Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence

Abstract

BackgroundIndividual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts.MethodsLifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics.ResultsTop weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years.ConclusionBehavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.

Participant perspectives of a 6-month telephone-based lifestyle coaching program

“…11,12,21 As with a real-world diabetic telephone health coaching program 22 , the majority of participants reported positive GHS experiences (satisfaction), which helped them to achieve their health-related goals. Maintaining selfmonitoring and motivation were identified as barriers to weight loss and physical activity 23 , and the positive experiences of most participants were underpinned by coaches' knowledge and professionalism. The rapport developed between coaches and participants facilitated adherence and motivation to complete the coaching program.…”

“…It has been recommended that complementing telephone-based coaching with other communication platforms (such as text messaging or web-based media) may facilitate coaching adherence and completion, and that digital interactive methods of intervention deserve further study. 23 Participant-level attrition factors included personal or family-related illnesses, feeling unwilling to change behaviour, and feeling that they no longer required assistance. Because the GHS is free, financial factors were not highlighted as a barrier to participation 28 ; however, both health-and timerelated factors were attributed to participant withdrawal, as also identified in other lifestyle interventions.…”

Comparison of Mindful and Slow Eating Strategies on Acute Energy Intake

“…Interventionists also strive to help participants modify behaviors and implement strategies to adopt a healthy diet. Commonly utilized strategies include, but are not limited to, barrier identification (3,10), goal setting (10), problem solving (3,10), and self-monitoring of weight, caloric intake, and physical activity (3,5,(10)(11)(12). Through the employment of these strategies, behavioral weight management programs endeavor to aid participants in creating a negative energy balance that will result in a reduction in body weight.…”

“…The most common behavioral eating techniques recommended for caloric restriction fit into five main categories: mindfulness, meal frequency (including breakfast eating and snacking), volumetrics (including fruit and vegetable consumption and water intake), stimulus control, and portion control (including plate size, bite/utensil size, and eating rate) (3,5,10,13,(16)(17)(18)(19)(20)(21). While these strategies are commonly recommended, research has not fully examined the effectiveness of some of these strategies on acute energy intake.…”

“…In behavioral weight management settings, eating strategies such as chewing a certain number of times, putting utensils down between bites, and using smaller plates and utensils are commonly suggested to decrease energy intake, thereby inducing weight loss [4,5,[7][8][9][10][11][12][13][14]. However, evidence regarding these strategies is mixed; some results suggest a decrease in energy intake (34,(60)(61)(62)(63) while others suggest no effect (64)or an increase in intake (31).…”