• Approach inspired by the high relapse rate of calorie restrictive diets.
• Move from a weight-centred approach to a health-centred one
• Improving health behaviours irrespective of weight outcome as it has been suggested you can still be healthy and overweight
• Idea that targeting weight as the issue does not target comorbidities directly like targeting health behaviour does
• Weight-loss dieting failure can be damaging to self-esteem so this approach would try to avoid that
• Energy expenditure increased in long term measures
• Improves body dissatisfaction long term
• Improvement in body image avoidance behaviours
• This non-diet approach minimised attrition rate and attribution of blame to self as a 'failure'
• non-diet approach saw metabolic fitness improvements however saw no weight loss. 

• Weight loss was not a goal of the programme however would have been beneficial. If neither diet or non-diet approaches produce long term weight loss achievements then the improved metabolic health in the non-diet approach is a suitable alternative.

• Stress is an environmental stressor and can be chronic.
• Chronic social stress can then change: diet preference, food consumption (e.g. high fat comfort food cravings) and body composition changes  = cause and affect of obesity and stress as triggers for one another

This intervention aims to encourage the first method of coping, as this is what will improve physical health in the long-term by reducing risk of co-morbidities.

1. cephalic (preparation for food, initiated by smell)
2. absorptive (bloodstream energy absorption)
3. fasting (High glucagon, low insulin, promotes conversion of fats to energy)

• Noise level (environments)
• Mental health conditions

However it is not evident if results of this study reported actual weight loss/change in obesity status.There seems to be a disconnect between mental health and physical health surrounding obesity.

• Categorised in the DSM IV
• 65% Female
• More common in women seeking weight loss treatment
• Positively correlated with depression
• Maintained by CBT and interpersonal psychotherapy (IPT) in the short term but these are expensive and difficult to maintain
• Effectively treated with self-help strategies (e.g. group video sessions or one-to-one telephone help) in the long term

Fatosphere entry may be positive for mental health - acting as a coping mechanism to stigma - but this intervention aims to avoid fat acceptance as this can prevent the want to change and improve physical health by not reducing weight. 

Highlighting that females may have a more damaging perspective of who is at fault for their weight-gain, which could drive them to negative states of mental health. Alternatively, this mindset could also drive the female to take autonomous control of their own behaviour. A factor which can be correlated with long-term change (Teixeira et al., 2015). Therefore, this intervention aims to make participants aware of their comorbidities in order to install the idea to all participants that they have personal control over their own situations.

• Adherence rates of 27 weight loss studies were compared.
•  Interventions that included social support improved adherence rates by 29% compared to those interventions that did not include social support.
• Participation in weight loss interventions that allow friends or family to participate may have important implications for weight loss and weight loss maintenance.
• Analysis determined that programs supervising and monitoring attendance improved adherence rates by 65% compared to self-monitoring programs and had the highest adherence rates overall.
• Increasing knowledge may improve self-efficacy.
• Accountability is used as a factor determining adherence, through supervision from either social support of professionals.
• There was better adherence to dietary interventions alone than exercise interventions alone however both in combination produce best weight loss results.

• Interventions analysed lasting less than 12 months had the highest adherence rate (69.9% vs 53% for over or equal to 12 months), however less than a year does not indicate long term weight loss adherence.Which is crucial for comorbidity reduction and overall health improvement.

1. Diet
2. Physical activity
3. Behaviour therapy   

• Participants in ILI lost significantly more weight than DSE at all points within weight check ups (1, 4 and 8 years).
• Comparable weight loss in ILI was noted across genders.

• Both group and one-on-one professional support
• Calorie restriction
• Structured meal plans
• Meal replacements
• Activity plans
• Behaviour counselling using: Cognitive behavioural therapy (CBT), problem solving methods, motivational interviewing & cultural tailoring

• Group meetings, less frequent than ILI (initially only 3 per year)
• Discussions on: diet, physical activity and social support
• Information, not behavioural strategies

Highlights the importance of actually offering behavioural strategies of change, not just informing the person of weight loss information. Note that even in the ILI condition, weight loss was not achieved for all participants.

This limited success reflects the short-term want which some obese people have to change. Meal replacements can be expensive and can be difficult to maintain for a long time period due to the strict schedules. The meal replacement plans can also coach patterns of food restriction and result in negative food-associations. This review has suggested that although meal replacements can help to seek short-term results, they will not be used for this intervention as the aim is instead focused on long-term weight-loss and improvements in well-being.

However, as this study was only a small sample size (n=63), post-hoc analysis showed that differences between control and HBM group understandings could be attributed to participant differences. Long term weight-loss after participation was not measured. Thus, this highlights that HBM knowledge may not transmit to actual behaviour and suggests the importance of educating and also finding a way to monitor that knowledge applies into actual weight-loss behaviour.

After 12 weeks, all participants (n=10) achieved weight loss and had a decrease in psychological distress. However, as this study was only a pilot study the sample size is too low to apply to a large population.  It is be cost effective to teach and give participants intangible skills like mindfulness over expensive weight loss equipment and so could be applied on a large-scale. However, 12 weeks did not asses long-term life results so further evidence is required to support the benefits of mindfulness in weight loss.

The benefits of using stress-relieving techniques like mindfulness and meditation on behaviour change has been discussed in section 1.

13 weight-loss studies were analysed which met the RCT criteria of trying to loose weight. However, studies with goals of improving the well-being of obese individuals were excluded from this analysis, despite prior research in this portfolio highlighting the benefits of a positive mental well-being and mental health when attempting a weight-loss journey.
Results after 1 year were considered 'long-term'. Although this is not considered enough time to measure whether weight-regain and habit relapse occurs.

This indicates the need for an intervention to encourage active participation and discourage passive engagement.
This could be achieved through the self-monitoring of behaviour.

• Based on social cognitive theory and control theory
• Encourages: goal setting, self-monitoring and social support
• Enables 'helpers' to reach the app user and support them in weight-loss

Positive effects of the app trial were found. However, 'helper' support engagement was reported low. Highlighting the need for social support to be encouraged in this intervention through other methods than relying on healthy individuals to engage on a friends journey and to not just rely on the individuals belief in themselves by discounting their vicarious experience of seeing other people engage in the weight-loss journey.

However, data collection was only taken from members of a weight loss blog who wanted their journey to be recorded. Perhaps these individuals already had levels of intrinsic motivation to loose weight irrespective of the social support.

By dividing studies by length of measurement period, this review was able to determine the predictors of long-term weight management.

Refining the search from after the year 2000 enabled modern and relevant research to be reviewed.

The majority of interventions analysed were RCT's (n=28), followed by National clinical trials (n=6) and non-rct's (n=1). Indicating that the studies analysed were conducted with high-standards regarding validity of data collection and the interpretation of findings.

Personal factors such as social support, QoL & well-being were not monitored for in this review, despite these factors also being found to have an influence over long-term weight-loss success.