Mediators of Weight Loss Maintenance in the Keep It Off Trial

BACKGROUND: An important step toward enhancing the efficacy of weight loss maintenance interventions is identifying the pathways through which successful interventions such as the Keep It Off trial have worked. PURPOSE: This study aimed to assess the viability of mediated relationships between the Keep It Off Guided intervention, conceptually and empirically grounded potential mediators, and weight. Repeated measurement of mediators and weight enabled documentation of the temporal ordering of intervention delivery and changes in mediators and in weight among participants randomized to the Guided intervention or Self-Directed comparison group. METHODS: Total, direct, and indirect effects of the Guided intervention on weight change were calculated and tested for significance. Indirect effects were comprised of the influence of the intervention on three change scores for each mediator and the relationship between mediator changes and weight changes 6 months later. RESULTS: Guided intervention participants regained about 2% less weight over 24 months than Self-Directed participants. Starting daily self-weighing accounted for the largest share of this difference, followed by not stopping self-weighing. CONCLUSIONS: Daily self-weighing mediated 24-month weight loss maintenance. TRIAL REGISTRATION NUMBER: The trial is registered withClinicalTrials.gov (Identifier: NCT00702455www.clinicaltrials.gov/ct2/show/NCT00702455).