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Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence

Elizabeth M Venditti14*, Judith Wylie-Rosett2, Linda M Delahanty3, Lisa Mele4, Mary A Hoskin5, Sharon L Edelstein4 and for the Diabetes Prevention Program Research Group

Author Affiliations

1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, 3811 O’Hara Street, Pittsburgh, PA 15213, USA

2 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA

3 Diabetes Research Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 340, Boston, MA 02114, USA

4 George Washington University Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852, USA

5 Southwestern American Indian Center, ACKCO Inc., 1616 Indian School Road, Suite 470, Phoenix, AZ 85016, USA

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:16  doi:10.1186/1479-5868-11-16

Published: 12 February 2014



Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts.


Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics.


Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years.


Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.

Lifestyle intervention; Diabetes prevention; Barriers; Behavioral approaches; Problem-solving; Toolbox strategies