Relapse prevention training and problem-solving therapy in the long-term management of obesity. A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description Preventing relapse in obesity through posttreatment maintenance systems: Comparing the relative efficacy of two levels of therapist support Mediators of weight loss and weight loss maintenance in middle-aged women. A randomized clinical trial comparing delivery of behavioral pediatric obesity treatment using standard and enhanced motivational approaches. Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Behavioral treatment of adult obesity: attentional controls and a 2-year follow-up. Weight Loss and Self-Regulatory Eating Efficacy in Older Adults: The Cooperative Lifestyle Intervention Program Treatment of pediatric obesity using a parent-only approach: a case example. Temporal Aspects of Psychosocial Predictors of Increased Fruit and Vegetable Intake in Adults with Severe Obesity: Mediation by Physical Activity An evaluation of enhanced self-regulation training in the treatment of childhood obesity. Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). A Dyadic Action Control Trial in Overweight and Obese Couples (DYACTIC) Potential mediators of change in a physical activity promotion course for university students: Project grad Mediators of weight loss in a family-based intervention presented over the internet. Evaluating Parents and Adult Caregivers as ‘Agents of Change’ for Treating Obese Children – Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement from the American Heart Association
This study compared 2 extended therapy programs for weight management with st and ard behavioral treatment ( BT ) without additional therapy contacts . Participants were 80 obese women who completed 20 weekly group sessions of BT and achieved a mean initial weight loss of 8.74 kg . Participants were r and omly assigned to a no-further-contact condition ( BT only ) or to one of two extended interventions consisting of relapse prevention training ( RPT ) or problem-solving therapy ( PST ) . No significant overall weight-change differences were observed between RPT and BT or between RPT and PST . However , participants who completed the PST intervention had significantly greater long-term weight reductions than BT participants , and a significantly larger percentage of PST participants achieved clinical ly significant losses of 10 % or more in body weight than did BT participants ( 35 % vs. 6 % ) Background Research on the motivational model proposed by Self-Determination Theory ( SDT ) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors , and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation . Although obesity is notoriously difficult to reverse and its recidivism is high , adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term . The purpose s of this study are twofold : i ) to describe a 3-year r and omized controlled trial ( RCT ) aim ed at testing a novel obesity treatment program based on SDT , and ii ) to present the rationale behind SDT 's utility in facilitating and explaining health behavior change , especially physical activity/exercise , during obesity treatment . Methods Study design , recruitment , inclusion criteria , measurements , and a detailed description of the intervention ( general format , goals for the participants , intervention curriculum , and main SDT strategies ) are presented . The intervention consists of a 1-year group behavioral program  for overweight and moderately obese women , aged 25 to 50 ( and pre-menopausal ) , recruited from the community at large through media advertisement . Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team ( 30 2 h sessions in total ) , and go through a program covering most topics considered critical for successful  weight control .  These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines . Comparison group receive a general health education curriculum . After the program , all subjects are follow-up for a period of 2 years . Discussion Results from this RCT will contribute to a better underst and ing of how motivational characteristics , particularly those related to physical activity/exercise behavioral self-regulation , influence treatment success , while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity . Trial Registration Clinical Trials Gov. Identifier The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program . Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program  were matched on absolute weight loss and r and omly assigned to one of two maintenance conditions . Subjects were assessed at pretreatment , posttreatment , and 3 , 6 , and 12 months following posttreatment using measures of weight , blood pressure , and depression . Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and /or maintained therapy-induced weight loss to a greater degree than control subjects . At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects . These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5.0 % ( 24-month ) in the intervention group and -1.7 + /- 5.0 % and -2.2 + /- 7.5 % in controls . Change in most psychosocial variables was associated with 12-month weight change , but only flexible cognitive restraint ( P < 0.01 ) , disinhibition ( P < 0.05 ) , exercise self-efficacy ( P < 0.001 ) , exercise intrinsic motivation ( P < 0.01 ) , and body dissatisfaction ( P < 0.05 ) predicted 24-month weight change . Lower emotional eating , increased flexible cognitive restraint , and fewer exercise barriers mediated 12-month weight loss ( R(2 ) = 0.31 , P < 0.001 ; effect ratio : 0.37 ) , but only flexible restraint and exercise self-efficacy mediated 24-month weight loss ( R(2 ) = 0.17 , P < 0.001 ; effect ratio : 0.89 ) . This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance , in a large sample of overweight women . Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss . For long-term success , interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy OBJECTIVE To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention ( self-directed ) for behavioral family-based pediatric obesity relative to the st and ard prescription of uniform behavioral skills use and interventionist goal assignment ( prescribed ) . METHODS In this r and omized clinical trial , 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks , with approaches diverging after week 5 . Anthropometric measurements from child and participating parent at baseline , posttreatment , and 3-month , 6-month , 1-year , and 2-year follow-ups were evaluated for change ( n = 59 in follow-up analyses ) . RESULTS The approaches demonstrated similar child body mass index ( BMI ) z-score and parent BMI change from baseline to posttreatment and throughout follow-up , with child and parent weight status lower than baseline at 2 years after treatment cessation . CONCLUSIONS An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the st and ard intervention approach BACKGROUND The rapid increase of obesity and diabetes risk beginning in youth , particularly those from disadvantaged communities , calls for prevention efforts . OBJECTIVE To examine the impact of a curriculum intervention , Choice , Control & Change , on the adoption of the energy balance-related behaviors of decreasing sweetened drinks , packaged snacks , fast food , and leisure screen time , and increasing water , fruits and vegetables , and physical activity , and on potential psychosocial mediators of the behaviors . DESIGN Ten middle schools were r and omly assigned within matched pairs to either intervention or comparison/delayed control conditions  during the 2006 - 2007 school year . SUBJECTS/ SETTING Students were from low-income New York City neighborhoods ; 562 were in the intervention condition , and 574 in the comparison condition . INTERVENTION Students received the 24 Choice , Control & Change lessons that used science inquiry investigations to enhance motivation for action , and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action . MAIN OUTCOME MEASURES Self-report instruments to measure energy balance-related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors . STATISTICAL ANALYSES Analysis of covariance with group ( intervention/control ) as a fixed factor and pretest as covariate . RESULTS Students in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks , smaller sizes of fast food , increased intentional walking for exercise , and decreased leisure screen time , but showed no increases in their intakes of water , fruits , and vegetables . They showed substantial increases in positive outcome expectations about the behaviors , self-efficacy , goal intentions , competence , and autonomy . CONCLUSIONS The Choice , Control & Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk , indicating that combining inquiry-based science education and behavioral theory is a promising approach BACKGROUND The increasing prevalence of overweight and obesity underscores the need for evidence -based , easily disseminable interventions for weight management that can be delivered on a population basis . The Transtheoretical Model ( TTM ) offers a promising theoretical framework for multiple behavior weight management interventions . METHODS Overweight or obese adults ( BMI 25 - 39.9 ; n=1277 ) were r and omized to no-treatment control or home-based , stage-matched multiple behavior interventions for up to three behaviors related to weight management at 0 , 3 , 6 , and 9 months . All participants were re-assessed at 6 , 12 , and 24 months . RESULTS Significant treatment effects were found for healthy eating ( 47.5 % versus 34.3 % ) , exercise ( 44.90 % versus 38.10 % ) , managing emotional distress ( 49.7 % versus 30.30 % ) , and untreated fruit and vegetable intake ( 48.5 % versus 39.0 % ) progressing to Action/Maintenance at 24 months . The groups differed on weight lost at 24 months . Co-variation of behavior change occurred and was much more pronounced in the treatment group , where individuals progressing to Action/Maintenance for a single behavior were 2.5 - 5 times more likely to make progress on another behavior . The impact of the  multiple behavior intervention was more than three times that of single behavior interventions . CONCLUSIONS This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating , exercise , managing emotional distress , and weight on a population basis . The treatment produced a high level of population impact that future multiple behavior interventions can seek to surpass Abstract This research included controls for both amount of extra-therapy attention focused on target behaviors and for quality and duration of attention provided during therapy . Two pairs of therapists each conducted one group for each of four experimental conditions : nonspecific therapy , nonspecific therapy + attention prompting , behavior therapy , behavior therapy + positive induction ( procedures design ed to maximize favorableness of expectancies ) . Sixty-five obese adults ( X overweight = 52 % ) attended 12 weekly group sessions and 3-month and 2-yr follow-ups . Ratings of expectancies , credibility and therapist characteristics were equivalent in all experimental conditions . Attrition was low ( 9.7 % ) and S s averaged 1–2 lb weight losses per week during treatment , while improving concurrently in eating habits , cardiovascular fitness and adjustment . However , only participants who were in groups conducted by the therapist pair which was rated especially ‘ democratic ’ maintained average weight losses at the 2-yr follow-up . These results demonstrate the potentially vital role of several ‘ nonspecific ’ factors in long-term outcomes associated with behavioral treatments for adult obesity Objectives . Using the weight efficacy lifestyle question naire ( WEL ) , we examined whether a group-mediated intervention for weight loss among older , obese adults result ed in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss . Methods . This was a r and omized controlled design , and 288 older adults received 1 of 3 treatments for 6 months : physical activity only ( PA ) , weight loss + physical activity ( WL + PA ) , or a successful aging ( SA ) health education program . The WEL was administered prior to r and omization and again at the 6-month follow-up visit . Results . A significant treatment effect was observed for the WEL , F ( 2,249 ) = 15.11 , p < .0001 , partial eta2 = .11 , showing that improvement occurred only in the WL + PA group as compared with PA and SA . Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss . Discussion . These results illustrate that WL + PA can be effective in improving  older adults ’ self-efficacy for the self-regulation of eating behavior and that these changes are prospect ively related to the amount of weight loss . Further research is warranted on an exp and ed concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults OBJECTIVE There is a great need for solution-oriented studies and descriptions of interventions for pediatric obesity in real-world setting s. This report describes a group-based behavioral parent-only intervention to promote healthier lifestyle habits and reduce weight status in an obese 12-year-old female participant . METHOD The behavioral parent-only intervention program described was part of a r and omized controlled trial that evaluated the impact of 2 behavioral interventions that addressed dietary intake , physical activity , and weight status in overweight and obese youth living in rural setting s. Both the child and parent were targeted for behavior change . The intervention included 12 group sessions over 4 months . Behavioral strategies , including self-monitoring , goal setting , performance feedback , reinforcement , stimulus control , and instruction in behavioral parenting strategies were flexibly applied to meet the needs of the family . Assessment s were completed at baseline , month-4 posttreatment , and month-10 follow-up . RESULTS The parent attended 10 of 12 treatment sessions . At follow-up the child had lost 17 pounds and grew 1.7 in . in height . The child also experienced improved quality of dietary intake and a drop in the number of self-reported unhealthy weight control behaviors . The parent experienced no notable decrease or increase in BMI . CONCLUSIONS The report describes the successful application of a behavioral intervention to address pediatric obesity that uses a parent-only approach . It is hoped that this presentation will facilitate discussion and help encourage further presentations of how the flexible application of evidence d-based interventions can be applied in real-world setting Effective and reliable obesity treatments are lacking because of a poor underst and ing of the health behavior change process . Community-based organizations with the capacity to train existing staff members are particularly well-positioned to implement evidence -based treatment protocol s to impact obesity-related behaviors such as unhealthy eating and lack of physical activity . The aim of this study was to assess temporal aspects of psychosocial predictors ( self-regulation , mood , and self-efficacy ) on increased fruit and vegetable intake in adults with severe obesity , while also accounting for mediation by physical activity volume . A 6-month , r and omized field investigation was conducted . Severely obese adults volunteered for behavioral support of physical activity coupled with nutrition education ( n = 73 ) or cognitive-behavioral methods for nutrition change ( n = 71 ) . Improvements in self-regulation , mood , self-efficacy , fruit and vegetable intake ( FV ) , and physical activity ( PA ) were significant , with significantly greater self-regulation at month 6 for the cognitive-behavioral group . Increase in FV was predicted by changes in the above psychosocial variables over 6 months , with mood change over 3 months also a significant predictor . Change in PA mediated the above relationships , with a reciprocal effect between changes in PA and FV . Findings have implication s for the large-scale behavioral treatment of obesity Obese children ( 8 - 13 years old ) and at least one of their parents participated in a behaviorally oriented treatment program .  Participants in a st and ard treatment condition experienced a multicomponent intervention in which parents were given primary responsibility for following program prescriptions . An enhanced child involvement condition provided the same basic intervention but with greater emphasis on , and training in , child self-regulation .  Children in both conditions achieved a significant reduction in percentage overweight and triceps skin-fold during the 6-month treatment period . Overall , the follow-up period of 3 years was characterized by increases above posttreatment levels . There was , however , some suggestion in the 3-year follow-up results and the long-term patterns over a 6 1/2-year period of the benefits of the enhanced child involvement approach . Findings are discussed in terms of suggestions for reconsideration of treatment goals , improved interventions , and refinements in the assessment of self-regulatory behavior We aim ed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth , Australia . We collected data at baseline , 4 months ( post-intervention ) and 1-year follow-up in a r and omized controlled trial of a program that focused on  weight loss , diet , and exercise . Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits . Outcomes examined were saturated fat intake ( % energy ) and physical activity ( hours per week ) . In total , 90/118 individuals r and omized to usual care and 102/123 to the program-completed follow-up . Sex was a moderator of response post-intervention for diet and physical activity , with a greater response among women with usual care and among men with the program .  Change in self-efficacy was a mediator of dietary change post-intervention [ effect size ( ES ) -0.055 , 95 % confidence interval ( CI ) -0.125 , -0.005 ] and at follow-up ( ES 0.054 , 95 % CI -0.127 , -0.005 ) , and in physical activity post-intervention ( ES 0.059 , 95 % CI 0.003 , 0.147 ) . These findings highlight different responses of men and women to the program , and the importance of self-efficacy as a mediator . Mediators for physical activity in the longer term should be investigated in other models , with appropriate cognitive measurements , in future trials Background Enhancing physical activity in overweight and obese individuals is an important means to promote health in this target population . The Health Action Process Approach ( HAPA ) , which was the theoretical framework of this study , focuses on individual self-regulation variables for successful health behavior change . One key self-regulation variable of this model is action control with its three subfacets awareness of intentions , self-monitoring and regulatory effort . The social context of individuals , however , is usually neglected in common health behavior change theories . In order to integrate social influences into the HAPA , this r and omized controlled trial investigated the effectiveness of a dyadic conceptualization of action control for promoting physical activity . Methods / Design This protocol describes the design of a single-blind r and omized controlled trial , which comprises four experimental groups : a dyadic action control group , an individual action control group and two control groups .  Participants of this study are overweight or obese , heterosexual adult couples who intend to increase their physical activity . Blocking as means of a gender-balanced r and omization is used to allocate couples to conditions and partners to either being the target person of the intervention or to the partner condition . The ecological momentary intervention takes place in the first 14 days after baseline assessment and is followed by another 14 days diary phase without intervention . Follow-ups are one month and six months later . Subsequent to the six-months follow-up another 14 days diary phase takes place . The main outcome measures are self-reported and accelerometer-assessed physical activity . Secondary outcome measures are Body Mass Index ( BMI ) , aerobic fitness and habitual physical activity . Discussion This is the first study examining a dyadic action control intervention in comparison to an individual action control condition and two control groups applying a single-blind r and omized control trial . Challenges with running couples studies as well as advantages and disadvantages of certain design -related decisions are discussed . This RCT was funded by the Swiss National Science Foundation ( PP00P1_133632/1 ) and was registered on 27/04/2012 at http://www.is rct n.com/IS RCT N15705531 The purpose of the study is to evaluate the performance of theoretically-derived mediators of health behavior change .  Participants were university seniors ( 184 females ; 154 males ) r and omly assigned to an intervention course design ed to promote physical activity or to a control course . Five physical activity outcomes and nine psychosocial mediating variables were assessed at baseline and the end of the 16-week course . For women , the intervention had significant effects on five of the mediators , including self-efficacy for making time , self-efficacy for resisting relapse , social support from friends , and experiential and behavioral processes of change . Among men , the intervention improved use of behavioral processes of change but also had the unintended effect of increasing perceived barriers to activity . For women , significant contributors to regressions explaining physical activity change were social support from friends ( for total activity ) and change in self-efficacy for resisting relapse ( for vigorous exercise ) . For men , significant explanatory variables included change in enjoyment ( for total activity ) , change in self-efficacy for resisting relapse ( for strength exercise ) , and change in benefits ( for moderate intensity activity ) . For both sexes , there were significant findings in the unexpected direction . Across the five physical activity outcomes , hypothesized mediators were inconsistent and weak contributors to the models . Investigating mediators of behavior change has the potential to stimulate improvements in theories and interventions OBJECTIVE To assess the process variables involved in a weight loss program for African-American adolescent girls . Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children , including program adherence , self-efficacy , and social support . The current study sought to broaden the underst and ing of these process variables as they pertain to an intervention program that is presented using the Internet . It was hypothesized that variables such as program adherence , dietary self-efficacy , psychological factors , and family environment factors would mediate the effect of the experimental condition on weight loss . RESEARCH METHODS AND PROCEDURES Participants were 57 adolescent African-American girls who joined the program with one obese parent ; family pairs were r and omized to either a behavioral or control condition in an Internet-based weight loss program .  Outcome data ( weight loss ) are reported for the first 6 months of the intervention . RESULTS Results partially supported the hypotheses . For weight loss among adolescents , parent variables pertaining to life and family satisfaction were the strongest mediating variables . For parental weight loss , changes in dietary practice s over the course of 6 months were the strongest mediators . DISCUSSION The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group . The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs This Scientific Statement addresses  Parents and Adult Caregivers ( PACs )  as ‘ agents of change ’ for obese children . Evidence is review ed to support the notion that PACs can leverage behavior change and reduce positive energy balance in obese youth , and research opportunities for the field are discussed . The Statement has three specific aims : First , the core behavior change strategies for PACs as used in family-based treatment programs are review ed . These strategies reduce childhood overweight compared to no treatment or nutrition education alone , although their limited potency is recognized . Second , the strength of evidence is evaluated for the hypothesis that greater parental ‘ involvement ’ in treatment is associated with greater reductions in child overweight . Drawing upon r and omized clinical trials that varied the degree/nature of parental involvement , and observational analyses that assessed parental adherence to behavioral strategies , we report limited and inconsistent support . For example , only 17 % of the intervention studies reported differential improvements in child overweight as function of parental involvement after treatment . On the other h and , greater parental adherence predicted better child weight outcomes after 2 and 5 years in certain studies . Third , research gaps identified throughout this review process are delineated and new opportunities for the field are proposed . For example , the assessment of refined parenting phenotypes , cultural tailoring of interventions , examination of family relationships , and incorporating new technologies in treatment represent topics needing further study . A conceptual model is proposed to guide research on underst and ing the determinants of parental feeding and physical-activity parenting practice s. The Statement strives to innovate the scope and potency of PAC treatments for childhood obesity
Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation , self-efficacy/barriers , self-regulation skills ( such as self-monitoring ) , flexible eating restraint , and positive body image .
For physical activity , significant putative mediators were high autonomous motivation , self-efficacy , and use of self-regulation skills .
For dietary intake , the evidence was much less clear , and no consistent mediators were identified .
Conclusions This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions .
Despite limited evidence , higher autonomous motivation , self-efficacy , and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes ; for weight control , positive body image and flexible eating restraint may additionally improve outcomes .
These variables represent possible targets for future lifestyle interventions in overweight/obese population
Background Relapse is high in lifestyle obesity interventions involving behavior and weight change .
Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment , including re source allocation .
This article review s the most consistent self-regulation mediators of medium- and long-term weight control , physical activity , and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults .