Obesity prevalence remains high for U.S. adults. Standardized behavioral treatment (SBT) has been demonstrated to be efficacious in achieving weight loss. Yet, an evaluation of the effectiveness of each behavioral strategy used in SBT is needed to optimize SBT and achieve improved long-term outcomes.

This secondary analysis used baseline and 12-month data from a randomized clinical trial testing the effect of three different self-monitoring approaches (paper record [PR], personal digital assistant [PDA], and PDA with daily tailored feedback messages [PDA+FB]) on weight loss. Observed variable path analysis was used to examine the mediation effects of social problem solving and adherence to self-monitoring of diet and exercise in this trial. The group effect was evaluated considering two comparisons: 1) PDAs vs. PR, and 2) daily tailored feedback (DTF) vs. none. Self-monitoring adherence was measured by the proportion of weeks that participants adhered to dietary/exercise self-monitoring. Social problem solving was measured by the Social Problem Solving Inventory-Revised (SPSI-R). Cardiometabolic risk factors considered were waist circumference, systolic blood pressure [SBP], diastolic blood pressure [DBP], high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol, triglycerides, and fasting glucose.

The sample was predominantly white (78%) and female (85%). Adherence to self-monitoring of diet and exercise partially mediated the group effect (PDAs vs. PR) on weight loss. Self-monitoring adherence also fully mediated the group effect (DTF vs. none) on changes in weight, waist circumference, SBP, DBP, total cholesterol, HDL, LDL, and triglycerides. Social problem solving did not mediate any group effect. Weight loss mediated the effect of social problem solving and self-monitoring adherence on changes in cardiometabolic risk factors. In addition, psychometric analysis revealed that the SPSI-R had high internal consistency reliability and convergent and concurrent validity in our sample. Age, income, education, mental health, perceived stress, and barriers to healthy eating were associated with social problem solving.

Future research examining the mechanism of social problem solving, adherence to self-monitoring of diet and exercise, and other behavioral factors used in SBT for obesity with longer follow-up in a larger sample is warranted to provide scientific evidence for optimizing SBT for the long-term.