Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers
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OBJECTIVES: To describe participants' adherence to multiple components (attendance, energy intake, fat gram, exercise goals, and self-monitoring eating and exercise behaviors) of a standard behavioral treatment program (SBT) for weight loss and how adherence to these components may influence weight loss and biomarkers (triglycerides, low density lipoproteins [LDL], high density lipoprotein, and insulin) during the intensive and less-intensive intervention phases. METHODS: A secondary analysis of a randomized clinical trial consisting of a SBT with either fat-restricted standard or lacto-ovo vegetarian diet. The 12-month intervention was delivered in 33 group sessions. The first six months reflected the intensive phase; the second six months, the less-intensive intervention phase. We conducted the analysis without regard to treatment assignment. Eligible participants included overweight/obese adults (N = 176; mean body mass index = 34.0 kg/m(2)). The sample was 86.9% female, 70.5% White, and 44.4 +/- 8.6 years old. The outcome measures included weight and biomarkers. RESULTS: There was a significant decline in adherence to each treatment component over time (P < 0.0001). In the first six months, adherence to attendance, self-monitoring and the energy goal were significantly associated with greater weight loss (P < 0.05). Adherence to attendance and exercise remained significantly associated with weight loss in the second six months (P < 0.05). Adherence to attendance, self-monitoring and exercise had indirect effects through weight loss on LDL, triglycerides, and insulin (P < 0.05). CONCLUSIONS: We observed a decline in adherence to each treatment component as the intervention intensity was reduced. Adherence to multiple treatment components was associated with greater weight loss and improvements in biomarkers. Future research needs to focus on improving and maintaining adherence to all components of the treatment protocol to promote weight loss and maintenance.
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In a two-year randomized clinical trial, at six months the PDA groups combined were more adherent to self-monitoring than the paper diary group, and dietary self-monitoring in this group had a significant indirect effect on percent weight loss.
“Findings at six months revealed that, compared to the paper diary group, the PDA groups combined were more adherent to self-monitoring and that dietary self-monitoring in this group had a significant indirect effect on percent weight loss (29, 36).”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [36]
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Experimental — accuracy not yet measuredAt the end of the intervention, only 25% of the sample continued to self-monitor.
“At the end of the intervention, only 25% of the sample continued to self-monitor (40, 41).”
From Self-monitoring in weight loss: a systematic review of the literature (2011) · cites this paper as [40]
The Results section (‘Adherence to treatment protocol’) reports that 22% of the sample continued to self-monitor at the end of the year, not 25%. It also reports 50% at six months. The claim captures the decline and approximate end-of-year proportion, but its stated percentage does not match the source. (LLM, conf=0.88)
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Current Theoretical Bases for Nutrition Intervention and Their Uses
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Body Composition Changes after a Weight Loss Intervention: A 3-Year Follow-Up Study
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- Authors
- Burke, L., Acharya, Elci, Sereika, Music, Styn, & Turk
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Burke, Lora
- Venue
- Patient Preference and Adherence
- Publisher
- Informa UK Limited
- Published
- 2009-06
- Volume
- 3
- Pages
- 151
- ISSN
- 1177-889X (ISSN-L)
- PMC
- PMC2778406
- OpenAlex
- W1732483754
- Cited by
- 141
- References
- 41
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 8 · 2023: 5 · 2022: 14 · 2021: 10 · 2020: 13 · 2019: 9 · 2018: 7 · 2017: 7 · 2016: 8 · 2015: 15 · 2014: 7 · 2013: 11 · 2012: 6
- FWCI
- 7.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Patient Preference and Adherence (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Funders
- National Institutes of Health (5p30dk046204-15)
- National Institute of Nursing Research (P30NR003924, K24NR010742)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058631, P30-DK046204)
- National Center for Research Resources (M01RR000056)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- medication adherence, behavioral weight loss, weight loss, self-monitoring, exercise adherence, low-fat diet, lacto-ovo-vegetarian diet, triglycerides, LDL cholesterol, HDL cholesterol, insulin, overweight and obesity, intervention intensity, biomarkers
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