Who’s Ready for Success in Weight Loss?

Predicting who’s ready for success in weight loss has been devilishly hard to do. Clinicians who treat obesity have been convinced that readiness is an important factor. But studies to validate a reliable way to measure that readiness have yielded mixed results.

Now the Look AHEAD study has yielded evidence that keeping detailed food records is a good predictor of success in a behavioral weight loss program. Adam Tsai and colleagues found that people who kept more detailed food records (>33 words/day) lost about one-third more weight (p<0.001) after a year than those who kept sparse records (<20 words/day). The findings have just been published online in Obesity.

Commenting on the findings, Tsai said:

This confirms what I learned from Tom Wadden – that self-monitoring in preparation and during an intervention is a good predictor of successful weight loss.

In a review published earlier this year in the American Journal of Lifestyle Medicine, Craig Johnston summarized prior findings on the subject. He concluded that depressive symptoms, social support, and weight loss early in the course of treatment have all been observed to predict later outcomes. But, he notes, they only account for 20-30% of the variance.

In the New England Journal of Medicine, Krista Casazza and colleagues labeled readiness (as measured by stages of change) as a myth of obesity treatment. Stages of change is a self-reported measurement that is notoriously unreliable in obesity. Self-reports about obesity are often inaccurate. Another reason this subject is so tricky is that bias can creep into beliefs about obesity and readiness to lose weight. “If you don’t lose weight, it must be because you’re not trying hard enough,” goes the thinking.

So, if food record details provide an objective measure of readiness that holds up in future studies, it will be a welcome tool.

Click here to read the study by Tsai et al, here to read the review by Johnston, and here to read the Casazza analysis in NEJM.

Focus and Determination, photograph © City Year / flickr

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