Understanding Racial and Ethnic Differences in Weight Loss Maintenance and Regain

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PROJECT SUMMARY Weight loss interventions can produce clinically meaningful weight reductions, although most individuals experience significant weight regain following treatment. While the biological, behavioral, and environmental factors influencing long-term weight loss maintenance (WLM) are complex, it is clear that behaviors and reinforcers facilitating WLM differ greatly from those required for initial weight loss. However, we currently lack a well-specified conceptual framework that integrates and organizes behavioral, environmental, social, and cultural factors related to WLM. Additionally, weight loss treatment outcomes differ for African Americans and Whites, with African Americans losing less weight initially and Whites experiencing greater long-term weight regain. However, the reasons for these racial/ethnic differences in treatment response are unclear. Therefore, the goal of this project is to improve our understanding of factors associated with WLM and weight regain for African Americans and Whites who previously achieved clinically meaningful weight loss (i.e., >5% weight reduction). By utilizing validated methods novel to the investigation of WLM, including the nominal group technique (NGT), card-sorting tasks, and cognitive mapping, we will examine factors associated with successful WLM as well as weight regain among African Americans and Whites. By recruiting from several ongoing weight loss studies, including the PI's current K23 randomized controlled trial of a WLM program, we will have access to sufficient numbers of individuals who previously achieved weight loss. In particular, we will target four groups of participants: 1) African American weight loss maintainers, 2) African American weight regainers, 3) White weight loss maintainers, and 4) White weight regainers. Through the NGT, African American and White weight loss maintainers and regainers will generate comprehensive and potentially culturally-specific lists of facilitators and barriers to WLM (Aim #1). These facilitators and barriers will then be prioritized and organized into meaningful categories by participants through card-sorting tasks, which will be included in cluster analytic methods and cognitive mapping to develop conceptual frameworks of WLM for African Americans and Whites (Aim #2). Findings from this study will help us understand differences in response to weight loss and WLM treatments and guide the future development of culturally-tailored WLM interventions.