A randomized controlled trial comparing prevention and promotion cognitive strategies in a behavioral weight‐loss intervention.

Objective: Two approaches may shift attention from short‐term rewards to longer‐term weight‐loss goals: focusing on long‐term consequences of unhealthy choices (prevention) or benefits of healthy choices (promotion). This randomized controlled trial tested the impact of prevention‐ versus promotion‐focused strategies in an internet‐delivered behavioral weight‐loss intervention (iBWL). Methods: A total of 95 participants with overweight/obesity were randomized to one of three 12‐week iBWLs: (1) STANDARD (n = 31), (2) PREVENT (standard iBWL+prevention‐focused training; n = 32), or (3) PROMOTE (standard iBWL+promotion‐focused training; n = 32). Participants in the two enhanced arms were trained in their assigned strategy, and lessons and weekly feedback featured arm‐specific content and reminders. Results: Intent‐to‐treat analysis revealed significant differences in weight loss and self‐control use at 12 weeks (weight loss p = 0.002, self‐control p = 0.0006). PREVENT was associated with 6.6% (±4.5%) weight loss and a 20.3% (±26.5%) increase in self‐control, STANDARD and PROMOTE were associated with 4.4% (±4.2%) and 3.1% (±3.1%) weight losses, respectively, and neither STANDARD nor PROMOTE participants exhibited significant changes in self‐control. Across arms, increased self‐control was associated with greater weight loss (p = 0.0005). Conclusions: Cognitive strategies to focus on preventing negative consequences of unhealthy choices led to greater weight loss and self‐control compared with both standard iBWL and promotion‐focused iBWL. Prevention strategies should be given further attention for overweight/obesity treatment. [ABSTRACT FROM AUTHOR]