Association Between Wake-Time Movement Behaviors and Weight Loss Maintenance

Abstract

Objective:

We examined whether wake-time movement composition was associated with weight loss maintenance among individuals who experienced clinically meaningful weight loss (> 5% of initial weight) using compositional data analysis.

Methods:

This was a secondary analysis from a behavioral weight loss maintenance intervention on weight regain over 12 months following clinically meaningful 3-month weight loss. Body weight was assessed at baseline, after weight loss (3 months), and at end of intervention (15 months). Wake-time behaviors (sedentary time [ST], light physical activity [LPA], and moderate-to-vigorous PA [MVPA]) were assessed at two time points during the maintenance intervention using accelerometry. Compositional data analysis was used to examine associations between wake-time movement composition and weight regain (kg).

Results:

Among 153 individuals (80.4% female, 69.9% White), wake-time movement composition was related to weight regain (p = 0.001). MVPA was negatively associated with weight regain (p’s < 0.05). Reallocating 10 min/day from ST or LPA to MVPA was associated with less weight regain (ST: −0.32 kg [−0.53, −0.12]; LPA: −0.37 kg [−0.59, −0.15]). Individuals who maintained clinically meaningful weight loss and those who did not differed in wake-time movement composition, driven by MVPA (36.1 vs. 24.3 min/day).

Conclusions:

The composition of wake-time behaviors, specifically MVPA, reduces weight regain after clinically meaningful weight loss in a behavioral weight loss maintenance intervention.

Trial Registration:

ClinicalTrials.gov identifier: NCT01664715

1 |. Introduction

By 2030, over half of the adults in the United States are projected to have overweight or obesity [1], which are associated with an increased risk for chronic disease, including cardiovascular disease [2], cancer [3], and type 2 diabetes [4]. Weight loss is associated with a reduced risk of chronic disease [5]. Yet over half of adults participating in weight management interventions will not maintain weight loss of > 5% of their initial weight 12–24 months following weight loss [6, 7]. Current recommendations for the prevention of weight regain following weight loss suggest a minimum of monthly contact with a trained interventionist to assist participants with adherence to a reduced-energy diet needed to maintain the lower body weight and increased moderate-to-vigorous physical activity (MVPA; 150–450 min/week) and self-monitoring of body weight [2, 8–10]. However, the MVPA recommendations, which are based primarily on prospective associations and secondary data analyses, have not been consistently supported by results from randomized trials [6].

Recent evidence suggests that changes in other wake-time movement behaviors, such as increasing light physical activity (LPA) and reducing sedentary time (ST), may prevent weight regain following weight loss and may be more acceptable to previously inactive adults with overweight and obesity than the currently recommended volumes of MVPA [2, 11–13]. This evidence is based on two major developments; first, cross-sectional studies demonstrate higher LPA is associated with lower weight-related outcomes [13], and individuals with normal weight have higher LPA and less ST relative to individuals with overweight or obesity [11, 12]. The second development is the increasing evidence that reducing ST alone or with MVPA is beneficial for many health outcomes [14], including weight maintenance [15]. Reducing ST and increasing MVPA was tested in a randomized control trial of partially supervised exercise training in older adults (n = 183), which found individuals in the exercise only group regained more weight relative to sitting less or sitting less and exercise groups [15]. These results indicate potential additive effects on weight regained [15], but that trial only evaluated wake-time behaviors in a subset of the population. Moreover, analyzing wake-time behavior data requires specialized techniques due to these behaviors’ exclusive and reciprocal properties within a fixed period (e.g., 15 h awake), as time spent in one behavior reduces the time available for other behaviors. One way to account for these properties is compositional data analysis (CoDA), whereby data are transformed into log ratios to consider that each movement behavior represents a unique component of the fixed period [16]. The two previous reports used isotemporal substitution modeling, a different methodology to assess movement behaviors, to evaluate the impact of wake-time movement behaviors on weight loss maintenance and have produced conflicting results [17, 18].

This report presents results from a CoDA with isotemporal substitution modeling to examine the association between wake-time movement behavior composition and weight regain following weight loss, using data collected in the Midwest Exercise Trial for the Prevention of Weight Regain (MET-POWeR) [19, 20]. MET-POWeR was designed to compare weight change in adults with overweight and obesity who achieved clinically meaningful weight loss following completion of a 3-month weight loss intervention and were randomized to one of three exercise volumes completed in conjunction with a 12-month behavioral weight maintenance intervention. We employed CoDA approaches to investigate two key questions: (1) the relationship between the composition of wake-time movement behaviors and weight regain; and (2) differences in the composition of wake-time movement behaviors between participants who achieved or did not achieve clinically meaningful weight loss (≥ 5%) across the 15-month intervention. For our first aim, we hypothesize that ST would be associated with more weight regained, whereas LPA and MVPA would be associated with less weight regain. For our second aim, we hypothesize that there will be a difference in wake-time behavior composition between individuals who sustain weight loss (≥ 5%) and those who did not sustain weight loss (< 5%). Those achieving clinically meaningful weight loss will achieve > 150 min/week of MVPA, and those who did not sustain weight loss will not meet this threshold.

2 |. Methods

Detailed descriptions of the design, methods, and results for the primary outcome from MET-POWeR have been published previously [19, 20]. The University of Kansas-Lawrence Institutional Review Board approved the MET-POWeR trial. As a brief overview, mean weight loss after 12 months of a multicomponent weight loss intervention did not differ by randomized exercise volume group (150, 225, or 300 min/week, p = 0.68). Intent-to-treat analysis revealed no significant overall trend across the three treatment groups, effects within the groups, or sex (p’s > 0.05 for all). Therefore, there was no difference in weight regain between the intervention groups.

2.1 |. MET-POWeR Design Overview

Adults with overweight or obesity who achieved ≥ 5% weight loss on completion of a 3-month multicomponent weight loss intervention (n = 235/298, 79%) were stratified by sex and magnitude of weight loss across the 3 months to one of three exercise groups. The study was powered to test the effectiveness of these groups in maintaining ≥ 5% of baseline weight in 287 participants [19, 20]. Both weight loss and maintenance interventions were conducted per existing guidelines, including reduced energy intake and diet and promotion of MVPA [2]. During the 3-month weight loss phase, participants completed an in-person, group-based lifestyle intervention which included increased exercise, a reduced-energy diet, and weekly behavioral counseling sessions with behavioral strategies. Participants were asked to exercise 5 days a week, with a minimum of 3 days a week at the study exercise facilities under the supervision of research staff. Participants achieving clinically significant weight loss (≥ 5%) during the 3-month weight loss phase were randomized to one of three groups during the maintenance phase (150, 225, or 300 min/week). Exercise progressed from 100 min/week to the intervention amount (150, 225, or 300 min/week at 70% of heart rate max) at 2 months, and remained at that amount for the remainder of the intervention (~10 months). In-person behavioral counseling sessions were weekly the first 3 months then progressed to twice per month via phone conference call over the final 9 months to assist participants in maintaining a diet with energy intake to sustain weight loss and to self-monitor diet and exercise. The duration and intensity of all exercise sessions (supervised + unsupervised) were verified by heart-rate monitors (RS 400; Polar Electro, Woodbury, New York).

2.2 |. Participant Inclusion/Exclusion

Participants in MET-POWeR were adults (BMI = 25–44.99 kg/m², age 21–55 years) who were able to exercise and willing to be randomized to one of three exercise groups. Clearance from their primary care physician was required. Exclusion criteria included participating in a research project involving weight loss or exercise in the previous 6 months; currently participating in a regular exercise program (i.e., > 500 kcal/week); not being weight stable (±4.5 kg) for 3 months before intake; being pregnant during the previous 6 months, currently lactating, or planning pregnancy; having a serious medical risk; having an eating disorder, current treatment for psychological issues, or taking psychotropic medications known to affect weight; adhering to specialized diets; and not having access to grocery shopping and meal preparation.

2.3 |. Wake-Time Movement Behaviors

Wake-time movement behaviors were assessed across 7 days using triaxial accelerometers before and following completion of the 3-month weight loss intervention and at 6 and 12 months during the maintenance intervention using ActiGraph GT3x accelerometers (ActiGraph LLC, Pensacola, Florida). Participants were asked to wear the ActiGraph on a belt over their non-dominant hip during waking hours, except for water-related activities such as showering and swimming. Nonwear time, defined as > 60 min of consecutive zeroes, allowing for 1–2 min of counts between zero and 100, were removed. The remaining accelerometer data, which were recorded in 60-s epochs, were then scored according to validated cut points (counts/min) for the vertical axis were used to define ST (≤ 100), time spent in LPA (101–2019), and MVPA (≥ 2020) [21, 22]. Wake-time behaviors were averaged across valid days within participants who had valid wear (≥ 8 h/day on ≥ 3 days) [23] at ≥ 1 time point during the active intervention (6 and 12 months).

2.4 |. Weight Loss Maintenance

Weight was measured using a digital scale accurate to ±0.1 kg (Befour Inc., Saukville, Wisconsin) between 6:00 and 10:00 a.m., after an overnight fast. Participants were weighed before breakfast and after attempting to void while wearing a standard hospital gown. Height was measured using a stadiometer (Model PE-WM-60–84; Perspective Enterprises, Portage, Michigan). BMI was calculated as weight in kilograms divided by height in meters squared. For the first aim, the primary outcome was absolute weight change (kg) across the weight maintenance program (0, 12 months). For the second aim, participants were categorized if their end-of-intervention weight was ≥ 5% below their initial weight before weight loss (clinically meaningful weight loss) or < 5% of their initial weight (did not sustain clinically meaningful weight loss). This definition aligned with the trial’s primary aim and demonstrates high agreement with other metrics of weight loss maintenance [24].

2.5 |. Covariates

Age, sex, race/ethnicity, and annual household income (≤ $39,000, > $39,000 to ≤ $79,000, > $79,000, or no response) were obtained from a baseline survey. In addition, average energy intake was derived from 3-day food records at multiple time points (0, 6, and 12 months of weight maintenance) as detailed elsewhere [25]. Data from the 3-day food records were entered in the Nutrition Data System for Research (Version 2014; University of Minnesota, Minneapolis, Minnesota) for calculation of energy intake.

2.6 |. Statistical Analysis

Descriptive statistics were calculated to describe the population, and all analyses were performed in R (Foundation for Statistical Computing, Vienna, Austria, version 4.3.0). The analytic sample was a subset confined to participants with complete data for wake-time movement behaviors, weight measures, and covariates. The current report uses CoDA, which accounts for the inherent dependence of wake-time movement behaviors that occur within a fixed period. The report further describes CoDA information commonly reported in other CoDA studies [26]. Compositional isotemporal substitution modeling can then be used to estimate the effect of hypothetically reallocating fixed amounts of time between movement behaviors on outcomes of interest, such as weight regain [27]. The first step was to confirm there were no zero values for ST, LPA, or MVPA before computing isometric log-ratios (ilrs); ilr coordinates were then created using a sequential binary partition process (Table S1) [28]. The final ilrs provided geometric means (i.e., percentages) of all three behaviors, which were linearly adjusted to sum to 1, or 100% of the wake-time period. The second step was adjusting the wake-time behaviors to the closest full hour of daily wear time (900 min) for the sample (890 min valid wear time). This step was achieved by dividing the wake-time behavior by total wear time and multiplying by 900, which allows participants with varying wear time durations (e.g., 830 and 970 min) to be compared evenly.

Our analysis addressed two aims. First, we assessed whether overall movement composition was associated with weight regain (kg) across the 12-month intervention by including both ilr coordinates from the sequential binary partition in a Type II ANOVA model. Subsequent models examined the association of individual wake-time behaviors (represented by the first of two ilrs in each respective model for ST, LPA, MVPA) with weight change. Finally, we compared the association of hypothetically reallocating time from one wake-time behavior to others using compositional isotemporal substitution modeling while holding the total composition constant. Compositional isotemporal substitution modeling first involved reallocating time from one wake-time behavior to the remaining two (i.e., proportional reallocation), followed by one-to-one substitutions between individual wake-time behaviors (while holding the third behavior constant) to align with approaches used in other CoDA studies [27]. These substitutions were primarily conducted using 10-min substitutions, although other iterations (5, 15, and 20 min) were also explored. All models used ilr coordinates derived from a pivot coordinate transformation, with results interpreted in reference to the behavior emphasized in the first pivot coordinate (ilr1). Importantly, model estimates represent the expected difference in weight regain relative to the sample’s mean composition, not absolute values.

Our second aim was to compare wake-time movement behaviors between participants who maintained clinically meaningful weight loss (≥ 5%) across the weight maintenance intervention and those who did not (< 5%). Average wake-time movement compositions between the two groups were compared using multivariate ANCOVA. Group differences were visualized using compositional mean bar plots, showing relative differences in ST, LPA, and MVPA between groups. We compared the distance from the compositional center to the overall center. All analyses were adjusted for covariates, including age, sex, race/ethnicity, income category, intervention group, baseline weight, weight loss before randomization, and energy intake, with statistical significance set at α < 0.05. All model assumptions, including linearity, homogeneity, and normality, were examined using the performance package in R.

3 |. Results

In total, 298 participants enrolled in the study. Of these, 235 participants who achieved clinically meaningful weight loss were randomized, and 153 participants with complete data (including accelerometry at one or more time points) were included in the analysis. The primary exclusion reason from analysis was insufficient accelerometry data at either time point (n = 72). As shown in Table 1, the average age was 43.8 ± 8.0 years, the majority were female (80.4%) or White (69.9%) and had a household income between $40,000 and $79,000 (41.7%) and a similar distribution across intervention groups (range: 30.8%–36.3%/group). Participants regained 1.0 ± 2.9 kg, with a wide range of amounts (median, Q1, Q3; 1.2, −0.5, 3.0 kg). A total of 137 of the 153 participants (89.5%) had valid wear for both time points. Across time points, participants contributed 5.2 ± 1.4 valid days, and wear time was 894.2 ± 100.8 min/day with the bottom 14.3% (22/153) reporting between 700 and 800 min (~11.6–13.3 h/day).

TABLE 1 |.

Descriptive statistics of the included sample (n = 153).

	6 months (n = 141)	12 months (n = 140)	Overall (n = 153)
	Mean ± SD	Mean ± SD	Mean ± SD	N (%)
Demographics
Age (years)			43.8 ± 8.0
Female				123 (80.4)
White				103 (69.9)
Household income
< $39,000				30 (18.4)
$40,000-$79,000				64 (41.7)
> $80,000				52 (34.9)
Prefer not to answer				7 (4.7)
Experimental group
150 min/week				47 (30.8)
225 min/week				51 (32.8)
300 min/week				55 (36.3)
Energy intake, kcal/day			1535.9 ± 300.3
Weight maintenance metrics
Baseline (before weight loss, initial) weight, kg			99.1 ± 17.0
Weight lost before intervention, kg			9.6 ± 3.1
Start of weight maintenance intervention (0 months) weight, kg			89.5 ± 15.7
Midpoint of weight maintenance intervention (6 months) weight, kg			89.0 ± 16.7
End of weight maintenance intervention (12 months) weight, kg			91.8 ± 17.7
Weight regained, kg			1.0 ± 2.9
Final weight loss ≥ 5% of initial weight				86 (56.2)
Percent weight regained, %			2.6 ± 7.0
Wake-time movement behaviors
Valid min/day	891.9 ± 106.16	893.9 ± 121.0	894.2 ± 100.8
Valid days	5.2 ± 1.6	5.1 ± 1.9	5.1 ± 1.4
Arithmetic means
Sedentary time, min/day	598.1 ± 113.3	614.3 ± 120.4	605.9 ± 102.0
Light physical activity, min/day	259.4 ± 74.2	251.9 ± 62.9	257.6 ± 64.2
Moderate-to-vigorous physical activity, min/day	34.3 ± 20.2	27.5 ± 18.6	30.6 ± 17.5
Compositional means
Sedentary time, min/day	602.2 ± 74.6	616.4 ± 67.1	608.7 ± 64.4
Light physical activity, % of composition	262.7 ± 72.7	255.8 ± 64.9	260.2 ± 62.8
Moderate-to-vigorous physical activity, min/day	35.0 ± 21.3	27.8 ± 18.4	30.9 ± 17.6

3.1 |. Association Between Wake-Time Behaviors and Weight Regain

The ternary diagram demonstrates that the average time-use composition across valid time points was mainly ST (67%, 608.7 ± 64.3 min/day), with some time allocated to LPA (29%, 260.2 ± 62.8 min/day) and MVPA (3%, 30.9 ± 17.5 min/day, Figure 1). The average wake-time movement composition was significantly associated with absolute weight regain after adjusting for covariates (F = 3.808, p = 0.001). Individual models demonstrated that higher MVPA was associated with substantially less weight regain (β ± SE: −1.19 ± 0.37, p = 0.002). However, there were no significant associations between either LPA (β ± SE: 1.54 ± 0.82, p = 0.06) or ST (β ± SE: −0.34 ± 0.81, p = 0.66) and weight regain.

FIGURE 1 |.

Average wake-time movement composition across a behavioral weight maintenance intervention. Diagram represents percent of time spent in each wake-time movement behavior, including ST (sedentary time), LPA (light physical activity), and MVPA (moderate-to-vigorous physical activity).

Results from compositional isotemporal substitution models performing proportional reallocation indicated that reallocation of 10 min/day from ST and/or LPA to MVPA was associated with significantly less weight regain (−0.34 kg, p < 0.05, Table 2). Using the average height of the sample (1.66 m), this change would translate into ~0.12 BMI points. In contrast, reallocating 10 min/day from MVPA to ST and LPA was associated with significantly greater weight regain (+0.50 kg, p < 0.05). One-to-one reallocations of 10 min/day of either ST or LPA to MVPA were associated with less weight regain (ST = −0.32 kg; LPA = −0.37 kg, both p < 0.05). In contrast, one-to-one reallocations of 10 min/day of MVPA to either ST or LPA were associated with significantly greater weight regain (ST = +0.49 kg; LPA = +0.54 kg, both p < 0.05). One-to-one reallocations of 5 and 20 min/day of either ST or LPA to MVPA were also associated with less weight regain, ranging in magnitude from −0.17 kg for 5 min/day (ST to MVPA) reallocations to −0.6 kg for 20 min/day reallocations (LPA to MVPA, Table S2). This change would translate into ~0.08 to 0.58 BMI points.

TABLE 2 |.

Reallocations (10 min/day) between wake-time behaviors during a behavioral weight maintenance intervention and weight regain.^a

		Weight regained (kg)
Behavior added	Behavior subtracted	Estimate (95% CI)
Proportional reallocation
ST	(LPA and MVPA)	−0.01 (−0.08, 0.05)
LPA	(ST and MVPA)	0.06 (−0.004, 0.13)
MVPA	(ST and LPA)	−0.34 (−0.54, −0.14)
(LPA and MVPA)	ST	0.01 (−0.05, 0.07)
(ST and MVPA)	LPA	−0.06 (−0.14, 0.01)
(ST and LPA)	MVPA	0.50 (0.20, 0.81)
One-to-one
ST	LPA	−0.05 (−0.12, 0.01)
ST	MVPA	0.49 (0.18, 0.79)
LPA	ST	0.05 (−0.01, 0.12)
LPA	MVPA	0.54 (0.22, 0.86)
MVPA	ST	−0.32 (−0.53, −0.12)
MVPA	LPA	−0.37 (−0.59, −0.15)

Note: Estimates presented are differences relative to the mean composition. p < 0.05 values are bolded.

Abbreviations: LPA = light physical activity, MVPA = moderate-to-vigorous physical activity, ST = sedentary time.

^aAssessed using compositional linear regression with adjustment for age, sex, race/ethnicity, income category, intervention group, baseline weight, weight loss before randomization, and energy intake.

3.2 |. Comparison of Wake-Time Movement Behaviors Between Participants Who Achieved or Did Not Achieve Clinically Meaningful Weight Loss (≥ 5%) at the End of the 15-Month Intervention

A total of 86 of the 153 participants achieved ≥ 5% weight loss at the end of the 15-month intervention. The average wake-time movement composition was significantly different between participants who did or did not achieve ≥ 5% weight loss (p = 0.0001). Reviewing the bar plots revealed the major difference from center was MVPA. MVPA was higher in participants who achieved ≥ 5% weight loss (36 min/day, 252 min/week) compared with participants who did not achieve ≥ 5% weight loss (24 min/day, 168 min/week, Figure 2). There were no major between-group differences in ST or LPA.

FIGURE 2 |.

Wake-time behavior compositional means between individuals who did or did not achieve clinically meaningful weight loss (n = 153). Clinically meaningful weight loss included participants with had a final weight loss ≥ 5% of their initial weight; did not achieve weight loss included participants who had a final weight loss < 5% of their initial weight. MVPA, moderate-to-vigorous physical activity.

4 |. Discussion

The purpose of this study was to investigate the relationship between wake-time movement behaviors and weight loss maintenance in a behavioral weight loss intervention. In this sample, the overall wake-time movement behavior composition was related to the amount of weight regained, driven by MVPA. Hypothetical substitutions from time spent at lower intensities to MVPA, even as little as 5 min/day, had benefits for weight loss maintenance. Accordingly, individuals who maintained clinically meaningful weight loss mainly differed in MVPA behaviors, rather than their amount of time spent in lower intensities. This study contributes to the evidence that, in the context of a weight loss maintenance program, additional time spent in MVPA measured by accelerometry, rather than LPA or ST, may be beneficial for preventing weight regain. These findings underscore the importance of meeting and exceeding existing recommendations for MVPA during weight maintenance programs.

We did not find support for our hypothesis that substituting ST with LPA would be associated with less weight regain. We attributed these null results between ST and LPA results to three primary considerations: the study design, population, and time scale. First, our hypotheses were based on cross-sectional studies [11, 13], though our study had a longitudinal design. Accordingly, unlike our longitudinal analysis, other cross-sectional CoDA studies find mixed evidence for the reallocation of ST to LPA on weight outcomes [29, 30], but that reallocation of LPA to MVPA is associated with lower weight outcomes [31, 32]. Second, another non-CODA study investigating a partially supervised weight regain intervention in older individuals found more weight regain in the exercise-only group relative to the sitting less group or sitting less and exercise groups [15], contrasting the current report’s results on the beneficial effects of only MVPA. That study reported a significant reduction in MVPA from 22.5 ± 21.0 to 8.4 ± 10.3 min/day across 12 months of weight maintenance and more weight regain (range: 2.4–5.2 kg/group) [15] relative to the current intensive intervention. These cross-sectional and less intensive intervention results may not generalize to an intervention focused on individuals engaging in exercise between 150 and 300 min/week to maintain their weight loss. The final consideration is that our results are based on 10-min allocations, which may not be sufficient to observe the benefit of weight regain. ST may need to be reallocated to LPA in much larger portions (e.g., > 1 h) for significant changes in energy expenditure and the weight benefit to be realized [31].

The current study found no significant association between LPA and more weight regain, contrary to our hypothesis and other theories on the role of LPA in weight maintenance [13]. In this secondary analysis, LPA promoted weight regain like ST. Given these similarities, it is possible that some of the LPA observed may be misclassification from sedentary behaviors, which include sitting, lying, or standing [21, 22]. Hip-worn devices are less capable of distinguishing postures compared to thigh-worn devices [33]. Thigh-worn devices may present compliance issues, as demonstrated in another weight maintenance trial where few participants returned such devices or contributed adequate wear [15]. Even so, this study’s results emphasize the importance of higher intensity activity (i.e., MVPA) for maintaining weight loss. These results align with recommendations for maintaining weight focusing on MVPA rather than LPA [2, 34, 35].

We found support for our hypothesis that individuals who achieved clinically meaningful weight loss would differ in MVPA. Both groups exceeded the minimum guidelines for MVPA (150 min/week), although those who maintained weight loss exhibited 87 more minutes of MVPA per week. This current trial was a partially supervised exercise trial [19, 20], which may have supported sustained and high levels of MVPA across 12 months. These results contrast with free-living or minimal-contact PA [36] or weight management trials, where a notable decline in MVPA is observed [34–36]. Hence, individuals who maintained weight loss may be those who continued engaging in the intervention (minimum: 150 min/week) or continued MVPA on their own later in the program. Weight loss maintenance was achieved at 252 min/week, which is slightly above the middle intervention group (225 min/week) but within the recommended range for weight maintenance (200–300 min/week) [2, 34, 35]. These findings may support a statement that those who engage in regular exercise are more likely to maintain weight loss, especially within a behavioral weight maintenance program [37]. However, individuals who did not achieve clinically meaningful weight loss still exceeded the guideline of 150 min/week with 168 min/week of MVPA. Additional weight regain may be attributed to other factors such as higher energy intake, though this was considered a covariate in the current analysis, and possibly a reduction of physical activity in later time points of the intervention. Indeed, time spent in LPA and MVPA was lower at 12 months as ST increased. The average of accelerometry measures may not capture changes across time. Accordingly, this analysis may not generalize to extended periods of weight maintenance (> 12 months) or individuals not engaged in a partially supervised exercise program, where we may postulate greater differences in wake-time behaviors that may occur between sustained stability or instability [35]. Weight maintenance requires continued vigilance and a healthy lifestyle to keep weight off [38].

Strengths of the current investigation include device-based measures of wake-time behaviors, an innovative statistical approach, data from across multiple time points, including key covariates of weight regain (i.e., energy intake) [18], and in a midlife population. Limitations of the current study are related to four areas: behaviors and measurement, including interpretation of the approach, weight maintenance outcome, and generalizability. First, a notable limitation is the exclusion of sleep, another 24-h movement behavior, as the accelerometer was removed overnight in the protocol. These procedures were implemented to increase compliance with the protocol and align with national practices, which is an improvement over past weight maintenance trials [15, 18]. This waist-worn protocol introduces another limitation as it may not detect stationary exercise, such as bicycling, and thus may under-detect some forms of MVPA. Further, in alignment with other CoDA studies [30, 32], the current study averaged across valid days; thus, conclusions regarding MVPA timing throughout the week (weekend vs. weekday) are limited. Second, a limitation is that the CoDA approach is a hypothetical substitution of time and not energy expenditure, which may impact a weight-related outcome. It is unclear if these additional amounts of MVPA and reduced time spent on other behaviors may result in varying amounts of weight regain in well-powered randomized trials. Third, we appreciate that there are various ways to evaluate weight maintenance; thus, the current study employed approaches that focused on weight regained (kg) and clinically meaningful weight loss, which may not directly account for initial weight like other metrics [24]. However, the percentage of weight loss before the intervention was a covariate in analysis. Finally, the generalizability of this sample may be limited, as only 65% of the sample was included in the analysis. The included sample was predominantly White and female, although obesity is a primary burden among individuals of color [1]. Still, the current trial was diverse in household income and followed evidence-based practices that can be recommended across populations.

Results from this study posit four separate areas for future research, namely improving our wake-time behavior measurement, LPA’s contribution to weight stability, and application to nontrial settings. First, additional exploration of sedentary-related metrics (prolonged bouts) [39], postures (sit/standing, etc.), and behaviors that are sedentary (e.g., sedentary screen time) may improve upon the current results, which were confined to device-based ST time. Second, these results require replication in a large-scale trial comparing wake-time composition, including modifications of LPA and ST, on weight loss maintenance. These appropriately designed trials may help clarify LPA’s individual and potential additive effect on maintaining weight loss. Third, these results support multibehavior approaches to weight loss and weight maintenance, as additional time spent in MVPA relative to other wake-time behaviors did not fully explain changes in weight regain; reduced energy intake is a critical component of weight loss and weight maintenance [2]. Finally, replication of the CoDA approach in a free-living or continued weight control sample (e.g., weight control registry) [40] without a behavioral weight maintenance intervention may provide further evidence of the contribution of wake-time behaviors to weight loss maintenance beyond the trial setting.

This analysis describes the impact of wake-time behaviors on weight regain in a behavioral weight maintenance trial. Based on the CoDA methodology and study design, these results underscore the provision of MVPA for weight maintenance and meeting the 200–300-min/week guidelines of MVPA for weight loss maintenance.

Supplementary Material

Additional supporting information can be found online in the Supporting Information section. Table S1: Description of compositional data analysis and compositional variation matrixes. Table S2: Reallocations between wake-time behaviors during a behavioral weight maintenance intervention and weight regain.

Study Importance.

• What is already known?

  • High amounts of moderate-to-vigorous physical activity (MVPA) are recommended for preventing weight regain.
  • The amount of sedentary time may also contribute to maintaining weight loss.
• What does this study add?

  • The collective composition of behaviors across the day (sedentary time, light physical activity, and MVPA) was related to weight loss maintenance.
  • Hypothetically, substituting sedentary time with light physical activity did not impact weight loss maintenance.
  • Individuals who maintained clinically meaningful weight loss engaged in device-based MVPA (250 min/week) within current recommendations (150–250 min/week).
• How might these results change the direction of research or the focus of clinical practice?

  • Results underscore the importance of MVPA during a behavioral intervention for maintaining weight loss.
  • These results support the higher end of MVPA recommendations for weight loss maintenance (250 min/week).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.