The utility of lifestyle-based health promotion interventions is directly impacted by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long-term; thus, the “adherence problem” represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that impact adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (i.e., reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.

ObjectiveTo examine the contributions of frequency, consistency, and comprehensiveness of dietary self-monitoring to long-term weight change.Design and MethodsParticipants included 220 obese women (mean±SD, age=59.3±6.1 years; BMI=36.8±4.9 kg/m2) who achieved a mean loss of -10.39±5.28% from baseline during 6 months of behavioral treatment and regained 2.30±7.28% during a 12-month extended-care period. The contributions of cumulative frequency (total number of food records) of self-monitoring, consistency across time (number of weeks with ≥3 records), and comprehensiveness of information recorded were examined as predictors of weight regain in a hierarchical linear regression analysis The mediating role of adherence to daily caloric intake goals was tested using a bootstrapping analysis.ResultsThe association between high total frequency of self-monitoring and reduced weight regain was moderated by weekly consistency of self-monitoring, p=.004; increased frequency produced beneficial effects on weight change only when coupled with high consistency (>3 days/week). There was no impact of comprehensiveness on weight change, p>.05. The favorable effect of high frequency/high consistency self-monitoring on weight change was partially mediated by participants’ success in meeting daily caloric intake goals (p< .001).ConclusionThe combination of high frequency plus high consistency of dietary self-monitoring improves long-term success in weight management.

Brief intervention to prevent weight gain was not effective in this sample. Future studies should investigate lengthening the intervention to enhance effectiveness and increasing recruitment to improve statistical power.