Successful behavior change in obesity interventions in adults

Overweight and obesity are among the main determinants of avoidable burden of disease worldwide. many interventions have been developed, tested and implemented to treat obesity. Many of such interventions aim at lifestyle changes -i.e. better nutrition, more physical activity to help people lose weight and avoid further weight gain. However, relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. In an article that just appeared in the journal BMC Medicine -with Prof. Pedro Teixeira as first author, and as part of the larger European Commission-funded Spotlight project-, we reviewed the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. Using a systematic review methodology we reviewed thirty-five studies testing 42 possible mediators of intervention effect. The results indicate that important prerequisites for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. We conclude that despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.