PROMOTING SMALL CHANGES FOR OBESITY TREATMENT : A FOLLOW-UP PROGRAM USING DIRECT BEHAVIOR RATINGS VIA EMAIL

Abstract

The rapid increase followed by a steady maintenance of elevated levels of obesity in the United States is alarming and necessitates action. While behavioral treatment of obesity is showing moderate success of initial weight loss, maintenance of lost weight is more common than traditional calorie restrictive dieting approaches. This is particularly relevant during the holiday season where people can gain 1-5% of their total body weight during this short period of time. Therefore, it is critical that we explore additional ways to help individuals maintain their lost weight, particularly during a challenging time of year. The purpose of the study was to examine the impact of using Direct Behavior Ratings via the Internet to help individuals successfully maintain their weight immediately following completion of a treatment program over a 6-week period during the holidays. The pilot study operated within a behavioral framework to deliver evidenced based formative assessment through the use DBR as a progress monitoring and self-monitoring tool delivered via the Internet through bi-weekly emails. Additionally, tailored quantitative and qualitative feedback was integrated through reports issued bi-weekly that contained graphical representations of the data in addition to therapeutic statements regarding individual progress. The pilot study consisted of a two-phase design wherein Phase I (non-experimental) was the initial treatment and Phase II (experimental) was the follow-up treatment. Phase I treatment consisted of the ASPIRE Small Changes Program utilizing cognitive behavioral therapy with the Traffic Light Diet and pedometers for physical activity. Initially, 16 participants were recruited from the ASPIRE Small Changes Program at East Carolina University's Psychological Assessment and Specialty Services (PASS) clinic; 14 participants were included in the final analysis. At the conclusion of treatment, group level weight maintenance was achieved. In addition, strong relationships were noted between the variables of red foods and green foods and compliance indicating participants who reported higher levels of success in meeting red and green food goals were also more likely to complete and return ratings as hypothesized. A strong relationship between weight change in Phase I and ratings of success in meeting red, green, and step count goals was evident. The weight maintenance achieved in our pilot sample provides promise for future utilization of DBR as a follow-up treatment delivered via the Internet. Based on our preliminary data there is reason to believe success in Phase I of treatment can encourage long term maintenance of dietary balance with minimal intervention. The findings of our pilot sample offer additional insight into the treatment of obesity and overweight with particular relevance to achieving follow-up weight maintenance. Subsequent research should continue to explore the utility of DBR for self-monitoring of healthy weight behaviors and the modality of the Internet for treatment delivery.