The utility of lifestyle-based health promotion interventions is directly affected by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long term; thus, the “adherence problem” represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that affect adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on the challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (ie, reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.

Objective: To examine the contributions of frequency, consistency, and comprehensiveness of dietary self‐monitoring to long‐term weight change.Methods: Participants included 220 obese women (mean ± SD, age = 59.3 ± 6.1 years; BMI = 36.8 ± 4.9 kg/m²) who achieved a mean weight loss of −10.39 ± 5.28% from baseline during 6 months of behavioral treatment and regained 2.30 ± 7.28% during a 12‐month extended‐care period. The contributions of cumulative frequency of self‐monitoring (total number of food records), consistency across time (number of weeks with ≥3 records), and comprehensiveness of information recorded were examined as predictors of weight regain in a hierarchical linear regression analysis. The mediating role of adherence to daily caloric intake goals was tested using a bootstrapping analysis.Results: The association between high total frequency of self‐monitoring and reduced weight regain was moderated by weekly consistency of self‐monitoring, P = 0.004; increased frequency produced beneficial effects on weight change only when coupled with high consistency (>3 days/week). There was no impact of comprehensiveness on weight change, P > 0.05. The favorable effect of high frequency/high consistency self‐monitoring on weight change was partially mediated by participants' success in meeting daily caloric intake goals (P < 0.001).Conclusion: The combination of high frequency plus high consistency of dietary self‐monitoring improves long‐term success in weight management.

Objective: Despite the proliferation of newer self‐monitoring technology (e.g., activity monitors and smartphone apps), their impact on weight loss outside of structured in‐person behavioral intervention is unknown.Methods: A randomized, controlled pilot study was conducted to examine efficacy of self‐monitoring technology, with and without phone‐based intervention, on 6‐month weight loss in adults with overweight and obesity. Eighty participants were randomized to receive standard self‐monitoring tools (ST, n = 26), technology‐based self‐monitoring tools (TECH, n = 27), or technology‐based tools combined with phone‐based intervention (TECH + PHONE, n = 27). All participants attended one introductory weight loss session and completed assessments at baseline, 3 months, and 6 months.Results: Weight loss from baseline to 6 months differed significantly between groups P = 0.042; there was a trend for TECH + PHONE (−6.4 ± 1.2 kg) to lose more weight than ST (−1.3 ± 1.2 kg); weight loss in TECH (−4.1 ± 1.4 kg) was between ST and TECH + PHONE. Fewer ST (15%) achieved ≥5% weight losses compared with TECH and TECH + PHONE (44%), P = 0.039. Adherence to self‐monitoring caloric intake was higher in TECH + PHONE than TECH or ST, Ps < 0.05.Conclusions: These results suggest use of newer self‐monitoring technology plus brief phone‐based intervention improves adherence and weight loss compared with traditional self‐monitoring tools. Further research should determine cost‐effectiveness of adding phone‐based intervention when providing self‐monitoring technology.