Which strategies to manage problem foods were related to weight loss in a randomized clinical trial?

Individuals managing their weight are often faced with problem foods that are difficult to resist eating. In the context of a weight-loss intervention, we characterized the most commonly reported problem foods and the behavioral strategies used to manage them, and examined which strategies were related to weight loss. Women with overweight and obesity (N = 186) participated in a one-year randomized trial of three interventions (NCT01474759): standard advice to eat less food, choosing portions based on energy density, and using pre-portioned foods. At Months 0, 6, and 12 of the trial, participants listed the foods they found most problematic and reported the frequency of using eight behavioral strategies to control intake of these foods, including three practices for avoiding exposure to problem foods and three for consuming them but limiting intake. The responses showed that 82% of the top three problem foods were in the categories of sweet baked items, salty snacks, starchy side dishes, chocolate and candy, and ice cream. After one year, women who reported more frequently using the strategy of limiting portions of problem foods had a greater rate of weight loss (kg/week), regardless of their intervention group (p < 0.0001). Among women who limited portions of problem foods less frequently, those using pre-portioned foods had greater initial weight loss compared to the other two groups, but then regained weight at a greater rate (p < 0.0001). The three avoidance strategies for problem foods were reported to be frequently used but were not found to be related to weight loss. These results suggest that adopting and maintaining strategies to manage portions of problem foods, rather than avoiding exposure to them, can be a more useful approach for weight loss.