N-of-1 study of weight loss maintenance assessing predictors of physical activity, adherence to weight loss plan and weight change

Objective: Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.  Design: N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit™) for six months. Eight previously obese adults who lost over 5% of body weight in the past year took part. Data were analysed using time series methods.  Main outcomes measures: Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits and environmental influences. Dependent variables were: objectively estimated step count and weight, and self- reported WLM plan adherence.  Results: For all participants, daily fluctuations of self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables including maintenance motivation and satisfaction with outcomes, self-regulation, habit and stable environment. Personal resources were not a consistent predictor of plan adherence.  Conclusion: This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions