Annals of Behavioral Medicine

, Volume 51, Issue 5, pp 741–753 | Cite as

Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change

  • Evan M. Forman
  • Leah M. Schumacher
  • Ross Crosby
  • Stephanie M. Manasse
  • Stephanie P. Goldstein
  • Meghan L. Butryn
  • Emily P. Wyckoff
  • J. Graham Thomas
Original Article



Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program.


In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss.


Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states.


Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses.


In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.


Dietary lapses Adherence Ecological momentary assessment EMA Behavioral weight loss Overweight 



This project was wholly funded by an R01 grant (R01DK095069) to the first author from the National Institute of Diabetes and Digestive and Kidney Diseases. We also want to thank the participants of this study as well at its research coordinator, Andrew Frohn.

Compliance with Ethical Standards

Conflict of Interest

Dr. Forman reports grants from the National Institute for Diabetes and Digestive and Kidney Diseases (award no. R01 DK095069), during the conduct of the study. Dr. Crosby reports personal fees from Health Outcome Solutions, outside the submitted work. None of the remaining authors report a conflict of interest.


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Copyright information

© The Society of Behavioral Medicine 2017

Authors and Affiliations

  • Evan M. Forman
    • 1
  • Leah M. Schumacher
    • 1
  • Ross Crosby
    • 2
    • 3
  • Stephanie M. Manasse
    • 1
  • Stephanie P. Goldstein
    • 1
  • Meghan L. Butryn
    • 1
  • Emily P. Wyckoff
    • 4
  • J. Graham Thomas
    • 5
  1. 1.Department of PsychologyDrexel UniversityPhiladelphiaUSA
  2. 2.Neuropsychiatric Research InstituteFargoUSA
  3. 3.Department of Psychiatry and Behavioral ScienceUniversity of North Dakota School of Medicine and Health SciencesFargoUSA
  4. 4.Department of Psychological SciencesUniversity of ConnecticutMansfieldUSA
  5. 5.Department of Psychiatry and Human Behavior, Warren Alpert Medical SchoolBrown UniversityProvidenceUSA

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