Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change

Evan M Forman, Leah M Schumacher, Ross Crosby, Stephanie M Manasse, Stephanie P Goldstein, Meghan L Butryn, Emily P Wyckoff, J Graham Thomas, Evan M Forman, Leah M Schumacher, Ross Crosby, Stephanie M Manasse, Stephanie P Goldstein, Meghan L Butryn, Emily P Wyckoff, J Graham Thomas

Abstract

Background: Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss program.

Purpose: In the context of a reduced calorie diet prescribed as part of a behavioral treatment, we aimed to characterize lapse occurrence, examine lapse frequency across treatment, examine predictors of lapses, and assess the relationship between lapses and weight loss.

Methods: Adults (n = 189) enrolled in a 12-month behavioral weight loss program completed ecological momentary assessment (EMA) at baseline, mid-treatment, and end of treatment. At each EMA survey, participants indicated whether a lapse had occurred, and responded to questions assessing situational, environmental, and affective states.

Results: Lapse frequency showed a curvilinear relationship over time, such that frequency first decreased and then increased. Lapse frequency at baseline was negatively associated with early and overall weight loss. Lapses most often occurred at home, in the evenings, on the weekends, and entailed eating a forbidden food. Greater overall levels of assessed affective and environmental triggers predicted lapses, and greater momentary hunger and deprivation, and the presence of palatable food, also prospectively predicted lapses.

Conclusions: In addition to characterizing lapse frequency, the current study identified prospective predictors of lapses across treatment. These findings support the importance of lapses to weight control and provide insight for potential targets of intervention to prevent lapse occurrence.

Keywords: Adherence; Behavioral weight loss; Dietary lapses; EMA; Ecological momentary assessment; Overweight.

Conflict of interest statement

Conflict of Interest: Dr. Forman reports grants from the National Institute for Diabetes and Digestive and Kidney Diseases (award # R01 DK095069), during the conduct of the study. Dr. Crosby reports personal fees from Health Outcome Solutions, outside the submitted work. None of the remaining authors report a conflict of interest.

Figures

Figure 1
Figure 1
Estimated mean number of lapses per week per participant by assessment point. Note: Values are based on predicted values from a GEE examining the effect of time on lapse frequency, when controlling for all other predictors in the model. Values are presented at the weekly level for interpretative purposes.
Figure 2
Figure 2
Average level of exposure to delicious food differentially predicts lapse occurrence from mid-treatment to end-of-treatment. Note: Low exposure and high exposure represents values −/+ 1SD of mean exposure level to delicious foods. Values reflect estimated marginal means when controlling for all other variables in the GEE model.
Figure 3
Figure 3
Odds of lapse by trigger type Note. *** p

Figure 4

Momentary availability of delicious food…

Figure 4

Momentary availability of delicious food differentially predicts lapse occurrence across assessment points Note:…

Figure 4
Momentary availability of delicious food differentially predicts lapse occurrence across assessment points Note: Values reflect estimated marginal means when controlling for all other variables in the GEE model.
Figure 4
Figure 4
Momentary availability of delicious food differentially predicts lapse occurrence across assessment points Note: Values reflect estimated marginal means when controlling for all other variables in the GEE model.

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