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Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators

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Abstract
Background: Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. Methods: A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately. Results: Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. Conclusions: This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.
Keywords
PRIMARY-CARE, PSYCHOSOCIAL PREDICTORS, PSYCHOLOGICAL-FACTORS, BODY-IMAGE, PHYSICAL-ACTIVITY, MIDDLE-AGED WOMEN, HEALTHY EATING BEHAVIORS, LIFE-STYLE INTERVENTIONS, WEIGHT-LOSS MAINTENANCE, RANDOMIZED CONTROLLED-TRIAL, Mediation analysis, Behavior change, Maintenance, Dietary intake, Physical activity, Weight control, Self regulation, Obesity, Lifestyle interventions

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MLA
Teixeira, Pedro J et al. “Successful Behavior Change in Obesity Interventions in Adults: a Systematic Review of Self-regulation Mediators.” BMC MEDICINE 13 (2015): n. pag. Print.
APA
Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J.-M., De Bourdeaudhuij, I., Lakerveld, J., et al. (2015). Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC MEDICINE, 13.
Chicago author-date
Teixeira, Pedro J, Eliana V Carraça, Marta M Marques, Harry Rutter, Jean-Michel Oppert, Ilse De Bourdeaudhuij, Jeroen Lakerveld, and Johannes Brug. 2015. “Successful Behavior Change in Obesity Interventions in Adults: a Systematic Review of Self-regulation Mediators.” Bmc Medicine 13.
Chicago author-date (all authors)
Teixeira, Pedro J, Eliana V Carraça, Marta M Marques, Harry Rutter, Jean-Michel Oppert, Ilse De Bourdeaudhuij, Jeroen Lakerveld, and Johannes Brug. 2015. “Successful Behavior Change in Obesity Interventions in Adults: a Systematic Review of Self-regulation Mediators.” Bmc Medicine 13.
Vancouver
1.
Teixeira PJ, Carraça EV, Marques MM, Rutter H, Oppert J-M, De Bourdeaudhuij I, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC MEDICINE. 2015;13.
IEEE
[1]
P. J. Teixeira et al., “Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators,” BMC MEDICINE, vol. 13, 2015.
@article{6866631,
  abstract     = {Background: Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults. 
Methods: A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately. 
Results: Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified. 
Conclusions: This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.},
  articleno    = {84},
  author       = {Teixeira, Pedro J and Carraça, Eliana V and Marques, Marta M and Rutter, Harry and Oppert, Jean-Michel and De Bourdeaudhuij, Ilse and Lakerveld, Jeroen and Brug, Johannes},
  issn         = {1741-7015},
  journal      = {BMC MEDICINE},
  keywords     = {PRIMARY-CARE,PSYCHOSOCIAL PREDICTORS,PSYCHOLOGICAL-FACTORS,BODY-IMAGE,PHYSICAL-ACTIVITY,MIDDLE-AGED WOMEN,HEALTHY EATING BEHAVIORS,LIFE-STYLE INTERVENTIONS,WEIGHT-LOSS MAINTENANCE,RANDOMIZED CONTROLLED-TRIAL,Mediation analysis,Behavior change,Maintenance,Dietary intake,Physical activity,Weight control,Self regulation,Obesity,Lifestyle interventions},
  language     = {eng},
  pages        = {16},
  title        = {Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators},
  url          = {http://dx.doi.org/10.1186/s12916-015-0323-6},
  volume       = {13},
  year         = {2015},
}

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