An Experimental Approach to Weight Loss Prescription: Are Participant Choice and Weight Loss Related?

• Published in: Obesity (Silver Spring, Md.) Vol. 30; p. 273
• Main Authors: Martinez, Caitlin, Hatley, Karen, Polzien, Kristen, Diamond, Molly, Tate, Deborah
• Format: Journal Article
• Language: English
• Published: Silver Spring Blackwell Publishing Ltd 01.11.2022
• Subjects: Meals; Weight control
• ISSN: 1930-7381; 1930-739X

Background: Behavioral weight loss programs typically use a single, standard prescription for diet and exercise for intervention duration. During the first 4 weeks of the mPWR pilot randomized trial, participants trialed combinations of 3 lifestyle factors-macronutrient intake, meal/snack pattern, and physical activity (PA)-before choosing a prescription to follow. Methods: The present analysis explores the relationships between the 3 factors, weight loss, and prescription chosen. Participants in the personalized arm were randomized to a factor order at baseline and trialed each factor for a total of 2 weeks. Self-monitoring was via a study-specific app, wearable tracker, wireless scale, and continuous glucose monitor. Participants had weekly counseling calls with a study interventionist. Results: Participants with at least 1 weight/factor who chose an mPWR prescription at 4 weeks were included (n=25). They were 50.3±10.5 yrs; mean BMI 35.3 kg/m2; 80% WHITE; 80% female; and 32% with HbA1c of 5.7-6.4%. Across all participants, 2-week weight losses (mean ± SD, lb) for each factor were: -2.41±2.47 on low-fat (LF), -4.48±2.90 on low carbohydrate (LC), -3.83±2.58 on 3 meals, -3.06 ± 2.72 on meals and snacks, -2.89 ± 3.36 on daily PA, and -4.00 ± 2.42 on weekly PA. Most participants lost more weight on LC (68%), 3 meals (64%), and weekly PA (52%). Most chose LC (65%), meals and snacks (88%), and weekly PA (54%). Though participants, on average, lost significantly more during the 2 weeks they were assigned to LC than LF (p=0.02), subgroup analyses showed that those who chose LC (n=17) had greater mean weight loss on LC (-5.42 ± 2.86) than LF (-2.41+2.84, p=.02); those who chose LF lost a similar amount of weight on LC (-2.48 ± 1.81) and LF (-2.43 ± 1.56). Conclusions: Weight loss may impact participant choice of intervention prescription. Exploration of response to and participant willingness to follow lifestyle prescriptions warrants future investigation.