Project Summary/Abstract
Obesity is one of the most important public health issues today, contributing to many of the primary causes
of morbidity and mortality in the United States. Still, treatment remains difficult and many people continually
struggle to lose weight. Thus there is critical need for improvements in methods for treating obesity. One
potential reason weight control is so difficult is the need to sacrifice immediate pleasures for long-term goals.
This requires placing significant value on future outcomes, such as health.
One strategy for doing so is to focus on the potential benefits of avoiding unhealthy choices. Health
messaging studies suggest that messages focused on promoting long-term benefits of healthier choices may
be effective in encouraging initiation of, or positive attitudes toward, healthy behaviors, however, longer-term
effects of these messages have not been studied in the context of obesity. By contrast, behavioral economic
work on Prospect Theory suggests focusing on preventing future negative consequences may be superior, and
the threat of weight gain is a more powerful motivator than the benefit of weight loss. Although prevention
strategies have been successfully employed in smoking cessation and anti-smoking campaigns, they are not
typically used in obesity treatment. In promising preliminary neuroimaging work, we identified increases in
brain regions involved in inhibitory control and decreases in cravings when using this PREVENT strategy.
The goal of this R03 is to test whether an intervention built upon the goal to PREVENT long-term
consequences of weight gain versus an intervention built upon the goal to PROMOTE long-term benefits of
weight loss is beneficial in altering valuation of health and taste in food choice decision-making, encouraging
adherence, reducing food cravings and consumption, and ultimate weight loss, as compared to a standard
behavioral weight loss program (BWL). A total of 90 overweight/obese men and women will be randomly
assigned to either PREVENT, PROMOTE, or standard BWL. Each intervention will have one in-person training
session wherein participants will learn key strategies of their assigned program, and the remaining 12 weekly
lessons will be delivered via internet. Baseline and 3-month (post-treatment) assessments will include the food
choice decision-making task featured in the parent K01 to measure valuation of health and taste, weight
measurement, and measurement of food cravings and consumption. To address feasibility, adherence and
engagement measures (i.e., lessons viewed, self-monitoring) will be collected during the internet program, and
memory for lesson content will be assessed post-treatment. Individual difference measures will also be
collected to provide preliminary data on factors that may influence success in each arm.
This project tests innovative approaches in the clinical treatment of obesity and will provide new insights
into the potential role of prevention versus promotion strategies for weight loss, further establishing Dr. Demos'
independent research career.