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Ecological momentary assessment of responses to dietary lapses among participants in a weight loss program and their relation to subsequent outcomes
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Ecological momentary assessment of responses to dietary lapses among participants in a weight loss program and their relation to subsequent outcomes

Leah M. Schumacher
Master of Science (M.S.), Drexel University
Jul 2015
DOI:
https://doi.org/10.17918/etd-6556
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Abstract

Weight loss--Research Weight gain--Psychological aspects Psychology
Behavioral weight loss programs are effective in producing moderate weight loss, but weight regain is common. Weight regain is believed to be due largely to poor adherence to the behaviors necessary for weight control, especially caloric restriction. Although most individuals attempting to lose weight and maintain weight loss experience occasional lapses in adherence, it is unclear what factors promote adherence to weight control goals after a dietary lapse. The present study thus examined individuals' attitudes toward themselves (e.g., self-critical, self-forgiving) after lapses and the relationships between these attitudes and subsequent lapse behavior using ecological momentary assessment (EMA) to determine if examination of lapses from this framework enhances understanding of lapse-relapse progression. Overweight and obese adults (n = 91) enrolled in a behavioral weight loss program completed EMA for 14 days at the beginning of treatment. Participants responded to 6 semi-random daily EMA prompts, and initiated an EMA survey whenever a dietary lapse occurred. Participants reported on their self-criticism, self-forgiveness, self-regard, and self-efficacy whenever a lapse occurred; they also reported their attribution for each lapse. Weight was measured at the beginning and end of the EMA period. Results revealed that 89% of participants experienced at least one lapse (M=6.88). Greater lapse frequency was associated with less weight loss. Participants tended to have positive self-attitudes after lapses, and variability in responses across lapses was somewhat limited. Although having a positive (e.g., greater self-efficacy, more positive self-regard) typical response to lapses was associated with better outcomes (i.e., fewer lapses, longer time until next lapse), having a more negative (i.e., less forgiving, more critical, more negative self-regard) in-the-moment response to lapses predicted longer time until next lapse, when examined among lapses that occurred on the same day. These results suggest that, contrary to tenets of traditional relapse prevention interventions, a harsher response to lapses may be beneficial for delaying future lapses at times. However, as having a more positive typical response was also associated with better outcomes, additional research is needed to clarify why and to what extent having a more "negative" response may confer benefit. Implications of these findings and directions for future research are discussed.

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