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Objective: Reduced schedules of dietary self-monitoring are typically recommended after the end of behavioral weight-loss programs; however, there exists little empirical evidence to guide these recommendations., Methods: We explored potential thresholds for dietary self-monitoring during a 9-month maintenance period following a 3-month weight-loss program in 74 adults with overweight or obesity (mean [SD] age = 50.7 [10.4] years, BMI = 31.2 [4.5] kg/m 2 ) who were encouraged to self-monitor weight, dietary intake, and physical activity daily and report their adherence to self-monitoring each week via a study website., Results: Greater self-monitoring was correlated with less weight regain for thresholds of ≥3 days/week, with the largest benefit observed for thresholds of ≥5 to ≥6 days/week (all p < 0.05); significant weight gain was observed for thresholds of ≥1 to ≥2 days/week, whereas no change in weight was observed for thresholds of ≥3 to ≥4 days/week, and weight loss was observed with thresholds of ≥5 or more days/week., Conclusions: Results demonstrate that self-monitoring at least 3 days/week may be beneficial for supporting long-term maintenance, although greater benefit (in relation to weight loss) may be realized at thresholds of 5 to 6 days/week. Future research should investigate whether individuals who were randomized to self-monitor at these different thresholds demonstrate differential patterns of weight-loss maintenance., (© 2024 The Obesity Society.)

Objective: The aim of this study was to develop a predictive algorithm of "high-risk" periods for weight regain after weight loss., Methods: Longitudinal mixed-effects models and random forest regression were used to select predictors and develop an algorithm to predict weight regain on a week-to-week basis, using weekly questionnaire and self-monitoring data (including daily e-scale data) collected over 40 weeks from 46 adults who lost ≥5% of baseline weight during an initial 12-week intervention (Study 1). The algorithm was evaluated in 22 adults who completed the same Study 1 intervention but lost <5% of baseline weight and in 30 adults recruited for a separate 30-week study (Study 2)., Results: The final algorithm retained the frequency of self-monitoring caloric intake and weight plus self-report ratings of hunger and the importance of weight-management goals compared with competing life demands. In the initial training data set, the algorithm predicted weight regain the following week with a sensitivity of 75.6% and a specificity of 45.8%; performance was similar (sensitivity: 81%-82%, specificity: 30%-33%) in testing data sets., Conclusions: Weight regain can be predicted on a proximal, week-to-week level. Future work should investigate the clinical utility of adaptive interventions for weight-loss maintenance and develop more sophisticated predictive models of weight regain., (© 2023 The Obesity Society.)

Objective: This study evaluated whether the transition of a face-to-face behavioral intervention to videoconferencing-based telehealth delivery during the COVID-19 pandemic resulted in significantly smaller weight losses than those typically observed in gold-standard, face-to-face programs., Methods: Participants were 160 adults with obesity (mean [SD] age = 49.2 [11.9] years, BMI = 36.1 [4.2] kg/m 2 ) enrolled in two cohorts of a 16-week comprehensive weight-management program. Cohort 1 began in person and transitioned to telehealth (Zoom) delivery during week 11 of the intervention because of COVID-19; Cohort 2 was conducted completely remotely. A noninferiority approach (using a clinically relevant noninferiority margin of 2.5%) was used to assess whether the weight losses observed were inferior to the 8% losses from baseline typically produced by gold-standard, face-to-face lifestyle interventions., Results: From baseline to postintervention, participants lost an average of 7.4 [4.9] kg, representing a reduction of 7.2% [4.6%]. This magnitude of weight change was significantly greater than 5.5% (t[159] = 4.7, p < 0.001), and, thus, was within the proposed noninferiority margin., Conclusions: These findings demonstrate that the results of behavioral weight-management interventions are robust, whether delivered in person or remotely, and that individuals can achieve clinically meaningful benefits from behavioral treatment even during a global pandemic. Pragmatic "lessons learned," including modified trial recruitment techniques, are discussed., (© 2022 The Obesity Society.)

Objective: This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research., Methods: A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention)., Results: COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest., Conclusions: These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations., (© 2020 The Obesity Society.)

Objective: This study aimed to investigate the roles of frequency and consistency of self-weighing in promoting weight-loss maintenance., Methods: Participants were 74 adults who completed a 3-month internet-based weight-loss program followed by a 9-month no-intervention maintenance period. Frequency of self-weighing was defined as the number of days that participants self-weighed during the maintenance period via a study-provided smart scale. Consistency was defined as the number of weeks that participants self-weighed at a certain frequency, with multiple minimum thresholds examined. Hierarchical regression analyses were used to assess associations among frequency, consistency, and weight change during the maintenance period., Results: Greater consistency was significantly associated with less weight regain when defined as the number of weeks that participants self-weighed on ≥6 d/wk or 7 d/wk (P values < 0.05). Contrary to hypotheses, frequency was not associated with weight change (P = 0.141), and there was not a significant interaction between frequency and consistency., Conclusions: Results demonstrate that consistency of self-weighing may be more important than total frequency for preventing weight regain after the end of a weight-loss program. Further, results suggest that a high level of consistency (self-weighing for ≥6 d/wk or 7 d/wk) may be necessary to promote successful weight-loss maintenance., (© 2020 The Obesity Society.)

Objective: Greater frequency of self-weighing has been associated with greater weight loss in weight management interventions, but little is known regarding the accuracy of self-reported weight data., Methods: Agreement between objective smart-scale and self-reported weight data was assessed in 74 adults (age = 50.7 years; BMI = 31.2 kg/m 2 ) enrolled in a 12-week, Internet-based weight management program. Participants were asked to self-weight daily using a study-provided smart scale and to self-report weights via the study website., Results: There was strong agreement between smart-scale and self-reported weight values (intraclass correlation = 0.982) but only moderate agreement regarding frequency of self-weighing assessed via each method (κ = 0.491; P < 0.0001). Greater self-weighing frequency was associated with greater weight loss across measures (all P < 0.001). Compared with days when participants did both, weights were 0.66 kg higher on days when participants self-weighed via the smart scale but did not self-report weight (8% of days) and 0.58 kg higher on days when they self-reported weight but did not self-weigh via the smart scale (4% of days; all P < 0.0001)., Conclusions: Results suggest that self-reported weight values are similar to smart-scale measurements; however, either method alone may underestimate self-weighing frequency. Furthermore, missing self-weighing data should not be treated as ignorable because weights may be higher than those observed on nonmissing days., (© 2019 The Obesity Society.)

Objective: Although the trajectory of weight change during and/or after behavioral weight management interventions is believed to include a period of weight loss followed by maintenance and later regain, the sparse data produced by existing study designs (conducting assessments at 3- to 6-month intervals) have limited investigation into the precise pattern., Methods: Seventy-five adults were asked to self-weigh daily via "smart" scales during a 12-week, Internet-based weight loss program and for an additional 9 months with no further intervention. Longitudinal change-point mixed-effect models were used to characterize overall weight change patterns and identify when individuals moved from weight loss to maintenance/regain., Results: Analyses suggested a three-phase model. During the first phase, participants lost weight at a (mean ± SE) rate of -0.46 ± 0.04 kg/wk; after 77.66 ± 3.96 days, they transitioned to regain (0.07 ± 0.02 kg/wk). The next transition occurred at 222.55 ± 7.23 days, after which the rate of regain decreased slightly (0.06 ± 0.02 kg/wk). Exploratory analyses identified baseline/demographic factors predicting the timing of transition points and slope of weight change within phases., Conclusions: In contrast to the hypothesized trajectory, results demonstrated that participants transitioned immediately from weight loss to regain (with no "maintenance" period) and later to a slower rate of regain. Future studies should investigate whether extended-care programs change or merely delay this pattern., (© 2017 The Obesity Society.)

Objective: To determine whether an acceptance-based behavioral intervention (ABBI) produces better weight losses than standard behavioral treatment (SBT) among individuals reporting high internal disinhibition., Methods: Participants were 162 adults with overweight or obesity (mean BMI 37.6 kg/m 2 ) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on weight change and internal disinhibition change over 24 months., Results: Mixed models analysis showed mean weight loss at 24 months was -4.1% (SE = 0.88) for ABBI and -2.4% (SE = 0.87) for SBT (P = 0.204). Secondary analyses showed that the ABBI group regained less weight from the end of treatment to the final follow-up (4.6 vs. 7.1 kg; P = 0.005), and that a significantly higher proportion of ABBI participants achieved a 5% weight loss (38% vs. 25%; P = 0.038) at 24 months., Conclusions: Results suggest that ABBI could be helpful for improving the maintenance of weight loss for individuals who report high internal disinhibition., Competing Interests: The authors declare that they have no conflict of interest., (© 2016 The Obesity Society.)

Objective: Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day., Methods: Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m 2 , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake., Results: Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F (1,5106)  = 12.66, P = 0.0004, β = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33., Conclusions: Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence., Competing Interests: The authors declare no conflicts of interest., (© 2016 The Obesity Society.)

Objective: Despite the proliferation of newer self-monitoring technology (e.g., activity monitors and smartphone apps), their impact on weight loss outside of structured in-person behavioral intervention is unknown., Methods: A randomized, controlled pilot study was conducted to examine efficacy of self-monitoring technology, with and without phone-based intervention, on 6-month weight loss in adults with overweight and obesity. Eighty participants were randomized to receive standard self-monitoring tools (ST, n = 26), technology-based self-monitoring tools (TECH, n = 27), or technology-based tools combined with phone-based intervention (TECH + PHONE, n = 27). All participants attended one introductory weight loss session and completed assessments at baseline, 3 months, and 6 months., Results: Weight loss from baseline to 6 months differed significantly between groups P = 0.042; there was a trend for TECH + PHONE (-6.4 ± 1.2 kg) to lose more weight than ST (-1.3 ± 1.2 kg); weight loss in TECH (-4.1 ± 1.4 kg) was between ST and TECH + PHONE. Fewer ST (15%) achieved ≥5% weight losses compared with TECH and TECH + PHONE (44%), P = 0.039. Adherence to self-monitoring caloric intake was higher in TECH + PHONE than TECH or ST, Ps < 0.05., Conclusions: These results suggest use of newer self-monitoring technology plus brief phone-based intervention improves adherence and weight loss compared with traditional self-monitoring tools. Further research should determine cost-effectiveness of adding phone-based intervention when providing self-monitoring technology., (© 2016 The Obesity Society.)