Commentary by Evan Forman, PhD and Susan Carnell, PhD
Early lapses on a weight control program are important clues to predict long-term success, according to new research presented at ObesityWeek 2015 in Los Angeles.
"Early lapse frequency is able to predict later weight loss," said study leader Evan Forman, PhD, Professor of Psychology at Drexel University in Philadelphia, PA. Early lapses, even if a dieter's weight loss is on track, predict a lack of long-term success, he found. His research also looked at acceptance-based approaches for weight loss, which teach strategies beyond standard weight loss programs. ABT teaches people how to tolerate hunger and loss of pleasure and how to make mindful decisions about eating.
Study Details About Approaches, Lapses
In the study funded by the National Institutes of Health, Forman randomly assigned 190 overweight and obese men and women to a standard behavior weight loss treatment program or to an acceptance-based behavioral treatment. Some experts recognize ABT as more effective. SBT focuses on nutritional and behavioral strategies for weight loss. ABT also provides nutritional and other weight loss information, but also includes an emphasis on deliberate decision-making, among other components. The deliberate decision-making is thought to help those who have impulsivity issues, which are known to be linked with weight gain.
ABT also aims to bolster dieters' commitment to change. It emphasizes building distress management skills and boosting awareness of goals and behavior that produce weight loss.
Forman and his team followed the participants over a year that included 25 treatment sessions. At the end of a year, ABT yielded significantly greater weight loss, about 13%, compared to SBT, at about 10%. (P=.01). "Many more [in ABT] reached their 10% weight loss goal," Dr. Forman said. While 60% of those in ABT reached it, just 40% of those in SBT did.
The participants in both groups reported about lapses using EMAs (ecological momentary assessments). “These prompts asked the men and women to answer questions about eating behavior about six times a day,” Dr. Forman said.
They reported on potential lapse triggers, such as the sight of food, being bored or emotional, and instances of lapses, such as eating when they did not intend to, or eating at a time they did not intend to.
At the study start, men and women reported an average of four lapses a week, with 44% involving a food they didn't intend to eat, 31% involving eating at a time they didn't intend to eat, and 25% involving eating a larger portion than intended. "Eating a food they hadn't intended to eat was the most common type of lapse reported," Forman said.
Evening was the most common or lapses, with 53% occurring then. "Lapses occurred at home more than anywhere else," Forman said. Nearly half were at home. Boredom, fatigue and deprivation feelings most strongly triggered lapses.
Frequency of early lapses (r=.20, P<.01) and, in particular, eating at a time not intended (r =.27, P<.01) predicted weight loss at end of treatment. That finding held even after controlling for early weight loss and being on track with weight loss.
Lapses increased by 10% from midpoint to end of treatment after remaining stable before that time.
Practical Lessons from Lapse, ABT Research
Health care providers might target boredom in weight loss programs and how to avoid it, Dr. Forman said, since boredom often triggered lapses. Avoiding boredom appears important, he said, even in those weight loss patients whose weight loss is on schedule.
The lapse research is important ''because it's something you can detect early'' and address, said Susan Carnell, PhD, Assistant Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University in Baltimore, MD, who commented on the findings. "It's like a warning sign or red flag," Dr. Carnell said. The people who have frequent early lapses may need additional interventions or a new intervention, she said.
While few treatments have outperformed standard behavioral treatment, Dr. Forman said, ''the demonstrated three-percentage point advantage of ABT in the current trial supports the infusion of mindful decision-making, psychological acceptance and behavioral commitment strategies into obesity interventions." “Those who have impulsivity issues would especially benefit,” he said.
November 20, 2015
Forman E. Dietary Lapses During Behavioral Weight Loss: Characteristics and Relationships with Later Success. The Obesity Society, ObesityWeek 2015, Los Angeles, CA. November 2-6, 2015.