Skip to main content
SpringerLink
Log in

Mediators of Weight Loss Maintenance in the Keep It Off Trial

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

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.

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

Trial Registration Number

The trial is registered with ClinicalTrials.gov (Identifier: NCT00702455 www.clinicaltrials.gov/ct2/show/NCT00702455).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jeffery RW, Drewnowski A, Epstein LH, et al.: Long-term maintenance of weight loss: current status. Health Psychol. 2000, 19:5–16.

    Article  CAS  PubMed  Google Scholar 

  2. Sarwer DB, von Sydow Green A, Vetter ML, Wadden TA: Behavior therapy for obesity: where are we now? Curr Opin Endocrinol Diabetes Obes. 2009, 16:347–352.

    Article  PubMed  Google Scholar 

  3. Levy RL, Jeffery RW, Langer SL, et al.: Maintenance-tailored therapy vs. standard behavior therapy for 30-month maintenance of weight loss. Prev Med. 2010, 51:457–459.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Perri MG, Nezu AM, McKelvey WF, et al.: Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol. 2001, 69:722–726.

    Article  CAS  PubMed  Google Scholar 

  5. Perri MG, Nezu AM, Patti ET, McCann KL: Effect of length of treatment on weight loss. J Consult Clin Psychol. 1989, 57:450–452.

    Article  CAS  PubMed  Google Scholar 

  6. Jeffery RW, Wing RR, Sherwood NE, Tate D: Physical activity and weight loss: Does prescribing higher physical activity goals improve outcome? American Journal of Clinical Nutrition. 2003, 78:669–670.

    Google Scholar 

  7. Tate DF Jr, Sherwood NE, Wing RR.Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain? Am J Clin Nutr. 2007, 85 (4):954–959.

    CAS  PubMed  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. Sherwood NE, Crain AL, Martinson BC, et al.: Keep it off: a phone-based intervention for long-term weight-loss maintenance. Contemp Clin Trials. 2011, 32:551–560.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sherwood NE, Crain AL, Martinson BC, et al.: Enhancing long-term weight loss maintenance: 2 year results from the Keep It Off randomized controlled trial. Prev Med. 2013, 56:171–177.

    Article  PubMed  Google Scholar 

  12. Wadden TA, Neiberg RH, Wing RR, et al.: Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011, 19:1987–1998.

    Article  PubMed Central  Google Scholar 

  13. Wadden TA, West DS, Neiberg RH, et al.: One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009, 17:713–722.

    Article  PubMed Central  Google Scholar 

  14. Palmeira AL, Branco TL, Martins SC, et al.: Change in body image and psychological well-being during behavioral obesity treatment: associations with weight loss and maintenance. Body Image. 2010, 7:187–193.

    Article  PubMed  Google Scholar 

  15. Faulconbridge LF, Wadden TA, Berkowitz RI, et al.: Changes in symptoms of depression with weight loss: results of a randomized trial. Obesity (Silver Spring). 2009, 17:1009–1016.

    Article  PubMed Central  Google Scholar 

  16. Baranowski T, Jago R: Understanding the mechanisms of change in children’s physical activity programs. Exerc Sport Sci Rev. 2005, 33:163–168.

    Article  PubMed  Google Scholar 

  17. Crain AL, Martinson BC, Sherwood NE, O’Connor PJ: The long and winding road to physical activity maintenance. Am J Health Behav. 2010, 34:764–775.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lewis BA, Marcus BH, Pate RR, Dunn AL: Psychosocial mediators of physical activity behavior among adults and children. Am J Prev Med. 2002, 23:26–35.

    Article  PubMed  Google Scholar 

  19. Napolitano MA, Papandonatos GD, Lewis BA, et al.: Mediators of physical activity behavior change: a multivariate approach. Health Psychol. 2008, 27:409–418.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Papandonatos GD, Williams DM, Jennings EG, et al.: Mediators of physical activity behavior change: findings from a 12-month randomized controlled trial. Health Psychol. 2012, 31:512–520.

    Article  PubMed  Google Scholar 

  21. Baranowski T, Anderson C, Carmack C: Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med. 1998, 15:266–297.

    Article  CAS  PubMed  Google Scholar 

  22. Mosher CE, Lipkus I, Sloane R, et al.: Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors’ maintenance of dietary practices and physical activity. Psychooncology. 2013, 22:876–885.

    Article  PubMed  Google Scholar 

  23. Shaikh AR, Vinokur AD, Yaroch AL, Williams GC, Resnicow K: Direct and mediated effects of two theoretically based interventions to increase consumption of fruits and vegetables in the Healthy Body Healthy Spirit trial. Health Educ Behav. 2011, 38:492–501.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Rothman AJ: Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000, 19:64–69.

    Article  CAS  PubMed  Google Scholar 

  26. Marlatt G, Gordon J: Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press. 1985.

    Google Scholar 

  27. Catenacci VA, Ogden LG, Stuht J, et al.: Physical activity patterns in the National Weight Control Registry. Obesity (Silver Spring). 2008, 16:153–161.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wing RR, Hill JO: Successful weight loss maintenance. Annu Rev Nutr. 2001, 21:323–341.

    Article  CAS  PubMed  Google Scholar 

  29. Gorin AA, Phelan S, Wing RR, Hill JO: Promoting long-term weight control: does dieting consistency matter? Int J Obes Relat Metab Disord. 2004, 28:278–281.

    CAS  PubMed  Google Scholar 

  30. 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.

    CAS  PubMed  Google Scholar 

  31. Charlson ME, Charlson RE, Peterson JC, et al.: The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008, 61:1234–1240.

    Article  PubMed  Google Scholar 

  32. Spencer EA, Appleby PN, Davey GK, Key TJ: Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002, 5:561–565.

    Article  PubMed  Google Scholar 

  33. Paffenbarger RS, Jr., Wing AL, Hyde RT: Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978, 108:161–175.

    Article  PubMed  Google Scholar 

  34. Pereira MA, FitzerGerald SJ, Gregg EW, et al.: A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc. 1997, 29:S1–205.

    Article  CAS  PubMed  Google Scholar 

  35. Harris J, French S, Jeffery R, McGovern P, Wing R: Dietary and physical activity correlates of long-term weight loss. Obes Res. 1994, 2:307–313.

    Article  CAS  PubMed  Google Scholar 

  36. Jeffery RW, Wing RR, Sherwood NE, Tate DF: Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr. 2003, 78:684–689.

    CAS  PubMed  Google Scholar 

  37. Subar AF, Thompson FE, Kipnis V, et al.: Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: the Eating at America’s Table Study. Am J Epidemiol. 2001, 154:1089–1099.

    Article  CAS  PubMed  Google Scholar 

  38. Thompson FE, Subar AF, Brown CC, et al.: Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study. J Am Diet Assoc. 2002, 102:212–225.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Evans C, Dolan B: Body Shape Questionnaire: derivation of shortened "alternate forms". Int J Eat Disord. 1993, 13:315–321.

    Article  CAS  PubMed  Google Scholar 

  41. MacKinnon DP, Lockwood CM, Williams J: Confidence limits for the indirect effect: distribution of the product and resampling methods Multivariate Behavioral Research. 2004, 39:99–128.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kraemer HC: Toward non-parametric and clinically meaningful moderators and mediators. Stat Med. 2008, 27:1679–1692.

    Article  PubMed  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. Zheng Y, Klem ML, Sereika SM, et al.: Self-weighing in weight management: a systematic literature review. Obesity (Silver Spring). 2015, 23:256–265.

    Article  PubMed  Google Scholar 

  45. Steinberg DM, Tate DF, Bennett GG, et al.: The efficacy of a daily self-weighing weight loss intervention using smart scales and e-mail. Obesity (Silver Spring). 2013, 21:1789–1797.

    PubMed  PubMed Central  Google Scholar 

  46. Steinberg DM, Bennett GG, Askew S, Tate DF: Weighing every day matters: daily weighing improves weight loss and adoption of weight control behaviors. J Acad Nutr Diet. 2015, 115:511–518.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Turk MW, Elci OU, Wang J, et al.: Self-monitoring as a mediator of weight loss in the SMART randomized clinical trial. Int J Behav Med. 2013, 20:556–561.

    Article  PubMed  Google Scholar 

  48. Peterson ND, Middleton KR, Nackers LM, et al.: Dietary self-monitoring and long-term success with weight management. Obesity (Silver Spring). 2014, 22:1962–1967.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. Anderson JW, Konz EC, Frederich RC, Wood CL: Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001, 74:579–584.

    CAS  PubMed  Google Scholar 

  51. Befort CA, Stewart EE, Smith BK, et al.: Weight maintenance, behaviors and barriers among previous participants of a university-based weight control program. Int J Obes (Lond). 2008, 32:519–526.

    Article  CAS  Google Scholar 

  52. Catenacci VA, Grunwald GK, Ingebrigtsen JP, et al.: Physical activity patterns using accelerometry in the National Weight Control Registry. Obesity (Silver Spring). 2011, 19:1163–1170.

    Article  PubMed  Google Scholar 

  53. Kruger J, Blanck HM, Gillespie C: Dietary and physical activity behaviors among adults successful at weight loss maintenance. Int J Behav Nutr Phys Act. 2006, 3:17.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Wing RR, Phelan S: Long-term weight loss maintenance. Am J Clin Nutr. 2005, 82:222S–225S.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. HealthPartners Institute, 8170 33rd Avenue South, MS23301A, Minneapolis, MN, USA

    A.L. Crain PhD, N.E. Sherwood PhD & B.C. Martinson PhD

  2. University of Minnesota, Minneapolis, MN, USA

    N.E. Sherwood PhD, B.C. Martinson PhD & R.W. Jeffery PhD

  3. Minneapolis Veterans Affairs, Minneapolis, MN, USA

    B.C. Martinson PhD

Authors
  1. A.L. Crain PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N.E. Sherwood PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B.C. Martinson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R.W. Jeffery PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A.L. Crain PhD.

Ethics declarations

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.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crain, A., Sherwood, N., Martinson, B. et al. Mediators of Weight Loss Maintenance in the Keep It Off Trial. ann. behav. med. (2017). https://doi.org/10.1007/s12160-017-9917-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12160-017-9917-x

Keywords

Search

Navigation