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Psychosocial Variables May Predict Likelihood of Weight Regain After Weight Loss
Study Overview
Objective. To identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial following a group-based weight loss program.
Design. Secondary analysis of a 2-phase randomized controlled trial. The first phase was a 6-month group-based weight loss program and the second phase was a 30-month trial comparing weight loss maintenance strategies.
Setting and participants. The patients studied were participants in the Weight Loss Maintenance trial [1], which was conducted at 4 US clinical centers. Eligible participants were overweight and obese adults with a BMI between 25 to 45 who were actively taking medication for hypertension, dyslipidemia, or both. 1685 patients were recruited into the weight-loss phase, and those who lost at least 4 kg (n = 1032) were then randomly assigned to 1 of the 3 maintenance arms: (a) self-directed with minimal intervention (control), (b) interactive technology that consisted of unlimited, interactive study website access, or (c) personal contact consisting of monthly, personalized telephone calls and quarterly face-to-face contact with a study interventionist. There was 1 death in each treatment group, so a total of 1029 participants were included in the analyses.
Main outcome measures. The researchers examined the associations between psychosocial variables and weight change outcomes at 12 and 30 months. Patients completed 5 self-report measures at the time of randomization into phase 2 of the study: a social support and exercise survey, a social support and eating habits survey, the SF-36, the Patient Health Questionnaire Depression Scale, and the Perceived Stress Scale.
Results. Of the 1029 participants initially included for analyses, 2 failed to provide complete data on the social support scales and 2 were identified as outliers at both 12 and 30 months. This resulted in a final sample size of 1025 participants; 63% were women, 61% were non-Latino white, and 38% were black. The mean age was 55.6 years. All groups regained weight, with the personal contact group having the least amount of gain. However, the mean weight at 30 months remained significantly lower than the mean weight at entry into phase 1.
Only 3 psychosocial variables were significantly related to weight loss at 12 and 30 months. At both time marks, less weight regain was associated with higher SF-36 mental health composite scores (P < 0.01). Interestingly, for black participants at the 12-month mark, more weight regain was associated with higher exercise encouragement from friends (P < 0.05). At 30 months, more weight regain was associated with friends’ encouragement for healthy eating (P < 0.05).
Conclusion. The psychosocial variables that were self-reported upon entering phase 2 may predict the ability of an individual to maintain weight loss at 12 and 30 months. The significant, complex interactions between these variables, race, sex, and treatment interventions need to be further studied for proper incorporation into a weight loss maintenance program.
Commentary
The case for the obesity epidemic has been long established. Unfortunately, the causes for weight gain can be complicated and multifactorial. Factors associated with weight gain include nonmodifiable factors such as age, sex, and race as well as modifiable factors like lifestyle, eating habits, and perceived stress [2]. The CDC states that about 78.6 million American adults are overweight or obese [3], and about 25% to 40% of US adults attempt to lose weight each year [4]. It is unclear what proportion of those who lose weight are successful at maintaining their weight loss [5,6].
Researchers and practitioners alike understand that maintaining weight loss is difficult. Most studies on weight regain have focused on biological and lifestyle factors [7]. This article did a good job in detailing gaps in knowledge and supporting the need for further study of psychosocial variables. The results demonstrated complex, interactive relationships between multiple factors. Three psychosocial variables were found to be statistically significant in relation to weight loss, but more significant relationships were found between race, perceived stress, and weight loss.
As a secondary analysis, this study carries the strengths of the initial study, including a 30-month study duration. In addition, this study was randomized and included 3 different treatment arms. Lastly, there was a large representation of black participants, and the authors suggested that the results may offer and initial characterization of this population.
A limitation of this study was the use of self-reported data, which may be subject to be bias and be less reliable than direct measured data. Also, these measures were apparently taken only once prior to the beginning of phase 2 with no rationale provided. Psychosocial variables such as social support, quality of life, and perceived stress are dynamic and cannot be accurately encapsulated in isolated moments in time. The sample’s diversity was also lacking as there were few Hispanics and no Asian
participants.
Applications for Clinical Practice
A few significant, interactive relationships were discovered in this examination and require further study. Continued research and a better understanding of these complex relationships are needed.
—Angela M. Godwin Beoku-Betts, MSN, FNP–BC
1. Svetkey LP, Stevens VJ, Brantley PJ, et al; Weight Loss Maintenance Collaborative Research Group. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008;299:1139–48.
2. Grundy SM. Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr. 1998 Mar;67(3 Suppl):563S–72S.
3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311:806–14.
4. Williamson DF, Serdula MK, Anda RF, et al. Weight loss attempts in adults: goals, duration, and rate of weight loss. Am J Public Health 1992;82:1251–7.
5. The National Weight Control Registry. (1994). Accessed 5 Oct 2014 at www.nwcr.ws/default.htm.
6. Kraschnewski JL, Boan J, Esposito J, et al. Long-term weight loss maintenance in the United States. Int J Obes (Lond) 2010;34:1644–54.
7. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol 2011;301:R581–600.
Study Overview
Objective. To identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial following a group-based weight loss program.
Design. Secondary analysis of a 2-phase randomized controlled trial. The first phase was a 6-month group-based weight loss program and the second phase was a 30-month trial comparing weight loss maintenance strategies.
Setting and participants. The patients studied were participants in the Weight Loss Maintenance trial [1], which was conducted at 4 US clinical centers. Eligible participants were overweight and obese adults with a BMI between 25 to 45 who were actively taking medication for hypertension, dyslipidemia, or both. 1685 patients were recruited into the weight-loss phase, and those who lost at least 4 kg (n = 1032) were then randomly assigned to 1 of the 3 maintenance arms: (a) self-directed with minimal intervention (control), (b) interactive technology that consisted of unlimited, interactive study website access, or (c) personal contact consisting of monthly, personalized telephone calls and quarterly face-to-face contact with a study interventionist. There was 1 death in each treatment group, so a total of 1029 participants were included in the analyses.
Main outcome measures. The researchers examined the associations between psychosocial variables and weight change outcomes at 12 and 30 months. Patients completed 5 self-report measures at the time of randomization into phase 2 of the study: a social support and exercise survey, a social support and eating habits survey, the SF-36, the Patient Health Questionnaire Depression Scale, and the Perceived Stress Scale.
Results. Of the 1029 participants initially included for analyses, 2 failed to provide complete data on the social support scales and 2 were identified as outliers at both 12 and 30 months. This resulted in a final sample size of 1025 participants; 63% were women, 61% were non-Latino white, and 38% were black. The mean age was 55.6 years. All groups regained weight, with the personal contact group having the least amount of gain. However, the mean weight at 30 months remained significantly lower than the mean weight at entry into phase 1.
Only 3 psychosocial variables were significantly related to weight loss at 12 and 30 months. At both time marks, less weight regain was associated with higher SF-36 mental health composite scores (P < 0.01). Interestingly, for black participants at the 12-month mark, more weight regain was associated with higher exercise encouragement from friends (P < 0.05). At 30 months, more weight regain was associated with friends’ encouragement for healthy eating (P < 0.05).
Conclusion. The psychosocial variables that were self-reported upon entering phase 2 may predict the ability of an individual to maintain weight loss at 12 and 30 months. The significant, complex interactions between these variables, race, sex, and treatment interventions need to be further studied for proper incorporation into a weight loss maintenance program.
Commentary
The case for the obesity epidemic has been long established. Unfortunately, the causes for weight gain can be complicated and multifactorial. Factors associated with weight gain include nonmodifiable factors such as age, sex, and race as well as modifiable factors like lifestyle, eating habits, and perceived stress [2]. The CDC states that about 78.6 million American adults are overweight or obese [3], and about 25% to 40% of US adults attempt to lose weight each year [4]. It is unclear what proportion of those who lose weight are successful at maintaining their weight loss [5,6].
Researchers and practitioners alike understand that maintaining weight loss is difficult. Most studies on weight regain have focused on biological and lifestyle factors [7]. This article did a good job in detailing gaps in knowledge and supporting the need for further study of psychosocial variables. The results demonstrated complex, interactive relationships between multiple factors. Three psychosocial variables were found to be statistically significant in relation to weight loss, but more significant relationships were found between race, perceived stress, and weight loss.
As a secondary analysis, this study carries the strengths of the initial study, including a 30-month study duration. In addition, this study was randomized and included 3 different treatment arms. Lastly, there was a large representation of black participants, and the authors suggested that the results may offer and initial characterization of this population.
A limitation of this study was the use of self-reported data, which may be subject to be bias and be less reliable than direct measured data. Also, these measures were apparently taken only once prior to the beginning of phase 2 with no rationale provided. Psychosocial variables such as social support, quality of life, and perceived stress are dynamic and cannot be accurately encapsulated in isolated moments in time. The sample’s diversity was also lacking as there were few Hispanics and no Asian
participants.
Applications for Clinical Practice
A few significant, interactive relationships were discovered in this examination and require further study. Continued research and a better understanding of these complex relationships are needed.
—Angela M. Godwin Beoku-Betts, MSN, FNP–BC
Study Overview
Objective. To identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial following a group-based weight loss program.
Design. Secondary analysis of a 2-phase randomized controlled trial. The first phase was a 6-month group-based weight loss program and the second phase was a 30-month trial comparing weight loss maintenance strategies.
Setting and participants. The patients studied were participants in the Weight Loss Maintenance trial [1], which was conducted at 4 US clinical centers. Eligible participants were overweight and obese adults with a BMI between 25 to 45 who were actively taking medication for hypertension, dyslipidemia, or both. 1685 patients were recruited into the weight-loss phase, and those who lost at least 4 kg (n = 1032) were then randomly assigned to 1 of the 3 maintenance arms: (a) self-directed with minimal intervention (control), (b) interactive technology that consisted of unlimited, interactive study website access, or (c) personal contact consisting of monthly, personalized telephone calls and quarterly face-to-face contact with a study interventionist. There was 1 death in each treatment group, so a total of 1029 participants were included in the analyses.
Main outcome measures. The researchers examined the associations between psychosocial variables and weight change outcomes at 12 and 30 months. Patients completed 5 self-report measures at the time of randomization into phase 2 of the study: a social support and exercise survey, a social support and eating habits survey, the SF-36, the Patient Health Questionnaire Depression Scale, and the Perceived Stress Scale.
Results. Of the 1029 participants initially included for analyses, 2 failed to provide complete data on the social support scales and 2 were identified as outliers at both 12 and 30 months. This resulted in a final sample size of 1025 participants; 63% were women, 61% were non-Latino white, and 38% were black. The mean age was 55.6 years. All groups regained weight, with the personal contact group having the least amount of gain. However, the mean weight at 30 months remained significantly lower than the mean weight at entry into phase 1.
Only 3 psychosocial variables were significantly related to weight loss at 12 and 30 months. At both time marks, less weight regain was associated with higher SF-36 mental health composite scores (P < 0.01). Interestingly, for black participants at the 12-month mark, more weight regain was associated with higher exercise encouragement from friends (P < 0.05). At 30 months, more weight regain was associated with friends’ encouragement for healthy eating (P < 0.05).
Conclusion. The psychosocial variables that were self-reported upon entering phase 2 may predict the ability of an individual to maintain weight loss at 12 and 30 months. The significant, complex interactions between these variables, race, sex, and treatment interventions need to be further studied for proper incorporation into a weight loss maintenance program.
Commentary
The case for the obesity epidemic has been long established. Unfortunately, the causes for weight gain can be complicated and multifactorial. Factors associated with weight gain include nonmodifiable factors such as age, sex, and race as well as modifiable factors like lifestyle, eating habits, and perceived stress [2]. The CDC states that about 78.6 million American adults are overweight or obese [3], and about 25% to 40% of US adults attempt to lose weight each year [4]. It is unclear what proportion of those who lose weight are successful at maintaining their weight loss [5,6].
Researchers and practitioners alike understand that maintaining weight loss is difficult. Most studies on weight regain have focused on biological and lifestyle factors [7]. This article did a good job in detailing gaps in knowledge and supporting the need for further study of psychosocial variables. The results demonstrated complex, interactive relationships between multiple factors. Three psychosocial variables were found to be statistically significant in relation to weight loss, but more significant relationships were found between race, perceived stress, and weight loss.
As a secondary analysis, this study carries the strengths of the initial study, including a 30-month study duration. In addition, this study was randomized and included 3 different treatment arms. Lastly, there was a large representation of black participants, and the authors suggested that the results may offer and initial characterization of this population.
A limitation of this study was the use of self-reported data, which may be subject to be bias and be less reliable than direct measured data. Also, these measures were apparently taken only once prior to the beginning of phase 2 with no rationale provided. Psychosocial variables such as social support, quality of life, and perceived stress are dynamic and cannot be accurately encapsulated in isolated moments in time. The sample’s diversity was also lacking as there were few Hispanics and no Asian
participants.
Applications for Clinical Practice
A few significant, interactive relationships were discovered in this examination and require further study. Continued research and a better understanding of these complex relationships are needed.
—Angela M. Godwin Beoku-Betts, MSN, FNP–BC
1. Svetkey LP, Stevens VJ, Brantley PJ, et al; Weight Loss Maintenance Collaborative Research Group. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008;299:1139–48.
2. Grundy SM. Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr. 1998 Mar;67(3 Suppl):563S–72S.
3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311:806–14.
4. Williamson DF, Serdula MK, Anda RF, et al. Weight loss attempts in adults: goals, duration, and rate of weight loss. Am J Public Health 1992;82:1251–7.
5. The National Weight Control Registry. (1994). Accessed 5 Oct 2014 at www.nwcr.ws/default.htm.
6. Kraschnewski JL, Boan J, Esposito J, et al. Long-term weight loss maintenance in the United States. Int J Obes (Lond) 2010;34:1644–54.
7. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol 2011;301:R581–600.
1. Svetkey LP, Stevens VJ, Brantley PJ, et al; Weight Loss Maintenance Collaborative Research Group. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA 2008;299:1139–48.
2. Grundy SM. Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr. 1998 Mar;67(3 Suppl):563S–72S.
3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311:806–14.
4. Williamson DF, Serdula MK, Anda RF, et al. Weight loss attempts in adults: goals, duration, and rate of weight loss. Am J Public Health 1992;82:1251–7.
5. The National Weight Control Registry. (1994). Accessed 5 Oct 2014 at www.nwcr.ws/default.htm.
6. Kraschnewski JL, Boan J, Esposito J, et al. Long-term weight loss maintenance in the United States. Int J Obes (Lond) 2010;34:1644–54.
7. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol 2011;301:R581–600.