Background
’s behavior, weight loss, obesity-related behaviors
Understanding and preventing weight regain in individuals who successfully lost weight is crucial from a public health perspective. However, while extensive evidence exists about the role of energy-balance related behaviors – physical activity and healthy eating—for sustained weight management [Concerning motivation, there is a body of research examining the effects of the satisfaction of psychological needs and autonomous vs. controlled motivations derived from the Self-Determination Theory—SDT [Higher needs satisfaction occurs when the context is perceived as need-supportive, providing autonomy support, structure, and involvement. In these contexts, behavior regulation becomes internalized and integrated, a path leading to increased motivational quality (i.e., autonomous motivation). The SDT postulates that autonomous motivation is the most sustainable form of energizing and directing one’s behavior (which can be branded as “wantivation”). Conversely, in needs frustration contexts, behavioral regulations become externalized, leading to controlled motivations that are less sustainable (which can be branded as “mustivation”), as they only energize and direct behavior as long as external contingencies remain present (Ryan & Deci, 2000).Concerning self-regulation, a systematic review showed that self-regulatory skills use (such as self-monitoring or goal setting and planning) is a mechanism of action exerting a positive effect on short-term weight control (< 12 months) in 92% of the times it was tested, and, in the medium to long-term (≥ 12 months), 83% of the times it was tested [Notwithstanding, most of the evidence is focused on how these putative predictors affect behavior change initiation, i.e., where participants are invited to a trial to start doing something new. Even the available long-term data mainly focuses on why and how participants learn and then maintain newly discovered processes. Instead, the present study looks mostly at behavior maintenance processes [These two themes integrate mechanisms of action – the processes through which interventions bring about change—which are worked via behavior change techniques (BCTs) included in the intervention [Notwithstanding, the NoHoW logic model covers only two behavior maintenance themes suggested by Kwasnicka et al. According to that paper, resources, environmental and social influences, and habits also play a role in long-term weight regain management [Most of the evidence above, about the effects of self-regulatory and motivational-based interventions, was developed in face-to-face settings, which are challenging to scale up in a problem as prevalent as weight loss maintenance. The use of digital-based behavior change interventions (DBCI), which include digital versions of the contents used in face-to-face interventions, is expected to provide a scalable and sustainable solution to change obesity-related behaviors [These results are similar to Webb et al. review in that DBCIs for weight management are more effective than minimal interventions and that using extra components (i.e., follow-up telephone calls) is associated with better outcomes. Notably, while these papers reviewed the interventions’ components’ quantity and mode of delivery alongside a brief description of the materials (e.g., self-monitoring and educational contents), they did not analyze the intervention’s component’s quality—which BCTs and how they were associated with the mechanisms of action and the programs’ effectiveness (the exception is the Carraça et al., 2021 paper). Indeed, a 2022 scoping review showed that only one of the included studies described all the putative links between all the BCTs and the mechanisms of action, while five only partially explained these links [In the paper describing all the links, Sniehotta et al. examined the effectiveness of a low-intensity DBCI to support weight loss maintenance in 288 adults that have lost ≥ 5% of their weight – the NULevel study [The studies reviewed above are examples of evidence scarcity about how the putative mechanisms of action targeted by DBCI’s contents affect the outcomes (i.e., via mediational analysis). This scarcity may be related to the null-to-small effects commonly observed in weight management DBCIs. Notwithstanding, we agree with O’Rourke and MacKinnon when they suggest doing mediational analysis even in the absence of intervention effects for the valuable information it may provide about the intervention successes or failures [In summary, the recent area of DBCI in weight management contexts is evolving rapidly. Recent reviews point to the importance of testing trials with evidence- and theory-based interventions [Operationalization of the NoHoW logic model for the present study