Abstract
BackgroundRelapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults.MethodsA comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately.ResultsThirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as “strong”, 15 as “moderate”, and 7 studies as “weak”. In addition, methodological quality of formal mediation analyses was “medium”. Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified.ConclusionsThis is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0323-6) contains supplementary material, which is available to authorized users.
Highlights
Relapse is high in lifestyle obesity interventions involving behavior and weight change
Eligibility criteria Studies were included in this review if they were intervention studies published since 2000 in the English language, used experimental designs, and referred to clinical or community behavior change interventions with overweight/obese adults (≥18 years old) aiming to reduce overweight/obesity
Studies should report outcomes assessed at least 6 months after the start of the intervention; include a quantitative assessment of change in weight/BMI, physical activity, or dietary intake as well as a quantitative assessment of potential mediators of successful behavior change
Summary
Relapse is high in lifestyle obesity interventions involving behavior and weight change. A wide variety of health behavior change theories has been employed to provide conceptual organization of these determinants, including social cognitive theories such as the theory of planned behavior [5], theories of motivation such as self-determination theory [6], theories distinguishing between motivational and post-motivational or volitional phases [7] such as the health action process approach (HAPA) [8], and self-regulation models such as control theory [9]. There is a need for research that identifies causal predictors of long-term weight control, including successful weight loss and maintenance [17]
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