Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the diabetes prevention program (DPP)

Abstract

OBJECTIVE - To identify the most important pretreatment characteristics and changes in psychological and behavioral factors that predict weight outcomes in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS - Approximately 25% of DPP lifestyle intervention participants ( n = 274) completed questionnaires to assess weight history and psychological and behavioral factors at baseline and 6 months after completion of the 16-session core curriculum. The change in variables from baseline to 6 months was assessed with t tests. Multivariate models using hierarchical logistic regression assessed the association of weight outcomes at end of study with each demographic, weight loss history, psychological, and behavioral factor. RESULTS - At end of study, 40.5%had achieved the DPP 7%weight loss goal. Several baseline measures (older age, race, older age when fi rst overweight, fewer self-implemented weight loss attempts, greater exercise self-efficacy, greater dietary restraint, fewer fat-related dietary behaviors, more sedentary activity level) were independent predictors of successful end-of-study weight loss with the DPP lifestyle program. The DPP core curriculum resulted in significant improvements in many psychological and behavioral targets. Changes in low-fat diet self-efficacy and dietary restraint skills predicted better long-term weight loss, and the association of low-fat diet self-ef ficacy with weight outcomes was explained by dietary behaviors. CONCLUSIONS - Health care providers who translate the DPP lifestyle intervention should be aware of pretreatment characteristics that may hamper or enhance weight loss, consider prioritizing strategies to improve low-fat diet self-effi cacy and dietary restraint skills, and examine whether taking these actions improves weight loss outcomes. © 2013 by the American Diabetes Association.