Utilization of Stimulus Control Strategies and Their Importance for Weight Outcomes During Behavioral Weight Loss
Authors:   , Crane Nicole T. , Butryn Meghan 
Published: October 2024

Exposure to palatable food cues in the modern obesogenic environment poses a significant barrier for weight control, making it difficult to maintain a calorie deficit. Management of environmental food cues, particularly in the home food environment (HFE), is a frequent target of gold-standard behavioral weight loss (BWL) treatment, typically through stimulus control content. BWL participants are taught to maximize availability of healthy foods and minimize availability of foods that make it difficult to meet prescribed calorie goals, decreasing the presence of stimuli that are conditioned to cue excess intake. However, little empirical work has been done to understand the usage and efficacy of stimulus control for weight management. This study examined stimulus control strategies targeting the HFE among adults enrolled in a BWL program (N = 187). Participants were provided with weekly treatment to induce weight loss in Months 0 to 3, followed by less frequent intervention contact. Weight was objectively measured at 0, 3, and 6 months. Self-report measures were administered at Months 0 and 3, including several novel measures created for this study to assess tempting foods in the HFE, grocery shopping habits, and utilization, barriers, and perceived importance of stimulus control strategies. Results showed modest usage of stimulus control among BWL participants. Strategies targeting grocery shopping or limiting portions of tempting foods in the home were used most frequently. Usage of stimulus control significantly increased from 0 to 3 months, though there is still noted room for improvement in the uptake of these strategies. While usage of stimulus control during treatment failed to predict concurrent weight loss, higher usage of stimulus control strategies (particularly those targeting availability and involving other household members) at 3 months prospectively predicted higher weight loss over the ensuing 3 months (Months 3-6). Findings also showed that perceived importance of stimulus control at 3 months was related to higher concurrent utilization, suggesting that participant buy-in for these skills is an important upstream variable to understand to facilitate uptake. Levels of hedonic hunger, participant gender, presence of children in the home, household size, and grocery shopping involvement emerged as relevant variables to consider in conceptualizing how a participant uses and views stimulus control during weight reduction. Finally, this study provided novel insights into the common barriers participants experience when enacting HFE modifications, which included household dynamics, a lack of support from other household members and challenges with tolerating the discomfort associated with HFE modifications. Findings from this project have several implications for future BWL treatments including refining stimulus control content (e.g., enhanced focus on grocery shopping or household factors) and incorporating novel approaches to assist BWL participants in successfully enacting HFE modifications (e.g., distress tolerance or acceptance-based skills).