Examining behavioral processes through which lifestyle interventions promote weight loss: Results from PREMIER

Objective To examine the behavioral processes through which lifestyle interventions impacted weight loss. Methods The analyses were limited to overweight and obese Black and White adults randomized to a PREMIER lifestyle intervention (N=501). Structural equation modeling was conducted to test the direct and indirect relationships of session attendance, days of self-monitoring diet and exercise, change in diet composition and exercise, and 6-month weight change. Results Greater session attendance was associated with increased self-monitoring, which was in turn significantly related to reduction in percent energy from total fat consumed. Change in percent energy from fat and self-monitoring was associated with 6-month percent change in weight. Both a decrease in fat intake and increase in self-monitoring are potential mediators of the relationship between attendance and weight change. Conclusions The findings provide a reasonable model that suggests regular session attendance and use of behavioral strategies like self-monitoring are associated with improved behavioral outcomes that are associated with weight loss.