Journal of Behavioral Medicine

, Volume 33, Issue 1, pp 35–46 | Cite as

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

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 

References

  1. Alhassan, S., Kim, S., Bersamin, A., King, A. C., & Gardner, C. D. (2008). Dietary adherence and weight loss success among overweight women: Results from the A TO Z weight loss study. International Journal of Obesity (London), 32(6), 985–991.CrossRefGoogle Scholar
  2. Baecke, J. A., Burema, J., & Frijters, J. E. (1982). A short questionnaire for the measurement of habitual physical activity in epidemiological studies. American Journal of Clinical Nutrition, 36(5), 936–942.PubMedGoogle Scholar
  3. Cohen, J. (1977). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  4. Evans, I. M. (1986). Response structure and the triple-response-mode concept. In R. O. Nelson & S. C. Hayes (Eds.), Conceptual foundations of behavioral assessment (pp. 131–155). New York: The Guilford Press.Google Scholar
  5. Haynes, R. B., McDonald, H., Garg, A. X., & Montague, P. (2002). Interventions for helping patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews (2). doi:10.1002/14651858.CD000011.
  6. Hays, R., Stacy, A. W., & DiMatteo, M. R. (1984). Covariation among health-related behaviors. Addictive Behaviors, 9(3), 315–318.CrossRefPubMedGoogle Scholar
  7. Levensky, E. R., & O’Donohue, W. T. (2006). Patient adherence and nonadherence to treatments. In W. T. O’Donohue & E. R. Levensky (Eds.), Promoting treatment adherence: A practical handbook for health care providers (pp. 1–14). Thousand Oaks, CA: Sage Publications Inc.Google Scholar
  8. Leventhal, H. (1993). Theories of compliance, and turning necessities into preferences: Application to adolescent health action. In N. A. Krasnegor, L. H. Epstein, S. B. Johnson, & S. J. Yaffe (Eds.), Developmental aspects of health compliance behavior (pp. 91–124). Hillsdale, NJ: Lawrence Erlbaum Associates Inc.Google Scholar
  9. Nelson, R. O., & Hayes, S. C. (1986). Conceptual foundations of behavioral assessment. New York: The Guilford Press.Google Scholar
  10. Neumark-Sztainer, D., Story, M., Toporoff, E., Himes, J. H., Resnick, M. D., & Blum, R. W. (1997). Covariations of eating behaviors with other health-related behaviors among adolescents. The Journal of Adolescent Health, 20(6), 450–458.CrossRefPubMedGoogle Scholar
  11. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill, Inc.Google Scholar
  12. Persky, I., Spring, B., Vander Wal, J. S., Pagoto, S., & Hedeker, D. (2005). Adherence across behavioral domains in treatment promoting smoking cessation plus weight control. Health Psychology, 24(2), 153–160.CrossRefPubMedGoogle Scholar
  13. Riekert, K. A. (2006). Integrating regimen adherence assessment into clinical practice. In W. T. O’Donohue & E. R. Levensky (Eds.), Promoting treatment adherence (pp. 17–34). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  14. Rosenberg, D. E., Norman, G. J., Sallis, J. F., Calfas, K. J., & Patrick, K. (2007). Covariation of adolescent physical activity and dietary behaviors over 12 months. The Journal of Adolescent Health, 41(5), 472–478.CrossRefPubMedGoogle Scholar
  15. Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., et al. (2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine, 360(9), 859–873.CrossRefPubMedGoogle Scholar
  16. Shearer, H. M., & Evans, D. R. (2001). Adherence to health care. In S. S. Kazarian & D. R. Evans (Eds.), Handbook of cultural health psychology (pp. 113–138). San Diego, CA: Academic Press.CrossRefGoogle Scholar
  17. Terre, L., Drabman, R. S., & Meydrech, E. F. (1990). Relationships among children’s health-related behaviors: A multivariate, developmental perspective. Preventive Medicine, 19(2), 134–146.CrossRefPubMedGoogle Scholar
  18. The Look AHEAD Research Group. (2006). The Look AHEAD study: A description of the lifestyle intervention and the evidence supporting it. Obesity, 14(5), 737–775.CrossRefGoogle Scholar
  19. U.S. Department of Agriculture. (1994–1996). Agricultural Research Service. Beltsville Human Nutrition Research Center, Food Surveys Research Group (Beltsville, MD). Continuing survey of food intakes by individuals.Google Scholar
  20. Warziski, M. T., Sereika, S. M., Styn, M. A., Music, E., & Burke, L. E. (2008). Changes in self-efficacy and dietary adherence: The impact on the weight loss in the PREFER study. Journal of Behavioral Medicine, 31, 81–82.CrossRefPubMedGoogle Scholar
  21. Williamson, D. A., Martin, C. K., & Stewart, T. M. (2006). Behavioral strategies for controlling obesity. In G. A. Bray & D. H. Ryan (Eds.), Overweight and the metabolic syndrome: From bench to bedside (pp. 219–232). New York: Springer.CrossRefGoogle Scholar

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

Personalised recommendations