INVESTIGATING THE ASSOCIATION BETWEEN THE RESIDENTIAL RETAIL FOOD ENVIRONMENT AND LONG-TERM WEIGHT LOSS MAINTENANCE AFTER PARTICIPATION IN A COMMERCIAL WEIGHT LOSS PROGRAM

Introduction: More than half of Americans have overweight or obesity. While some successfully lose weight, many find it difficult to maintain weight loss long-term. This thesis investigates the association of the residential retail food environment with weight maintenance behaviors, diet quality, weight loss maintenance duration and odds of weight loss maintenance. Methods: Data were obtained from the WW Success Registry, a nationwide convenience sample of individuals who had lost weight in WW (a commercial weight loss program) and maintained weight loss for at least a year (n=6,946). Home addresses were geo-coded and the Retail Food Environment Index (RFEI) was calculated as the ratio of unhealthy (fast food and convenience stores) to healthy (supermarket/grocery stores and fruit and vegetable markets) outlets around the home. Regression models were fit to examine the association between the RFEI and 1) practice of psychological coping and self-monitoring strategies, 2) self-reported weight maintenance effort and difficulty, 3) overall diet quality measured by the Healthy Eating Index-2015 4) weight loss maintenance duration and 5) odds of weight loss maintenance. Adjusted models controlled for individual (age, sex, race/ethnicity, education) and neighborhood (median household income, availability of fitness/recreation centers and parks, walkability) factors. Results: Compared to individuals living in the healthiest food environments, those living in the unhealthiest food environments reported increased use of self-monitoring: Mean score of 2.66 compared to 2.58 (95% CI =2.59, 2.72), increased weight maintenance effort: Mean score of 4.57 compared to 4.46 (95% CI = 4.47, 4.67), increased weight 2 maintenance difficulty: 3.12 compared to 3.03 (95% CI=3.04, 3.20), lower diet quality: Mean HEI score was 70.06 compared to 71.5 (95% CI: 68.8, 71.3) , and shorter weight loss maintenance duration: Mean weight maintenance duration was 3.7 years compared to 3.2 years (95% CI=2.9, 3.5). Conclusions: Among adults enrolled in the WW Success Registry, on average, those living in the unhealthiest retail food environments reported greater practice of self-monitoring strategies, more difficulty and effort in maintaining weight loss, lower overall diet quality, and shorter weight loss maintenance duration compared to those in the healthiest retail food environments