Despite the benefits of weight loss, attempts at weight-loss maintenance are short-lived. Once active maintenance interventions end, individuals often give up lifestyle and self-regulatory changes and regain the weight they lost. We propose that individuals need to learn a novel set of stability skills that optimize current satisfaction with lifestyle and self-regulatory habits: (a) learn to eat a healthy diet and be more active without feeling deprived (relative deprivation theory) and (b) learn to regulate or 'fine-tune' the balance between eating, activity, and weight with the minimum effort and attention necessary (limited resources theory). We also propose that individuals will be more successful if they learn these stability skills before initiating weight loss (i.e., stability first), thus, capitalizing on initial motivation, providing mastery, and increasing self-efficacy for maintaining a stable weight in the future (social cognitive theory). The current revision will test whether learning stability skills before losing weight improves long-term weight management (i.e., during a subsequent follow-up). In this randomized trial, 232 overweight and obese adults will be randomly assigned to 1 of 2 conditions. In the Stability Skills condition, individuals will initially learn stability skills in a 3-month preparatory module before participating in a standard 6-month behavioral weight-loss program. In the Control condition, individuals will initially learn nutrition consumer skills (of demonstrated interest to participants but unrelated to weight stability and maintenance) in a 3-month preparatory module before participating a standard weight-loss program identical to that received in Stability Skills. Participants in both conditions will be assessed during a 12-month follow-up after the weight-loss programs; offered the same number of classes during the 9-month intervention period; and will start and finish the 6-month weight loss programs at the same time. Outcomes will be measured at baseline, 3, 9, 15 and 21 months. Primary aims will examine whether Stability Skills individuals (1a) gain less weight during the 12-month follow-up; and (1b) lose more weight over the entire 21-month study than Control individuals. Secondary aims will: (2a) examine condition differences on lifestyle and self-regulatory changes (e.g., diet, activity, weighing), psychological outcomes (e.g., depressive symptoms), and weight stability; (2b) examine baseline moderators (e.g., gender); and (2c) investigate mediators (e.g., deprivation, effort and attention, and self-efficacy). ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA112594-02
Application #
7468017
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Nebeling, Linda C
Project Start
2007-07-11
Project End
2011-05-31
Budget Start
2008-06-01
Budget End
2009-05-31
Support Year
2
Fiscal Year
2008
Total Cost
$494,227
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Kiernan, Michaela; Brown, Susan D; Schoffman, Danielle E et al. (2013) Promoting healthy weight with ""stability skills first"": a randomized trial. J Consult Clin Psychol 81:336-46
Kiernan, M; Schoffman, D E; Lee, K et al. (2013) The Stanford Leisure-Time Activity Categorical Item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women. Int J Obes (Lond) 37:1597-602
Kiernan, Michaela; Moore, Susan D; Schoffman, Danielle E et al. (2012) Social support for healthy behaviors: scale psychometrics and prediction of weight loss among women in a behavioral program. Obesity (Silver Spring) 20:756-64
Brown, Susan D; Lee, Katherine; Schoffman, Danielle E et al. (2012) Minority recruitment into clinical trials: experimental findings and practical implications. Contemp Clin Trials 33:620-3
Moore, Susan D; King, Abby C; Kiernan, Michaela et al. (2011) Outcome expectations and realizations as predictors of weight regain among dieters. Eat Behav 12:60-3