loss trial (N = 163) completed a self-report measure of EE and underwent an EMA protocol that assessed momentary emotions and eating behaviors. Momentary EE was derived from EMA data using generalized linear mixed-effects models. Linear regression models examined associations between both EE measures and concurrent BMI as well as weight losses over 30 months. Retrospectively self-reported EE and momentary EE were negatively correlated with one another (r = -0.27). Higher momentary EE and higher retrospectively reported EE both predicted higher concurrent BMI, and higher retrospectively reported EE predicted poorer weight loss outcomes at all time points (p < 0.05). By contrast, higher momentary EE predicted improved weight outcomes at 1-year and 2-year follow-up (p < 0.05). Our findings extend prior research suggesting that retrospective self-report EE measures capture a different construct than intended and suggest that momentary EE could predict improved weight loss outcomes.
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Affiliation(s)
- Christina Chwyl
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
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23
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Panza E, Fehling KB, Pantalone DW, Dodson S, Selby EA. Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2021; 8:420-428. [PMID: 34926715 PMCID: PMC8675908 DOI: 10.1037/sgd0000431] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity. METHODS Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant. RESULTS Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period. CONCLUSIONS Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.
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Affiliation(s)
- Emily Panza
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert School of Medicine, Brown University
| | - Kara B. Fehling
- Rutgers, the State University of New Jersey, New Brunswick, NJ
| | - David W. Pantalone
- University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Samira Dodson
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Binghamton University, Binghamton, NY
| | - Edward A. Selby
- Rutgers, the State University of New Jersey, New Brunswick, NJ
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24
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Roordink EM, Steenhuis IHM, Kroeze W, Schoonmade LJ, Sniehotta FF, van Stralen MM. Predictors of lapse and relapse in physical activity and dietary behaviour: a systematic search and review on prospective studies. Psychol Health 2021; 38:623-646. [PMID: 34851220 DOI: 10.1080/08870446.2021.1981900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Behaviour change maintenance seems to be difficult for many people. To prevent people from relapsing, insight into determinants of relapse is needed. We synthesized the evidence on predictors of lapse and relapse in physical activity and dietary behaviour change. DESIGN Prospective studies in adults aged ≥18 years were identified from systematic searches in PsycINFO, PubMed and Cinahl. Methodological quality was analysed, and data were synthesized narratively. MAIN OUTCOME MEASURES Lapse and relapse in physical activity and dietary behaviour. RESULTS 37 articles were included. For several predictors, evidence for an association was found, with self-efficacy as the only consistent predictor across the different outcomes, predicting both lapse and relapse in physical activity, and relapse in dietary behaviour. For most other variables, evidence for prospective relationships with lapse and relapse was insufficient. CONCLUSION Most predictors on lapse and relapse were not examined frequently enough to draw conclusions from; many predictors were studied only once or had inconclusive evidence. To be able to provide more substantiated conclusions, more high-quality research is needed. Practitioners and intervention programs could focus on sustainability of behaviour change, by targeting the outcome of interest and its relevant predictors by using behaviour change techniques that have proven effective.
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Affiliation(s)
- Eline M Roordink
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department Care for Nutrition and Health, School of Nursing, Christian University of Applied Sciences, Ede, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioral Science, Newcastle University, Newcastle upon Tyne, UK
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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Momentary predictors of dietary lapse from a mobile health weight loss intervention. J Behav Med 2021; 45:324-330. [PMID: 34807334 DOI: 10.1007/s10865-021-00264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Identifying factors that influence risk of dietary lapses (i.e., instances of dietary non-adherence) is important because lapses contribute to suboptimal weight loss outcomes. Existing research examining lapse risk factors has had methodological limitations, including retrospective recall biases, subjective operationalizations of lapse, and has investigated lapses among participants in gold-standard behavioral weight loss programs (which are not accessible to most Americans). The current study will address these limitations by being the first to prospectively assess several risk factors of lapse (objectively operationalized) in the context of a commercial mobile health (mHealth) intervention, a highly popular and accessible method of weight loss. N = 159 adults with overweight or obesity enrolled in an mHealth commercial weight loss program completed ecological momentary assessments (EMAs) of 15 risk factors and lapses (defined as exceeding a point target for a meal/snack) over a 2-week period. N = 9 participants were excluded due to low EMA compliance, resulting in a sample of N = 150. Dietary lapses were predicted by momentary increases in urges to deviate from one's eating plan (b = .55, p < .001), cravings (b = .55, p < .001), alcohol consumption (b = .51, p < .001), and tiredness (b = .19, p < .001), and decreases in confidence related to meeting dietary goals (b = -.21, p < .001) and planning food intake (b = -.15, p < .001). This study was among the first to identify prospective predictors of lapse in the context of a commercial mHealth weight loss program. Findings can inform mHealth weight loss programs, including just-in-time interventions that measure these risk factors, calculate when risk of lapse is high, and deliver momentary interventions to prevent lapses.
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26
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Forman EM, Chwyl C, Berry MP, Taylor LC, Butryn ML, Coffman DL, Juarascio A, Manasse SM. Evaluating the efficacy of mindfulness and acceptance-based treatment components for weight loss: Protocol for a multiphase optimization strategy trial. Contemp Clin Trials 2021; 110:106573. [PMID: 34555516 DOI: 10.1016/j.cct.2021.106573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
Behavioral weight loss treatment (BT) for individuals with overweight and obesity is effective but leaves room for improvement. Mindfulness and acceptance-based treatments may bolster weight loss outcomes; yet, little is known about the efficacy of the individual components or the combinations of components that are most effective in producing weight loss above and beyond standard BT strategies for weight loss. This protocol manuscript describes the use of a multiphase optimization strategy to evaluate the independent and combinatory efficacy of three mindfulness and acceptance-based components (mindful awareness, willingness, values). Using a 2 × 2 × 2 factorial design, participants (N = 288) will be randomized to one of eight conditions, each representing a combination of core MABT strategies in addition to foundational BT strategies. Assessments occur at baseline, mid-treatment (week 24 through 26), post-treatment, and at 6, 12, and 24-month follow-up. The primary aim is to elucidate the independent efficacy of each MABT component on weight loss above gold-standard BT. The secondary aims are to evaluate the independent effect of these components on calorie intake, physical activity, and overall quality of life; evaluate target engagement (i.e., the degree to which each treatment component affects proposed mechanisms of action); and evaluate the potential moderating effect of susceptibility to internal and external food cues on outcomes. The exploratory aim is to quantify any component interaction effects (which may be synergistic, fully additive, or partially additive).
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA.
| | - Christina Chwyl
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Lauren C Taylor
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Donna L Coffman
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Adrienne Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
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27
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Jones SE, Moore RC, Pinkham AE, Depp CA, Granholm E, Harvey PD. A cross-diagnostic study of Adherence to Ecological Momentary Assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence. ACTA ACUST UNITED AC 2021; 29-30. [PMID: 34541425 DOI: 10.1016/j.pmip.2021.100085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Ecological momentary assessment (EMA) offers a highly valid strategy to assess everyday functioning in people with severe mental illness. Adherence is generally good, but several questions regarding the impact of study length, daily density of sampling, and symptom severity on adherence remain. Methods EMA adherence in two separate studies was examined. One sampled participants with schizophrenia (n=106) and healthy controls (n=76) 7 times per day for 7 days and the other sampled participants with schizophrenia (n=104) and participants with bipolar illness (n=76) 3 times per day for 30 days. Participants were asked where they were, who they were with, what they were doing and how they were feeling in both studies. The impact of rates of very early adherence on eventual adherence was investigated across the samples, and adherence rates were examined for associations with mood state and most common location when answering surveys. Results Median levels of adherence were over 80% across the samples, and the 10th percentile for adherence was approximately 45% of surveys answered. Early adherence predicted study-long adherence quite substantially in every sample. Mood states did not correlate with adherence in the patient samples and being home correlated with adherence in only the bipolar sample. Implications Adherence was quite high and was not correlated with the length of the study or the density of sampling per study day. There was a tendency for bipolar participants who were more commonly away from home to answer fewer surveys but overall adherence for the bipolar patients was quite high. These data suggest that early nonadherence is a potential predictor of eventual nonadherence and study noncompletion.
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Affiliation(s)
- Sara E Jones
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX.,University of Texas Southwestern Medical Center, Dallas TX
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Eric Granholm
- UCSD Health Sciences Center, La Jolla, CA.,San Diego VA Medical Center La Jolla, CA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL.,Bruce W. Carter VA Medical Center, Miami, FL
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28
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Crochiere RJ, Zhang FZ, Juarascio AS, Goldstein SP, Thomas JG, Forman EM. Comparing ecological momentary assessment to sensor-based approaches in predicting dietary lapse. Transl Behav Med 2021; 11:2099-2109. [PMID: 34529044 DOI: 10.1093/tbm/ibab123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Ecological momentary assessment (EMA; brief self-report surveys) of dietary lapse risk factors (e.g., cravings) has shown promise in predicting and preventing dietary lapse (nonadherence to a dietary prescription), which can improve weight loss interventions. Passive sensors also can measure lapse risk factors and may offer advantages over EMA (e.g., objective, automatic, semicontinuous data collection), but currently can measure only a few lapse predictors, a notable limitation. This study preliminarily compared the burden and accuracy of commercially available sensors versus established EMA in lapse prediction. N = 23 adults with overweight/obesity completed a 6-week commercial app-based weight loss program. Participants wore a Fitbit, enabled GPS tracking, completed EMA, and reported on EMA and sensor burden poststudy via a 5-point Likert scale. Sensed risk factors were physical activity and sleep (accelerometer), geolocation (GPS), and time, from which 233 features (measurable characteristics of sensor signals) were extracted. EMA measured 19 risk factors, lapse, and categorized GPS into meaningful geolocations. Two supervised binary classification models (LASSO) were created: the sensor model predicted lapse with 63% sensitivity (true prediction rate of lapse) and 60% specificity (true prediction rate of non-lapse) and EMA model with 59% sensitivity and 72% specificity. EMA model accuracy was higher, but self-reported EMA burden (M = 2.96, SD = 1.02) also was higher (M = 1.50, SD = 0.94). EMA model accuracy was superior, but EMA burden was higher than sensor burden. Findings highlight the promise of sensors in contributing to lapse prediction, and future research may use EMA, sensors, or both depending on prioritization of accuracy versus participant burden.
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Affiliation(s)
- Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA 19104, USA
| | - Fengqing Zoe Zhang
- The Miriam Hospital's Weight Control and Diabetes Research Center, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA 19104, USA
| | - Stephanie P Goldstein
- The Miriam Hospital's Weight Control and Diabetes Research Center, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Graham Thomas
- The Miriam Hospital's Weight Control and Diabetes Research Center, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA 19104, USA
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29
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Goldstein SP, Brick LA, Thomas JG, Forman EM. Examination of the relationship between lapses and weight loss in a smartphone-based just-in time adaptive intervention. Transl Behav Med 2021; 11:993-1005. [PMID: 33902112 DOI: 10.1093/tbm/ibaa097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We developed a smartphone-based just-in-time adaptive intervention (JITAI), called OnTrack, that provides personalized intervention to prevent dietary lapses (i.e., nonadherence from the behavioral weight loss intervention diet). OnTrack utilizes ecological momentary assessment (EMA; repeated electronic surveys) for self-reporting lapse triggers, predicts lapses using machine learning, and provides brief intervention to prevent lapse. We have established preliminary feasibility, acceptability, and efficacy of OnTrack, but no study has examined our hypothesized mechanism of action: reduced lapse frequency will be associated with greater weight loss while using OnTrack. This secondary analysis investigated the association between lapse frequency and the weekly percentage of weight loss. Post hoc analyses evaluated the moderating effect of OnTrack engagement on this association. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used OnTrack with a digital weight loss program for 10 weeks. Engagement with OnTrack (i.e., EMA completed and interventions accessed) was recorded automatically, participants self-reported dietary lapses via EMA, and weighed weekly using Bluetooth scales. Linear mixed models with a random effect of subject and fixed effect of time revealed a nonsignificant association between weekly lapses and the percentage of weight loss. Post hoc analyses revealed a statistically significant moderation effect of OnTrack engagement such that fewer EMA and interventions completed conferred the expected associations between lapses and weight loss. Lapses were not associated with weight loss in this study and one explanation may be the influence of engagement levels on this relationship. Future research should investigate the role of engagement in evaluating JITAIs.
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Affiliation(s)
- Stephanie P Goldstein
- The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Graham Thomas
- The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, PA, USA
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30
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Song T, Yu P, Bliokas V, Probst Y, Peoples GE, Qian S, Houston L, Perez P, Amirghasemi M, Cui T, Hitige NPR, Smith NA. A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case. JMIR Mhealth Uhealth 2021; 9:e20650. [PMID: 34283030 PMCID: PMC8335618 DOI: 10.2196/20650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/09/2020] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. OBJECTIVE This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. METHODS We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. RESULTS In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. CONCLUSIONS This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.
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Affiliation(s)
- Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Vida Bliokas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yasmine Probst
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Gregory E Peoples
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Lauren Houston
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Pascal Perez
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Mehrdad Amirghasemi
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Tingru Cui
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Nadeesha Pathiraja Rathnayaka Hitige
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Natalie Anne Smith
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia
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31
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Coffman DL, Oliva IB, Forman EM. Does acceptance-based treatment moderate the effect of stress on dietary lapses? Transl Behav Med 2021; 11:2110-2115. [PMID: 34245302 DOI: 10.1093/tbm/ibab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Weight loss interventions are successful to the extent that participants adhere to calorie-reduced dietary prescriptions and may be undermined by dietary lapses triggered by external or internal factors, such as stress. The purpose of this study was to examine whether an acceptance-based treatment (ABT) versus a standard behavioral treatment (SBT) moderated the effect of stress on dietary lapses. Ecological momentary assessment data were collected from 189 participants who were randomly assigned to either ABT or SBT. Between-subject and within-subject stress were used to predict lapse occurrence along with intervention condition, and the interaction between intervention condition and stress using a generalized linear mixed-effects model. Gender, time of day, and baseline mean lapses/day were included as control variables. Higher mean baseline lapses/day, female gender, and later time of day were significantly associated with increased odds of lapse. Between-subject stress was positively and significantly related to the odds of lapse. Compared to SBT, ABT showed a significant decrease in the odds of lapse at an individual's average level of within-subject stress, but the interaction of intervention condition with within-subject stress was not statistically significant. Participants with high overall stress levels lapsed more frequently than those with low overall stress levels. There was a significant decrease in the odds of lapse for the ABT group at a participant's own average stress level, suggesting that ABT may be beneficial at participants' usual stress levels but when they deviate from their usual stress level, there are no treatment differences.
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Affiliation(s)
- Donna L Coffman
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA
| | - Isabela Batista Oliva
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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32
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Behr H, Ho AS, Mitchell ES, Yang Q, DeLuca L, Michealides A. How Do Emotions during Goal Pursuit in Weight Change over Time? Retrospective Computational Text Analysis of Goal Setting and Striving Conversations with a Coach during a Mobile Weight Loss Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126600. [PMID: 34205282 PMCID: PMC8296374 DOI: 10.3390/ijerph18126600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022]
Abstract
During behavioral weight management, individuals reflect on their progress and barriers through goal pursuit (goal setting and goal striving). Emotions during goal pursuit are largely unknown, and previous investigations of emotions in weight management have primarily relied on self-report. In this retrospective study, we used a well-validated computational text analysis approach to explore how emotion words changed over time during goal setting and striving conversations with a coach in a mobile weight loss program. Linear mixed models examined changes in emotion words each month from baseline to program end and compared emotion words between individuals who set an overall concrete goal for the program (concrete goal setters) and those who set an overall abstract goal (abstract goal setters). Contrary to findings using self-report, positive emotion words were stable and negative emotion words significantly increased over time. There was a marginal trend towards greater negative emotion word use being associated with greater weight loss. Concrete goal setters used more positive words than abstract goal setters, with no differences in negative emotion words and weight loss. Implications include the possibility that individuals may need increasing support over time for negative emotions expressed during goal setting and striving, and concrete goals could boost positive emotion. Future research should investigate these possibilities.
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Affiliation(s)
- Heather Behr
- Department of Integrative Health, Saybrook University, 55 W Eureka St, Pasadena, CA 91103, USA;
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
| | - Annabell Suh Ho
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
| | - Ellen Siobhan Mitchell
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
- Correspondence:
| | - Qiuchen Yang
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
| | - Laura DeLuca
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA
| | - Andreas Michealides
- Academic Research, Noom, 229 W 28th St., New York, NY 10461, USA; (A.S.H.); (Q.Y.); (L.D.); (A.M.)
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Goldstein SP, Thomas JG, Brick LA, Zhang F, Forman EM. Identifying behavioral types of dietary lapse from a mobile weight loss program: Preliminary investigation from a secondary data analysis. Appetite 2021; 166:105440. [PMID: 34098003 DOI: 10.1016/j.appet.2021.105440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022]
Abstract
Success in behavioral weight loss (BWL) programs depends on adherence to the recommended diet to reduce caloric intake. Dietary lapses (i.e., deviations from the BWL diet) occur frequently and can adversely affect weight loss outcomes. Research indicates that lapse behavior is heterogenous; there are many eating behaviors that could constitute a dietary lapse, but they are rarely studied as distinct contributors to weight outcomes. This secondary analysis aims to evaluate six behavioral lapse types during a 10-week mobile BWL program (eating a large portion, eating when not intended, eating an off-plan food, planned lapse, being unaware of caloric content, and endorsing multiple types of lapse). Associations between weekly behavioral lapse type frequency and weekly weight loss were investigated, and predictive contextual characteristics (psychological, behavioral, and environmental triggers for lapse) and individual difference (e.g., age, gender) factors were examined across lapse types. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used a mobile BWL program for 10 weeks, self-weighed weekly using Bluetooth scales, completed daily ecological momentary assessment of lapse behavior and contextual characteristics, and completed a baseline demographics questionnaire. Linear mixed models revealed significant negative associations between unplanned lapses and percent weight loss. Unplanned lapses from eating a large portion, eating when not intended, and having multiple "types" were significantly negatively associated with weekly percent weight loss. A lasso regression showed that behavioral lapse types share many similar stable factors, with other factors being unique to specific lapse types. Results add to the prior literature on lapses and weight loss in BWL and provide preliminary evidence that behavioral lapse types could aid in understanding adherence behavior and developing precision medicine tools to improve dietary adherence.
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Affiliation(s)
- Stephanie P Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & the Miriam Hospital/Weight Control and Diabetes Research Center, United States.
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & the Miriam Hospital/Weight Control and Diabetes Research Center, United States
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, United States
| | - Fengqing Zhang
- Department of Psychology, College of Arts and Sciences, Drexel University, United States
| | - Evan M Forman
- Department of Psychology, College of Arts and Sciences, Drexel University, United States; Center for Weight, Eating, And Lifestyle Sciences (WELL Center), Drexel University, United States
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Pagoto S, Tulu B, Waring ME, Goetz J, Bibeau J, Divito J, Groshon L, Schroeder M. Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App. JMIR Mhealth Uhealth 2021; 9:e24249. [PMID: 33792547 PMCID: PMC8050748 DOI: 10.2196/24249] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/29/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. OBJECTIVE This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. METHODS We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. RESULTS A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants' ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. CONCLUSIONS Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171.
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Affiliation(s)
- Sherry Pagoto
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Bengisu Tulu
- Worcester Polytechnic University, Foisie Business School, Worcester, MA, United States
| | - Molly E Waring
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Jared Goetz
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Jessica Bibeau
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Joseph Divito
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Laurie Groshon
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
| | - Matthew Schroeder
- University of Connecticut, Department of Allied Health Sciences, Storrs, CT, United States
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O'Connor SG, Boyd P, Bailey CP, Shams-White MM, Agurs-Collins T, Hall K, Reedy J, Sauter ER, Czajkowski SM. Perspective: Time-Restricted Eating Compared with Caloric Restriction: Potential Facilitators and Barriers of Long-Term Weight Loss Maintenance. Adv Nutr 2021; 12:325-333. [PMID: 33463673 PMCID: PMC8009736 DOI: 10.1093/advances/nmaa168] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
A growing body of literature examines the potential benefits of a time-based diet strategy referred to as time-restricted eating (TRE). TRE, a type of intermittent fasting, restricts the time of eating to a window of 4-12 h/d but allows ad libitum intake during eating windows. Although TRE diets do not overtly attempt to reduce energy intake, preliminary evidence from small studies suggests that TRE can lead to concomitant reduction in total energy, improvements in metabolic health, and weight loss. Unique features of the TRE diet strategy may facilitate adherence and long-term weight loss maintenance. In this Perspective, we explore the potential multilevel (i.e., biological, behavioral, psychosocial, environmental) facilitators and barriers of TRE for long-term weight loss maintenance in comparison with the more commonly used diet strategy, caloric restriction (CR). Compared with CR, TRE may facilitate weight loss maintenance by counteracting physiological adaptations to weight loss (biological), allowing for usual dietary preferences to be maintained (behavioral), preserving executive functioning (psychosocial), and enabling individuals to withstand situational pressures to overeat (environmental). However, TRE may also pose unique barriers to weight loss maintenance, particularly for individuals with poor baseline diet quality, internal or social pressures to eat outside selected windows (e.g., grazers), and competing demands that interfere with the scheduling of eating. Future studies of TRE in free-living individuals should consider the multiple levels of influence impacting long-term adherence and weight loss maintenance. Ultimately, TRE could be one strategy in a toolkit of tailored diet strategies to support metabolic health and weight loss maintenance.
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Affiliation(s)
- Sydney G O'Connor
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Patrick Boyd
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Caitlin P Bailey
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Marissa M Shams-White
- Epidemiology and Genomics Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tanya Agurs-Collins
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kara Hall
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jill Reedy
- Epidemiology and Genomics Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Edward R Sauter
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Susan M Czajkowski
- Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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36
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Goldstein SP, Hoover A, Evans EW, Thomas JG. Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol. Digit Health 2021; 7:2055207620988212. [PMID: 33598309 PMCID: PMC7863144 DOI: 10.1177/2055207620988212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity. Yet, many individuals in BOT do not achieve clinically significant weight loss and/or experience weight regain. Lapses (i.e., eating that deviates from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it can be difficult to assess. We propose to study lapses using a multi-method approach, which allows us to identify objectively-measured characteristics of lapse behavior (e.g., eating rate, duration), examine the association between lapse and weight change, and estimate nutrition composition of lapse. Method We are recruiting participants (n = 40) with overweight/obesity to enroll in a 24-week BOT. Participants complete biweekly 7-day ecological momentary assessment (EMA) to self-report on eating behavior, including dietary lapses. Participants continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Participants complete 24-hour dietary recalls via structured interview at 6-week intervals to measure the composition of all food and beverages consumed. Results While data collection for this trial is still ongoing, we present data from three pilot participants who completed EMA and wore the ActiGraph to illustrate the feasibility, benefits, and challenges of this work. Conclusion This protocol will be the first multi-method study of dietary lapses in BOT. Upon completion, this will be one of the largest published studies of passive eating detection and EMA-reported lapse. The integration of EMA and passive sensing to characterize eating provides contextually rich data that will ultimately inform a nuanced understanding of lapse behavior and enable novel interventions.Trial registration: Registered clinical trial NCT03739151; URL: https://clinicaltrials.gov/ct2/show/NCT03739151.
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Affiliation(s)
| | - Adam Hoover
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, USA
| | - E Whitney Evans
- The Miriam Hospital Weight Control and Diabetes Research Center, Providence, USA
| | - J Graham Thomas
- The Miriam Hospital Weight Control and Diabetes Research Center, Providence, USA
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37
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Thøgersen-Ntoumani C, Dodos LA, Stenling A, Ntoumanis N. Does self-compassion help to deal with dietary lapses among overweight and obese adults who pursue weight-loss goals? Br J Health Psychol 2020; 26:767-788. [PMID: 33368932 PMCID: PMC8451927 DOI: 10.1111/bjhp.12499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Objectives Self‐compassion can facilitate self‐improvement motivation. We examined the effects of self‐compassion in response to dietary lapses on outcomes relevant to weight‐loss strivings using a longitudinal design. The indirect effects of self‐compassion via guilt and shame were also explored. Design An Ecological Momentary Assessment methodology was employed with a sample of adults who were overweight or obese attempting to lose weight via dietary restriction (N = 56; Mage = 34.88; SD = 13.93; MBMI = 32.50; SD = 6.88) and who responded to brief surveys sent to their mobile phones twice daily for two weeks. Methods Dietary temptations and lapses were assessed at each diary entry, and self‐compassion in response to dietary lapses, intention to continue dieting, weight‐loss‐related self‐efficacy, negative reactions to the lapse, and self‐conscious emotions were surveyed on occasions when participants reported having experienced a dietary lapse. The participants were also weighed in a laboratory prior to the EMA phase and via self‐report straight after the EMA phase. Weight was measured again in the laboratory 12 weeks after the EMA period. Results Bayesian multilevel path analyses showed that self‐compassion did not predict weight loss. However, at the within‐person level, self‐compassion was positively related to intentions and self‐efficacy to continue dieting, and negatively related to negative affective reactions to the lapses. Guilt mediated the associations of self‐compassion with intention, self‐efficacy, and negative reactions. Conclusion Self‐compassion may be a powerful internal resource to cultivate when dieters experience inevitable setbacks during weight‐loss strivings which could facilitate weight‐loss perseverance.
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Affiliation(s)
- Cecilie Thøgersen-Ntoumani
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Louisa A Dodos
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andreas Stenling
- Department of Psychology, Umeå University, Sweden.,Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Nikos Ntoumanis
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
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38
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Lawlor ER, Hughes CA, Duschinsky R, Pountain GD, Hill AJ, Griffin SJ, Ahern AL. Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study. Clin Obes 2020; 10:e12395. [PMID: 32767708 PMCID: PMC7116423 DOI: 10.1111/cob.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.
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Affiliation(s)
- Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Carly A Hughes
- Fakenham Medical Practice, Norfolk, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Robbie Duschinsky
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | | | - Andrew J Hill
- Division of Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
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Martins C, Dutton GR, Hunter GR, Gower BA. Revisiting the Compensatory Theory as an explanatory model for relapse in obesity management. Am J Clin Nutr 2020; 112:1170-1179. [PMID: 32936896 PMCID: PMC7657332 DOI: 10.1093/ajcn/nqaa243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022] Open
Abstract
Weight regain remains the main challenge in obesity management, and its etiology remains elusive. The aim of the present review was to revise the available evidence regarding the "Compensatory Theory," which is an explanatory model of relapse in obesity treatment, and to propose alternative mechanisms that can contribute to weight regain. It has been proposed, and generally accepted as true, that when a person loses weight the body fights back, with physiological adaptations on both sides of the energy balance equation that try to bring body weight back to its original state: this is the Compensatory Theory. This theory proposes that the increased orexigenic drive to eat and the reduced energy expenditure that follow weight loss are the main drivers of relapse. However, evidence showing a link between these physiological adaptations to weight loss and weight regain is lacking. Here, we propose that the physiological adaptations to weight loss, both at the level of the homeostatic appetite control system and energy expenditure, are in fact a normalization to a lower body weight and not drivers of weight regain. In light of this we explore other potential mechanisms, both physiological and behavioral, that can contribute to the high incidence of relapse in obesity management. More research is needed to clearly ascertain whether the changes in energy expenditure and homeostatic appetite markers seen in reduced-obese individuals are a compensatory mechanism that drives relapse or a normalization towards a lower body weight, and to explore alternative hypotheses that explain relapse in obesity management.
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Affiliation(s)
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
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40
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Panza E, Olson K, Goldstein CM, Selby EA, Lillis J. Characterizing Lifetime and Daily Experiences of Weight Stigma among Sexual Minority Women with Overweight and Obesity: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4892. [PMID: 32645883 PMCID: PMC7369986 DOI: 10.3390/ijerph17134892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/20/2022]
Abstract
Sexual minority women are disproportionately impacted by obesity yet are underrepresented in weight stigma research. This Ecological Momentary Assessment (EMA) study is a secondary analysis that aimed to elucidate the frequency and contextual characteristics of perceived experiences of lifetime and momentary weight stigma among sexual minority women with overweight/obesity. Participants were 55 sexual minority women ages 18-60 with a body mass index ≥25 kg/m2. Perceived lifetime weight stigma events were assessed at baseline. For the subsequent five days, participants used a smartphone to complete five daily, random EMA prompts assessing the frequency/characteristics of perceived weight stigma events in daily life. All participants reported at least one lifetime weight stigma event. During the EMA period, participants reported 44 momentary weight stigma events (M = 0.80), with 24% of participants reporting at least one event. During most instances of weight stigma, women perceived the stigma's cause to be their weight and another minority identity (e.g., sexual orientation). Findings showing high rates of perceived lifetime weight stigma in this sample and frequent co-occurrence of perceived weight stigma with stigma due to other marginalized identities in daily life underscore the need for future, larger studies investigating weight stigma through an intersectional lens in sexual minority women with overweight/obesity.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, USA; (K.O.); (C.M.G.); (J.L.)
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, USA; (K.O.); (C.M.G.); (J.L.)
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, USA; (K.O.); (C.M.G.); (J.L.)
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Edward A. Selby
- Department of Psychology, Rutgers, the State University of New Jersey, New Brunswick, NJ 08901, USA;
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, USA; (K.O.); (C.M.G.); (J.L.)
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
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41
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Kim H, Kim S, Kong SS, Jeong YR, Kim H, Kim N. Possible Application of Ecological Momentary Assessment to Older Adults' Daily Depressive Mood: Integrative Literature Review. JMIR Ment Health 2020; 7:e13247. [PMID: 32484442 PMCID: PMC7298638 DOI: 10.2196/13247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Ecological momentary assessment is a method of investigating individuals' real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. OBJECTIVE The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. METHODS We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles' references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were "ecological momentary assessment," "smartphone assessment," "real time assessment," "electronic daily diary," "mHealth momentary assessment," "mobile-based app," and "experience sampling method," combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. RESULTS Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants' depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. CONCLUSIONS Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users' experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.
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Affiliation(s)
- Heejung Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Sunah Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Seong Sook Kong
- School of Nursing, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | | | - Hyein Kim
- Severance Hospital, Seoul, Republic of Korea
| | - Namhee Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
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42
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Kerrigan SG, Schumacher L, Manasse SM, Loyka C, Butryn ML, Forman EM. The association between negative affect and physical activity among adults in a behavioral weight loss treatment. PSYCHOLOGY OF SPORT AND EXERCISE 2020; 47:101507. [PMID: 32440257 PMCID: PMC7241248 DOI: 10.1016/j.psychsport.2019.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Many individuals engaged in behavioral weight loss make suboptimal increases in moderate-to-vigorous physical activity (MVPA). Theoretically, reductions in negative affect could reinforce MVPA. However, little work has been done investigating the association between facets of negative affect (e.g., average levels of negative affect, variability in negative affect) and MVPA among individuals attempting to increase MVPA as part of a behavioral weight loss attempt. METHODS Participants (n = 139) provided data at month 6 of a year-long behavioral weight loss program (at which point the prescription for MVPA had reached the highest level). Participants wore an accelerometer and provided EMA ratings of affect over the same week. RESULTS Individuals engaged in more frequent and longer periods of MVPA had lower average negative affect and variability in negative affect across the assessment period. Lower negative affect one day predicted greater time spent in MVPA on the next day; lower variability in negative affect than one's average level also predicted greater time spent in MVPA on the next day. Greater engagement in MVPA than one's own mean on one day did not predict mean or variability in affect. DISCUSSION Engaging in MVPA over time may reduce negative affect, while lower negative affect may increase motivation to engage in MVPA. Importantly, day-to-day effects indicated that affect is an important acute predictor of MVPA behavior. It is possible that individuals, particularly those with higher negative affect or variability in negative affect, may benefit from the inclusion of skills to manage negative affect in programs prescribing physical activity.
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Affiliation(s)
| | - Leah Schumacher
- WELL Center, Drexel University, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
- Department of Psychology, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI
| | - Stephanie M Manasse
- WELL Center, Drexel University, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
| | - Caitlin Loyka
- WELL Center, Drexel University, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
- Department of Psychology, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
| | - Meghan L Butryn
- WELL Center, Drexel University, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
- Department of Psychology, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
| | - Evan M Forman
- WELL Center, Drexel University, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
- Department of Psychology, 3141 Chestnut Street, Stratton 119, Philadelphia, PA
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43
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Goldstein SP, Thomas JG, Foster GD, Turner-McGrievy G, Butryn ML, Herbert JD, Martin GJ, Forman EM. Refining an algorithm-powered just-in-time adaptive weight control intervention: A randomized controlled trial evaluating model performance and behavioral outcomes. Health Informatics J 2020; 26:2315-2331. [PMID: 32026745 PMCID: PMC8925642 DOI: 10.1177/1460458220902330] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Suboptimal weight losses are partially attributable to lapses from a prescribed diet. We developed an app (OnTrack) that uses ecological momentary assessment to measure dietary lapses and relevant lapse triggers and provides personalized intervention using machine learning. Initially, tension between user burden and complete data was resolved by presenting a subset of lapse trigger questions per ecological momentary assessment survey. However, this produced substantial missing data, which could reduce algorithm performance. We examined the effect of more questions per ecological momentary assessment survey on algorithm performance, app utilization, and behavioral outcomes. Participants with overweight/obesity (n = 121) used a 10-week mobile weight loss program and were randomized to OnTrack-short (i.e. 8 questions/survey) or OnTrack-long (i.e. 17 questions/survey). Additional questions reduced ecological momentary assessment adherence; however, increased data completeness improved algorithm performance. There were no differences in perceived effectiveness, app utilization, or behavioral outcomes. Minimal differences in utilization and perceived effectiveness likely contributed to similar behavioral outcomes across various conditions.
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Affiliation(s)
| | | | - Gary D Foster
- WW (Weight Watchers), USA; University of Pennsylvania, USA
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44
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Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. AMERICAN PSYCHOLOGIST 2020; 75:235-251. [PMID: 32052997 PMCID: PMC7027681 DOI: 10.1037/amp0000517] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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45
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Crochiere RJ, Kerrigan SG, Lampe EW, Manasse SM, Crosby RD, Butryn ML, Forman EM. Is physical activity a risk or protective factor for subsequent dietary lapses among behavioral weight loss participants? Health Psychol 2020; 39:240-244. [PMID: 31916827 DOI: 10.1037/hea0000839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Dietary lapses drive weight loss failure, and specific factors influence risk of lapse. Physical activity (PA) may be one such risk factor, though whether PA increases or decreases appetite, and thus risk of lapse, is unclear. In fact, most studies examining the relation between PA and energy intake are limited by use of laboratory-based settings, intensive PA manipulations, and healthy-weight samples. This study aimed to maximize ecological validity by examining the extent to which free-living PA of various intensities prospectively predicts same-day dietary lapses among individuals enrolled in a weight loss program. METHOD Participants were 130 adults with overweight/obesity in a behavioral weight loss treatment instructed to follow a PA and dietary prescription. At midtreatment, moderate-to-vigorous PA (MVPA) and light PA were measured using hip-worn Actigraph GT3X+ accelerometers (Actigraph, Pensacola, FL). Lapses were assessed using ecological momentary assessment. Within-subject total PA (b = -0.012, SE = 0.005, p = .01) and light PA (b = -0.014, SE = 0.006, p = .01) negatively predicted lapse. MVPA followed the same pattern, but the effect was not statistically significant (b = -0.013, SE = 0.009, p = .12). CONCLUSION This study was the first to investigate if objectively measured PA prospectively predicts lapse from a weight loss program. Results suggested that for every additional 10 min of total PA one engaged in, the risk of lapse decreased by 1%. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center) and Department of Psychology, Drexel University
| | | | - Elizabeth W Lampe
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center) and Department of Psychology, Drexel University
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University
| | | | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center) and Department of Psychology, Drexel University
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center) and Department of Psychology, Drexel University
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46
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Tang X, Andres A, West DS, Lou X, Krukowski RA. Eating behavior and weight gain during pregnancy. Eat Behav 2020; 36:101364. [PMID: 32032810 DOI: 10.1016/j.eatbeh.2020.101364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Little is known about the relationship between eating behavior and weight gain during pregnancy. PURPOSE Our objective was to assess the relationship among self-reported cognitive restraint, disinhibition, and hunger, and excessive gestational weight gain (GWG) as defined by the Institute of Medicine's (IOM) 2009 guidelines. Based on previous research examining eating behaviors and weight gain in non-pregnant women, we hypothesized that excessive GWG would be related to higher cognitive restraint, higher disinhibition, and higher perception of hunger. METHODS 190 pregnant women from the Glowing study completed the Three-Factor Eating Questionnaire (TFEQ) at the enrollment visit, which included subscales assessing restraint, disinhibition, and hunger. Participants' height and weight from <10 weeks through 36 weeks gestation were measured, allowing classification within or in excess of the IOM guidelines adjusted for the week of the final measurement. RESULTS The odds that a participant would gain weight above IOM recommendations was 1.2 times higher (OR = 1.17, 95% CI = 1.05-1.29) for each one-unit increase in the disinhibition subscale in the unadjusted logistic regression. However, after controlling for sociodemographic characteristics and baseline BMI categories, participants' TFEQ scores were not associated with the likelihood of having GWG above IOM guidelines. Eating behaviors subscales were modestly correlated with baseline BMI categories (all rs < 0.50 with p-values ranging from <0.001 to 0.619). CONCLUSIONS Although disinhibition scores had a significant relationship with excessive GWG, the significance of this relationship was not sustained after adjusting for sociodemographic characteristics and baseline BMI categories.
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Affiliation(s)
- Xuyang Tang
- Department of Preventive Medicine, University of Tennessee Health Science Center, United States of America
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences, United States of America
| | - Delia S West
- Arnold School of Public Health, Department of Exercise Science, University of South Carolina, United States of America
| | - Xiangyang Lou
- Department of Biostatistics, University of Florida, United States of America
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, United States of America.
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47
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Godfrey KM, Schumacher LM, Butryn ML, Forman EM. Physical Activity Intentions and Behavior Mediate Treatment Response in an Acceptance-Based Weight Loss Intervention. Ann Behav Med 2019; 53:1009-1019. [PMID: 30951589 DOI: 10.1093/abm/kaz011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acceptance-based treatment (ABT) for weight loss has shown promise for improving outcomes relative to standard behavioral treatment (SBT). One way in which ABT may improve outcomes is through increasing physical activity (PA) intentions and behavior but little research has examined these as mediators of ABT on weight change. PURPOSE This study sought to examine ABT's effects on intentions for PA and several objectively measured PA variables during treatment and analyze PA intentions and behaviors as mediators of ABT's effect on weight loss. METHODS Participants (N = 189) with overweight/obesity randomized to 1 year of either ABT or SBT completed ecological momentary assessment of PA intentions, accelerometer-based PA assessment, and had weight measured at baseline, mid-treatment, and end of treatment. RESULTS ABT had a significantly higher increase than SBT in PA intention minutes at mid-treatment and end of treatment (p < 0.001), and both groups had nonlinear increases in moderate-to-vigorous physical activity (MVPA) that were not significantly different. Sequential mediation models found that ABT's effect on weight loss was partially mediated by higher PA intention minutes at mid-treatment leading to increased MVPA minutes per week. Increased MVPA minutes were obtained by participants increasing the number of days with MVPA bouts. CONCLUSIONS ABT's effect on weight loss throughout treatment resulted, in part, from participants increasing their intentions for PA. Controlling for group, higher PA intentions were associated with more PA obtained through more days with exercise.
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Affiliation(s)
- Kathryn M Godfrey
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Leah M Schumacher
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA.,Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
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48
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Forman EM, Goldstein SP, Crochiere RJ, Butryn ML, Juarascio AS, Zhang F, Foster GD. Randomized controlled trial of OnTrack, a just-in-time adaptive intervention designed to enhance weight loss. Transl Behav Med 2019; 9:989-1001. [DOI: 10.1093/tbm/ibz137] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This randomized trial demonstrated qualified support for the ability of a machine learning-powered, smartphone-based just-in-time, adaptive intervention to enhance weight loss over and above a commercial weight loss program.
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Stephanie P Goldstein
- Weight Control & Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
| | - Fengqing Zhang
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, USA
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49
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Ross KM, Qiu P, You L, Wing RR. Week-to-week predictors of weight loss and regain. Health Psychol 2019; 38:1150-1158. [PMID: 31566400 DOI: 10.1037/hea0000798] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Despite increased interest in the development of individually tailored weight management programs, little is known about what factors proximally predict weight change. METHOD The current study investigated proximal (week-to-week) predictors of weight loss and regain in 74 adults during a 3-month, Internet-based behavioral weight loss program followed by a 9-month "maintenance" period (during which no additional intervention was provided). Participants were asked to self-weigh daily using scales that transmitted weight via the cellular network and to answer a brief questionnaire each week querying mood, behaviors, and cognitions hypothesized to be associated with weight loss and regain. RESULTS Longitudinal multilevel models demonstrated that weight loss during initial intervention was proximally predicted by (a) greater frequency of self-monitoring weight and caloric intake, consistency between eating choices and weight loss goals, and importance of "staying on track" with these goals and (b) less negative mood, boredom with weight control efforts, hunger, and temptation to eat foods "not on plan" (ps < .05). Greater weight regain after intervention was also proximally predicted by these factors (with effects in the opposite direction) and additionally by less physical activity, less positive mood, more stress, greater temptation to skip planned physical activity, and higher ratings of the amount of effort required to stay on track (ps < .05). CONCLUSIONS Results confirmed the importance of self-monitoring for weight loss and maintenance and identified other key week-to-week predictors of weight change. Results also supported efforts to develop intervention approaches specifically focused on weight loss maintenance. Future research should investigate whether using identified predictors to tailor intervention content and timing can improve weight outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Peihua Qiu
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida
| | - Lu You
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
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50
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Steward T, Picó-Pérez M, Mestre-Bach G, Martínez-Zalacaín I, Suñol M, Jiménez-Murcia S, Fernández-Formoso JA, Vilarrasa N, García-Ruiz-de-Gordejuela A, Veciana de las Heras M, Custal N, Virgili N, Lopez-Urdiales R, Menchón JM, Granero R, Soriano-Mas C, Fernandez-Aranda F. A multimodal MRI study of the neural mechanisms of emotion regulation impairment in women with obesity. Transl Psychiatry 2019; 9:194. [PMID: 31431608 PMCID: PMC6702163 DOI: 10.1038/s41398-019-0533-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/16/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
Maladaptive emotion regulation contributes to overeating and impedes weight loss. Our study aimed to compare the voluntary downregulation of negative emotions by means of cognitive reappraisal in adult women with obesity (OB) and female healthy controls (HC) using a data-driven, multimodal magnetic resonance imaging (MRI) approach. Women with OB (n = 24) and HC (n = 25) carried out an emotion regulation task during functional MRI scanning. Seed-to-voxel resting-state connectivity patterns derived from activation peaks identified by this task were compared between groups. Diffusion tensor imaging (DTI) was used to examine white matter microstructure integrity between regions exhibiting group differences in resting-state functional connectivity. Participants in the OB group presented reduced activation in the ventromedial prefrontal (vmPFC) cortex in comparison to the HC group when downregulating negative emotions, along with heightened activation in the extrastriate visual cortex (p < 0.05, AlphaSim-corrected). Moreover, vmPFC peak activity levels during cognitive reappraisal were negatively correlated with self-reported difficulties in emotion regulation. OB patients exhibited decreased functional connectivity between the vmPFC and the temporal pole during rest (peak-pFWE = 0.039). Decreased fractional white-matter track volume in the uncinate fasciculus, which links these two regions, was also found in participants with OB. Taken together, our findings are indicative of emotion regulation deficits in OB being underpinned by dysfunctional hypoactivity in the vmPFC and hyperactivity in the extrastriate visual cortex. Our results provide a potential target circuit for neuromodulatory interventions to improve emotion regulation skills and weight-loss intervention outcomes.
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Affiliation(s)
- Trevor Steward
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCiber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0001 2179 088Xgrid.1008.9Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia
| | - Maria Picó-Pérez
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0001 2159 175Xgrid.10328.38Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Gemma Mestre-Bach
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCiber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Maria Suñol
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCiber Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Susana Jiménez-Murcia
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCiber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Jose A. Fernández-Formoso
- 0000 0000 9314 1427grid.413448.eCiber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Nuria Vilarrasa
- 0000 0000 8836 0780grid.411129.eDepartment of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Amador García-Ruiz-de-Gordejuela
- 0000 0000 8836 0780grid.411129.eBariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Misericordia Veciana de las Heras
- 0000 0000 8836 0780grid.411129.eNeurology Department, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Nuria Custal
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Nuria Virgili
- 0000 0000 8836 0780grid.411129.eDepartment of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Rafael Lopez-Urdiales
- 0000 0000 8836 0780grid.411129.eDepartment of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - José M. Menchón
- 0000 0000 8836 0780grid.411129.eDepartment of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCiber Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Roser Granero
- 0000 0000 9314 1427grid.413448.eCiber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain ,grid.7080.fDepartament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain. .,Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907, Barcelona, Spain. .,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain.
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, C/Feixa Llarga s/n, 08907, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907, Barcelona, Spain.
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