THE ROLE OF BEHAVIORAL TREATMENT AND STRESS ON DIETARY LAPSE: SECONDARY ANALYSIS OF ECOLOGICAL MOMENTARY ASSESSMENT SURVEY DATA DURING A WEIGHT LOSS PROGRAM

Abstract

Introduction: Overweight and obesity are growing problems in the United States, as these conditions are frequently associated with chronic diseases that may lead to morbidity and premature mortality. Behavioral interventions for weight loss have shown promise in decreasing body weight and improving health in adults with overweight and obesity. However, weight loss interventions may be undermined by dietary lapses. Stress is a known risk factor of overweight and obesity, and may affect dietary lapse as it has been associated with enhanced appetite and increased energy intake. Therefore, studying behavioral treatment strategies and their possible role as modifiers of the effect of stress on lapse may help inform improved strategies for the future. Objectives: This secondary analysis aims to study the effectiveness of acceptance-based strategies in reducing dietary lapses throughout a 12-month weight loss program compared to a standard behavioral treatment. Furthermore, it will investigate whether the effect of stress on lapse occurrence is modified by treatment condition. Methods: Data analyses were performed using ecological momentary assessment survey data obtained from 189 participants with overweight and obesity that had participated in a 12-month weight loss program, and had been randomized to either acceptance-based or standard behavioral treatment. Mixed effects regression models with information on participants’ stress level and lapse occurrence collected at multiple instances at baseline (first 3 weeks), mid-treatment (at 6 months), and end-of-treatment (at 12 months) were used to answer the research questions presented in this study. Results: The acceptance-based treatment (ABT) was shown to decrease the odds of lapsing compared to the standard behavioral treatment (SBT) at mid-treatment in the model controlling for gender (OR = 0.716, CI [0.516, 0.994]). In the model with data from female participants only, ABT was also shown to decrease the odds of lapsing compared to SBT (OR = 0.686, CI [0.489, 0.964]). At end-of-treatment the decrease in odds of lapsing was not statistically significant for ABT compared to SBT. Between-subject stress, lapse frequency at baseline, and gender were strong predictors of lapse at mid- and end-of-treatment; however, treatment condition did not modify the effect of between-subject stress on lapse. Although treatment condition did not modify the effect of within-subject stress level on lapse, the main effect of treatment condition (i.e., within-subject stress level equal to zero) showed a decrease in the odds of lapsing for individuals receiving ABT compared to SBT at mid-treatment in the model controlling for gender (OR = 0.718, CI [0.517, 0.997]), and in the model with data from female participants only (OR = 0.688, CI [0.490, 0.966]). Conclusion: This study suggests that acceptance-based strategies are more effective at reducing dietary lapse when compared to cognitive strategies delivered to adults with overweight and obesity during an intensive behavioral intervention for weight loss. A better understanding of the mechanisms through which acceptance-based strategies improve dietary behavior may be achieved with the inclusion of potential mediators of the association in the analytical models.