Jessica Gokee LaRose

Preventing Weight Gain in Young Adults: A Randomized Controlled Pilot Study

CONTEXT Weight gain in young adults is an important public health problem and few interventions have been successful. BACKGROUND This pilot study evaluated the preliminary efficacy of two self-regulation approaches to weight-gain prevention: Small Changes (changes in energy balance of roughly 200 kcal/day) and Large Changes (initial weight loss of 5-10 lbs to buffer against future weight gains). INTERVENTION Participants were enrolled in 8-week programs teaching Small or Large Changes (SC; LC). Both approaches were presented in a self-regulation framework, emphasizing daily self-weighing. DESIGN Randomized controlled pilot study. SETTING/PARTICIPANTS Young adults (N=52) aged 18-35 years (25.6+/-4.7 years, BMI of 26.7+/-2.4 kg/m(2)) were recruited in Providence RI and Chapel Hill NC. MAIN OUTCOME MEASURES Adherence to intervention, weight change, and satisfaction/confidence in approach assessed at 0, 8, and 16 weeks. Data were collected in 2008 and analyzed in 2008-2009. RESULTS Participants attended 84% of sessions, and 86.5% and 84.5% of participants completed post-treatment and follow-up assessments, respectively. Participants adhered to their prescriptions. Daily weighing increased markedly in both groups, whereas the eating and exercise changes observed in the SC and LC reflected the specific approach taught. Weight changes were significantly different between groups at 8 weeks (SC= -0.68+/-1.5 kg, LC= -3.2+/-2.5 kg, p<0.001) and 16 weeks (SC= -1.5+/-1.8 kg, LC= -3.5+/-3.1 kg, p=0.006). Participants in both groups reported high levels of satisfaction and confidence in the efficacy of the approach they were taught. CONCLUSIONS Both Small and Large Change approaches hold promise for weight-gain prevention in young adults; a fully powered trial comparing the long-term efficacy of these approaches is warranted.

Differences in motivations and weight loss behaviors in young adults and older adults in the National Weight Control Registry

The goal of this study was to compare young adults (YA) and older adults (OA) in the National Weight Control Registry on motivations for weight loss and weight‐loss behaviors.

Daily self-weighing within a lifestyle intervention: impact on disordered eating symptoms.

OBJECTIVE To determine whether daily self-weighing (DSW) is associated with disordered eating (DE) symptoms within an adult lifestyle intervention (LI), and to examine changes in DE symptoms during the 18-month trial. METHOD One-hundred and seventy-eight adults (53% female, 90% White, 52.0 ± 8.6 years, BMI = 35.0 ± 4.4 kg/m2) were enrolled in a randomized trial testing 2 dietary prescriptions within a LI (standard vs. limited dietary variety). Both arms were taught DSW and had the same contact schedule and calorie and activity goals. Frequency of weighing and DE were assessed at 0, 6, 12, and 18 months. Analyses controlled for treatment arm. RESULTS At baseline, 16.3% of participants reported weighing ≥ daily compared with 83.7%, 72.3%, and 68.2% at 6, 12, and 18 months, respectively. There was no relationship between change in frequency of self-weighing and change in DE symptoms at any time point. Further, there were no significant differences between those who weighed ≥ daily versus < daily on DE composite scores at baseline or 6 months; at 12 and 18 months participants who weighed ≥ daily reported lower DE scores compared with those who weighed < daily (p = .008 and .043 at 12 and 18 months, respectively). Participants who weighed ≥ daily achieved better weight losses than those weighing < daily at 12 and 18 months (p = .003 and <.001). There was a significant reduction over time in DE symptoms (p < .0001) and a reduction in odds of meeting criteria for Binge Eating Disorder (BED; ps < .001). CONCLUSIONS Daily self-weighing did not appear to be related to increased disordered eating behavior and was associated with better weight loss outcomes.

Frequent self‐weighing as part of a constellation of healthy weight control practices in young adults

Frequent self‐weighing is linked with weight management success, but concern has been raised about its possible association with unhealthy practices. This study examined the association of self‐weighing with other weight control behaviors in a sample for whom frequent weighing might be questioned—namely, normal‐weight or overweight (BMI of 21‐29.9) young adults (age 18‐35).

Development and validation of the weight control strategies scale

To develop and validate the Weight Control Strategies Scale (WCSS), a self‐report instrument to assess the use of specific behaviors thought to facilitate weight loss.

Young adults’ performance in a low intensity weight loss campaign

Young adults (YA) are underrepresented in behavioral weight loss programs and achieve poorer outcomes than older adults (OA). There has been a call to develop programs specifically targeting this age group. This study examined the performance of YA enrolled in a low‐intensity, team‐based weight loss campaign and compared their outcomes to OA to determine the utility of such an approach for weight loss in this population. Shape Up Rhode Island (SURI) 2009 was a 12‐week online team‐based weight loss and exercise competition (N = 6,795, 81% female, 94% white, age = 44.7 ± 11.2, BMI = 29.4 ± 5.9). YA was defined as 18–35 years and OA as >35 years; YA and OA were compared on enrollment, retention, weight loss, and change in steps. A total of 1,562 YA enrolled and 715 completed the program. Fewer YA completed compared with OA (46 vs. 62%, P < 0.001). However, among completers, YA achieved greater percent weight loss (‐4.5 ± 4.0 vs. −3.8 ± 3.2%) and greater daily step change (+1,578.2 ± 3,877.2 vs. +1,342.2 ± 3,645.7) than OA (Ps < 0.001). Further, more YA completers achieved a ≥5% weight loss (40 vs. 29%, P < 0.001). Findings were consistent in the overweight/obese (OW/OB) subsample, and using ≤25 years of age as the cut off for YA. Weight losses among YA in this low‐intensity weight loss campaign were quite promising, with over 700 YA completing the program and on average achieving a 4.5% weight loss. Indeed, the potential public health impact of such an approach is substantial; future efforts to develop programs for this age group may benefit from using a low‐intensity, team‐based approach.

Effects of weight‐focused social comparisons on diet and activity outcomes in overweight and obese young women

To investigate social comparison processes as a potential mechanism by which social networks impact young womens weight control thoughts and behaviors and to examine whether social comparisons with close social ties (i.e., friends) have a greater influence on weight control outcomes relative to more emotionally distant ties.

A Randomized Trial Testing a Contingency-Based Weight Loss Intervention Involving Social Reinforcement

Even though behavioral weight loss interventions are conducted in groups, a social contingency (SC) paradigm that capitalizes on the social reinforcement potential of the weight loss group has never been tested. We tested a weight loss intervention in which participation in the weight loss group was contingent upon meeting periodic weight goals. We hypothesized that making access to the group dependent upon weight loss would improve weight outcomes. Participants (N = 62; 84% female; 94% white; age = 51.9 ± 9.0; BMI = 34.7 ± 4.5) were randomized to 6‐months of standard behavioral weight loss (SBWL) or to a behavioral program that included a SC paradigm. Both groups engaged in social cohesion activities. Participants in SC who did not meet weight goals did not attend group meetings; instead, they received individual treatment with a new interventionist and returned to group once their weight goals were met. SC did not improve overall weight loss outcomes (SC: −10.0 ± 4.9 kg, SBWL: −10.8 ± 6.4 kg, P = 0.63). Similarly, overall weight loss was not significantly different in the subgroup of participants in the SC and SBWL conditions who did not meet periodic weight loss goals (−7.3 ± 4.1 kg vs. −7.1 ± 3.5 kg, P = 0.90). Surprisingly, “successful” SC participants (who met their weight goals) actually lost less weight than “successful” SBWL participants (−12.4 ± 3.2 kg vs. −14.5 ± 4.7 kg, P = 0.02). Whereas contingency‐based treatments have been tested for other health behaviors (e.g., substance abuse), this is the first study to test a SC intervention for weight loss. This approach did not improve overall weight loss outcomes. Our attempt to offer appropriate clinical care by providing individual treatment to SC participants when needed may have mitigated the effects of the SC paradigm.

Adapting evidence-based behavioral weight loss programs for emerging adults: A pilot randomized controlled trial:

Emerging adults are at high risk of obesity but behavioral weight loss programs do not meet their needs. Emerging adults (N = 52, age = 22.3 ± 2 years, body mass index = 34.2 ± 5.5 kg/m2, 46.2% non-Hispanic White) were randomly assigned to one of three behavioral weight loss programs adapted based on formative work: face-to-face behavioral weight loss, web-based behavioral weight loss, or web plus optional community sessions (Hybrid). Assessments occurred at 0 and 3 months. Engagement and self-monitoring were highest in Hybrid. Intent-to-treat weight losses were −2.8 ± 2.9 percent in face-to-face behavioral weight loss, −2.2 ± 4.5 percent in web-based behavioral weight loss, and 4.8 ± 4.9 percent in Hybrid. Percent achieving ⩾5 percent weight loss was highest in Hybrid (63%). Findings suggest potential for adapted behavioral weight loss to promote engagement and weight loss in emerging adults.

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

Frequent self‐weighing is associated with better weight loss and maintenance among adults. Emerging adults ages 18–25 rarely enroll in behavioural weight loss trials, and thus, little is known about their willingness to engage in frequent self‐weighing and its association with weight loss in this age group.