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

Elizabeth M. Venditti, Judith Wylie-Rosett, Linda M. Delahanty, Lisa Mele, Mary A. Hoskin, Sharon L. Edelstein

Research output: Contribution to journalArticle

42 Scopus citations

Abstract

Background: Individual 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.Methods: Lifestyle 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.Results: Top 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.Conclusion: Behavioral 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.

Original languageEnglish (US)
Article number16
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Volume11
Issue number1
DOIs
StatePublished - Feb 12 2014

Keywords

  • Barriers
  • Behavioral approaches
  • Diabetes prevention
  • Lifestyle intervention
  • Problem-solving
  • Toolbox strategies

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Nutrition and Dietetics

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