Implementation Intentions for Weight Loss and Dietary Change in College Students With Overweight and Obesity
Condition: Obesity
MeSH terms: Obesity; Overweight; Weight Loss
Study type: Interventional
Phase: Phase 2

Summary: 
      One in three college students have overweight or obesity and are in need of brief and simple
      weight loss interventions that complement their unstructured lifestyles. Implementation
      intentions, a strategy that connects a goal-aligned behavior to a cue, facilitate
      goal-attainment for a wide variety of health-behaviors, but have not been tested as a
      stand-alone treatment for weight loss in students. College students with overweight or
      obesity (N = 95) were randomized to one of three conditions: an implementation intention
      group (IMP), an enhanced implementation intention group (IMP+) that included text message
      reminders and fluency training (i.e., training for speed and accuracy), and a control goal
      intention group (GOL) for four weeks. Participants completed anthropometric and self-report
      assessments pre- and post-treatment as well as experience-sampling assessments during the
      study to assess how implementation intentions contribute more directly to behavior change
    

Detailed description: 
      Obesity poses a serious public health concern. Thirty-five percent of college students are
      overweight/obese, putting them at increased risk of overweight and obesity in later
      adulthood. The study of effective interventions for weight loss has been neglected in this
      population, and those that have been assessed had high attrition due to time burden. Brief
      interventions are needed for weight loss in students with obesity to improve current weight
      status and prevent associated comorbidities in later adulthood.

      Self-regulatory behaviors are necessary to achieve weight loss goals, specifically
      goal-striving behaviors that aid in the planning and execution of goal-aligned actions5.
      Implementation intentions are a widely-utilized self-regulatory goal striving strategy that
      function by creating a mental link between a critical environmental or internal retrieval cue
      and a goal-aligned behavior (e.g. "if I want dessert, then I will eat an apple").
      Implementation intentions are effective because they 1) create a strong association between a
      goal-aligned behavior and a retrieval cue for that behavior, increasing the likelihood that
      the goal-aligned behavior will be accessed and employed when the cue is encountered, and 2)
      increase attention for and cognitive accessibility of the retrieval cue, thus increasing
      opportunities for goal-aligned action. Implementation intentions effectively facilitate
      health-related goal attainment with regard to diet and weight loss. However, mechanisms
      underlying implementation intentions may weaken when used in applied, naturalistic settings
      and when multiple implementation intentions are maintained, due to complexity and difficulty
      of goal achievement. Enhancements that strengthen implementation intention effects should
      improve use for clinically-relevant diet change and weight loss in applied interventions.

      Strengthening these mechanisms via improved encoding and retrieval should help maintain
      potency.

      Fluency training (i.e., training for speed and accuracy) improves encoding and retention of
      information14,15 and should strengthen the already present link between the cue and the
      goal-aligned behavior, facilitating employment of the predetermined behavior, even when
      competing goals are introduced in applied settings. Additionally, external reminders serve to
      support memory for and increase accessibility of the multiple cues, allowing for maximal
      opportunities for the goal-aligned behaviors to be retrieved and utilized. Given high use of
      mobile devices in college students, text message reminders can serve as external reminders in
      this population and have been used previously to complement implementation intention use.

      Thus, this proposal aims to test the efficacy of an implementation intention intervention
      alone (IMP) and in combination with fluency training and text message reminders (IMP+)
      against a goal-intention control (GOL) on weight loss and dietary behaviors. A three-group
      randomized-controlled intervention paradigm will be employed across four weeks. Ecological
      momentary assessment (EMA), the repeated testing of participants in real time, will be used
      to provide a more in-depth snapshot of implementation intention usage and its role as the
      mechanism of change in the intervention. Work to date examining implementation intentions has
      been limited to the laboratory or has utilized retrospective self-report, which limit
      external validity and are susceptible to recall bias. This will be the first study to examine
      implementation intention use with the externally-valid measurement that EMA provides.
      Additionally, given literature that supports implementation intention use during periods when
      goal striving is challenged (e.g. negative mood, etc.), the study will additionally assess
      their efficacy during disruptive internal and external states. At post-treatment, weight and
      dietary change will be assessed. Students with overweight/obesity wanting to lose weight, but
      not currently enrolled in a weight loss program, will be assessed. Specifically, the study
      will:

      Specific Aim 1: Evaluate the effects of IMP and IMP+ on weight (Specific Aim 1a) and diet
      (Specific Aim 1b). Participants in IMP and IMP+ will lose more weight and show greater diet
      improvements compared to individuals in GOL. Participants in IMP+ will lose more weight and
      show greater diet improvements compared to participants in the IMP.

      Exploratory Aim: Explore effective use of implementation intentions as the underlying
      mechanism of treatment outcome and their successful employment when distractions threaten
      goal attainment.
    

Intervention name(s): Implementation Intentions; Fluency Training; Text Messages; Goal Intentions
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Implementation intentions aid in pre-planning and habitualization of behaviors, as they serve to identify the when, where, and how of behaviors leading to goal attainment. Often taking the form of "If/when situation x arises, then I will do y!", implementation intentions can be conceptualized in two parts, namely, an environmental or internal retrieval cue and a goal-directed behavioral response. Implementation intentions are effective because they 1) create a strong association between a retrieval cue and a goal-aligned behavior, increasing the likelihood that the goal-aligned behavior will be retrieved and utilized when the cue is encountered, and 2) increase attention for and cognitive accessibility of the retrieval cue, increasing opportunities for goal-aligned action .; Fluency training is a learning strategy that requires an individual to perform a skill or demonstrate knowledge repeatedly for both accuracy and response rate; the goal is to enhance automaticity of the response and promote endurance and retention of skills and knowledge over time and in the face of distractors. Participants completed 1 minute fluency training protocol 4 times throughout the study.; SMS reminders sent to phone of implementation intentions 16 times throughout the study.; Intentions to complete a goal that do not specify a plan about how to do so (compared to implementation intentions, that do)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: three-group parallel randomized-controlled trial
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Obesity; College Students; Implementation Intentions