Journal of Behavioral Medicine

, Volume 33, Issue 1, pp 35–46

Adherence is a multi-dimensional construct in the POUNDS LOST trial

  • Donald A. Williamson
  • Stephen D. Anton
  • Hongmei Han
  • Catherine M. Champagne
  • Ray Allen
  • Eric LeBlanc
  • Donna H. Ryan
  • Katherine McManus
  • Nancy Laranjo
  • Vincent J. Carey
  • Catherine M. Loria
  • George A. Bray
  • Frank M. Sacks
Article

DOI: 10.1007/s10865-009-9230-7

Cite this article as:
Williamson, D.A., Anton, S.D., Han, H. et al. J Behav Med (2010) 33: 35. doi:10.1007/s10865-009-9230-7

Abstract

Research on the conceptualization of adherence to treatment has not addressed a key question: Is adherence best defined as being a uni-dimensional or multi-dimensional behavioral construct? The primary aim of this study was to test which of these conceptual models best described adherence to a weight management program. This ancillary study was conducted as a part of the POUNDS LOST trial that tested the efficacy of four dietary macronutrient compositions for promoting weight loss. A sample of 811 overweight/obese adults was recruited across two clinical sites, and each participant was randomly assigned to one of four macronutrient prescriptions: (1) Low fat (20% of energy), average protein (15% of energy); (2) High fat (40%), average protein (15%); (3) Low fat (20%), high protein (25%); (4) High fat (40%), high protein (25%). Throughout the first 6 months of the study, a computer tracking system collected data on eight indicators of adherence. Computer tracking data from the initial 6 months of the intervention were analyzed using exploratory and confirmatory analyses. Two factors (accounting for 66% of the variance) were identified and confirmed: (1) behavioral adherence and (2) dietary adherence. Behavioral adherence did not differ across the four interventions, but prescription of a high fat diet (vs. a low fat diet) was found to be associated with higher levels of dietary adherence. The findings of this study indicated that adherence to a weight management program was best conceptualized as being multi-dimensional, with two dimensions: behavioral and dietary adherence.

Keywords

Adherence Overweight Obesity Randomized controlled trial Lifestyle behavior modification 

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Donald A. Williamson
    • 1
  • Stephen D. Anton
    • 1
  • Hongmei Han
    • 1
  • Catherine M. Champagne
    • 1
  • Ray Allen
    • 1
  • Eric LeBlanc
    • 1
  • Donna H. Ryan
    • 1
  • Katherine McManus
    • 2
  • Nancy Laranjo
    • 2
  • Vincent J. Carey
    • 2
  • Catherine M. Loria
    • 3
  • George A. Bray
    • 1
  • Frank M. Sacks
    • 2
  1. 1.Pennington Biomedical Research CenterLSU SystemBaton RougeUSA
  2. 2.Department of NutritionHarvard School of Public HealthBostonUSA
  3. 3.National Heart, Lung, and Blood InstituteBethesdaUSA

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