Young adults are increasingly at risk for obesity. Data indicate that more than half of women and men between the ages of 20 and 39 are overweight or obese . Young adults also experience the greatest rate of weight gain, averaging 1 to 2 pounds per year, with significant increases during their early to mid-twenties [2, 3]. Further, data indicate that the largest weight gains occur among those young adults who are already overweight , and young adults who are overweight initially also are at greatest cardiovascular risk due to weight gained during these years [2–4]. Despite the problem of overweight and obesity in young adults, such individuals are underrepresented in standard behavioral weight loss programs, and on average, those who do enroll achieve less than half the weight loss achieved by older adult participants . In fact, recent reanalysis of data from two ongoing adult behavioral weight loss trials demonstrated that only 7% of enrolled participants were between 18 and 35; and at 6 months, young adults in these trials has lost an average of only 3.7 kg, compared to an average of 8.0 kg achieved by older adults in these same studies . To date, no treatment programs have specifically targeted young adults for weight loss, and little is known about the type of approach best suited for this critical period in the developmental lifespan.
One of the simplest strategies that holds potential to reverse the weight gain commonly associated with this period is teaching young adults to weigh themselves frequently and use this information to make adjustments in their behavior as needed. Frequent self-weighing has been associated with positive outcomes in weight gain prevention, weight loss, and weight maintenance studies [6–9]. To date, however, frequency of weighing has not been directly manipulated within a randomized clinical trial for weight loss, and doing so within a self-regulation framework may improve current treatment efforts. Specifically, self-regulation in this context includes self-observation (i.e., regular weighing), self-evaluation (i.e., comparing one's weight to desired weight range), and self-reinforcement (i.e., reinforcing efforts to lose weight or maintain weight) or adjustments in behavior (i.e., making changes to calorie or exercise prescription).
Self-regulation programs of a similar nature have been effective in the management of diabetes , as well as weight loss maintenance . A self-regulation program using daily weighing may be particularly beneficial in improving weight loss efforts with young adults, who, as a group struggle with self-regulation across a variety of health-related behaviors. For example, extant research indicates that cigarette smoking, binge drinking, and heavy alcohol use all peak in young adulthood [11–13]. As in weight control, self-monitoring of these behaviors is related to decreased use [14, 15], and researchers have used self-regulation theory as a framework for these findings . Directly relevant to the self-regulation of weight, as adolescents become young adults, they are more likely to eat fast food and decrease their exercise . Daily self-weighing provides a mechanism to allow young adults to see how their behaviors (e.g., alcohol or fast food intake) impact their weight and would enable them to react with appropriate behavior changes before weight gain accumulates over time. It is well established that self-monitoring is predictive of weight loss , but it is also well known that self-monitoring declines over time . Daily weighing may be more easily maintained than traditional forms of self-monitoring (i.e., calorie and fat intake), and therefore may be appealing to young adults in the midst of significant life transitions and with considerable time demands.
Despite the potential benefits associated with daily self-weighing, some researchers have argued that frequent weighing may result in an increased risk of developing eating disorders or in negative effects on mood [19, 20]. However, there are few data to support these concerns , and the studies that have raised these concerns have been conducted with adolescent samples, not adults [20, 22, 23]. Rather, available data provide no evidence of adverse effects of daily weighing within an adult population . However, this has not been evaluated specifically in a young adult sample, in which the development and/or onset of disordered eating behaviors may be more likely .
General goals of the current pilot study were to assess the feasibility of recruiting and retaining overweight and obese young adults in a behavioral weight loss program, and to evaluate the potential to achieve significant weight losses through a brief intervention. More specifically, we sought to determine whether young adults would adhere to different self-weighing prescriptions, whether daily weighing and self-regulation would improve weight loss outcomes, and whether untoward effects of daily weighing would be observed. We randomized participants to one of two groups: a behavioral self-regulation (BSR) program that used daily self-weighing, or a tailored version of standard behavioral treatment (SBT) that promoted weekly weigh-ins at group only. Both groups were active treatments that taught the same core behavioral strategies, provided identical calorie and exercise prescriptions, and limited enrollment to young adults between 21 and 35. Further, lessons in both groups were tailored to specific problem areas facing this age group (e.g., fast food, alcohol, time management). We hypothesized that participants in both treatment arms would adhere to their self-weighing prescriptions, and that both arms would produce significant weight losses at post-treatment. We predicted that the self-regulation condition that emphasized daily weighing would lead to better longer-term weight losses once treatment was discontinued.