Self-management of weight in adults with overweight and obesity: characterising and evaluating cognitive and behavioural strategies

Background: The majority of adults in the UK are overweight or obese, and many embark on weight loss attempts, often without professional support. This dissertation set out to hone in on the cognitive and behavioural strategies used by adults with overweight and obesity attempting to lose weight, particularly in self-guided attempts, and to test the relationship between use of these strategies and weight loss success. Methods: A new taxonomy and questionnaire were developed to provide a framework to identify the cognitive and behavioural strategies used by individuals during weight loss attempts. The taxonomy was used in a systematic review and meta-analysis of self-help interventions for weight loss and in a systematic review of qualitative studies of self-directed weight loss. The questionnaire was used in an observational cohort study in adults with overweight and obesity trying to lose weight. Results: The taxonomy and questionnaire consist of 117 strategies. The qualitative review illuminated a range of attitudes and beliefs towards these strategies and highlighted the centrality of interpretation of self-monitored data. The quantitative review found that self-help interventions led to greater weight loss than unsupported attempts to lose weight at six months. In the cohort study, despite heterogeneity in the strategies employed, coherent patterns of behaviours emerged for individual participants. Strategies related to motivational support, dietary impulse control, and weight loss planning and monitoring were associated with greater weight loss. Conclusion: This dissertation demonstrates that self-help interventions can lead to significant weight loss and provides results to guide the content of such interventions. It maps out a previously uncharted area and provides a set of tools for further research and intervention development