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Summary Introduction Dietary self‐monitoring in behavioral weight loss programmes traditionally involves keeping track of all foods and beverages to achieve a calorie deficit. While effective, adherence declines over time. WW™ (formerly Weight Watchers), a widely available commercial weight management programme, sought to pilot an approach that permitted participants to consume over 200 foods without monitoring them. Methods The current study used a pre‐post evaluation design with anthropometric, psychosocial and physical health assessments at baseline, 3 and 6 months. Results Participants (N = 152) were, on average, 48.4 (±12.3) years old, with body mass index (BMI) of 32.8 (±4.8) m/kg2 and 94% female. Mean weight loss was 6.97 + 5.55 kg or 7.9 ± 6.1% of initial body weight (ps < .0001) at 6 months. One third (32.6%) of the sample lost 10% or more of initial body weight. Significant improvements in hunger, cravings, happiness, sleep, quality of life, aerobic stamina, flexibility and blood pressure were observed. Attendance at group meetings, as well as decreases in hunger, and fast food cravings from baseline to 3 months were associated with achieving 10% weight loss at 6 months (p < .01). Conclusions Using an approach that does not require self‐monitoring of all foods and beverages produced significant weight losses and other physical and psychosocial improvements.

Objective This study aimed to characterize young adults who experienced significant weight gains (> 10%) over 3 years in a weight gain prevention program. Methods Secondary data analysis from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized trial comparing two self-regulation interventions and a control arm in young adults (18-35 years; BMI 21-30.9 kg/m2 ), was used. Large Gainers (≥ 10% of their body weight; n = 48), Small Gainers (2.6%-9.9%; n = 149), and Weight Stable participants (± 2.5%; n = 143) were compared on dimensions affecting weight gain. Results Differences in weight gain among the three groups were significant by year 1 and subsequently increased. Those who became Large Gainers were heavier at baseline and further below their highest weight, and they reported more weight cycling than Weight Stable, with Small Gainers intermediate. Neither study arm nor pregnancy explained weight change differences among the three groups. Large Gainers reported more depressive symptoms than Weight Stable at years 1 and 2. Large Gainers were less likely to weigh themselves at least weekly at 4 months, before differences in weight gain emerged, and at years 1 and 2. Conclusions Large Gainers (representing almost 10% of participants) could be identified early by greater weight issues at baseline and lower use of weight gain prevention strategies.

OBJECTIVE The study objective was to determine whether two self-regulation interventions that reduced 3-year weight gain in young adults remain effective at 6 years. METHODS A randomized trial was conducted in two academic settings in 599 young adults, aged 18 to 35 years, with normal weight or overweight; 504 (84%) reconsented for a 6-year extension (Study of Novel Approaches to Weight Gain Prevention-Extended [SNAP-E]) with ongoing intervention and assessments. Weight gain over 6 years was compared for all assigned to Control, Large Changes (LC; lose 5-10 pounds initially), and Small Changes (SC; make small daily changes in intake and activity). RESULTS Weight change from baseline to 6 years did not differ significantly among the three groups (Control = 3.9 kg, SC = 4.1 kg, and LC = 2.8 kg). However, there was a significant age-by-treatment interaction (P = 0.002). Among those

Objective This study aimed to determine the impact of weight gain prevention interventions on changes in cardiovascular risk factors over 6 years. Methods The Study of Novel Approaches to Weight Gain Prevention (SNAP) randomized 599 participants (ages 18-35; 46% with BMI 21-25; 54% with BMI 25-30) to Large Changes (produce buffer by losing 5-10 pounds initially), Small Changes (daily small changes in intake and activity) or Control and followed 355 participants with ongoing intervention and assessments through 6 years. Results There were no significant differences among interventions for changes in weight or cardiovascular disease (CVD) risk factors from baseline to 6 years. However, 44% of participants gained ≥5%, and only 14% lost ≥5% over 6 years. Weight changes, from baseline to year 6, were significantly associated with changes in risk factors, especially insulin and high-density lipoprotein cholesterol. Earlier weight changes (e.g., weight cycling) had no beneficial or adverse effect on changes in CVD risk factors at 6 years, independent of 6-year weight changes. Conclusions Despite participation in a weight gain prevention trial, almost half of these young adults gained ≥5% or more over 6 years, with significant worsening in CVD risk factors. Greater attention to long-term weight gain prevention in young adults is needed.

Author(s): Tate, Deborah F; Lytle, Leslie; Polzien, Kristen; Diamond, Molly; Leonard, Kelsey R; Jakicic, John M; Johnson, Karen C; Olson, Christine M; Patrick, Kevin; Svetkey, Laura P; Wing, Rena R; Lin, Pao-Hwa; Coday, Mathilda; Laska, Melissa N; Merchant, Gina; Czaja, Sara J; Schulz, Richard; Belle, Steven H | Abstract: ObjectiveThe goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.MethodsIntervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.ResultsThe intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.ConclusionsWeight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.

Introduction Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS. Purpose To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS. Methods A total of 280 physically inactive YACS (diagnosed at ages 18–39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures. Conclusions IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.

Objective To determine whether eating self-efficacy (ESE) and physical activity self-efficacy (PASE) are predictive of dietary intake, physical activity, and weight change within a behavioral weight-loss intervention, and whether dietary intake and physical activity mediate relationships between self-efficacy and weight change. Method The study sample included 246 participants from a randomized trial with complete data on study variables at 12 months. ESE, PASE, calories consumed, minutes of moderate-to-vigorous physical activity (MVPA), and weight were measured at baseline, 6, and 12 months. Results ESE at baseline was associated with 12-month percent weight loss (PWL), and was mediated by average calories consumed at 6 and 12 months. Change in ESE from baseline to 6 months was associated with calories consumed at 12 months and 12-month percent weight loss, but the mediated relationship was not significant. Baseline PASE was not associated with average MVPA at 6 and 12 months or 12-month PWL, but change in PASE from baseline to 6 months was associated with 12-month PWL through its effect on MVPA at 12 months. Conclusion Increases in ESE and PASE during the active phase of the intervention are predictive of dietary intake, physical activity and weight loss at later points, but further research should include explorations of the reciprocal relationship between behavior and self-efficacy to better inform intervention strategies that target self-efficacy and promote behavior change. (PsycINFO Database Record

Objective To examine the amount of objectively measured MVPA and LPA that is associated with long-term weight loss and the maintenance of clinically significant weight loss. Methods Adults (N = 260; BMI: 25 to 10 (MET-min/week) was computed from bouts >10 min and >3.0 METs and MVPA 3.0 METs. LPA was computed from bouts between 1.5 to 10% weight loss. Similar results were observed for MVPA > 10 and LPA with participants grouped on achieving >10% weight loss at 6 months and sustaining this at 18 months. Conclusions MVPA > 10 of 200-300 min per week, coupled with increased amounts of LPA, are associated with improved long-term weight loss. Interventions should promote engagement in these amounts and types of physical activity.

Few randomized studies have examined differential effects of group size in behavioral weight control, especially in hybrid programs that include Internet treatment approaches. Randomized controlled trial (n = 195) comparing a 4 month hybrid internet weight loss program coupled with monthly face to face groups of 100 persons (Large Group, LG; 1 group) or to the same approach with monthly groups of 20 persons (Small Group, SG; 4 groups). Repeated-measures mixed-model analysis with age and race as covariates were used to estimate primary (weight) and secondary outcomes, and to test group differences in change over time. The sample was 46.3 years old ±10.4, 90.3% female, and 51.9% non-white, with BMI 37.9 ± 8.4 kg/m2. Participants in the LG were more likely to return for the 4-month assessment visit than those in the SG (p = 0.04). Participants randomized to both the LG and SG conditions experienced significant WL over time (no between group difference: −4.1 kg and −3.7 kg, respectively) and weight loss was positively associated with attendance at monthly meetings and logins to the website. Satisfaction with the program was high and similar in both groups (94.4% reported that they were “satisfied” or “very satisfied”). Using a hybrid approach of in-person and online weight loss interventions may be an effective way to reach larger and more diverse populations. Delivering the face to face component of the intervention in groups larger than those traditionally delivered (20–25 people) could increase the cost-effectiveness of group-based behavioral weight loss interventions. NCT01615471 . Registered June 6, 2012. Registered retrospectively.

Background: Replacement of caloric beverages with noncaloric beverages may be a simple strategy for promoting modest weight reduction; however, the effectiveness of this strategy is not known. Objective: We compared the replacement of caloric beverages with water or diet beverages (DBs) as a method of weight loss over 6 mo in adults and attention controls (ACs). Design: Overweight and obese adults [n = 318; BMI (in kg/m 2 ): 36.3 6 5.9; 84% female; age (mean 6 SD): 42 6 10.7 y; 54% black] substituted noncaloric beverages (water o rD Bs) for caloric beverages (200 kcal/d) or made dietary changes of their choosing (AC) for 6 mo. Results: In an intent-to-treat analysis, a significant reduction in weight and waist circumference and an improvement in systolic blood pressure were observed from 0 to 6 mo. Mean (6SEM) weight losses at 6 mo were 22.5 6 0.45% in the DB group, 22.03 6 0.40% in the Water group, and 21.76 6 0.35% in the AC group; there were no significant differences between groups. The chance of achieving a 5% weight loss at 6 mo was greater in the DB group than in the AC group (OR: 2.29; 95% CI: 1.05, 5.01; P = 0.04). A significant reduction in fasting glucose at 6 mo (P = 0.019) and improved hydration at 3 (P = 0.0017) and 6 (P = 0.049) mo was observed in the Water group relative to the AC group. In a combined analysis, participants assigned to beverage replacement were 2 times as likely to have achieved a 5% weight loss (OR: 2.07; 95% CI: 1.02, 4.22; P = 0.04) than were the AC participants. Conclusions: Replacement of caloric beverages with noncaloric beverages as a weight-loss strategy resulted in average weight losses of 2% to 2.5%. This strategy could have public health significance and is a simple, straightforward message. This trial was registered at clinicaltrials.gov as NCT01017783. Am J Clin Nutr 2012;95:555‐ 63.

Objective: The objective was to examine the efficacy of adding a technology-based program to an in-person, behavioral weight loss intervention. Research Methods and Procedures: Fifty-seven subjects (BMI = 33.1 ± 2.8 kg/m2; age = 41.3 ± 8.7 years) participated in a 12-week intervention with random assignment to Standard In-Person Behavioral Weight Control Program (SBWP) or Intermittent or Continuous Technology-Based Program (INT-TECH, CON-TECH). SBWP subjects received seven individualized weight loss sessions encouraging dietary and exercise modifications. INT-TECH and CON-TECH subjects received all SBWP components; additionally, these groups used a SenseWear Pro Armband (BodyMedia, Inc.) to monitor energy expenditure and an Internet-based program to monitor eating behaviors. These features were used by INT-TECH subjects during weeks 1, 5, and 9 and CON-TECH subjects weekly throughout the intervention. Results: Intent-to-treat analysis revealed weight loss of 4.1 ± 2.8 kg, 3.4 ± 3.4 kg, and 6.2 ± 4.0 kg, for SBWP, INT-TECH, and CON-TECH groups, respectively (CON-TECH > INT-TECH, p ≤ 0.05). Discussion: These results indicate that the technology-based program needs to be used continuously throughout the intervention period to significantly impact weight loss. Future studies should examine the long-term and independent effect of this technology on weight loss, and for whom this intervention format is most effective.

Background:African-Americans lose less weight during a behavioral intervention compared with Whites, which may be from differences in dietary intake or physical activity.Methods:Subjects (30% African American, 70% White; n = 346; 42.4 ± 9.0 yrs.; BMI = 33.0 ± 3.7 kg/m2) in an 18-month weight loss intervention were randomized to a standard behavioral (SBWI) or a stepped-care (STEP) intervention. Weight, dietary intake, self-report and objective physical activity, and fitness were assessed at 0, 6, 12, and 18 months.Results:Weight loss at 18 months was greater in Whites (–8.74 kg with 95% CI [–10.10, –7.35]) compared with African Americans (–5.62 kg with 95% CI [–7.86, –3.37]) (P = .03) in the SBWI group and the STEP group (White: –7.48 kg with 95% CI [–8.80, –6.17] vs. African American: –4.41kg with 95% CI [–6.41, –2.42]) (P = .01). Patterns of change in dietary intake were not different between groups. Objective physical activity (PA) changed over time (P < .0001) and was higher in Whites when compared with African Americans (P = .01).Conclusions:Whites lost more weight (3.10 kg) than African American adults. Although there were no differences in dietary intake, Whites had higher levels of objective PA and fitness. Thus, the discrepancy in weight loss may be due to differences in PA rather than dietary intake. However, the precise role of these factors warrants further investigation.

Objective To examine the amount of objectively measured MVPA and LPA that is associated with long-term weight loss and the maintenance of clinically significant weight loss. Design and Methods Adults (N=260; BMI: 25 to 10 (METmin/wk) was computed from bouts ≥10 minutes and ≥3.0 METS and MVPA10 and LPA, with both measures being significantly greater at 18 months in those with ≥10% weight loss. Similar results were observed for MVPA>10 and LPA with participants grouped on achieving ≥10% weight loss at 6 months and sustaining this at 18 months. Conclusions MVPA>10 of 200 to 300 minutes per week, coupled with increased amounts of LPA, are associated with improved long-term weight loss. Interventions should promote engagement in these amounts and types of physical activity.

CONTEXT: Given the obesity epidemic, effective but resource-efficient weight loss treatments are needed. Stepped-treatment approaches customize interventions based on milestone completion and can be more effective while costing less to administer than conventional treatment approaches. OBJECTIVE: To determine whether a stepped-care weight loss intervention (STEP) compared with a standard behavioral weight loss intervention (SBWI) would result in greater weight loss. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 363 overweight and obese adults (body mass index: 25

Few studies have been conducted that have examined the long-term effect of different doses of physical activity (PA) on weight change in overweight adults without a prescribed reduction in energy intake. This study examined the effect of different prescribed doses of PA on weight change, body composition, fitness, and PA in overweight adults. Two hundred seventy-eight overweight adults (BMI: 25.0-29.9 kg/m²; age: 18-55 years) with no contraindications to PA were randomized to one of three intervention groups for a period of 18 months. MOD-PA was prescribed 150 min/week and HIGH-PA 300 min/week of PA. Self-help group (SELF) was provided a self-help intervention to increase PA. There was no recommendation to reduce energy intake. MOD-PA and HIGH-PA were delivered in a combination of in-person and telephone contacts across 18 months. 18-month percent weight change was -0.7 ± 4.6% in SELF, -0.9 ± 4.7% in MOD-PA, and -1.2 ± 5.6% in HIGH-PA. Subjects were retrospectively grouped as remaining within ±3% of baseline weight (WT-STABLE), losing >3% of baseline weight (WT-LOSS), or gaining >3% of baseline weight (WT-GAIN) for secondary analyses. 18-month weight change was 0.0 ± 1.3% for WT-STABLE, +5.4 ± 2.6% for WT-GAIN, and -7.4 ± 3.6% for WT-LOSS. 18-month change in PA was 78.2 ± 162.6 min/week for WT-STABLE, 74.7 ± 274.3 for WT-GAIN, and 161.9 ± 252.6 min/week for WT-LOSS. The weight change observed in WT-LOSS was a result of higher PA combined with improved scores on the Eating Behavior Inventory (EBI), reflecting the adoption of eating behaviors to facilitate weight loss. Strategies to facilitate the maintenance of these behaviors are needed to optimize weight control.

This chapter reviews studies on the role of physical activity in weight control. Excess body weight is linked to increased risk of numerous chronic diseases, including heart disease, type 2 diabetes, and several forms of cancer. Physical activity is an important lifestyle behavior that can result in favorable changes to body weight, body composition, and related health risks. However, to achieve favorable changes in body weight, an adequate dose of physical activity is required.

There is an increasing prevalence of overweight and obesity in the United States and other developed countries. This can have significant public health implications because of the association of excess body weight with increased risk of chronic diseases. It has been suggested that the increasing prevalence of excess body weight (overweight and obesity) and related diseases also has a significant impact on health care costs. Physical activity can significantly affect weight control and can also have an independent effect on associated chronic disease risk factors. However, physical activity participation is less than optimal. Thus, it is important for health care professionals to understand the role of physical activity in weight loss, the prevention of weight gain, and the prevention of weight regain, and to understand how to provide accurate and meaningful information to their patients.