Barriers to Weight Loss in a Stepped-Care Approach to Behavioral Weight Loss Treatment

Abstract

Over two-thirds of the United States' adult population are overweight or obese, and these numbers continue to grow (Ogden, Carroll, Kit, & Flegal, 2014). Obesity is a disease that is a common comorbidity with other serious health conditions, including heart disease and diabetes (National Heart, Lung, and Blood Institute, 2012; Mokdad et al., 2003). Behavioral weight loss treatments (BWLT) are typically the treatment of choice in cases other than extreme obesity (Miller, Koceja, & Hamilton, 1997). A more recent innovation in BWLT research has been the application of stepped-care principles. A stepped-care approach typically begins with treatment that is low-intensity. For individuals who do not meet treatment goals after a predefined period, the intensity of treatment is increased (Watzke et al., 2014). Nevertheless, barriers to weight loss and weight loss maintenance are poorly understood. The current study aimed to examine barriers, depressive symptoms, and social support at four different time points to identify contributing factors to poor weight loss outcomes, attrition, and the need for stepped-care in a behavioral weight loss intervention. Fifty-three individuals (MBMI=35.6, SDBMI=6.4) were recruited for the stepped-care behavioral weight loss intervention. Social pressure, food craving, stress and depression, and cost of diet barriers reported during the current intervention were related to attrition, stepped-care need, and weight loss. Interestingly, greater helpfulness and frequency of weight loss support were related to attrition, greater stepped-care need, and worse weight loss outcomes. It is important for future research to improve assessment of barriers to weight loss. Additionally, future weight loss interventions should consider the current findings, especially teaching skills to cope with social pressure and food cravings.