Christakis and colleagues have shown that health behaviors cluster in social networks and suggest social norms may account for the clustering. This study examined: (i) whether obesity clusters among young adults and whether social norms do in fact account for the clustering, and (ii) among overweight/obese (OW/OB) young adults, whether number of social contacts trying to lose weight is associated with weight loss intentions and whether social norms for weight loss account for this effect. Normal weight (NW) and OW/OB young adults (N = 288; 66% female; 75% white) completed measures assessing number of OW social contacts and social norms for obesity. OW/OB young adults also indicated number of OW social contacts currently trying to lose weight, social norms for weight loss, and weight loss intentions. Compared to NW, OW/OB young adults were more likely to have OW romantic partners and best friends and had more OW casual friends and family members (Ps < 0.05), but social norms for obesity did not differ between groups, and social norms did not mediate the relationship between OW social contacts and participants' weight status. However, among OW/OB young adults, having more social contacts trying to lose weight was associated with greater intention to lose weight (r = 0.20, P = 0.02) and social norms for weight loss fully mediated this effect (P < 0.01). This study is the first to show that social contacts and normative beliefs influence weight status and intentions for weight control in young adults. Findings underscore the importance of targeting social influence in the treatment and prevention of obesity in this high‐risk age group.
Objective To examine whether adding either small, variable financial incentives or optional group sessions improves weight losses in a community-based, Internet behavioral program. Design and methods Participants (N=268) from Shape Up Rhode Island 2012, a 3 month Web-based community wellness initiative, were randomized to: Shape Up+Internet behavioral program (SI), Shape Up+Internet program+Incentives (SII), or Shape Up+Internet program+Group sessions (SIG). Results At the end of the 3 month program, SII achieved significantly greater weight losses than SI (SII:6.4% [5.1-7.7]; SI:4.2% [3.0-5.6]; P=.03); weight losses in SIG were not significantly different from the other two conditions (SIG: 5.8% [4.5-7.1], P’s≥.10). However, at the 12 month no treatment follow-up visit, both SII and SIG had greater weight losses than SI (SII: 3.1% [1.8-4.4]; SIG: 4.5% [3.2-5.8]; SI: 1.2% [-0.1-2.6]; P’s≤.05). SII was the most cost-effective approach at both 3 (SII: $34/kg; SI: $34/kg; SIG: $87/kg) and 12 months (SII: $64/kg; SI: $140/kg; SIG: $113/kg). Conclusions Modest financial incentives enhance weight losses during a community campaign and both incentives and optional group meetings improved overall weight loss outcomes during the follow-up period. However, the use of the financial incentives is the most cost-effective approach.
Objective Since large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared amount of weight regain, behaviors, and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight via either bariatric surgery or non-surgical methods. Design Surgical participants (n = 105) were matched with two non-surgical participants (n = 210) on gender, entry weight, maximum weight loss, and weight maintenance duration and compared prospectively over 1 year. Results Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ≥ 13.6 kg off for 5.5 ± 7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (p = 0.034), but did not significantly differ in magnitude of weight regain (1.8 ± 7.5 kg and 1.7 ± 7.0 kg for surgical and non-surgical groups, respectively; p = 0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups. Conclusions Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight loss maintenance comparable to that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight loss method.
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