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DPP: Pre-treatment characteristics predicted weight outcomes
Recent data released from the Diabetes Prevention Program demonstrate that pre-treatment characteristics, weight history, psychological and behavioral predictors, and changes to cognitive and behavioral factors play an important role in predicting weight outcomes.
Linda M. Delahanty, MS, RD, and other researchers utilized 25% of the Diabetes Prevention Program (DPP) patients in the lifestyle intervention group (n=274) who completed questionnaires to assess their weight history and psychological and behavioral factors at baseline and 6 months.
Delahanty, of the department of medicine at Massachusetts General Hospital Diabetes Center, and colleagues conducted t tests and multivariate models to determine the association of weight loss with pre-treatment characteristics.
According to data, greater exercise self-efficacy and dietary restraint, fewer high-fat dietary behaviors and more sedentary activity levels were independent, modifiable, pre-treatment predictors for obtaining a 7% weight-loss goal at the end of the study. Furthermore, at baseline, lower activity levels were linked to greater increases in activity (P<.0001), researchers wrote.
They also discovered that fewer previous formal weight-loss programs and less frequent emotional eating were found to be positive predictors for obtaining 7% weight loss at 6 months. However, this was not the case at the end of the study.
Patients with more previous weight-loss attempts tended to be younger when they first became overweight, with more frequent weight cycling, more cravings, and felt deprived when dieting and less competent at weight loss at baseline (all P<.0001).
“Although baseline and early changes in perceived stress, feelings of being deprived while dieting, binge eating severity, weight loss self-sufficiency, and exercise self-sufficiency were significantly (P<.05) associated with the ability to achieve weight loss outcomes at 6 months and end of study, these variables were not independent predictors of weight outcomes when confounders were eliminated,” they wrote.Delahanty and colleagues suggest further research based on these findings to improve strategies to enhance weight-loss outcomes.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopThe DPP was a success in that it clearly showed lifestyle interventions are successful at promoting weight loss and may be effective in improving metabolic risk profiles among individuals at risk for, or currently diagnosed with diabetes; and that they improved outcomes greater than pharmaceutical intervention (which also worked, but not to the same extent).
The current study examined issues beyond the physical and metabolic changes associated with the DPP. It is often thought that weight loss and improvements in other disease risk outcomes enhance feelings of self-efficacy, and this study supports that notion. Specifically, the DPP was found to not only enhance exercise-related self-efficacy, but also self-efficacy associated with adhering to a low-fat diet and promoting greater dietary restraint. The DPP offered intensive support from lifestyle coaches for the first 6 months with individually tailored sessions and periodic group classes offered after the first 6 months. This suggests that programs which offer consistent early support and provisions or encouragement for a sufficient period of time following intervention can result in substantial long-term health benefits. It was particularly exciting to see that this lifestyle program improved exercise self-efficacy, since adherence to exercise programs, especially long term, can be challenging for many patients.
This article also points to promising areas for future research. For example, among this population, more previous weight loss attempts were related to an inability to achieve meaningful weight loss through the DPP.
This highlights that future lifestyle interventions and research support is needed for those most in need or at greatest risk for obesity and diabetes. As the incidence of childhood obesity increases, more of the population may fit this profile and be in need of successful lifestyle interventions that work for them.