As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face to face. (ClinicalTrials.gov number, NCT00067145 [ClinicalTrials.gov].)

BACKGROUND-Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking.

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Objectives: To examine whether a weight loss program delivered to one spouse has beneficial effects on the untreated spouse and the home environment. Methods: We assessed untreated spouses of participants in three sites of Look AHEAD, a multicenter randomized controlled trial evaluating the impact of intentional weight loss on cardiovascular outcomes in overweight individuals with type 2 diabetes. Participants and spouses (n ¼ 357 pairs) were weighed and completed measures of diet and physical activity at 0 and 12 months. Spouses completed household food and exercise environment inventories. We examined differences between spouses of participants assigned to the intensive lifestyle intervention (ILI) or to the enhanced usual care (DSE; diabetes support and education). Results: Spouses of ILI participants lost À2.2±4.5 kg vs À0.2±3.3 kg in spouses of DSE participants (Po0.001). In addition, more ILI spouses lost X5% of their body weight than DSE spouses (26 vs 9%, Po0.001). Spouses of ILI participants also had greater reductions in reported energy intake (P ¼ 0.007) and percent of energy from fat (P ¼ 0.012) than DSE spouses. Spouse weight loss was associated with participant weight loss (Po0.001) and decreases in high-fat foods in the home (P ¼ 0.05). Conclusion: The reach of behavioral weight loss treatment can extend to a spouse, suggesting that social networks can be utilized to promote the spread of weight loss, thus creating a ripple effect. Keywords: weight loss; ripple effect; social network; home environment It is well established that the weights of marital partners are correlated at the start of marriage, 1-4 that weight gain after marriage is common, 5-7 and also that the weights of husbands and wives change in a similar fashion over time. 5,8 Although there is increasing evidence that interpersonal relationships can exert a social influence on obesity, 9 it is not known whether delivering a weight loss intervention to one spouse has a beneficial effect on the untreated spouse.There are many reasons to hypothesize that weight loss in one spouse will have a 'ripple effect' on the other spouse. If one spouse changes his or her eating and exercise habits, the other spouse might emulate these new health behaviors. Correlations between the diet and exercise patterns of spouses have been reported, 3,10 suggesting that spouses model each others' health behaviors. Untreated spouses might also be influenced by cues within the shared home environment. Cross-sectional examinations have found associations between the number of high-fat foods in the home and fat intake, 11 fruit and vegetable availability and intake of these foods, 12,13 and exercise equipment availability and physical activity. 14 Behavioral weight loss treatment includes recommendations to change the home food and exercise environment to prompt healthy behaviors. 15 To the extent to which such changes are made, the untreated spouse should demonstrate improvements in diet, physical activity, and weight similar to the treated spouse.

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BackgroundWeight gain during young adulthood is common and is associated with increased cardiovascular risk. Preventing this weight gain from occurring may be critical to improving long-term health. Few studies have focused on weight gain prevention, and these studies have had limited success. SNAP (Study of Novel Approaches to Weight Gain Prevention) is an NIH-funded randomized clinical trial examining the efficacy of two novel self-regulation approaches to weight gain prevention in young adults compared to a minimal treatment control. The interventions focus on either small, consistent changes in eating and exercise behaviors, or larger, periodic changes to buffer against expected weight gains.Methods/DesignSNAP targets recruitment of six hundred young adults (18–35 years) with a body mass index between 21.0-30.0 kg/m2, who will be randomly assigned with equal probability to: (1) minimal intervention control; (2) self-regulation with Small Changes; or (3) self-regulation with Large Changes. Both interventions receive 8 weekly face-to-face group sessions, followed by 2 monthly sessions, with two 4-week refresher courses in each of subsequent years. Participants are instructed to report weight via web at least monthly thereafter, and receive monthly email feedback. Participants in Small Changes are taught to make small daily changes (~100 calorie changes) in how much or what they eat and to accumulate 2000 additional steps per day. Participants in Large Changes are taught to create a weight loss buffer of 5–10 pounds once per year to protect against anticipated weight gains. Both groups are encouraged to self-weigh daily and taught a self-regulation color zone system that specifies action depending on weight gain prevention success. Individualized treatment contact is offered to participants who report weight gains. Participants are assessed at baseline, 4 months, and then annually. The primary outcome is weight gain over an average of 3 years of follow-up; secondary outcomes include diet and physical activity behaviors, psychosocial measures, and cardiovascular disease risk factors.DiscussionSNAP is unique in its focus on weight gain prevention in young adulthood. The trial will provide important information about whether either or both of these novel interventions are effective in preventing weight gain.Trial registrationClinicalTrials.gov, NCT01183689

Objective: To compare the enrollment, attendance, retention and weight losses of young adults in behavioral weight loss (BWL) programs with older participants in the same trials. Methods: Data were pooled from three NIH-funded adult BWL trials from two clinical centers in different regions of the country (total N ¼ 298); young adults were defined as those aged 18-35 years. Both young adults and adults were compared on session attendance, retention at the 6-month assessment, weight loss and physical activity at 6 months. Results: Young adults represented 7% of the sample, attended significantly fewer sessions than did adults (52 vs 74%, respectively; Po0.001) and were less likely to be retained for the 6-month assessment (67 vs 95%, respectively; Po0.05). Controlling for demographic variables, study and baseline weight, the mean weight losses achieved were significantly less for young adults compared with adults (À4.3 kg (6.3) vs À7.7 kg (7.0), respectively; Po0.05); fewer young adults achieved X5% weight loss at 6 months compared with older participants (8/21 (38%) vs 171/277 (62%); Po0.05). After controlling for session attendance, differences in the mean weight loss were not significant (P ¼ 0.81). Controlling for baseline values, study and demographics, changes in total physical activity over the initial 6 months of treatment were less for young adults compared with adults, but these differences only approached statistical significance (P ¼ 0.07). Conclusion: These data indicate that standard programs do not meet the weight control needs of young adults. Research is urgently required to improve recruitment and retention efforts with this high-risk group.

Objective: To determine the feasibility of recruiting and retaining young adults in a brief behavioral weight loss intervention tailored for this age group, and to assess the preliminary efficacy of an intervention that emphasizes daily self-weighing within the context of a self-regulation model. Methods:Forty young adults (29.1 ± 3.9 years, range 21-35, average BMI of 33.36 ± 3.4) were randomized to one of two brief behavioral weight loss interventions: behavioral self-regulation (BSR) or adapted standard behavioral treatment (SBT). Assessments were conducted at baseline, post-treatment (10 weeks), and follow-up (20 weeks). Intent to treat analyses were conducted using general linear modeling in SPSS version 14.0.Results: Participants in both groups attended an average of 8.7 out of 10 group meetings, and retention rates were 93% and 88% for post-treatment and follow-up assessments, respectively. Both groups achieved significant weight losses at post-treatment (BSR = -6.4 kg (4.0); SBT = -6.2 kg (4.5) and follow-up (BSR = -6.6 kg (5.5); SBT = -5.8 kg (5.2), p < .001; but the interaction of group × time was not statistically significant, p = .84. Across groups, there was a positive association between frequency of weighing at follow-up and overall weight change at follow-up (p = .01). Daily weighing was not associated with any adverse changes in psychological symptoms. Conclusion:Young adults can be recruited and retained in a behavioral weight loss program tailored to their needs, and significant weight losses can be achieved and maintained through this brief intervention. Future research on the longer-term efficacy of a self-regulation approach using daily self-weighing for weight loss in this age group is warranted.