When someone decides to lose weight, the beginning of the process is often encouraging. Their progress may be visible to themselves and the people around them, in addition to bringing perks like higher energy levels. 

But after significant weight loss has been achieved, these exciting milestones start to plateau. At this point, it can be harder to find motivation to continue healthy behaviors and maintain the weight loss.  

“Weight loss maintenance is one of the most challenging problems in obesity treatment, regardless of how the original weight loss was achieved – whether through surgery, lifestyle intervention, or medication,” says professor Tricia Leahey, co-director of the UConn Weight Management Research Group.  

Leahey, principal investigator, and her fellow co-director and co-investigator, professor Amy Gorin, received a new, $3.8 million R01 research grant from the National Institutes of Health (NIH) to investigate new interventions for weight loss maintenance. 

These pilot interventions will be grounded in the principles of behavioral economics, which help explain why humans sometimes make choices that seem irrational. 

The interventions aim to address what’s known as the intention-behavior gap – the gap between what a person intends to do (such as going on a walk) and what they actually do (such as watching a movie on the couch). This gap tends to widen after a person’s initial weight loss has been successfully achieved and can be compounded by biology and other factors working against long-term maintenance.  

The gap is one critical factor why most people who achieve clinically significant weight loss regain nearly all the weight within a few years, meaning that health risks such as heart disease and diabetes return. 

Weight loss maintenance is one of the most challenging problems in obesity treatment, regardless of how the original weight loss was achieved.

With an eye toward designing solutions that will ultimately help reduce the risk of these chronic diseases for more people, Leahey, Gorin, and their co-researchers will conduct a five-year trial, recruiting over 500 participants across the country.  

“Narrowing the gap between intention and behavior is critical to supporting weight loss maintenance success. This trial tests four novel strategies for doing so,” says Gorin, who is a professor in the Department of Psychological Sciences as well as UConn’s Senior Vice Provost. 

In phase 1 of the trial, participants will be supported during an initial period of weight loss. Participants who successfully lose over 5% of their body weight and are interested in participating in the maintenance trial will move onto phase 2, in which they will be randomly assigned an intervention to test. 

Making Healthy Choices Easier

The interventions are designed to combat common obstacles that people encounter as they try to maintain weight loss. 

One example of such an obstacle is the tension between short-term and long-term gratification. Humans, like all animals, are psychologically inclined to choose behaviors that feel good in the moment. But sometimes these behaviors (e.g. snacking mindlessly) are at odds with their long-term goals (maintaining a healthy weight). 

To help address this, one intervention specifically targets future thinking, helping participants keep in mind their long-term goals and build the skills to prioritize their future wins. 

Another intervention focuses on variety. More than just the spice of life, variety is essential to infusing interest and purpose into everyday activities.  

So, rather than instructing participants to aim for the same exact exercise or dietary every week, this intervention will have them alternate between different goals. They may focus on increasing their daily step count for two weeks, then shift to focus on reducing sugar-sweetened beverages for the next two. 

A third intervention will focus on rewards. According to Leahey, research has found that even small financial incentives – averaging just three dollars a week – are effective at not only providing extrinsic motivation for weight loss maintenance, but also fostering intrinsic motivation. 

These small boosts may help by mimicking the feelings of reward and accomplishment people might experience at the beginning of a weight loss journey. 

The fourth and final intervention focuses on choice architecture – the idea that our surroundings shape our choices. 

“It’s this idea of setting your environment up for success,” says Leahey. “We can eliminate triggers in our environment that are inconsistent with our goals, and increase cues for healthy eating and activity. Instead of having potato chips out on the counter, we can have a fruit bowl, or pre-cut vegetables for snacks. We can pre-prepare healthy meals so that they’re easily accessible and ready.” 

Health Support in Your Pocket

This trial will be able to deliver interventions virtually, to participants across the country, through a mobile app. Participants will also be given wearable fitness trackers and log their food intake. They will receive personalized feedback and support throughout their entire participation. 

This mobile format “allows us to reach individuals we may not have been able to reach before – for instance, folks in rural settings, or who may have barriers related to transportation or childcare or unconventional work hours,” says Leahey. “It allows us to recruit a more diverse population, which is an important aspect of this trial as well.” 

Designing these interventions for success in a mobile environment also means that they could be highly translatable to various care contexts, says Leahey. 

“Since it’s all app-based, there isn’t a lot of need for human interaction, which drives costs and is oftentimes unrealistic in real-world settings,” she says. 

At the end of the trial, the researchers will evaluate which intervention (or combination of interventions) produced the largest treatment effect for less than $500 – the maximum amount Medicare and Medicaid services will reimburse per patient for obesity treatment. 

Given the portable format and low overhead costs, the results of the trial could be adopted by commercial weight-loss companies (like Noom or Weight Watchers), workplace wellness programs, and community organizations like YMCAs. 

The mobile format also reflects a core value of UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP), which prioritizes innovative approaches to public health challenges. Leahey is the director of InCHIP, and she notes that the InCHIP’s grants management team was instrumental in securing and facilitating this award. 

In addition to Leahey and Gorin, the research team includes: 

• Linda Collins, co-investigator (NYU School of Global Public Health) 

• Nickie Buckner, software solutions (One Cow Standing, LLC) 

• Brian Yates, consultant/cost analysis 

• Talea Cornelius, biostatistician (Columbia University)