1 Kaiser Permanente Center for Health Research, Portland, OR, USA.
2 Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Health Educ Behav. 2018 Dec;45(6):997-1007. doi: 10.1177/1090198118757823. Epub 2018 Feb 24.
We have demonstrated previously that patterns of behavioral adherence in the first 6 months of behavioral lifestyle interventions were associated with significant weight loss at 18 months. In this article, we extend this work to examine patterns of behavioral adherence over 18 months and to explore baseline demographic and psychosocial predictors.
Latent class analysis was applied separately to the Weight Loss Maintenance and PREMIER trials data to examine patterns of adherence to the following recommendations: (1) consuming ≥9 servings of fruits and vegetables per day, (2) ≤25% of energy from total fat, (3) ≤7% energy from saturated fat, and (4) ≥180 minutes of moderate-to-vigorous physical activity per week. Multinomial logistic regression was used to test demographic and psychosocial predictors of latent class membership.
Four distinct subgroups with common patterns of behavioral adherence were identified in each trial including, Behavioral Maintainers, who maintained adherence to all behavioral recommendations for 1 year, Nonresponders, who did not adhere to the recommendations at any time point, and latent classes that reflected patterns of adherence to one or two behaviors or behavioral relapse. A significantly higher proportion of Behavioral Maintainers sustained ≥5% weight loss for 1 year compared with Nonresponders. Participants with higher vitality scores at baseline were more likely to belong to a latent class with long-term adherence to one or more recommendations than the Nonresponders class.
Regular assessment of health behaviors and psychosocial measures such as vitality may help identify nonresponders and inform treatment tailoring to improve long-term behavioral and weight outcomes.
我们之前已经证明，在行为生活方式干预的前 6 个月中，行为依从模式与 18 个月时的显著体重减轻有关。在本文中，我们将这项工作扩展到 18 个月时的行为依从模式，并探讨基线人口统计学和心理社会预测因素。
分别对体重维持和 PREMIER 试验数据应用潜在类别分析，以检查以下建议的依从模式：（1）每天摄入≥9 份水果和蔬菜，（2）总脂肪能量摄入≤25%，（3）饱和脂肪能量摄入≤7%，以及（4）每周进行≥180 分钟的中等至剧烈体力活动。多分类逻辑回归用于测试潜在类别成员的人口统计学和心理社会预测因素。
在每个试验中都确定了四个具有共同行为依从模式的不同亚组，包括行为维持者，他们在 1 年内保持了对所有行为建议的依从性，不依从者，他们在任何时间点都不依从建议，以及反映对一种或两种行为的依从性或行为复发的模式的潜在类别。与不依从者相比，行为维持者中有更高比例的人维持了≥5%的体重减轻，持续了 1 年。基线活力得分较高的参与者比不依从者更有可能属于长期依从一种或多种建议的潜在类别。
定期评估健康行为和心理社会措施，如活力，可能有助于识别不依从者，并为改善长期行为和体重结果提供治疗调整信息。
