Systematic development of a complex intervention for weight cycling

Abstract

Evidence from the past 30 years in obesity research suggests that success in weight loss is modest in size and temporary, with only 5% of individuals succeeding in maintaining their weight long-term. This is found to be true regardless of which strategy dieters employ, with slower, less drastic methods being favoured by academics and endorsed by the NHS and dietetics practitioners as a solution for weight cycling/ yoyo dieting. Yet the problem of repeated intentional weight loss followed by unintended regain persists and often is associated with harrowing psychological costs for those who experience it.

The Medical Research Council’s Framework for systematic development and evaluation of complex interventions was used to develop a psychosocial intervention for individuals who repeatedly lose and regain weight (weight cyclers/yoyo dieters). This staged development process began with a systematic literature search (study 1) to identify the determinants of weight cycling with the aim to conduct a systematic review. However, on completion of the search it was evident that there is little conceptual and definitional clarity around the term weight cycling. Therefore, a large body of heterogeneous literature was included in the final structured review. The findings established that weight cycling is a multifactorial phenomenon, impacted by a host of physiological, cognitive, affective, social and environmental determinants and a successful intervention needs to address more than just the self-regulatory aspects of weight control. The second stage (study 2) involved conducting a framework analysis study with 27 dieters, to establish how the factors identified by the systematic review map out onto the experience of repeat dieters. The qualitative stage established that affective factors are particularly important where long-term weight control is concerned and that any intervention for weight cycling should provide a focus on emotions. However, inter and intra individual variability needs to be considered, at the point of intervention design, to ensure that individuals receive help that is relevant and appropriate to their needs. The final stage of identifying the evidence base (study 3) consisted of stakeholder consultations, where 7 subject specialists (researchers and practitioners) and 5 repeat dieters were presented with the findings from studies 1 and 2 and their input was sought on the content, form, logistics and delivery of the proposed intervention. Study 3 confirmed that the population of repeat dieters is highly heterogeneous in terms of intervention needs and that heterogeneity was evident in the variety of emotions that dieters experienced. Experts identified relevant therapeutic models (ACT, DBT and CFT).

Date of Award	24 May 2017
Original language	English
Awarding Institution	Northumbria University
Supervisor	Vincent Deary (Supervisor), Michael Smith (Supervisor) & Amy Russo (Supervisor)