Identifying psychological predictors of adherence to a community-based lifestyle modification program for weight loss among Chinese overweight and obese adults

• Published in: Nutrition research and practice Vol. 13; no. 5; pp. 415 - 424
• Main Authors: Leung, Alice Wai Yi, Chan, Ruth Suk Mei, Sea, Mandy Man Mei, Woo, Jean
• Format: Journal Article
• Language: English
• Published: Korea (South) 한국영양학회 01.10.2019; Korean Nutrition Society; The Korean Nutrition Society and the Korean Society of Community Nutrition
• Subjects: Body weight; Body weight loss; Diet; Lifestyles; Motivation; Nutrition research; Obesity; Original Research; Overweight; Physical activity; Questionnaires; 생활과학; Obesity; nutrition; adherence; psychological factors; physical activity
• ISSN: 1976-1457; 2005-6168
• DOI: 10.4162/nrp.2019.13.5.415

Existing evidence on lifestyle modification programs for weight loss is limited by the high attrition rate of such programs. Identifying predictors of adherence to a lifestyle modification program could result in program improvement. However, little is known about behavior-specific adherence and its psychological predictors. This study aimed to examine the psychological predictors of adherence after one-month participation in a community-based lifestyle modification program among Chinese overweight and obese adults in Hong Kong. A total of 205 Chinese overweight and obese adults aged 38.9 ± 10.5 years completed the study. Data were collected at baseline and after one month using self-reported questionnaires, which assessed knowledge (self-developed scale), motivation (Treatment Self-Regulation Questionnaire), stage of change (Stage of Exercise Scale) and self-efficacy (Self-Rated Abilities for Health Practices Scale). At one month, a 4-day dietary recall and the International Physical Activity Questionnaire-Short Form were used to assess dietary and physical activity (PA) adherence. Food and PA diaries were examined to indicate self-monitoring. Program attendance was tracked between baseline and one-month follow-up. After one month, participants reported high dietary adherence, attendance, and adherence to self-monitoring but low PA adherence. Multiple regression analyses suggested that diet self-efficacy (baseline) and nutrition knowledge (one-month change) were independent predictors of dietary adherence score at one month, whereas autonomous PA motivation (baseline) and PA self-efficacy (both baseline and one-month change) were independent predictors of PA adherence score at one month. No significant psychological predictor was identified for attendance or self-monitoring. The results suggest that the effect of psychological factors on adherence differs between diet and PA adherence outcomes. To promote adherence, practitioners should assess self-efficacy, knowledge, and motivation at the beginning of a weight-loss program and explore behavior-specific strategies to improve knowledge and self-efficacy. The results of this study have direct implications for program improvements.