Self-Efficacy Based Treatment for Long-term Weight LossObesity is a major, chronic health problem associated with an extremely high rate of relapse. Approximately80% of of adults who intentionally lose weight regain 50% of the weight within a year. Standard behavioraltreatment (SBT) protocols have been used in clinical trials of weight loss for nearly two decades with littleimprovement in the rates of weight loss maintenance. There is increasing evidence that self-efficacy, one'sperception of his capability to perform certain behaviors, is a factor that influences weight loss maintenanceand a focus on enhancing self-efficacy might alter outcomes. The strongest of the four sources of selfefficacyenhancement is mastery performance. While an SBT program provides standard goals for allparticipants, it does not use a tailored approach nor does it set goals in an incremental manner to increasethe likelihood of performance mastery occurring. The intervention in the proposed study will beoperationalized to build on the four sources of self-efficacy in order to enhance participants' perceptions oftheir capability to make and sustain lifestyle changes. We propose to conduct a two-group randomizedcontrolled study: the experimental group will consist of a modified SBT weight loss intervention - it willdeliver the standard content in group sessions but be supplemented by individual sessions guided by selfefficacytheory and provide tailored, incremental goals for weight loss and accordingly incremental calorieand fat restriction goals (SE + mSBT) that will be increased as the goals are achieved; the comparison groupwill receive an SBT weight loss intervention that will be delivered in group sessions and provide standardcalorie and fat restriction goals that are based on baseline weight (< or =/> 200 Ibs). We hypothesize that theexperimental group will have improved weight loss maintenance, quality of life, adherence to lifestylechange, and a reduced coronary heart disease (CHD) risk profile. The sample of 120 adults will have a bodymass index between 27 and 43 and at least two risk factors for CHD. The intervention will last 18 monthsand assessments will be conducted at 0, 6, 12, and 18 months. If demonstrated to have efficacy inmaintaining weight loss, the proposed intervention could reduce the rate of recidivism following weight losstreatment and be considered for translation to clinical practice sites.
