Few obesity prevention programs have reduced risk for weight gain over follow-up and those that have are very intensive (M duration = 52 hrs.), making dissemination difficult and costly. A brief 3-hr selective prevention program (Healthy Weight) involving participant-driven healthy dietary and physical activity lifestyle changes significantly reduced increases in BMI and obesity onset relative to alternative interventions and assessment- only controls through 3-yr follow-up. It targets young adults with body dissatisfaction as this is a prevalent risk factor for obesity and such individuals are motivated t make healthy lifestyle changes. To enhance efficacy, we added activities designed to induce dissonance regarding unhealthy dietary and activity practices, drawing from a highly efficacious dissonance-based eating disorder prevention program. Social psychology experiments show that people strive to maintain consistency between thoughts, words, and actions. Thus, we added verbal, written, and behavioral exercises wherein youth discuss costs of obesity, an unhealthy diet, and sedentary behaviors, benefits of leanness, a healthy diet, and physical activity, and institutions that contribute to obesity. Engaging in these activities putatively increases the likelihood that participants will seek to align their actions with the perspectives expressed in the sessions, resulting in healthier future lifestyle choices. A pilot trial found tha this new Project Health intervention significantly reduced increases in BMI relative to both the Healthy Weight intervention and an educational brochure condition from pre to post (d = .40 and .42 respectively), comparing favorably to effect sizes from the most efficacious intensive prevention programs. Further, other obesity prevention programs have not significantly outperformed credible alternative interventions. We propose to conduct a rigorous multisite effectiveness trial that will test whether adding the dissonance-induction elements to the originally efficacious Healthy Weight intervention improves weight gain prevention effects: 300 college students at risk for future unhealthy weight gain by virtue of body dissatisfaction will be randomized to a refined 8-hr dissonance-based Project Health intervention or an 8-hr Healthy Weight intervention, completing assessments of body fat and other outcomes at pre, post, and 6, 12, and 24 month follow-ups.
Aim 1 will test whether Project Health reduces increases in % body fat relative to Healthy Weight;secondary outcomes are depressive and eating disorder symptoms.
Aim 2 will test whether Project Health participants report cognitive dissonance regarding eating unhealthy foods and engaging in sedentary behaviors and whether changes in dissonance, as well as reported dietary intake and objectively measured activity level, mediate the effects of the intervention on change in % body fat.
Aim 3 will investigate potential moderators that may amplify (pretest body dissatisfaction, preference for consistency) or mitigate (emotional eating, substance use) intervention effects. We will improve upon most obesity prevention trials by using a long-term follow-up, an active control condition, and direct measures of body composition and activity.

Public Health Relevance

A brief effective obesity prevention program that can be easily and inexpensively disseminated could substantially reduce the incidence of obesity, which is vital because obesity is prevalent, causes marked morbidity and mortality, and is treatment resistant. The proposed project, which is based on promising preliminary data from rigorous prevention trials and a highly efficacious dissonance-based eating disorder prevention program, would be the first translational project to use persuasion principles from social psychology for obesity prevention.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD071900-03
Application #
8681491
Study Section
Clinical and Integrative Diabetes and Obesity Study Section (CIDO)
Program Officer
Haverkos, Lynne
Project Start
2012-08-20
Project End
2017-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Oregon Research Institute
Department
Type
DUNS #
City
Eugene
State
OR
Country
United States
Zip Code
97403
Stice, Eric; Rohde, Paul (2018) Attempt to Replicate Evidence that Weight and Shape Concerns Amplify the Effects of Gradual Lifestyle Improvement Obesity Prevention Programs. Obesity (Silver Spring) 26:1254
Stice, E; Rohde, P; Shaw, H et al. (2018) An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program. Int J Obes (Lond) 42:462-468
Rohde, Paul; Arigo, Danielle; Shaw, Heather et al. (2018) Relation of self-weighing to future weight gain and onset of disordered eating symptoms. J Consult Clin Psychol 86:677-687
Rohde, Paul; Desjardins, Christopher D; Arigo, Danielle et al. (2018) Mediators of two selective prevention interventions targeting both obesity and eating disorders. Behav Res Ther 106:8-17
Shaw, Heather; Rohde, Paul; Stice, Eric (2018) Using participant feedback to improve two selective eating disorder and obesity prevention programs. Eat Behav 30:93-97
Arigo, Danielle; Rohde, Paul; Shaw, Heather et al. (2017) Psychosocial Predictors of Physical Activity Change Among College Students in an Obesity Prevention Trial. J Phys Act Health 14:513-519
Rohde, Paul; Stice, Eric; Shaw, Heather et al. (2017) Age effects in eating disorder baseline risk factors and prevention intervention effects. Int J Eat Disord 50:1273-1280
Rohde, Paul; Stice, Eric; Gau, Jeff M (2017) Predicting persistence of eating disorder compensatory weight control behaviors. Int J Eat Disord 50:561-568
Stice, Eric; Yokum, Sonja; Veling, Harm et al. (2017) Pilot test of a novel food response and attention training treatment for obesity: Brain imaging data suggest actions shape valuation. Behav Res Ther 94:60-70
Stice, Eric; Yokum, Sonja; Burger, Kyle et al. (2015) A pilot randomized trial of a cognitive reappraisal obesity prevention program. Physiol Behav 138:124-32

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