Mediators of Weight Loss Maintenance in the Keep It Off Trial

  • A.L. CrainEmail author
  • N.E. Sherwood
  • B.C. Martinson
  • R.W. Jeffery
Original Article



An important step toward enhancing the efficacy of weight loss maintenance interventions is identifying the pathways through which successful interventions such as the Keep It Off trial have worked.


This study aimed to assess the viability of mediated relationships between the Keep It Off Guided intervention, conceptually and empirically grounded potential mediators, and weight. Repeated measurement of mediators and weight enabled documentation of the temporal ordering of intervention delivery and changes in mediators and in weight among participants randomized to the Guided intervention or Self-Directed comparison group.


Total, direct, and indirect effects of the Guided intervention on weight change were calculated and tested for significance. Indirect effects were comprised of the influence of the intervention on three change scores for each mediator and the relationship between mediator changes and weight changes 6 months later.


Guided intervention participants regained about 2% less weight over 24 months than Self-Directed participants. Starting daily self-weighing accounted for the largest share of this difference, followed by not stopping self-weighing.


Daily self-weighing mediated 24-month weight loss maintenance.

Trial Registration Number

The trial is registered with (Identifier: NCT00702455


Weight loss maintenance Behavioral intervention Maintenance Physical activity Self-monitoring 



This study was funded by the National Cancer Institute/National Institute of Health/Department of Health and Human Services (grant number R01CA128211).

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors AL Crain, NE Sherwood, BC Martinson, and RW Jeffery declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© The Society of Behavioral Medicine 2017

Authors and Affiliations

  • A.L. Crain
    • 1
    Email author
  • N.E. Sherwood
    • 1
    • 2
  • B.C. Martinson
    • 1
    • 2
    • 3
  • R.W. Jeffery
    • 2
  1. 1.HealthPartners InstituteMinneapolisUSA
  2. 2.University of MinnesotaMinneapolisUSA
  3. 3.Minneapolis Veterans AffairsMinneapolisUSA

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