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... Motivational Goal #2: Cultivate identity as a successful weight loser The rich tradition of self-presentation and cognitive dissonance research indicates public presentation fosters private identity =-=(24)-=-. One study that used self-presentation theory to promote physical activity among African-American adolescents found that teens who made a video for their peers describing ways to increase physical ac...

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...d be no weight change from baseline (entry into weight loss trial) among subjects lost to follow-up. Summary effect estimates and standard errors were computed using standard methods for imputed data =-=(39)-=-. The effect of the intervention method on weight maintenance was evaluated for moderation effects of race and autonomous self regulation and body weight at the beginning of the maintenance phase. No ...

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...d amplifying personal motivations for behavior change while resolving ambivalence surrounding the behavior change (8) is consistent with other motivational theories, such as self determination theory =-=(12)-=-, which suggests that successful long-term weight maintenance is expected when the reasons for self-regulation are volitional or autonomous. Some evidence suggests that higher levels of autonomous sel...

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...vated by the desire to avoid returning to an unfavorable baseline state. This distinction forms a central conceptual foundation for the novel maintenance program. Similarly, motivational interviewing =-=(8)-=- is a key component of our novel approach. MI has been demonstrated to be effective in promoting behavior change across a range of health arenas (9), including weight loss (10,11). The focus of MI on ...

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...oss, few have proven successful in preventing regain (1,2). Individuals who continue to engage in modified dietary and physical activity behaviors are most likely to successfully maintain weight loss =-=(3,4)-=-. Thus, current behavioral weight loss maintenance approaches typically focus on helping participants refine dietary and exercise self-management skills that initially produced weight loss (5,6). Alth...

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...al Foundation Several current theories of motivation are relevant to weight loss maintenance and informed the theoretically-based motivation-focused program tested in this trial. For example, Rothman =-=(7)-=- speculated that initiation of behavior change is motivated by the desire to achieve positive future goals; whereas, maintenance is motivated by the desire to avoid returning to an unfavorable baselin...

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...tenance is expected when the reasons for self-regulation are volitional or autonomous. Some evidence suggests that higher levels of autonomous selfregulation predict more successful weight management =-=(13,14)-=-, with internalization of perceived autonomous reasons for behavior change hypothesized to prompt continued self regulation and long term success. However, current maintenance approaches do not explic...

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...sed on reviewing and refining behavioral skills in problem solving, goal setting, social support, and relapse prevention. New skill development topics introduced included reversing small weight gains =-=(18)-=-, improving body image and self esteem (19), and expanding exercise options. Motivation-focused Maintenance Program—This novel maintenance intervention focused on increasing and sustaining motivation ...

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...ht loss programs has been shown to enhance weight loss outcomes compared with the skillbased approach alone (10,11) and MI techniques are consistent with efforts to support autonomous self regulation =-=(12,27)-=-. In the motivation-focused program, women were encouraged to identify their personal reasons for weight management and to identify their core personal values (e.g. religion, family, health) to determ...

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...s randomized to behavioral weight control regardless of maintenance condition. The 24-session program was modeled after the Diabetes Prevention Program (16) and the Look AHEAD lifestyle interventions =-=(17)-=-. Weekly group sessions included an individual weigh in and followed a structured protocol. Participants were encouraged to lose 10% of their baseline body weight. A reduced calorie balanced diet was ...

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...trinsic motivation (reasons that are imposed externally). The two TSRQ subscales (Autonomous Self Regulation and Controlled Self Regulation) have been demonstrated to be valid across health behaviors =-=(32)-=-, with higher scores indicating greater levels of motivation. Autonomous regulation measured by this questionnaire predicts successful weight loss among morbidly obese individuals engaged in a very lo...

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...ng the maintenance program included attendance at group sessions and submission of self-monitoring diaries. Both of these parameters are consistently associated with better obesity treatment outcomes =-=(16,37,38)-=-. West et al. Page 6 Int J Obes (Lond). Author manuscript; available in PMC 2011 August 1. N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript Data Analysis Baseline de...

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...her sources of pleasurable activity can provide positive coping strategies to replace more dysfunctional patterns (29). Further, increasing the frequency of pleasant events can reduce dysphoric moods =-=(30)-=-, and higher levels of depressive symptoms may interfere with sustained weight maintenance (3). Early obesity treatment research focused on increasing alternative sources of reinforcement (31), but re...

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...tenance is expected when the reasons for self-regulation are volitional or autonomous. Some evidence suggests that higher levels of autonomous selfregulation predict more successful weight management =-=(13,14)-=-, with internalization of perceived autonomous reasons for behavior change hypothesized to prompt continued self regulation and long term success. However, current maintenance approaches do not explic...

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... loss (3,4). Thus, current behavioral weight loss maintenance approaches typically focus on helping participants refine dietary and exercise self-management skills that initially produced weight loss =-=(5,6)-=-. Although existing weight maintenance programs place tremendous emphasis on behavioral skill refinement, it is unlikely that regain is due solely, or even primarily, to a skill deficit. Rather, parti...

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...milarly, adult dialysis patients who made a video describing their successful coping strategies later reported better psychological adjustment than patients discussing difficulties with their disease =-=(26)-=-. Using a paradigm similar to this, participants were videotaped discussing the positive things done to produce weight loss, increase exercise and/or improve eating habits, and strategies to overcome ...

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...th the outcomes they have obtained, they will be more likely to continue maintaining new behaviors. The intuitive appeal of this model is strong, and while empirical tests have produced mixed results =-=(20,21)-=-, in general, greater satisfaction with weight loss outcomes is associated with better long-term maintenance (22). Therefore, the motivationfocused intervention sought to remind participants of unfavo...

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...peal of this model is strong, and while empirical tests have produced mixed results (20,21), in general, greater satisfaction with weight loss outcomes is associated with better long-term maintenance =-=(22)-=-. Therefore, the motivationfocused intervention sought to remind participants of unfavorable aspects of their pre-weight loss state and to heighten their satisfaction with their post-weight loss state...

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... loss (3,4). Thus, current behavioral weight loss maintenance approaches typically focus on helping participants refine dietary and exercise self-management skills that initially produced weight loss =-=(5,6)-=-. Although existing weight maintenance programs place tremendous emphasis on behavioral skill refinement, it is unlikely that regain is due solely, or even primarily, to a skill deficit. Rather, parti...

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...to promote physical activity among African-American adolescents found that teens who made a video for their peers describing ways to increase physical activity reported greater exercise self-efficacy =-=(25)-=-. Similarly, adult dialysis patients who made a video describing their successful coping strategies later reported better psychological adjustment than patients discussing difficulties with their dise...

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...ting the congruence between personal values and weight loss behaviors were used to support and promote internalization of autonomous motivations to engage in recommended weight maintenance behaviors. =-=(28)-=-. An autonomysupportive approach such as this has recently been demonstrated useful in weight maintenance by investigators using a self-determination theory based intervention (14). Motivational Goal ...

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...weight loss among morbidly obese individuals engaged in a very low calorie diet (13). Further, an MI-based intervention for dietary change demonstrated increased autonomous motivation on this measure =-=(33)-=-. Participants indicated the degree to which they focused on positive progress to sustain engagement in weight control behaviors using a single-item question (“the way I keep trying to maintain my wei...

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...y. Higher scores indicate higher levels of non-food related, self-reinforcing activities. Measures of Self Identity—Self identify was assessed using an adaptation of the Exercise Identity Scale (EIS) =-=(34,35)-=-. EIS items inquire about the degree to which an individual agrees with statements reflecting greater self identity as an exerciser using a 5point scale, with higher scores denoting greater salience o...

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...h and the novel motivation-focused program. The final 18-month weight loss average of −5.5% among women in the skill-based group is comparable to outcomes reported for the Diabetes Prevention Program =-=(40)-=- and other behavioral obesity programs (5). Thus, the skill-based West et al. Page 9 Int J Obes (Lond). Author manuscript; available in PMC 2011 August 1. N IH -PA Author M anuscript N IH -PA Author M...

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...oss, few have proven successful in preventing regain (1,2). Individuals who continue to engage in modified dietary and physical activity behaviors are most likely to successfully maintain weight loss =-=(3,4)-=-. Thus, current behavioral weight loss maintenance approaches typically focus on helping participants refine dietary and exercise self-management skills that initially produced weight loss (5,6). Alth...

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...otivational interviewing (8) is a key component of our novel approach. MI has been demonstrated to be effective in promoting behavior change across a range of health arenas (9), including weight loss =-=(10,11)-=-. The focus of MI on identifying and amplifying personal motivations for behavior change while resolving ambivalence surrounding the behavior change (8) is consistent with other motivational theories,...

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...th the outcomes they have obtained, they will be more likely to continue maintaining new behaviors. The intuitive appeal of this model is strong, and while empirical tests have produced mixed results =-=(20,21)-=-, in general, greater satisfaction with weight loss outcomes is associated with better long-term maintenance (22). Therefore, the motivationfocused intervention sought to remind participants of unfavo...

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...on research suggests that developing a balanced lifestyle that includes hobbies and other sources of pleasurable activity can provide positive coping strategies to replace more dysfunctional patterns =-=(29)-=-. Further, increasing the frequency of pleasant events can reduce dysphoric moods (30), and higher levels of depressive symptoms may interfere with sustained weight maintenance (3). Early obesity trea...

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...y; motivational interviewing Long-term weight control is an elusive goal in obesity treatment. Although several approaches produce initial weight loss, few have proven successful in preventing regain =-=(1,2)-=-. Individuals who continue to engage in modified dietary and physical activity behaviors are most likely to successfully maintain weight loss (3,4). Thus, current behavioral weight loss maintenance ap...

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...d in this manuscript. NIH Public Access Author Manuscript Int J Obes (Lond). Author manuscript; available in PMC 2011 August 1. Published in final edited form as: Int J Obes (Lond). 2011 February ; 35=-=(2)-=-: 259–269. doi:10.1038/ijo.2010.138. N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript Results—Both treatment groups (motivation-focused and skill-based) achieved com...

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...nance program. Similarly, motivational interviewing (8) is a key component of our novel approach. MI has been demonstrated to be effective in promoting behavior change across a range of health arenas =-=(9)-=-, including weight loss (10,11). The focus of MI on identifying and amplifying personal motivations for behavior change while resolving ambivalence surrounding the behavior change (8) is consistent wi...

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...otivational interviewing (8) is a key component of our novel approach. MI has been demonstrated to be effective in promoting behavior change across a range of health arenas (9), including weight loss =-=(10,11)-=-. The focus of MI on identifying and amplifying personal motivations for behavior change while resolving ambivalence surrounding the behavior change (8) is consistent with other motivational theories,...

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...ntinence through Diet and Exercise; PRIDE). Details of this trial and 6-month outcomes demonstrating that lifestyle intervention is an effective treatment for urinary incontinence have been published =-=(15)-=-. In brief, 338 overweight and obese women with urinary incontinence were recruited between July 2004 and April 2006 in Providence, Rhode Island and Birmingham, Alabama. Women were eligible to partici...

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...ills in problem solving, goal setting, social support, and relapse prevention. New skill development topics introduced included reversing small weight gains (18), improving body image and self esteem =-=(19)-=-, and expanding exercise options. Motivation-focused Maintenance Program—This novel maintenance intervention focused on increasing and sustaining motivation to utilize the dietary, physical activity, ...

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... recall of the aversive impact excessive weight had at baseline, participants wore a backpack with ten pounds of flour while they climbed stairs to recreate the experience of being ten pounds heavier =-=(23)-=-. Sessions also emphasized positive progress made by having participants “brag” about their accomplishments. West et al. Page 4 Int J Obes (Lond). Author manuscript; available in PMC 2011 August 1. N ...

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...c moods (30), and higher levels of depressive symptoms may interfere with sustained weight maintenance (3). Early obesity treatment research focused on increasing alternative sources of reinforcement =-=(31)-=-, but recent treatment recent has emphasized this less. Thus, a systematic focus on developing a balanced lifestyle that includes hobbies and other enjoyable activities that do not contribute negative...

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...y. Higher scores indicate higher levels of non-food related, self-reinforcing activities. Measures of Self Identity—Self identify was assessed using an adaptation of the Exercise Identity Scale (EIS) =-=(34,35)-=-. EIS items inquire about the degree to which an individual agrees with statements reflecting greater self identity as an exerciser using a 5point scale, with higher scores denoting greater salience o...

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...ence of exercise to self identity. The measure has established reliability and good construct validity (34,35) and has been shown to be sensitive to changes following a physical activity intervention =-=(36)-=-. Four items from the EIS were administered and items were also adapted to examine self concept as a successful weight maintainer and a successful dieter. Treatment Adherence—Adherence data collected ...

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...ng the maintenance program included attendance at group sessions and submission of self-monitoring diaries. Both of these parameters are consistently associated with better obesity treatment outcomes =-=(16,37,38)-=-. West et al. Page 6 Int J Obes (Lond). Author manuscript; available in PMC 2011 August 1. N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript Data Analysis Baseline de...