Perspectives of health practitioners and adults who regained weight on predictors of relapse in weight loss maintenance behaviors: a concept mapping study

Figures & data

Figure 1. The concept mapping process. Adapted from ‘An introduction to concept mapping for program planning and evaluation’ by W. Trochim, 1989, Evaluation and Program Planning, 12, 1-16.

Table 1. Demographics and characteristics of health practitioners and persons who regained weight.

	Health practitioners (N = 39)	Persons who regained weight (N = 21)
Gender (N)
Male	0	3
Female	39	18
Age (years)
Mean (SD)	48.2 (9.9)	53.5 (8.9)
Educational level (N)*
Low	3	3
Middle	12	13
High	24	5
Profession (N)
Dietitian	14	-
Weight loss consultant	19	-
Lifestyle coach	5	-
Other	1	-

*Low level of education: primary education and lower general secondary education; Middle level of education: higher general secondary education, pre-university education, and secondary vocational education; High level of education: bachelor’s degree, master’s degree, and doctoral degree.

Table 2. Perceived predictors of relapse and importance rating as indicated by health practitioners and persons who regained weight.

		Health practitioners (N = 39)					Persons who regained weight (N = 21)
	Example of statement within perceived predictor	Mean importance rating per group*					Mean importance rating of all groups	Mean importance rating per group			Mean importance rating of all groups
Perceived predictors		P1	P2	P3	P4	P5		W1	W2	W3
Individual characteristics
Change in daily structure	‘changes in living situation, e.g. vacation, changes daily structure’	3.5	4.4	4.4	3.8	4.6	4.1	-	-	-	-
Stress	‘experiencing stress’	4.0	4.1	4.1	3.6	4.6	4.1	4.0	3.8	-	3.9
Maladaptive coping skills^a	‘finding comfort in food’	3.9	3.9	4.4	4.5	3.7	4.1	4.0	4.1	-	4.1
Habitual behavior	‘strong former unhealthy habits’	3.5	4.1	4.3	4.0	4.4	4.1	-	-	-	-
Lack of self-efficacy regarding weight loss maintenance	‘lack of faith in yourself’	3.5	4.1	4.3	4.3	4.2	4.1	3.7	-	-	3.7
Decrease in motivation	‘not feeling like dieting or exercising anymore’	3.6	4.3	3.7	4.4	3.9	4.0	3.9	3.7	3.6	3.7
Lifestyle imbalance or experiencing a life event	‘setbacks in life’	3.1	3.9	4.4	4.3	4.2	4.0	3.5	4.2	3.9	3.9
Lack of perseverance	‘lack of discipline’	4.2	3.6	3.2	4.3	4.3	3.9	3.9	3.8	3.6	3.8
Negative emotional state	‘not being at ease with yourself’	3.0	4.1	3.0	3.9	4.6	3.7	3.9	3.8	3.5	3.7
Goal disengagement	‘it takes too long to see results’	3.7	3.6	2.8	4.3	4.0	3.7	4.2	3.4	-	3.8
Maladaptive weight loss strategy	‘starting a diet that is not realistic to maintain’	3.5	4.0	3.6	3.8	3.4	3.7	-	3.0	3.5	3.3
Obstructing beliefs about lifestyle change	‘seeing losing weight as an ongoing battle’	3.4	4.0	3.3	3.6	3.6	3.6	3.4	3.6	3.5	3.5
Abstinence violation effect	‘today I failed, so I give up’	3.3	3.7	3.1	3.7	3.7	3.5	3.5	3.8	3.9	3.7
Lack of self-knowledge regarding needs and difficulties	‘not knowing their own pitfalls’	4.6	4.6	-	4.6	3.8	4.4	-	-	-	-
Unrealistic initial goal setting	‘setting the bar too high’	3.8	4.1	3.8	4.2	-	4.0	4.0	-	-	4.0
Limited cognitive capacity	‘lack of ability to be flexible, e.g. to vary in diet’	3.6	3.5	4.3	-	3.4	3.7	3.1	-	3.5	3.3
Physiological state^a	‘being hungry’	3.4	3.6	-	3.3	3.5	3.5	-	3.4	-	3.4
Physiological barriers^b	‘having an injury’	2.7	3.3	-	3.1	3.1	3.1	3.7	3.2	2.7	3.2
Perceived time barriers	‘having too little time to exercise’	2.9	3.0	2.5	-	3.4	3.0	3.2	2.8	2.6	2.9
Low self-value	‘lack of self-esteem’	-	4.4	4.4	-	4.0	4.3	-	-	-	-
Lack of resilience	‘lack of resilience’	4.0	-	3.9	4.5	-	4.1	-	-	-	-
No sense of urgency to lose weight	‘not seeing the urgent need of losing weight’	3.7	4.5	-	4.0	-	4.1	-	-	3.6	3.6
Lack of maintenance goal setting	‘after the weight loss goal is reached, the attention drops’	3.4	-	4.1	3.5	-	3.7	-	4.4	4.1	4.3
Lack of self-monitoring	‘not being aware of a relapse’	3.6	-	3.8	3.5	-	3.6	-	-	-	-
Perceived general barriers	‘unable to cook dinner’	2.7	3.6	-	3.4	-	3.2	-	-	-	-
Unrealistic outcome expectancy	‘too high expectations’	4.0	-	-	-	3.9	4.0	-	-	2.8	2.8
Excuses	‘seeking excuses’	-	-	2.4	4.0	-	3.2	-	4.3	-	4.3
Lack of self-control	‘lack of self-control’	-	-	-	4.5	-	4.5	-	-	-	-
General emotional state	‘falling back into old patterns due to emotional events’	-	-	4.4	-	-	4.4	-	-	4.6	4.6
Locus of control	‘feelings of having no influence’	3.7	-	-	-	-	3.7	-	-	-	-
Impulsivity	‘character: difficult to control yourself’	-	3.4	-	-	-	3.4	-	-	-	-
Positive emotional state	‘celebrating with dinner’	-	3.1	-	-	-	3.1	-	-	3.4	3.4
Craving^a	‘feeling that you must snack in the evening’	-	-	-	-	-	-	-	4.2	3.8	4.0
Indulgence^a	‘food as a reward’	-	-	-	-	-	-	3.6	3.7	3.8	3.7
Lack of knowledge^a	‘too much and contradictory information about nutrition in the media’	-	-	-	-	-	-	3.6	2.7	3.4	3.2
Rationalization	‘already having a hard enough time’	-	-	-	-	-	-	-	2.8	-	2.8
Environmental characteristics
Non-supportive physical environment	‘tempting environment at work and at home’	3.6	3.5	3.7	3.4	4.2	3.7	3.9	3.4	3.4	3.6
Lack of social support	‘ceasing of a sport buddy’	3.2	3.5	3.5	4.3	3.9	3.7	3.4	3.1	3.0	3.2
Perceived financial barriers	‘not having enough financial resources’	2.9	3.1	2.5	2.5	2.9	2.8	-	-	-	-
Perceived weather barriers^b	‘the weather is bad’	2.3	2.4	2.3	2.8	2.7	2.5	3.3	3.9	2.0	3.1
Social pressure^a	‘group pressure, e.g. at a party’	2.9	3.2	3.6	-	3.9	3.4	-	-	-	-
Social norm	‘don’t want to say no when someone made an effort’	2.7	-	3.5	3.5	3.7	3.4	-	3.3	3.8	3.6
Tempting social environment^a	‘seeing other people eat’	-	-	-	-	-	-	3.7	3.2	3.6	3.5

Not applicable (-), indicates a perceived predictor was not mentioned during the concept mapping session within this group.

*Mean importance rating per group: P indicates ‘practitioners’; W indicates ‘persons who regained weight’. Numbers indicate the different groups (e.g. W1 = weight regain group 1).

^a Perceived predictor is specifically aimed at dietary behavior.

^b Perceived predictor is specifically aimed at physical activity.

Trochim, W. M. (1989). An introduction to concept mapping for planning and evaluation. Evaluation and Program Planning, 12(1), 1–16.

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