Background: Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a\nrandomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers\nand the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform\ndissemination efforts.\nMethods: Lifestyle coaches documented barriers and approaches after each session (mean session attendance =\n50.3 �± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68%\nfemale, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage\nof the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic\ncharacteristics.\nResults: Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays\n(54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time\nmanagement (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having\nany type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were\nsignificantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical\nactivity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness\nand access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle\ncoaches used problem-solving with most participants (=75% short-term; > 90% long term) and regularly reviewed\nself-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (=10%) but\nincreased over 3.2 years.\nConclusion: Behavioral problem solving approaches have short and long term dissemination potential for many\nkinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the\nconsistent use of these approaches appears warranted.
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