title: Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change.
abstract: BACKGROUND
  Process evaluation is important for improving theories of behavior change and behavioral intervention methods. The present study reports on the process outcomes of a pilot test of the theoretical model (the Process Model for Lifestyle Behavior Change; PMLBC) underpinning an evidence-informed, theory-driven, group-based intervention designed to promote healthy eating and physical activity for people with high cardiovascular risk.
  
  
  METHODS
  108 people at high risk of diabetes or heart disease were randomized to a group-based weight management intervention targeting diet and physical activity plus usual care, or to usual care. The intervention comprised nine group based sessions designed to promote motivation, social support, self-regulation and understanding of the behavior change process. Weight loss, diet, physical activity and theoretically defined mediators of change were measured pre-intervention, and after four and 12 months.
  
  
  RESULTS
  The intervention resulted in significant improvements in fiber intake (M between-group difference = 5.7 g/day, p < .001) but not fat consumption (-2.3 g/day, p = 0.13), that were predictive of weight loss at both four months (M between-group difference = -1.98 kg, p < .01; R(2) = 0.2, p < 0.005), and 12 months (M difference = -1.85 kg, p = 0.1; R(2) = 0.1, p < 0.01). The intervention was successful in improving the majority of specified mediators of behavior change, and the predicted mechanisms of change specified in the PMBLC were largely supported. Improvements in self-efficacy and understanding of the behavior change process were associated with engagement in coping planning and self-monitoring activities, and successful dietary change at four and 12 months. While participants reported improvements in motivational and social support variables, there was no effect of these, or of the intervention overall, on physical activity.
  
  
  CONCLUSIONS
  The data broadly support the theoretical model for supporting some dietary changes, but not for physical activity. Systematic intervention design allowed us to identify where improvements to the intervention may be implemented to promote change in all proposed mediators. More work is needed to explore effective mechanisms within interventions to promote physical activity behavior.
authors.affiliation: Department for Health, University of Bath, Bath, BA2 7AY, UK. f.b.gillison@bath.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Gillison
authors.affiliation: Department for Health, University of Bath, Bath, BA2 7AY, UK. a.stathi@bath.ac.uk.
authors.forename: Afroditi
authors.initials: A
authors.lastname: Stathi
authors.affiliation: School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Prasuna.Reddy@newcastle.edu.au.
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
authors.affiliation: Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK. Rachel.Perry@bristol.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Perry
authors.affiliation: Department for Health, University of Bath, Bath, BA2 7AY, UK. g.j.taylor@bath.ac.uk.
authors.forename: Gordon
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Department for Health, University of Bath, Bath, BA2 7AY, UK. p.bennett@bath.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Bennett
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia. Director@greaterhealth.org.
authors.forename: James
authors.initials: J
authors.lastname: Dunbar
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK. c.j.greaves@exeter.ac.uk.
authors.forename: Colin
authors.initials: C
authors.lastname: Greaves
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D020377:Self Efficacy; D012944:Social Support; D015431:Weight Loss; D061217:Weight Reduction Programs