Behavioral Weight Loss and Maintenance: A 25-Year Research Program Informing Innovative Programming

Abstract

Introduction Behavioral interventions targeting sustained weight loss have largely failed for decades, with little chance of improvement using prevailing methods. Objective To address treatment limitations, a focused 25-year research program was reviewed through the lens of social cognitive theory, probative investigations, and original predictive models. Innovative, but evidence-based, treatment suggestions were sought. Results Task 1 of the research program addressed adherence to exercise, a well-established requirement for maintained weight loss. A culminating model addressing this treatment aspect suggested that interrelations among changes in self-regulatory skills usage, self-efficacy, and mood should guide exercise-support programming. Task 2 attached an eating-behavior change component and probed for malleable psychosocial variables predictive of success over the weight-loss phase (initial 6 months after treatment initiation). After thorough evaluation of selected theory- and research-driven psychosocial variables, changes in self-regulation, self-efficacy, and mood were again deemed to be the most salient predictors driving eating change. In Task 3, treatment foci related to changes in the 3 psychosocial variables were supported into the weight-loss maintenance phase (beyond 6 months), and the carry-over of changes in self-regulation and self-efficacy from exercise- to eating-related contexts was identified and leveraged. Task 4 suggested value in additionally addressing emotional eating as a distinct factor. Conclusion Suggestions informing principles and extensions of a treatment approach previously demonstrating atypically high degrees of success with maintaining weight loss in field- and community-based settings are provided. Those methods emanate from the reviewed research program, which shaped novel procedures to leverage exercise-induced psychosocial changes for their carry-over benefits for controlling eating.

Keywords: Cognitive-Behavioral; Exercise; Obesity; Self-Regulation; Treatment; Weight Loss.

Figure 1:

Research program-related evolution of predictive models for exercise adherence. Δ = change in the designated construct.

Figure 2:

Overarching philosophy shaping treatment curricula.

Figure 3:

Path model toward change in body mass index incorporating factors derived from social cognitive theory and Baker and Brownell’s predictive model.

Figure 4:

Proposed pathways toward weight loss through treatment-associated changes in self-regulation, self-efficacy, and mood carried over from exercise to eating contexts. Adapted with permission from: Annesi JJ. Supported exercise improves controlled eating and weight through its effects on psychosocial factors: extending a systematic research program toward treatment development. Perm J 2012;16(1):7–18. doi:10.7812/11-136.

Figure 5:

Causal chain predicting weight loss and weight-loss maintenance through psychosocial mediators and moderators. Adapted with permission from: Annesi JJ. Sequential changes advancing from exercise-induced psychological improvements to controlled eating and sustained weight loss: a treatment-focused causal chain model. Perm J 2020;24:19.235. doi:10.7812/TPP/19.235. Δ= change in the designated construct; a = path a (predictor → mediator); b = path b (mediator → outcome); c′ = path c′ (predictor → outcome, controlling for the mediator); Eat = for eating; Ex = for exercise; SE = self-efficacy; SR = self-regulation. The proposed sequence of interrelations among variables is represented with labels from 1 to 7.