Journal of Behavioral Medicine

, Volume 37, Issue 6, pp 1155–1168

Psychosocial predictors of weight regain in the weight loss maintenance trial

  • Phillip J. Brantley
  • Diana W. Stewart
  • Valerie H. Myers
  • Molly R. Matthews-Ewald
  • Jamy D. Ard
  • Janelle W. Coughlin
  • Gerald J. Jerome
  • Carmen Samuel-Hodge
  • Lillian F. Lien
  • Christina M. Gullion
  • Jack F. Hollis
  • Laura P. Svetkey
  • Victor J. Stevens
Article

Abstract

This study’s purpose was to identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial, following a group-based weight loss program. Participants (N = 1025) were predominately women (63 %) and 38 % were Black (mean age = 55.6 years; SD = 8.7). At 12 months, higher SF-36 mental health composite scores were associated with less weight regain (p < .01). For Black participants, an interaction existed between race and friends’ encouragement for exercise, where higher exercise encouragement was related to more weight regain (p < .05). At 30 months, friends’ encouragement for healthy eating was associated with more weight regain (p < .05), whereas higher SF-36 mental health composite scores were related to less weight regain (p < .0001). Perceived stress and select health-related quality of life indices were associated with weight regain; this relationship varied across gender, race, and treatment conditions. Temporal changes in these variables should be investigated for their impact on weight maintenance.

Keywords

Weight loss maintenance Psychosocial predictors Obesity Quality of life Social support 

Referencess

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edition, text revision). Washington DC: Author.CrossRefGoogle Scholar
  2. Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure: DASH Collaborative Research Group. New England Journal of Medicine, 336(16), 1117–1124. doi:10.1056/NEJM199704173361601 PubMedCrossRefGoogle Scholar
  3. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  4. Bandura, A., & Adams, N. (1977). Analysis of self-efficacy theory of behavioral change. Cognitive Therapy and Research, 1(4), 287–310.CrossRefGoogle Scholar
  5. Barte, J. C. M., Ter Bogt, N. C. W., Bogers, R. P., Teixeira, P. J., Blissmer, B., Mori, T. A., et al. (2010). Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obesity Reviews, 11(12), 899–906. doi:10.1111/j.1467-789X.2010.00740.x PubMedCrossRefGoogle Scholar
  6. Bock, B. C., Marcus, B. H., Pinto, B. M., & Forsyth, L. H. (2001). Maintenance of physical activity following an individualized motivationally tailored intervention. Annals of Behavioral Medicine, 23(2), 79–87.PubMedCrossRefGoogle Scholar
  7. Brantley, P. J., Appel, L. J., Hollis, J., Stevens, V., Ard, J., Champagne, C., et al. (2008). Design considerations and rationale of a multi-center trial to sustain weight loss: The weight loss maintenance trial. Clinical Trials, 5, 546–556. doi:10.1177/1740774508096315 PubMedCentralPubMedCrossRefGoogle Scholar
  8. Byrne, S. M. (2002). Psychological aspects of weight maintenance and relapse in obesity. Journal of Psychosomatic Research, 53, 1029–1036.PubMedCrossRefGoogle Scholar
  9. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.PubMedCrossRefGoogle Scholar
  10. Delahanty, L. M., Peyrot, M., Shrader, P. J., Williamson, D. A., Meigs, J. B., & Nathan, D. M. (2013). Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the diabetes prevention program (DPP). Diabetes Care, 36(1), 34–40. doi:10.2337/dc12-0733 PubMedCentralPubMedCrossRefGoogle Scholar
  11. Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New England Journal of Medicine, 346(6), 393–403. doi:10.1056/NEJMoa012512 PubMedCentralCrossRefGoogle Scholar
  12. Elfhag, K., & Rossner, S. (2005). Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews, 6, 67–85. doi:10.1111/j.1467-789X.2005.00170.x PubMedCrossRefGoogle Scholar
  13. Fabricatore, A. N., Wadden, T. A., Moore, R. H., Butryn, M. L., Heymsfield, S. B., & Nguyen, A. M. (2009). Predictors of attrition and weight loss success: Results from a randomized controlled trial. Behaviour Research and Therapy, 47, 685–691. doi:10.1016/j.brat.2009.05.004 PubMedCentralPubMedCrossRefGoogle Scholar
  14. Friedman, K. E., Reichmann, S. K., Costanzo, P. R., Zelli, A., Ashmore, J. A., & Musante, G. J. (2005). Weight stigmatization and ideological beliefs: Relation to psychological functioning in obese adults. Obesity Research, 5, 907–916.CrossRefGoogle Scholar
  15. Funk, K. L., Stevens, V. J., Appel, L. J., Bauck, A., Brantley, P. J., Champagne, C. M., et al. (2010). Associations of internet website use with weight change in a long-term weight loss maintenance program. Journal of Medical Internet Research, 12(3), e29.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Halding, A., Heggdal, K., & Wahl, A. (2008). Experiences of self-blame and stigmatization for self-infliction among individuals living with COPD. Scandinavian Journal of Caring Sciences, 25, 100–107. doi:10.1111/j.1471-6712.2010.00796.x CrossRefGoogle Scholar
  17. Hollis, J. F., Gullion, C. M., Stevens, V. J., Brantley, P. J., Appel, L. J., Ard, J. D., et al. (2008). Weight loss during the intensive intervention phase of the weight-loss maintenance trial. American Journal of Preventive Medicine, 35, 118–126. doi:10.1016/k.amepre.2008.04.013 PubMedCentralPubMedCrossRefGoogle Scholar
  18. House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241, 540–545. doi:10.1177/0022146510383501 PubMedCrossRefGoogle Scholar
  19. Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., et al. (2008). Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Preventive Medicine, 46(3), 238–246. doi:10.1016/j.ypmed.2007.09.010 PubMedCentralPubMedCrossRefGoogle Scholar
  20. Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515.CrossRefGoogle Scholar
  21. Kumanyika, S. K., Espeland, M. A., Bahnson, J. L., Bottom, J. B., & Whelton, P. K. (2002). Ethnic comparison of weight loss in the trial of nonpharmacologic interventions in the elderly. Obesity Research, 10, 96–106. doi:10.1038/oby.2002.16 PubMedCrossRefGoogle Scholar
  22. Kumanyika, S. K., Obarzanek, E., Stevens, V. J., Hebert, P. R., & Whelton, P. K. (1991). Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. American Journal of Clinical Nutrition, 53, 1631S–1638S.PubMedGoogle Scholar
  23. Liebbrand, R., & Fitcher, M. M. (2002). Maintenance of weight loss after obesity treatment: Is continuous support necessary? Behaviour Research and Therapy, 40, 1275–1289. doi:10.1016/S0005-7967(01)00099-7 CrossRefGoogle Scholar
  24. McHorney, C. A., Ware, J. E., Lu, J. F. R., & Sherbourne, C. D. (1994). The MOS 36-item short-form health survey (SF-36®): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Medical Care, 32(4), 40–66.PubMedCrossRefGoogle Scholar
  25. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York, NY: The Guilford Press.Google Scholar
  26. Perri, M. G., Nezu, A. M., Patti, E. T., & McCann, K. L. (1989). Effect of length of treatment on weight loss. Journal of Consulting and Clinical Psychology, 57, 450–452.PubMedCrossRefGoogle Scholar
  27. Perri, M. G., Shapiro, R. M., Ludwig, W. W., Twentyman, C. T., & McAdoo, W. G. (1984). Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone. Journal of Consulting and Clinical Psychology, 52(3), 404–413. doi:10.1037/0022-006X.52.3.404 PubMedCrossRefGoogle Scholar
  28. Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.PubMedCrossRefGoogle Scholar
  29. Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. doi:10.4278/0890-1171-12.1.38 PubMedCrossRefGoogle Scholar
  30. Rickel, K. A., Milsom, V. A., Ross, K. M., Hoover, V. J., Peterson, N. D., & Perri, M. G. (2011). Differential response of African American and Caucasian women to extended-care programs for obesity management. Ethnicity and Disease, 21, 170–175.PubMedCentralPubMedGoogle Scholar
  31. Rogers, W., & Lange, M. M. (2013). Rethinking the vulnerability of minority populations in research. American Journal of Public Health, 103(12), 2141–2146. doi:10.2105/AJPH.2012.301200 PubMedCrossRefGoogle Scholar
  32. Rohyans, L. M., & Pressler, S. J. (2009). Depressive symptoms and heart failure: Examining the sociodemographic variables. Clinical Nurse Specialist, 23, 138–144. doi:10.1016/S0735-1097(01)01334-1 PubMedCentralPubMedCrossRefGoogle Scholar
  33. Rollnick, S., Mason, P., & Butler, C. (1999). Health behavior change: A guide for practitioners. London: Churchill Livingston.Google Scholar
  34. Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRefGoogle Scholar
  35. Sallis, J. F., Grossman, R. M., Pinski, R. B., Patterson, T. L., & Nader, P. R. (1987). The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine, 16, 825–836. doi:10.1016/0091-7435(87)90022-3 PubMedCrossRefGoogle Scholar
  36. Schafer, J. L. (1997). Analysis of incomplete multivariate data. New York: Chapman and Hall.CrossRefGoogle Scholar
  37. Schvey, N. A., Puhl, R. M., & Brownell, K. D. (2011). The impact of weight stigma on caloric consumption. Obesity, 19(10), 1957–1962. doi:10.1038/oby.2011.204 PubMedCrossRefGoogle Scholar
  38. Sciamanna, C. N., Kiernan, M., Rolls, B. J., Boan, J., Stuckey, H., & Dellasega, C. (2011). Practices associated with weight loss versus weight-loss maintenance: Results of a national study. American Journal of Preventive Medicine, 41(2), 159–166. doi:10.1016/j.amepre.2011.04.009 PubMedCrossRefGoogle Scholar
  39. Stevens, V. J., Obarzanek, E., Cook, N. R., Lee, I. M., Appel, L. J., Smith, W. D., et al. (2001). Long-term weight loss and changes in blood pressure: Results of the trials of hypertension prevention, phase II. Annals of Internal Medicine, 134(1), 1–11. doi:10.7326/0003-4819-134-1-200101020-00007 PubMedCrossRefGoogle Scholar
  40. Sutin, A. R., & Terracciano, A. (2013). Perceived weight discrimination and obesity. PLoS ONE, 8(7), e70048. doi:10.1371/journal.pone.0070048 PubMedCentralPubMedCrossRefGoogle Scholar
  41. Svetkey, L. P., Ard, J. D., Stevens, V. J., Loria, C. M., Young, D. Y., Hollis, J. F., et al. (2012). Predictors of long-term weight loss in adults with modest initial weight loss by sex and race. Obesity, 20(9), 1820–1828. doi:10.1038/oby.2011.88 PubMedCrossRefGoogle Scholar
  42. Svetkey, L. P., Stevens, V. J., Brantley, P. J., Appel, L. J., Hollis, J. F., Loria, C. M., et al. (2008). Comparison of strategies for sustaining weight loss: The weight loss maintenance randomized controlled trial. Journal of the American Medical Association, 229, 1139–1148. doi:10.1001/jama.299.10.1139 CrossRefGoogle Scholar
  43. Teixeira, P. J., Going, S. B., Houtkooper, L. B., Cussler, E. C., Martin, C. J., Metcalfe, L. L., et al. (2002). Weight loss readiness in middle-aged women: Psychosocial predictors of success for behavioral weight reduction. Journal of Behavioral Medicine, 25(6), 499–523.PubMedCrossRefGoogle Scholar
  44. Tukey, J. W. (1977). Exploratory data analysis (p. 688). Reading, MA: Addison-Wesley.Google Scholar
  45. Turk, M. W., Yang, K., Hravnak, M., Sereika, S. M., Ewing, L. J., & Burke, L. E. (2009). Randomized clinical trials of weight-loss maintenance: A review. The Journal of Cardiovascular Nursing, 24(1), 58–80. doi:10.1097/01.JCN.0000317471.58048.32 PubMedCentralPubMedCrossRefGoogle Scholar
  46. Vieira, P. N., Silva, M. N., Mata, J., Coutinho, S. R., Santos, T. C., Sardina, L. B., et al. (2012). Correlates of health-related quality of life, psychological well-being, and eating self-regulation after successful weight loss maintenance. Journal of Behavioral Medicine, 36, 601–610. doi:10.1007/s10865-012-9454-9 PubMedCrossRefGoogle Scholar
  47. Wadden, T. A., Butryn, M. L., & Byrne, K. J. (2004). Efficacy of lifestyle modification for long-term weight control. Obesity Research, 12(Suppl. 32), 1515–1625. doi:10.1038/oby.2004.282 Google Scholar
  48. Wadden, T. A., Neiberg, R. H., Wing, R. R., Clark, J. M., Delahanty, L. M., Hill, J. O., et al. (2011). Four-year weight losses in the Look AHEAD study: Factors associated with long-term success. Obesity, 19(10), 1987–1999. doi:10.1038/oby.2011.230 PubMedCentralPubMedCrossRefGoogle Scholar
  49. Wang, Y., & Chen, X. (2011). How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults? Journal of the American Dietetic Association, 111(12), 1904–1911. doi:10.1016/j.jada.2011.09.036 PubMedCentralPubMedCrossRefGoogle Scholar
  50. Ware, J. E., Kosinski, M., & Keller, S. K. (1994). SF-36 ® Physical and mental health summary scales: A user’s manual. Boston: The Health Institute.Google Scholar
  51. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short form health survey (SF-36): Conceptual framework and item selection. Medical Care, 30, 473–483. doi:10.1097/00005650-199206000-00002 PubMedCrossRefGoogle Scholar
  52. Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 ® Health survey manual and interpretation guide. Boston: New England Medical Center, The Health Institute.Google Scholar
  53. Watson, D. L., Tharp, R. G., Loomis, L. H., & Steinberg, S. (1989). Self-directed behavior: Self-modification for personal adjustment (5th ed.). Pacific Grove, CA: Brooks/Cole.Google Scholar
  54. West, D. S., DiLillo, V., Bursan, Z., Gore, S. A., & Greene, P. G. (2007). Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care, 30, 1081–1087. doi:10.2337/dc06-1966 PubMedCrossRefGoogle Scholar
  55. West, D. S., Prewitt, T. E., Bursac, Z., & Felix, H. C. (2008). Weight loss of black, white, and Hispanic men and women in the diabetes prevention program. Obesity, 16, 1413–1420. doi:10.1038/oby.2008.224 PubMedCrossRefGoogle Scholar
  56. Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70(1), 115–126.PubMedCrossRefGoogle Scholar
  57. Wing, R. R., & Hill, J. O. (2001). Successful weight loss maintenance. Annual Reviews in Nutrition, 21, 323–341.CrossRefGoogle Scholar
  58. Wing, R. R., Papandonatos, G., Fava, J. L., Gorin, A. A., Phelan, S., McCaffery, J., et al. (2008). Maintaining large weight losses: The role of behavioral and psychological factors. Journal of Consulting and Clinical Psychology, 76(6), 1015–1021. doi:10.1037/a0014159 PubMedCentralPubMedCrossRefGoogle Scholar
  59. Wott, C. B., & Carels, R. A. (2010). Overt weight stigma, psychological distress and weight loss treatment outcomes. Journal of Health Psychology, 15(4), 608–614. doi:10.1177/1359105309355339 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Phillip J. Brantley
    • 1
  • Diana W. Stewart
    • 2
  • Valerie H. Myers
    • 3
  • Molly R. Matthews-Ewald
    • 1
  • Jamy D. Ard
    • 4
  • Janelle W. Coughlin
    • 5
  • Gerald J. Jerome
    • 6
  • Carmen Samuel-Hodge
    • 7
  • Lillian F. Lien
    • 8
  • Christina M. Gullion
    • 9
  • Jack F. Hollis
    • 9
  • Laura P. Svetkey
    • 10
  • Victor J. Stevens
    • 9
  1. 1.Behavioral Medicine Laboratory, Pennington Biomedical Research CenterLouisiana State University SystemBaton RougeUSA
  2. 2.Department of Health Disparities ResearchUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Klein Buendel, Inc.GoldenUSA
  4. 4.Department of Epidemiology and PreventionWake Forest Baptist Medical CenterWinston-SalemUSA
  5. 5.Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of KinesiologyTowson UniversityTowsonUSA
  7. 7.Department of Nutrition, School of Public Health and School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  8. 8.Division of EndocrinologyDuke University Medical CenterDurhamUSA
  9. 9.Health Sciences Programs, Center for Health ResearchKaiser Permanente NorthwestPortlandUSA
  10. 10.Division of Nephrology and the Sarah W. Stedman Nutrition and Metabolism CenterDuke University Medical CenterDurhamUSA

Personalised recommendations