Application of social cognitive theory in weight management: Time for a biological component?

Abstract

The increasing prevalence of obesity worldwide and its associated negative health impact have increased the need for effective treatments (1). Although some individuals are successful in achieving weight loss, the vast majority of individuals who lose clinically meaningful amounts of weight through lifestyle change will regain weight over a period of 1 to 5 years (2,3). This phenomenon is highly discouraging to patients, clinicians, and researchers alike, and it currently represents the Achilles' heel of obesity treatment. Lifestyle interventions are the first-line treatment for obesity, and empirically supported health behavior change models are recognized to be important for the development of effective behavior change interventions. Social cognitive theory (SCT), in particular, is a foundational health behavior change model underlying traditional lifestyle interventions for weight loss (4). SCTbased interventions have consistently been found to support the initiation of behavioral changes in weight-loss interventions (5). As illustrated in Figure 1A, SCT posits that an individual's behavior exists in reciprocal relationships with personal factors (i.e., cognitions, emotions) and environmental factors (6). Thus, this model is consistent with a personalized approach to weight management (7). Despite the utility of SCT for facilitating the behavior changes needed for initial weight loss, this model has been less effective in facilitating long-term adherence to recommended lifestyle changes to achieve clinically impactful weight loss with sustainable weight-loss maintenance. We believe that part of the reason for the disappointing outcomes is that current approaches have failed to recognize the important role of biological factors in energy

Randomized controlled trial of a novel lifestyle intervention used with or without meal replacements in work sites

“…The specific goal-setting activities for HWL focused on daily self-weighing rather than the daily logging of food and physical activities that are core requirements of traditional interventions. In addition, HWL's revised interpretation of Social Cognitive Theory included biological antecedents of food intake as factors influencing program adherence [4,7]. Therefore, although many lifestyle interventions in the clinical setting [16,17] are not focused on hunger and are aimed at managing, rather than reducing, food cravings [17], core HWL elements aimed to reduce hunger and food cravings and develop healthier food preferences.…”

“…We developed a novel lifestyle intervention for weight management (Healthy Weight for Living [HWL]) based on a revised health behavior change model [4,7]. The new approach emphasizes addressing biological antecedents of food intake (hunger, food cravings, and food preferences) and developing intrinsic motivation for behavior changes leading to weight loss, topics that receive limited emphasis in traditional lifestyle interventions.…”

Factors associated with choice of behavioural weight loss program by adults with obesity

“…1 Despite this recognized conceptual foundation, the mean weight loss achieved by participants of such lifestyle intervention programs (2%-4%) 1,2 is relatively lower than the amounts needed for clinically impactful benefits. 3,4 In addition, weight regain is common. 5 The limited effectiveness of traditional weight loss programs may be due to limitations of the underlying health behaviour change model 4 or the burdensome nature of the core program activities.…”

“…3,4 In addition, weight regain is common. 5 The limited effectiveness of traditional weight loss programs may be due to limitations of the underlying health behaviour change model 4 or the burdensome nature of the core program activities. 6 These concerns justify the development and testing of alternative types of behavioural interventions.…”

“…As part of their core strategies, such programs encourage participants to identify goals for energy intake, physical activity, and weight loss; to keep daily food and activity logs; and to give the logs to intervention counsellors weekly for review and accountability 1 . Despite this recognized conceptual foundation, the mean weight loss achieved by participants of such lifestyle intervention programs (2%–4%) 1,2 is relatively lower than the amounts needed for clinically impactful benefits 3,4 . In addition, weight regain is common 5 .…”