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While previous research has utilized remote delivery of yoga interventions, no research has specifically interrogated the effectiveness of remote yoga intervention delivery. In this secondary analysis of weight-maintenance trial data, we examined participant perceptions of essential yoga properties across in-person and remote formats, hypothesizing that perceptions would not differ following remote delivery. 24 women with overweight or obesity (34.6±4.1 kg/m2, 48.2±9.9 years) received a 12-week Iyengar yoga intervention (2x/week) following a 3-month behavioral weight loss program. Of 23 participants who completed follow-up questionnaires, 12 received the planned in-person intervention and 11 received a remote intervention (delivered live) due to the COVID-19 pandemic. The Essential Properties of Yoga Questionnaire (EPYQ) was completed online by participants and by the instructors to measure the perceptions of the relative emphasis placed on the essential components of the yoga intervention via 14 subscales. Linear regression models were used to compare perceptions of each EPYQ dimension across in-person and remote delivery methods, as well as between participants and instructors, independent of delivery method. 13 of the 14 subscales did not differ between delivery modalities (p>0.05). Participants perceived more individual attention within in-person yoga (p = 0.003). For both delivery methods, instructors perceived breathwork, restorative postures, and body locks to be incorporated to a lesser degree compared to participants (β = -1.28, p = 0.003; β = -1.57, p = 0.019; β = -1.39, p = 0.036; respectively). No other significant differences across the participant and instructor scores were observed. Findings provide preliminary support for the use of live remote delivery of yoga, effectively communicating most essential yoga properties when compared to in-person classes. However, participants perceived more individual attention with in-person versus remote delivery; thus, future remote-based yoga interventions may benefit from providing additional individualized feedback.

Yoga targets psychological processes which may be important for long-term weight loss (WL). This study is the first to examine the feasibility, acceptability, and preliminary efficacy of yoga within a weight management program following WL treatment. 60 women with overweight or obesity (34.3±3.9 kg/m2, 48.1±10.1 years) were randomized to receive a 12-week yoga intervention (2x/week; YOGA) or a structurally equivalent control (cooking/nutrition classes; CON), following a 3-month behavioral WL program. Feasibility (attendance, adherence, retention) and acceptability (program satisfaction ratings) were assessed. Treatment groups were compared on weight change, mindfulness, distress tolerance, stress, affect, and self-compassion at 6 months. Initial WL (3-mo WL) was evaluated as a potential moderator. Attendance, retention, and program satisfaction ratings of yoga were high. Treatment groups did not differ on WL or psychological constructs (with exception of one mindfulness subscale) at 6 months. However, among those with high initial WL (≥5%), YOGA lost significantly more weight (-9.0kg vs. -6.7kg) at 6 months and resulted in greater distress tolerance, mindfulness, and self-compassion and lower negative affect, compared to CON. Study findings provide preliminary support for yoga as a potential strategy for improving long-term WL among those losing ≥5% in standard behavioral treatment.

Background The COVID‐19 pandemic resulted in mandated stay‐at‐home orders, potentially resulting in changes in mental health (e.g., stress, anxiety) and challenges maintaining healthy dietary and physical activity behaviors. Objective This study examined how stress was associated with mental well‐being and weight loss behaviors during the COVID‐19 pandemic among adults enrolled in an internet‐based weight loss program. Methods Participants enrolled in a weight‐loss program residing in Rhode Island or Massachusetts, USA, completed a brief survey on their mental health and current weight‐loss behaviors during the COVID‐19 pandemic. Surveys were completed between 14 April 2020 and 21 April 2020, approximately one month after stay‐at‐home orders were mandated. Linear regression was used to examine associations between stress, mental health, and weight‐loss behaviors. Results A total of 99 participants completed the survey (79% female, 91% white, 52.2 ± 9.8 years, 34.0 ± 5.2 kg/m2, 77% reported moderate to extreme stress). Greater stress was associated with higher BMI (p = 0.04), higher education (p = 0.04), working more hours (p = 0.003), and having school‐age children at home (p = 0.002). Greater stress was also associated with higher levels of anxiety, worry, and concern regarding COVID‐19 (p's < 0.001) and having less time to spend on weight‐loss efforts (p < 0.001), after controlling for BMI and education. Conclusions Many individuals enrolled in a weight‐loss program experienced more stress during COVID‐19 compared to before the pandemic. This stress was related to more mental health challenges as well as more difficulties finding time for weight management efforts.

To explore barriers and facilitators to healthy eating during the COVID-19 pandemic among adults enrolled in an internet-based weight loss program. Adults in an internet-delivered weight loss program were recruited to participate. Participants completed online study surveys and a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview included questions to explore how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes. Participants (n = 30) were primarily female (83%) and white (87%), 54.6 ± 10.0 years old, and had a mean body mass index of 31.1 ± 4.5 kg/m 2 . Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring. General themes with eating were a change in eating out frequency or modality, cooking more, and changes in alcohol consumption. Eating habits among adults enrolled in a weight loss program changed during the COVID-19 pandemic. Future weight loss programs and public health recommendations should consider modifying recommendations to place increased emphasis on strategies to overcome barriers to healthy eating and promote facilitators that may help with healthy eating, particularly during unexpected circumstances or events.

Background Internalized weight stigma (Internalized‐WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class‐III) obesity and Internalized‐WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully‐remote lifestyle modification intervention (LM) followed by mindful self‐compassion training (MSC) or control. Methods Twenty‐eight women with Class‐III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized‐WS were randomized to a virtually‐delivered 4‐month LM followed by a 2‐month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4‐(post‐LM), 6‐(post‐MSC/CON), and 9‐month (follow‐up). Results Improvements in Internalized‐WS, shame, and self‐compassion were observed with LM. Mean 4‐month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post‐MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized‐WS, self‐compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6‐month, and at 9‐month trended lower in MSC versus CON. Conclusion Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized‐WS, self‐compassion, and intuitive eating. Continued work is needed to elucidate effects of self‐compassion training on Internalized‐WS, its mechanisms, and linkages to cardiometabolic health and long‐term weight loss.

Objective There is substantial inter‐individual variability in response to weight loss interventions and emerging evidence suggests that weight loss during the early weeks of an intervention may be predictive of longer‐term weight loss. This secondary analysis of data from a commercial program therefore examined 1) the associations between early weight loss (i.e., week 4) with final visit weight loss and duration on the program, and 2) other predictors of lower weight loss at final visit. Methods Client charts of adults with overweight or obesity (N = 748) were analyzed. Clients were stratified into categories of weight loss at the week 4 (< and ≥2%, 3% and 4%) and final visits (< and ≥5% and 10%). Multivariate logistic regression was used to assess predictors of <5% and <10% final visit weight loss. Results The odds ratios for losing <5% or <10% of weight at the final visit were higher (49.0 (95% CI: 13.84, 173.63) and 20.1 (95% CI: 6.96, 58.06)) for clients who lost <2% or <3% compared to those who lost ≥2% or ≥3% at week 4. Other predictors of not losing a clinically relevant amount of weight included female sex, use of higher calorie meal plans and shorter time in the program, among others. Those who lost ≥2% at week 4 also had a significantly greater percent program completion (109.2 ± 75.2% vs. 82.3 ± 82.4, p < 0.01) compared with those who did not meet the 2% threshold. Conclusions Lower 4‐week weight loss was identified as a strong predictor of not losing a clinically relevant amount of weight. These results may be useful for the early identification of individuals who can be targeted for additional counseling and support to aid in attaining weight loss goals. This analysis adds to the growing evidence suggesting that weight loss during the early weeks of an intervention may be predictive of longer‐term success. To our knowledge, this analysis is also the first to evaluate the sensitivity and specificity of various weight loss thresholds within the context of a commercial weight loss program. An additional unique aspect of this study, not typically evaluable in clinical trials that have a defined study length or within research trials which incentivize participants for study completion, is the evaluation of the relationship between early weight loss and time spent in the program.

Cancer survivors face long-term health challenges posttreatment. Physical activity (PA) can help manage cancer-related side effects and offer additional health benefits, yet up to 80% of survivors do not meet PA guidelines. Effective and translatable PA interventions are needed. This randomized trial assessed the feasibility, acceptability, and preliminary efficacy of a 12-week automated Internet program for increasing moderate-to-vigorous physical activity (MVPA) among cancer survivors. A secondary aim examined the effect of the intervention on physical and mental well-being. Inactive (<60 min/wk of PA) cancer survivors who completed cancer-directed treatment in the past 3-12 months or those on a stable maintenance treatment regimen were randomized to the Energize! Exercise Program or Newsletter control condition. The Energize! Program was fully automated and involved weekly behaviorally-based video lessons, homework assignments, exercise planning and reporting, and progressive MVPA goals (75 to 200 min/wk). Algorithm-generated personalized feedback was provided based on PA goal attainment and homework completion. The newsletter group received bimonthly PA education newsletters (a total of 6). Assessments occurred at baseline, 3 months (postintervention), and 6 months (following a 3-month no-contact follow-up). Feasibility was assessed via enrollment and retention rates, acceptability was assessed via intervention engagement metrics and program satisfaction questionnaire, and MVPA was assessed via both self-report and accelerometer (min/wk of total and \"bouted\" MVPA [accumulated in bouts ≥10 min]). Health-related outcomes (eg, quality of life, fatigue, psychological distress, psychological symptoms, and fear of cancer recurrence) were assessed via electronic questionnaires. Forty-six adults aged 55.2 (SD 8.3) years, with BMI mean 33.0 (SD 7.6) kg/m²; 42 (91.3%) female, and 37 (80.4%) non-Hispanic White enrolled in this trial. Feasibility metrics indicate that 69% (46/67) of those who screened eligible were randomized and 6-month retention among randomized participants was 94% (43/46). Acceptability was also high, as evidenced by the percentage of lessons viewed (mean 87.7%, SD 21.3%), exercise plans submitted (mean 82.6%, SD 25.8%), homework assignments completed (mean 77.2%, SD 25.2%), and weeks in which exercise minutes were logged (mean 85.9%, SD 22.1%). Program satisfaction ratings were higher in Energize (mean 5.8, SD 1.6; 1-7 scale) versus Newsletter (mean 3.2, SD 1.6; P<.001). Energize! increased self-reported (92.7 min/wk), bouted (35.4 min/wk), and total (46.3 min/wk) MVPA at 3 months (Cohen d=0.74-0.94), and these changes were partially maintained at 6 months. Increases in MVPA were smaller among Newsletter participants (d=0.28-0.47). Group differences in health-related outcomes were minimal and mixed, favoring Energize! over Newsletter for vitality (d=0.63) and somatization (d=0.76) at 3 months, and for depression (d=0.59) and anxiety (d=0.51) at 6 months. The automated Energize! Program is feasible, acceptable, and associated with positive changes in MVPA, yet future studies are needed to improve MVPA long-term. Findings suggest that self-guided PA programs may be beneficial for increasing MVPA among cancer survivors.

Background. This study examines factors associated with physical activity (PA) and sedentary behaviors (SB) in young adults (18–35 years) and compares objective and subjective assessment measures of PA and SB. Methods. 595 young adults ( 27.7 ± 4.4 years; 25.5 ± 2.6 kg/m2) enrolled in the Study of Novel Approaches to Weight Gain Prevention (SNAP) trial. Hours/day spent in SB (<1.5 METs) and minutes/week spent in bout-related moderate-to-vigorous intensity PA (MVPA; ≥3 METs and ≥10 min) were assessed using self-report and objective measures. Demographic factors associated with SB and MVPA were also explored (i.e., age, gender, BMI, ethnicity, work and relationship status, and number of children). Results. Objective MVPA ( 263 ± 246 min/wk) was greater than self-report estimates ( 208 ± 198 min/wk; p < 0.001 ) and differed by 156 ± 198 min/wk at the individual level (i.e., the absolute difference). Females, overweight participants, African Americans, and those with children participated in the least amount of MVPA. Objective estimates of SB ( 9.1 ± 1.8 hr/day; 64.5% of wear time) were lower than subjective estimates ( 10.1 ± 3.5 hr/day; p < 0.001 ), differing by 2.6 ± 2.5 hr/day for each participant. Conclusion. Young adults interested in weight gain prevention engage in both high levels of MVPA and SB, with participants self-reporting fewer MVPA minutes and more SB compared to objective estimates. This study is registered at ClinicalTrials.gov (NCT01183689).

Dietary lapses can hinder weight loss and yoga can improve self-regulation, which may protect against lapses. This study examined the effect of yoga on dietary lapses, potential lapse triggers (e.g., affective states, cravings, dietary temptations), and reasons for initiating eating following weight loss treatment. Sixty women with overweight/obesity (34.3 ± 3.9 kg/m ) were randomized to a 12 week yoga intervention (2x/week; YOGA) or contact-matched control (cooking/nutrition classes; CON) following a 12-week behavioral weight loss program. Participants responded to smartphone surveys (5x/day) over a 10-day period at baseline, 12, and 24 weeks to assess lapses and triggers. At 24 weeks, YOGA and CON differed on several types of lapses (i.e., less eating past full, eating more than usual, loss of control when eating, self-identified overeating, difficulty stopping eating in YOGA), and YOGA was less likely to eat to feel better or in response to stress (ps < 0.05). YOGA also reported less stress and anxiety and more positive affect (ps < 0.01); dietary temptations and cravings did not differ from CON. Yoga resulted in fewer dietary lapses and improved affect among women with overweight/obesity following weight loss. While preliminary, findings suggest that yoga should be considered as a potential component of weight loss treatment to target dietary lapses.

Background Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by different monitors are comparable and can be interpreted similarly across studies. Methods We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro 2 Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≥4 days of ≥8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5–2.9 METs), moderate-to-vigorous (MVPA; ≥3.0 METs), and total PA (TPA; ≥1.5 METs) according to each monitor was compared. Results Fifty-five participants (BMI 48.4 ± 8.2 kg/m 2 ) met wear time requirements. Daily time spent in sedentary (RT3 582.9 ± 94.3; SWA 602.3 ± 128.6 min), light (RT3 131.9 ± 60.0; SWA 120.6 ± 65.7 min), MVPA (RT3 25.9 ± 20.9; SWA 29.9 ± 19.5 min), and TPA (RT3 157.8 ± 74.5; SWA 150.6 ± 80.7 min) was similar between monitors ( p  > 0.05). While the average difference in TPA between the two monitors at the group level was 7.2 ± 64.2 min; the average difference between the two monitors for each participant was 45.6 ± 45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level. Conclusions Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used.