Barriers to Weight Loss in a Stepped-Care Approach to Behavioral Weight Loss Treatment

Over two-thirds of the United States' adult population are overweight or obese , and these numbers continue to grow (Ogden , Carroll , Kit , & Flegal , 2014). Obesity is a disease that is a common comorbidity with other serious health conditions , including heart disease and diabetes (National Heart , Lung , and Blood Institute , 2012; Mokdad et al. , 2003). Behavioral weight loss treatments (BWLT) are typically the treatment of choice in cases other than extreme obesity (Miller , Koceja , & Hamilton , 1997). A more recent innovation in BWLT research has been the application of stepped-care principles. A stepped-care approach typically begins with treatment that is low-intensity. For individuals who do not meet treatment goals after a predefined period , the intensity of treatment is increased (Watzke et al. , 2014). Nevertheless , barriers to weight loss and weight loss maintenance are poorly understood. The current study aimed to examine barriers , depressive symptoms , and social support at four different time points to identify contributing factors to poor weight loss outcomes , attrition , and the need for stepped-care in a behavioral weight loss intervention. Fifty-three individuals (MBMI=35.6 , SDBMI=6.4) were recruited for the stepped-care behavioral weight loss intervention. Social pressure , food craving , stress and depression , and cost of diet barriers reported during the current intervention were related to attrition , stepped-care need , and weight loss. Interestingly , greater helpfulness and frequency of weight loss support were related to attrition , greater stepped-care need , and worse weight loss outcomes. It is important for future research to improve assessment of barriers to weight loss. Additionally , future weight loss interventions should consider the current findings , especially teaching skills to cope with social pressure and food cravings