A remote-based yoga intervention for improving long-term weight loss

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PROJECT SUMMARY Effective interventions with strong dissemination potential are critical for addressing the obesity epidemic. Internet-delivered weight loss (IDWL) programs overcome many of the barriers common to face-to-face interventions (e.g., geographical constraints, lack of childcare, high cost), but weight losses are approximately half of that observed within in-person treatment. Novel approaches for improving long-term weight loss (WL) within IDWL programs are needed. Yoga has been found to be an effective strategy for treating a variety of health conditions (e.g., CVD risk factors, depression, pain syndromes), but has been largely overlooked within the context of obesity management. Yoga has also been shown to strengthen self-regulatory skills (e.g., emotion regulation, cognitive regulation, and self-related processes) which are important for keeping WL off long-term. Nonetheless, only two randomized trials to date have combined yoga and behavioral WL treatment. While findings are initially promising, significant limitations include a lack of a control group and small sample size in one study and a short follow-up (12 weeks) in the other. Also, mechanisms through which yoga impacts WL within a weight management program have not been explored. In our pilot study, we found that providing yoga following three months of behavioral WL treatment led to favorable effects on dietary lapses (i.e., discrete episodes of dietary non-adherence which threaten WL), improved affect, and increased ability to resist dietary temptations compared to a contact-matched control. Further, yoga had a significant effect on WL and measures of self-regulation (distress tolerance, mindfulness, and self-compassion) among individuals who lost more weight within the first three months of treatment. Adherence to the yoga intervention, retention, and program satisfaction ratings were high. The proposed trial expands upon these promising preliminary findings by increasing the length of yoga treatment (3 to 9 months), assessing participants over a longer, 18-month period, broadening participant characteristics (including men and increasing racial/ethnic diversity), and increasing the sample size, so that it is sufficiently powered to examine primary (WL) and secondary outcomes (dietary lapses and other uncomfortable experiences which could trigger a dietary lapse) at 12 months. Further, it seeks to fill an important gap in the literature by formally assessing the mechanisms through which yoga impacts WL. All individuals will receive a 12-month Internet-delivered WL program and will be randomized at the end of month 3 to a 9-month yoga program (delivered via videoconference) or 9-month health and wellness program (contact-matched control). Participants will be followed for 6 months beyond the end of treatment (final assessment at 18 months). This fully remote trial has great potential to impact both the yoga and weight control fields and is particularly relevant given emerging research indicating that many individuals now prefer online healthcare programs vs. in-person programs.