Effects of a Personal Trainer and Financial Incentives on Exercise Adherence in Overweight Women in a Behavioral Weight Loss Program

Exercise is important for long-term weight loss, but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program. This paper presents two studies, one conducted at the University of Pittsburgh and one at the University of Minnesota, that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise. Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk. Study 2 investigated the effect of a lottery incentive for exercise adherence. In both studies, the effect of these manipulations was examined in the context of a 24-week standard behavioral weight control program with three supervised exercise sessions per week. Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions, perhaps due in part to the limited statistical power of the studies. Future studies should focus on better understanding the barriers to exercise and designing behavioral interventions that address these barriers.     

Men Gain Additional Psychological Benefits by Adding Exercise to a Weight‐Loss Program

Objective: Adding exercise to a comprehensive weight‐loss program might not only attenuate any psychological distress associated with weight‐loss attempts but also may provide psychological benefits. This study examined whether a diet‐plus‐exercise weight‐loss program improved psychological outcomes more than a diet‐only weight‐loss program or an assessment‐only control group. Research Methods and Procedures: This study was part of a larger 1‐year randomized weight‐loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year. Results: Men and women in either weight‐loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet‐plus‐exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet‐only program. Women in the diet‐plus‐exercise program did not experience additional psychological benefits specific to weight control than those in the diet‐only program, despite increases in aerobic capacity. Discussion: The pattern seen for overweight men in the diet‐plus‐exercise program at 1 year—greater restraint, less disinhibition, and less hunger—is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.     

Behavioral Strategies of Individuals Who Have Maintained Long-Term Weight Losses

MCGUIRE, MAUREEN T., RENA R. WING, MARY L. KLEM, AND JAMES O. HILL. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. Objective: The purpose of the present study was to compare the behaviors of individuals who have achieved long-term weight loss maintenance with those of regainers and weight-stable controls. Research Methods and Procedures: Subjects for the present study were participants in a random-digit dial telephone survey that used a representative sample of the U. S. adult population. Eating, exercise, self-weighing, and dietary restraint characteristics were compared among weight-loss maintainers: individuals who had intentionally lost ≥10% of their weight and maintained it for ≥1 year (n = 69), weight-loss regainers: individuals who intentionally lost ≥10% of their weight but had not maintained it (n = 56), and weight-stable controls: individuals who had never lost ≥10% of their maximum weight and had maintained their current weight (±10 pounds) within the past 5 years (n= 113). Results: Weight-loss maintainers had lost an average of 37 pounds and maintained it for over 7 years. These individuals reported that they currently used more behavioral strategies to control dietary fat intake, have higher levels of physical activity (especially strenuous activity), and greater frequency of self-weighing than either the weight-loss regainers or weight-stable controls. Maintainers and regainers did not differ in reported levels of dietary restraint, but both had higher levels of restraint than the weight-stable controls. Discussion: These results suggest that weight-loss maintainers use more behavioral strategies to control their weight than either regainers or weight-stable controls. It would thus appear that long-term weight maintenance requires ongoing adherence to a low-fat diet and an exercise regimen in addition to continued attention to body weight.     

Vegetarian and Weight‐Loss Diets among Young Adults

Objective: Young adults frequently experiment with vegetarian and weight‐loss diets. Comparisons of their experiences on these two different diets may help in the development of approaches to improve long‐term adherence to weight‐loss regimens. In the current study vegetarian and weight‐loss diets were compared on how long and how strictly they were followed, and reasons why they were initiated and discontinued. Research Methods and Procedures: From 428 college students surveyed, four groups were delineated: 1) 59 participants had been following a vegetarian diet but not a weight‐loss diet (Vegetarian), 2) 117 participants had tried a weight‐loss diet but not a vegetarian diet (Weight Loss), 3) 133 participants had followed both a vegetarian and a weight‐loss diet (Both), and 4) 119 participants had not tried either diet (Neither). Results: Differences were examined by comparing the Vegetarian and Weight‐Loss groups as well as by comparing the two diets within the Both group. Duration of the vegetarian diet was much greater than the weight‐loss diet; most participants in the Vegetarian group (62%) remained on their diet for more than 1 year, whereas the majority of the Weight‐Loss participants (61%) followed their diet for 1 to 3 months. Similar results were found when comparing the two diets within the Both group. How strictly the two diets were followed, however, did not differ. Analyses revealed that reasons for discontinuing a diet varied; participants were more likely to cite boredom as a reason for discontinuing a weight‐loss diet than a vegetarian diet (53% vs. 5% between groups and 30% vs. 10% within the Both group). Discussion: The longer duration of the vegetarian diet relative to the weight‐loss diet warrants further investigation. Results could possibly be applied to behavioral weight‐loss treatment to improve long‐term maintenance.     

Does the Method of Weight Loss Effect Long-Term Changes in Weight,Body Composition or Chronic Disease Risk Factors in Overweight or Obese Adults? A Systematic Review

Background

Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain.

Objective

To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors.

Data Sources

PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review.

Study Eligibility Criteria

Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included.

Study Appraisal and Synthesis Methods

Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up).

Results

Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.     

Does Weight Loss Maintenance Become Easier Over Time?

Objective: Studies of health‐related behaviors, including weight loss, have shown that risk of relapse decreases over time, although reasons for this relationship are unclear. The purpose of this cross‐sectional study was to determine if subjects who have maintained weight losses for varying periods of time report different strategies for weight loss maintenance or differences in the effort and pleasure associated with weight maintenance behaviors. Research Methods and Procedures: Subjects were 758 women and 173 men who had maintained losses of at least 30 lb (mean = 60 lb) for 2 years or longer (mean = 6.8 ± 7.0 years). Self‐administered questionnaires assessed subjects’ use of weight maintenance strategies in the past year and their perceptions of the effort, attention, and pleasure associated with weight maintenance. Results: Subjects who had maintained weight losses longer used fewer weight maintenance strategies and reported that less effort was required to diet and maintain weight and that less attention was required to maintain weight. The pleasure derived from exercise, low‐fat eating, and maintaining weight was unrelated to duration of weight loss maintenance. Discussion: As duration increases, a shift in the balance between the effort and pleasure of weight maintenance may occur. This shift may increase the likelihood of continued maintenance.     

Economic evaluation of weight loss interventions in overweight and obese women

Objective: To conduct a clinical and economic evaluation of outpatient weight loss strategies in overweight and obese adult U.S. women. Research Methods and Procedures: This study was a lifetime cost‐use analysis from a societal perspective, using a first‐order Monte Carlo simulation. Strategies included routine primary care and varying combinations of diet, exercise, behavior modification, and/or pharmacotherapy. Primary data were collected to assess program costs and obesity‐related quality of life. Other data were obtained from clinical trials, population‐based surveys, and other published literature. This was a simulated cohort of healthy 35‐year‐old overweight and obese women in the United States. Results: For overweight and obese women, a three‐component intervention of diet, exercise, and behavior modification cost $12,600 per quality‐adjusted life year gained compared with routine care. All other strategies were either less effective and more costly or less effective and less cost‐effective compared with the next best alternative. Results were most influenced by obesity‐related effects on quality of life and the probabilities of weight loss maintenance. Discussion: A multidisciplinary weight loss program consisting of diet, exercise, and behavior modification provides good value for money, but more research is required to confirm the impacts of such programs on quality of life and the likelihood of long‐term weight loss maintenance.     

Weight loss maintenance in severely obese adults after an intensive lifestyle intervention: 2- to 4-year follow-up

Objective: To evaluate the long‐term weight loss maintenance after 2 to 4 years in severely obese subjects after a lifestyle intervention at a weight loss camp in Denmark. Research Methods and Procedures: In a retrospective follow‐up study, we assessed weight loss after 21 weeks of treatment at a weight loss camp, weight loss maintenance after 2 to 4 years, and numbers of subjects with a weight loss maintenance of ≥10% of a total number of 435 severely obese adults participating in an intensive lifestyle intervention with a primary focus on physical activity. Results: We obtained follow‐up data of 249 subjects (180 women and 69 men) with an initial body weight of 142 ± 32 kg. After 21 weeks at the camp, the subjects had reduced their body weight with a mean of 21.9 ± 13 kg (corresponding to a 15% weight loss). The average weight loss maintenance was 5.3% at a follow‐up after 2 to 4 years, and 28.3% had maintained a weight loss above 10% after 4 years of follow‐up. Discussion: Weight loss camps are a relatively new commercial approach in treating severely obese subjects. However, the results demonstrate that even with a multidisciplinary intensive setting with focus on diet, exercise, and psychological counseling, only 28% had maintained a weight loss above 10% after 4 years. This emphasizes that obesity is a chronic condition that needs additional strategies after a weight loss intervention in the efforts to maintain a sufficient weight loss.     

A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet

Objective: The objective was to assess the effect of a low‐fat, vegan diet compared with the National Cholesterol Education Program (NCEP) diet on weight loss maintenance at 1 and 2 years. Research Methods and Procedures: Sixty‐four overweight, postmenopausal women were randomly assigned to a vegan or NCEP diet for 14 weeks, and 62 women began the study. The study was done in two replications. Participants in the first replication (N = 28) received no follow‐up support after the 14 weeks, and those in the second replication (N = 34) were offered group support meetings for 1 year. Weight and diet adherence were measured at 1 and 2 years for all participants. Weight loss is reported as median (interquartile range) and is the difference from baseline weight at years 1 and 2. Results: Individuals in the vegan group lost more weight than those in the NCEP group at 1 year [?4.9 (?0.5, ?8.0) kg vs. ?1.8 (0.8, ?4.3); p < 0.05] and at 2 years [?3.1 (0.0, ?6.0) kg vs. ?0.8 (3.1, ?4.2) kg; p < 0.05]. Those participants offered group support lost more weight at 1 year (p < 0.01) and 2 years (p < 0.05) than those without support. Attendance at meetings was associated with improved weight loss at 1 year (p < 0.001) and 2 years (p < 0.01). Discussion: A vegan diet was associated with significantly greater weight loss than the NCEP diet at 1 and 2 years. Both group support and meeting attendance were associated with significant weight loss at follow‐up.     

Prescribed “Breaks” as a Means to Disrupt Weight Control Efforts

Objective: Research on long‐term maintenance of weight loss is hampered by the fact that relapse typically does not occur until after 6 months. We sought to determine whether relapses could be induced earlier by intentionally interrupting the momentum of weight loss during a treatment program and thus provide a model for weight maintenance research. Research Methods and Procedures: Subjects (N = 142) were recruited at two centers and randomly assigned to a control group, a long break group (LB), or a short break group (SB). The control group received a standard behavioral weight loss program with 14 weekly sessions; the LB and SB groups received the same. However, the LB group took a 6‐week break after lesson 7, and the SB group took a 2‐week break after lessons 3, 6, and 9. Participants were instructed to stop all weight loss efforts during breaks. Results: Participants seemed to take breaks as prescribed, with interruptions in self‐monitoring, dietary adherence, and self‐weighing (but not in exercise). However, participants quickly resumed these behaviors after the break. Breaks produced a slowing of weight loss or slight regain, but weight losses during the breaks were not significantly different from the control group. Importantly, overall weight losses (0 to 5 months or 0 to 11 months) did not differ between conditions. Discussion: This study was not successful in developing a method to experimentally produce weight loss relapses. However, the finding that prescribed breaks do not have adverse effects may have clinical application.     

Sertraline and Relapse Prevention Training Following Treatment by Very-Low-Calorie Diet: A Controlled Clinical Trial

WADDEN, THOMAS A, SUSAN J BARTLETT, GARY D FOSTER, ROBERT A GREENSTEIN, BARBARA J WINGATE, ALBERT J STUNKARD AND KATHLEEN A LETIZIA. Sertraline and relapse prevention training following treatment by very-low-calorie diet: a controlled clinical trial. Obes Res. This study examined the combination of sertraline, a selective serotonin reuptake inhibitor, and relapse prevention training in the maintenance of weight loss following treatment by a very-low-calorie diet. A total of 53 women who had lost a mean (± SD) of 22.9 ± 7.1 kg from a pretreatment weight of 103.1 ± 17.8 kg were randomly assigned to a 54-week weight maintenance program that was combined with either: 1) 200 mg/d of sertraline; or 2) placebo. During the first 6 weeks, sertraline subjects lost significantly more weight and reported significantly greater reductions in hunger and preoccupation with food than did subjects on placebo. After this time, however, women in both conditions regained weight steadily. The 13 sertraline subjects who completed the 54-week study regained 17.7 ± 10.6 kg of their original 26.3 ± 7.6 kg loss, equal to a regain of 70.9 ± 41.7%. The 17 placebo completers regained 11.8 ± 9.0 kg of their 23.4 ± 7.8 kg loss, equal to a 46.5 ± 34.6% regain. End-of-treatment differences between groups in weight change were not statistically significant. Nor were there significant differences between the two conditions at any time in changes in fat-free mass, resting metabolic rate or dysphoria, all of which tended to increase with weight regain. The results are discussed in relation to findings from other long-term studies that combined diet and medication.     

Physical Activity as a Predictor of Weight Maintenance in Previously Obese Subjects

We examined the association between exercise and weight loss maintenance in a group of 45 previously obese subjects 2 years post very-low-calorie diet (VLCD) to suggest exercise goals for this population. At baseline, subjects weighed a mean 100 kg and had a mean total cholesterol (TC) of 5.8 mmol/L. With VLCD they lost an average 28 kg and decreased their TC by 1.6 mmol/L. Two years post-VLCD their weight and lipids were measured and they completed a physical activity survey (Paffenbarger). Subjects were grouped into tertiles by reported exercise levels: low active (< 850 kcals per week), moderate active (850–1575 kcals per week) and high active (> 1575 kcals per week). Walking accounted for the greatest calorie expenditure (65%). Analysis of variance showed that baseline characteristics and weight and blood lipid changes during the VLCD did not differ (P>0.05) among groups. At follow-up, high active patients maintained significantly greater weight loss, had a lower percent regain and a significantly greater decrease in total cholesterol (P < 0.05) than less active patients. Multiple regression analysis indicated that total exercise calories independently predicted overall weight loss and percent regain (r = 0.66 and r = 0.62, respectively). Exercise calories also predicted total cholesterol change (r=-0.37). The high active group walked more miles (16.2 per week) than the low and moderate active groups (4.8 and 9.1 per week, respectively) and exercised more days per week (5.3 vs. 1.9 and 3.7). The low and moderate active groups regained virtually equal amounts of weight, even though the moderate group expended twice as many kcals per week as the low active group. These data demonstrate that increased exercise levels enhance weight loss maintenance.     

Three-year weight change in successful weight losers who lost weight on a low-carbohydrate diet

Objective: The purpose of this study was to evaluate long‐term weight loss and eating and exercise behaviors of successful weight losers who lost weight using a low‐carbohydrate diet. Research Methods and Procedures: This study examined 3‐year changes in weight, diet, and physical activity in 891 subjects (96 low‐carbohydrate dieters and 795 others) who enrolled in the National Weight Control Registry between 1998 and 2001 and reported ≥30‐lb weight loss and ≥1 year weight loss maintenance. Results: Only 10.8% of participants reported losing weight after a low‐carbohydrate diet. At entry into the study, low‐carbohydrate diet users reported consuming more kcal/d (mean ± SD, 1895 ± 452 vs. 1398 ± 574); fewer calories in weekly physical activity (1595 ± 2499 vs. 2542 ± 2301); more calories from fat (64.0 ± 7.9% vs. 30.9 ± 13.1%), saturated fat (23.8 ± 4.1 vs. 10.5 ± 5.2), monounsaturated fat (24.4 ± 3.7 vs. 11.0 ± 5.1), and polyunsaturated fat (8.6 ± 2.7 vs. 5.5 ± 2.9); and less dietary restraint (10.8 ± 2.9 vs. 14.9 ± 3.9) compared with other Registry members. These differences persisted over time. No differences in 3‐year weight regain were observed between low‐carbohydrate dieters and other Registry members in intent‐to‐treat analyses (7.0 ± 7.1 vs. 5.7 ± 8.7 kg). Discussion: It is possible to achieve and maintain long‐term weight loss using a low‐carbohydrate diet. The long‐term health effects of weight loss associated with a high‐fat diet and low activity level merits further investigation.     

Dietary adherence during weight loss predicts weight regain

This study examined the relationship between previous dietary adherence during a low-calorie diet weight loss intervention and subsequent weight change during a 2-year follow-up for weight maintenance. One hundred and sixteen healthy, recently weight reduced (lost ~12 kg, BMI 22-25 kg/m2) premenopausal women were studied. Dietary adherence was assessed by doubly labeled water (DLW) and body composition change. Comparisons were made between the upper and lower tertiles for previous dietary adherence and subsequent weight change at 1- and 2-year follow-up. Percent weight regained was significantly lower (30.9 ± 6.7% vs. 66.7 ± 9.4%; P < 0.05) in the upper compared to the lower adherence tertile for previous weight loss dietary adherence (49.9 ± 8.8% vs. 96.8 ± 12.8% P < 0.05) at 1- and 2-year follow-up, respectively. This difference was partly explained by increases in daily activity-related energy expenditure (AEE) (+95 ± 45 kcal/day vs. -44 ± 42 kcal/day, P < 0.05) and lower daily energy intake (2,066 ± 71 kcal/day vs. 2,289 ± 62 kcal/day, P < 0.05) in the higher tertile for previous dietary adherence, compared to the lower. These findings suggest that higher adherence (i.e., higher tertile) to the previous low-calorie diet predicts lower weight regain over 2-year follow-up for weight maintenance, which is explained by lower energy intake and higher physical activity. Finally, how well an individual adheres to a low-calorie diet intervention during weight loss may be a useful tool for identifying individuals who are particularly vulnerable to subsequent weight regain.     

Exercise‐Induced Reduction in Obesity and Insulin Resistance in Women: a Randomized Controlled Trial

Objectives : To determine the effects of equivalent diet‐ or exercise‐induced weight loss and exercise without weight loss on subcutaneous fat, visceral fat, and insulin sensitivity in obese women. Research Methods and Procedures : Fifty‐four premenopausal women with abdominal obesity [waist circumference 110.1 ± 5.8 cm (mean ± SD)] (BMI 31.3 ± 2.0 kg/m²) were randomly assigned to one of four groups: diet weight loss (n = 15), exercise weight loss (n = 17), exercise without weight loss (n = 12), and a weight‐stable control group (n = 10). All groups underwent a 14‐week intervention. Results : Body weight decreased by ～6.5% within both weight loss groups and was unchanged in the exercise without weight loss and control groups. In comparison with controls, cardiorespiratory fitness improved within the exercise groups only (p < 0.01). Reduction in total, abdominal, and abdominal subcutaneous fat within the exercise weight loss group was greater (p < 0.001) than within all other groups. The reduction in total and abdominal fat within the diet weight loss and exercise without weight loss groups was greater than within controls (p < 0.001) but not different from each other (p > 0.05). Visceral fat decreased within all treatment groups (p < 0.008), and these changes were not different from each other. In comparison with the control group, insulin sensitivity improved within the exercise weight loss group alone (p < 0.001). Discussion : Daily exercise without caloric restriction was associated with substantial reductions in total fat, abdominal fat, visceral fat, and insulin resistance in women. Exercise without weight loss was also associated with a substantial reduction in total and abdominal obesity.     

Weight loss and exercise training effect on oxygen uptake and heart rate response to locomotion

Effects of resistance and aerobic training on the ease of physical activity during and after weight loss are unknown. The purpose of the study was to determine what effect weight loss combined with either aerobic or resistance training has on the ease of locomotion (net V[Combining Dot Above]O2 and heart rate). It is hypothesized that exercise training will result in an increased ease, lowers heart rate during locomotion. Seventy-three overweight premenopausal women were assigned to diet and aerobic training, diet and resistance training, or diet only. Subjects were evaluated while overweight, after diet-induced weight loss (average, 12.5 kg loss), and 1 year after weight loss (5.5 kg regain). Submaximal walking, grade walking, stair climbing, and bike oxygen uptake and heart rate were measured at all time points. Weight loss diet was 800 kcal per day. Exercisers trained 3 times per week during weight loss and 2 times per week during 1-year follow-up. Resistance training increased strength, and aerobic training increased maximum oxygen uptake. Net submaximal oxygen uptake was not affected by weight loss or exercise training. However, heart rate during walking, stair climbing, and bicycling was reduced after weight loss. No significant differences in reduction in heart rate were observed among the 3 treatment groups for locomotion after weight loss. However, during 1-year follow-up, exercise training resulted in maintenance of lower submaximal heart rate, whereas nonexercisers increased heart rate during locomotion. Results suggest that moderately intense exercise is helpful in improving the ease of movement after weight loss. Exercise training may be helpful in increasing the participation in free-living physical activity.     

Binge Eating Disorder Affects Outcome of Comprehensive Very-Low-Calorie Diet Treatment

To determine the effects of binge eating disorder (BED) on weight loss and maintenance in women undergoing treatment for obesity, we studied the weight changes of 38 women (body mass index >30 kg/m²), 21 of whom met proposed criteria for BED and 17 of whom reported few problems with binge eating, during and after a 26-week comprehensive very-low-calorie diet (VLCD) treatment program. All 17 subjects without and 16/21 subjects with BED returned for four follow-up visits over 12 months (p=0.05). While a similar proportion of subjects with and without BED reported absolute adherence to both the modified fast and refeeding, those with BED showed a significantly different distribution in energy intake from those without BED, with fewer small and more large lapses among those who deviated from the diet (p<0.05). There was no significant difference in mean weight loss over the 26 weeks of treatment, but subjects with BED showed significantly diminished weight loss during the middle third of treatment (p<0.05). Black subjects, regardless of the presence of BED, lost significantly less weight during treatment than white subjects (p<0.005). Although there was no significant difference in mean weight loss at any of the four follow-up visits between subjects with and without BED, 25% of subjects with BED had regained >50% of their lost weight by three-month follow-up, vs. no subjects without the disorder (p<0.05). One year after completing treatment, approximately half of BED (+) and BED (-) subjects had a good outcome, maintaining a weight loss ≥10% of initial body weight. However, 35% of subjects with BED, and none of the subjects without BED, had a poor outcome (p<0.05). We conclude that many individuals with BED will respond well to a medically supervised comprehensive VLCD program, attaining medically significant weight loss. However, this subgroup appears to be at risk for early major regain of lost weight and for poor outcome one year following weight-loss treatment.     

Valuing the Benefits of Weight Loss Programs: An Application of the Discrete Choice Experiment

Objective: Obesity is a leading health threat. Determination of optimal therapies for long‐term weight loss remains a challenge. Evidence suggests that successful weight loss depends on the compliance of weight loss program participants with their weight loss efforts. Despite this, little is known regarding the attributes influencing such compliance. The purpose of this study was to assess, using a discrete choice experiment (DCE), the relative importance of weight loss program attributes to its participants and to express these preferences in terms of their willingness to pay for them. Research Methods: A DCE survey explored the following weight loss program attributes in a sample of 165 overweight adults enrolled in community weight loss programs: cost, travel time required to attend, extent of physician involvement (e.g., none, monthly, every 2 weeks), components (e.g., diet, exercise, behavior change) emphasized, and focus (e.g., group, individual). The rate at which participants were willing to trade among attributes and the willingness to pay for different configurations of combined attributes were estimated using regression modeling. Results: All attributes investigated appeared to be statistically significant. The most important unit change was “program components emphasized” (e.g., moving from diet only to diet and exercise). Discussion: The majority of participants were willing to pay for weight loss programs that reflected their preferences. The DCE tool was useful in quantifying and understanding individual preferences in obesity management and provided information that could help to maximize the efficiency of existing weight loss programs or the design of new programs.     

Exercise Training Prevents Regain of Visceral Fat for 1 Year Following Weight Loss

The purpose of this study was to determine what effect aerobic and resistance exercise training has on gain of visceral fat during the year following weight loss. After being randomly assigned to aerobic training, resistance training, or no exercise training, 45 European‐American (EA) and 52 African‐American (AA) women lost 12.3 ± 2.5 kg on a 800 kcal/day diet. Computed tomography was used to measure abdominal subcutaneous and visceral adipose tissue, whereas total fat and regional fat (leg, arm, and trunk) were measured by dual energy X‐ray absorptiometry after weight loss and 1 year following the weight loss. Because not all the subjects adhered to the 2 time/week 40 min/day exercise training during the 1‐year follow‐up, subjects were divided into five groups for analysis: aerobic adherers, aerobic nonadherers, resistance adherers, resistance nonadherers, and no exercise. No significant differences were observed between the aerobic training and resistance training adherers for any variable. However, the aerobic (3.1 kg) and resistance (3.9 kg) exercise adherers gained less weight than any of the other three groups (all >6.2 kg). In addition, the two exercise adherence groups did not significantly increase visceral fat (<0.8%) as compared with the 38% increase for the two nonadhering exercise groups and the 25% for the nonexercise group. In conclusion, as little as 80 min/week aerobic or resistance training had modest positive effects on preventing weight regain following a diet‐induced weight loss. More importantly, both aerobic and resistance training prevented regain of potentially harmful visceral fat.     

Changes in Self-Efficacy and Decisional Balance for Exercise among Obese Women in a Weight Management Program

PINTO, BERNARDINE M., MATTHEW W. CLARK, DEAN G. CRUESS, LYNDA SZYMANSKI, AND VINCENT PERA. Changes in self-efficacy and decisional balance for exercise among obese women in a weight management program. Obes Res. Objective: To assess changes in eating and exercise self-efficacy and decisional balance for exercise in an obese population enrolled in a multi-disciplinary weight management program. Research Method and Procedures: Thirty-two obese women were assessed at entry and after 12 weeks of treatment. Results: Participants showed 15% mean weight loss after 12 weeks of treatment. Mean minutes of self-reported exercise increased by 229%. Participants demonstrated significant improvements in self-efficacy for both eating and exercise and health parameters but not in decisional balance for exercise adoption. Discussion: These results may have implications for the practitioner in that self-efficacy changes occur during successful weight loss, but decisional balance for exercise may not change until individuals enter maintenance. These results imply that practitioners may be advised to shift from confidence building to relapse prevention early on in treatment, and that focusing on strengthening the pros of exercise and reducing the cons of exercise may need to remain constant during treatment.