Are motivational and self-regulation factors associated with 12 months’ weight regain prevention in the NoHoW study? An analysis of European adults

Abstract

Purpose Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experienc‑ ing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. Methods The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost>5% weight in the past year (N=870, complete data only, 68.7% female, 44.10±11.86 years, 84.47±17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus’ path analytical models informed by NoHoW’s logic model. Results The bivariate correlations confrmed key mediators’ potential efect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2=23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifcally, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain preven‑ tion via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are signifcant in participants who regained or maintained their weight. Conclusions These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents.