Is Dietary Nonadherence Unique to Obesity and Weight Loss? Results From a Randomized Clinical Trial

Emma J Stinson, Paolo Piaggi, Susanne B Votruba, Colleen Venti, Barbara Lovato-Morales, Scott Engel, Jonathan Krakoff, Marci E Gluck, Emma J Stinson, Paolo Piaggi, Susanne B Votruba, Colleen Venti, Barbara Lovato-Morales, Scott Engel, Jonathan Krakoff, Marci E Gluck

Abstract

Objective: Weight stigma is associated with poor dietary adherence, yet adherence is essential for weight loss and maintenance. This study aimed to determine differences in dietary adherence and perceived hunger between lean individuals and two groups of individuals with obesity.

Methods: In a 6-week outpatient dietary intervention (23 males; aged 48 [SD 14] years), lean participants (n = 23; BMI 23 [SD 2] kg/m2 ) received a weight-maintaining energy needs (WMEN) diet, and participants with obesity (BMI 36 [SD 7]) were randomized to either WMEN (n = 18) or a 35% calorie-reduced (CR) diet (n = 19). All food was provided, and multiple adherence and hunger ratings were assessed daily and weekly on an outpatient basis and in person at twice-weekly visits (e.g., 24-hour recall, diaries).

Results: Weight decreased more in the group of CR individuals with obesity (β = -0.301 kg/wk, P = 0.02) compared with the group of lean individuals and the group of WMEN individuals with obesity. However, total percent adherence did not differ between groups (P = 0.60), and hunger scores did not change across groups over time (P = 0.08).

Conclusions: Results indicate that there are no differences in dietary adherence between lean individuals and individuals with obesity and adherence is not associated with adiposity or hunger. Thus, the belief that nonadherence (e.g., lack of willpower) is unique to obesity is untrue and may perpetuate weight bias and stigma.

Trial registration: ClinicalTrials.gov NCT01862796.

Conflict of interest statement

The authors declared no conflict of interest.

© 2020 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Figures

Figure 1
Figure 1
(A) CONSORT diagram. (B) Study protocol design.
Figure 2
Figure 2
Association between baseline percent body fat (PFAT) and total adherence scores (%); Pearson correlation coefficient (r) is reported along with its significance. Lean group is represented by orange squares, individuals with obesity calorie reduced (CR) by blue diamonds, and individuals with obesity weight‐maintaining energy needs (WMEN) by gray triangles. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Total adherence scores (%) between the three groups, lean = 59%, individuals with obesity weight‐maintaining energy needs (WMEN) = 54%, and individuals with obesity calorie reduced (CR) = 57%, were not significantly different, P = 0.60. Error bars represent the means with 95% confidence intervals.
Figure 4
Figure 4
(A) Absolute weight change trajectories (visit weight minus baseline weight) show that the individuals with obesity calorie reduced (CR) lost significantly more weight over the 6 weeks compared with the individuals with obesity weight‐maintaining energy needs (WMEN) and the lean group (P = 0.02). (B) Average subjective hunger score trajectories were not significantly different between groups (P = 0.08). Error bars represent 95% confidence intervals of the means. Mixed models were adjusted for age, time (days), sex, and baseline weight (weight loss model only) using a first‐order autoregressive covariance structure. [Color figure can be viewed at wileyonlinelibrary.com]

References

    1. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight: specific practices among U.S. adults. Am J Prev Med 2004;26:402‐406.
    1. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health 2015;105:e54‐e59.
    1. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008:Cd000011. doi:10.1002/14651858.CD000011.pub3
    1. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA 2002;288:2880‐2883.
    1. Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta‐analysis. Patient Prefer Adherence 2016;10:1547‐1559.
    1. Heymsfield SB, Harp JB, Reitman ML, et al. Why do obese patients not lose more weight when treated with low‐calorie diets? A mechanistic perspective. Am J Clin Nutr 2007;85:346‐354.
    1. Acharya SD, Elci OU, Sereika SM, et al. Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers. Patient Prefer Adherence 2009;3:151‐160.
    1. Laitner MH, Minski SA, Perri MG. The role of self‐monitoring in the maintenance of weight loss success. Eat Behav 2016;21:193‐197.
    1. Compher CW, Hanlon A, Kang Y, Elkin L, Williams NN. Attendance at clinical visits predicts weight loss after gastric bypass surgery. Obes Surg 2012;22:927‐934.
    1. Krukowski RA, Harvey‐Berino J, Bursac Z, Ashikaga T, West DS. Patterns of success: online self‐monitoring in a web‐based behavioral weight control program. Health Psychol 2013;32:164‐170.
    1. Peterson ND, Middleton KR, Nackers LM, Medina KE, Milsom VA, Perri MG. Dietary self‐monitoring and long‐term success with weight management. Obesity (Silver Spring) 2014;22:1962‐1967.
    1. Fitzpatrick SL, Bandeen‐Roche K, Stevens VJ, et al. Examining behavioral processes through which lifestyle interventions promote weight loss: results from PREMIER. Obesity (Silver Spring) 2014;22:1002‐1007.
    1. Davis C, Levitan RD, Muglia P, Bewell C, Kennedy JL. Decision‐making deficits and overeating: a risk model for obesity. Obes Res 2004;12:929‐935.
    1. Adler NE, Epel ES, Castellazzo G, Ickovics JR. Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women. Health Psychol 2000;19:586‐592.
    1. World Health Organization . Energy and protein requirements: report of a joint FAO/WHO/UNU Expert Consultation. WHO;1985.
    1. Garrel DR, Jobin N, de Jonge LH. Should we still use the Harris and Benedict equations? Nutr Clin Pract 1996;11:99‐103.
    1. Wilson PW, Paffenbarger RS Jr, Morris JN, Havlik RJ. Assessment methods for physical activity and physical fitness in population studies: report of a NHLBI workshop. Am Heart J 1986;111:1177‐1192.
    1. Stone AA, Shiffman S. Ecological momentary assessment (EMA) in behavorial medicine. Ann Behav Med 1994;16:199‐202.
    1. Williamson DA, Anton SD, Han H, et al. Adherence is a multi‐dimensional construct in the POUNDS LOST trial. J Behav Med 2010;33:35‐46.
    1. Jolliffe T. Principal Component Analysis. 2nd ed. Springer‐Verlag; 2002.
    1. Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrika 1965;30:179‐185.
    1. Kaiser HF. The varimax criterion for analytic rotation in factor analysis. Psychometrika 1958;23:187‐200.
    1. Snitker S. Use of body fatness cutoff points. Mayo Clinic Proc 2010;85:1057. doi:10.4065/mcp.2010.0583
    1. Burke LE, Conroy MB, Sereika SM, et al. The effect of electronic self‐monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial. Obesity (Silver Spring) 2011;19:338‐344.
    1. Handjieva‐Darlenska T, Holst C, Grau K, et al. Clinical correlates of weight loss and attrition during a 10‐week dietary intervention study: results from the NUGENOB project. Obes Facts 2012;5:928‐936.
    1. Dalle Grave R, Calugi S, Compare A, et al. Weight loss expectations and attrition in treatment‐seeking obese women. Obes Facts 2015;8:311‐318.
    1. Hadziabdic MO, Mucalo I, Hrabac P, Matic T, Rahelic D, Bozikov V. Factors predictive of drop‐out and weight loss success in weight management of obese patients. J Hum Nutr Diet 2015;28(suppl 2):24‐32.
    1. Murawski ME, Milsom VA, Ross KM, et al. Problem solving, treatment adherence, and weight‐loss outcome among women participating in lifestyle treatment for obesity. Eat Behav 2009;10:146‐151.
    1. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ. Relapse prevention training and problem‐solving therapy in the long‐term management of obesity. J Consult Clin Psychol 2001;69:722‐726.
    1. Moran AM, Everhart DE, Davis CE, Wuensch KL, Lee DO, Demaree HA. Personality correlates of adherence with continuous positive airway pressure (CPAP). Sleep Breath 2011;15:687‐694.
    1. Jerant A, Chapman B, Duberstein P, Robbins J, Franks P. Personality and medication non‐adherence among older adults enrolled in a six‐year trial. Br J Health Psychol 2011;16:151‐169.
    1. Gelb SR, Shapiro RJ, Thornton WJ. Predicting medication adherence and employment status following kidney transplant: the relative utility of traditional and everyday cognitive approaches. Neuropsychology 2010;24:514‐526.
    1. Lichtman SW, Pisarska K, Berman ER, et al. Discrepancy between self‐reported and actual caloric intake and exercise in obese subjects. N Engl J Med 1992;327:1893‐1898.
    1. Zheng Y, Burke LE, Danford CA, Ewing LJ, Terry MA, Sereika SM. Patterns of self‐weighing behavior and weight change in a weight loss trial. Int J Obes (Lond) 2016;40:1392‐1396.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren