Annals of Behavioral Medicine

, Volume 46, Issue 3, pp 369–381 | Cite as

Behavioral Mediators of Treatment Effects in the Weight Loss Maintenance Trial

  • J. W. Coughlin
  • C. M. Gullion
  • P. J. Brantley
  • V. J. Stevens
  • A. Bauck
  • C. M. Champagne
  • A. T. Dalcin
  • K. L. Funk
  • J. F. Hollis
  • G. J. Jerome
  • L. F. Lien
  • C. M. Loria
  • V. H. Myers
  • L. J. Appel
Original Article



The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss. Personal contact was superior to interactive technology and self-directed conditions.


We aimed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms.


Overweight/obese adults at risk for cardiovascular disease (n = 1,032) who lost at least 4 kg were randomized to personal contact, interactive technology, or self-directed. After 30 months, 880 participants had data on weight and behavioral strategies.


Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology. Increased intake of fruits and vegetables, more frequent self-weighing, and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed.


Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials.

( number NCT00054925)


Obesity Weight maintenance Weight regain Behavioral strategies Mediators 


  1. 1.
    National Institutes of Health/National Heart LaBI. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obesity Research 6, 51S-210S. 1998.Google Scholar
  2. 2.
    World Health Organization. Obesity: Preventing and managing the global epidemic. 2000.Google Scholar
  3. 3.
    Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, Burke LE. Randomized clinical trials of weight loss maintenance: A review. J Cardiovasc Nurs. 2009;24:58-80.PubMedCrossRefGoogle Scholar
  4. 4.
    Brantley PJ, Appel LJ, Hollis JF, et al. Design considerations and rationale of a multi-center trial to sustain weight loss: The weight loss maintenance trial. Clinical Trials. 2008;5:546-556.PubMedCrossRefGoogle Scholar
  5. 5.
    Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: The weight loss maintenance randomized controlled trial. JAMA. 2008;299:1139-1148.PubMedCrossRefGoogle Scholar
  6. 6.
    Hollis JF, Gullion CM, Stevens VJ, et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med. 2008;35:118-126.PubMedCrossRefGoogle Scholar
  7. 7.
    Stevens VJ, Funk KL, Brantley PJ, et al. Design and implementation of an interactive website to support long-term maintenance of weight loss. J Med Internet Res. 2008;10:e1.PubMedCrossRefGoogle Scholar
  8. 8.
    Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173-1182.PubMedCrossRefGoogle Scholar
  9. 9.
    Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry. 2001;158:848-856.PubMedGoogle Scholar
  10. 10.
    Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59:877-883.PubMedCrossRefGoogle Scholar
  11. 11.
    Kraemer HC, Kiernan M, Essex M, Kupfer DJ. How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches. Health Psychol. 2008;27:S101-S108.PubMedCrossRefGoogle Scholar
  12. 12.
    Daniels MJ, Roy JA, Kim C, Hogan JW. Perri MG. Biometrics: Bayesian Inference for the causal effect of mediation; 2012.Google Scholar
  13. 13.
    Teixeira PJ, Silva MN, Coutinho SR, et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring). 2010;18:725-735.CrossRefGoogle Scholar
  14. 14.
    Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117-1124.PubMedCrossRefGoogle Scholar
  15. 15.
    Karanja NM, Obarzanek E, Lin PH, et al. Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group. J Am Diet Assoc. 1999;99:S19-S27.PubMedCrossRefGoogle Scholar
  16. 16.
    Rowlands AV, Thomas PW, Eston RG, Topping R. Validation of the RT3 triaxial accelerometer for the assessment of physical activity. Med Sci Sports Exerc. 2004;36:518-524.PubMedCrossRefGoogle Scholar
  17. 17.
    Jerome GJ, Young DR, Laferriere D, Chen C, Vollmer WM. Reliability of RT3 accelerometers among overweight and obese adults. Med Sci Sports Exerc. 2009;41:110-114.PubMedCrossRefGoogle Scholar
  18. 18.
    Harlan LC, Block G. Use of adjustment factors with a brief food frequency questionnaire to obtain nutrient values. Epidemiology. 1990;1:224-231.PubMedCrossRefGoogle Scholar
  19. 19.
    Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychol Methods. 2002;7:422-445.PubMedCrossRefGoogle Scholar
  20. 20.
    Li Y, Schneider JA, Bennett DA. Estimation of the mediation effect with a binary mediator. Stat Med. 2007;26:3398-3414.PubMedCrossRefGoogle Scholar
  21. 21.
    Mackinnon DP, Warsi G, Dwyer JH. A simulation study of mediated effect measures. Multivariate Behav Res. 1995;30:41.PubMedCrossRefGoogle Scholar
  22. 22.
    Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed. New York: Wiley; 2002.Google Scholar
  23. 23.
    Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutr Rev. 2004;62:1-17.PubMedCrossRefGoogle Scholar
  24. 24.
    Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: The Women's Health Initiative Dietary Modification Trial. JAMA. 2006;295:39-49.PubMedCrossRefGoogle Scholar
  25. 25.
    Stamler J, Dolecek TA. Relation of food and nutrient intakes to body mass in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr. 1997;65:366S-373S.PubMedGoogle Scholar
  26. 26.
    Jeffery RW, Sherwood NE, Brelje K, et al. Mail and phone interventions for weight loss in a managed-care setting: Weigh-to-be one-year outcomes. Int J Obes Relat Metab Disord. 2003;27:1584-1592.PubMedCrossRefGoogle Scholar
  27. 27.
    Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355:1563-1571.PubMedCrossRefGoogle Scholar
  28. 28.
    Linde JA, Jeffery RW, French SA, Pronk NP, Boyle RG. Self-weighing in weight gain prevention and weight loss trials. Ann Behav Med. 2005;30:210-216.PubMedCrossRefGoogle Scholar
  29. 29.
    Jeffery RW, French SA. Preventing weight gain in adults: The pound of prevention study. Am J Public Health. 1999;89:747-751.PubMedCrossRefGoogle Scholar
  30. 30.
    Butryn ML, Phelan S, Hill JO, Wing RR. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity (Silver Spring). 2007;15:3091-3096.CrossRefGoogle Scholar
  31. 31.
    Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66:239-246.PubMedGoogle Scholar
  32. 32.
    Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S-225S.PubMedGoogle Scholar
  33. 33.
    Catenacci VA, Ogden LG, Stuht J, et al. Physical activity patterns in the National Weight Control Registry. Obesity (Silver Spring). 2008;16:153-161.CrossRefGoogle Scholar
  34. 34.
    Kruger J, Blanck HM, Gillespie C. Dietary practices, dining out behavior, and physical activity correlates of weight loss maintenance. Prev Chronic Dis. 2008;5:A11.PubMedGoogle Scholar
  35. 35.
    Wing RR, Papandonatos G, Fava JL, et al. Maintaining large weight losses: The role of behavioral and psychological factors. J Consult Clin Psychol. 2008;76:1015-1021.PubMedCrossRefGoogle Scholar
  36. 36.
    Swartz AM, Tarima S, Miller NE, et al. Prediction of body fat in older adults by time spent in sedentary behavior. J Aging Phys Act. 2012;20:332-344.PubMedGoogle Scholar
  37. 37.
    Dunton GF, Berrigan D, Ballard-Barbash R, Graubard B, Atienza AA. Joint associations of physical activity and sedentary behaviors with body mass index: Results from a time use survey of US adults. Int J Obes (Lond). 2009;33:1427-1436.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  • J. W. Coughlin
    • 1
  • C. M. Gullion
    • 2
  • P. J. Brantley
    • 3
  • V. J. Stevens
    • 2
  • A. Bauck
    • 2
  • C. M. Champagne
    • 3
  • A. T. Dalcin
    • 1
  • K. L. Funk
    • 2
  • J. F. Hollis
    • 2
  • G. J. Jerome
    • 4
  • L. F. Lien
    • 5
  • C. M. Loria
    • 6
  • V. H. Myers
    • 7
  • L. J. Appel
    • 1
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Kaiser Permanente Center for Health ResearchOaklandUSA
  3. 3.Pennington Biomedical Research CenterLouisiana State University SystemBaton RougeUSA
  4. 4.Towson UniversityTowsonUSA
  5. 5.Duke University Medical CenterDurhamUSA
  6. 6.National Heart, Lung, and Blood InstituteBethesdaUSA
  7. 7.Klein Buendel, Inc.GoldenUSA

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