Distinguishing early patterns of physical activity goal attainment and weight loss in online behavioral obesity treatment using latent class analysis

• Published in: Translational behavioral medicine Vol. 11; no. 12; pp. 2164 - 2173
• Main Authors: Stansbury, Melissa L, Harvey, Jean R, Krukowski, Rebecca A, Pellegrini, Christine A, Wang, Xuewen, West, Delia S
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.12.2021
• Subjects: Behavior therapy; Care and treatment; Ethnicity; Exercise; Female; Goals; Goals (Psychology); Health aspects; Humans; Latent Class Analysis; Male; Methods; Minority Groups; Obesity; Obesity - therapy; Patient outcomes; Physical Activity; Psychological aspects; Telemedicine; Weight Loss; United States; Adherence; Goal attainment; Physical activity; Weight loss
• ISSN: 1869-6716; 1613-9860
• DOI: 10.1093/tbm/ibab130

Abstract Physical activity (PA) goal adherence is consistently associated with greater weight loss during behavioral obesity treatment, and early weight loss response predicts future weight loss success. However, it remains unclear which behaviors during the initial weeks of treatment distinguish responders from nonresponders and might be effective targets for improving treatment outcomes. To characterize subgroups with distinct patterns of PA goal adherence during the initial 2 months of an online, group-based weight control program and determine associations between these patterns and 6-month weight loss. Participants received an online behavioral obesity intervention with PA goals and daily self-monitoring. Weekly adherence to step goals and moderate-to-vigorous PA (MVPA) minute goals based on self-monitoring records were examined using latent class analysis. Body weight was objectively measured at 0, 2, and 6 months. Participants (N = 212; 91.5% female, 31.6% race/ethnic minority, mean body mass index: 35.8 ± 5.9 kg/m2) clustered into three subgroups based on early goal attainment: “Both PA Goals,” “MVPA Goals Only,” and “Neither PA Goal.” The “Both PA Goals” class had significantly greater 6-month weight loss (estimated mean weight loss [95% CI]: −9.4% [7.4 to 11.5]) compared to the “MVPA Goals Only” (−4.8% [3.4 to 6.1]) and “Neither PA Goal” classes (−2.5% [1.4 to 3.6]). Individuals meeting both PA goals early in treatment achieve greater weight losses than those meeting MVPA but not step goals, pointing to the need to explore factors associated with nonadherence to each of the PA goals to better understand these potential targets for treatment refinement and adaptive interventions. Lay Summary This study is the first to characterize subgroups of individuals engaged in a behavioral weight control program with distinct patterns of early physical activity (PA) goal attainment. These early PA patterns emerged as a novel factor associated with subsequent weight loss and provide an important lens to view early treatment engagement. The greatest weight losses were seen in the subgroup likely to meet program goals for both weekly minutes of moderate-to-vigorous PA and daily steps. Understanding the factors associated with PA goal attainment during the initial 2 months of a behavioral weight control program may provide insights that will allow early identification of likely treatment success and detect individuals at risk for reduced weight losses, which could signal individuals for whom additional or different support may then be directed to increase weight loss success. This commentary provides an overview of how tailored physical activity intervention development may benefit from 1) improving the engagement of diverse knowledge users in co-design and 2) gaining a better understanding of the ethical considerations that may affect the use of technology to support tailored interventions.