Exercise engagement is necessary, although not sufficient, for long-term weight management, and patients pursuing weight loss are often encouraged to increase their exercise as a health-promoting behavior. Unfortunately, patients are also exposed to wide-spread socio-cultural messaging that weight loss is a simple matter of “calories in = calories out.” Further, public health messaging which pairs exercise and caloric restriction (e.g., “eat less, move more” slogans) may facilitate the idea that exercise drives weight loss specifically by offsetting caloric intake. Thus, many patients may view exercise as a tool to offset calories they consume through eating. 

Compensatory exercise is performed with the intent to “make up for” eating, either by exercising when one otherwise wouldn’t or exercising longer/harder than one otherwise would. Importantly, compensatory exercise among individuals pursuing weight loss could also put them at increased risk for disordered eating and impair their weight loss efforts. For example, compensatory exercise could contribute to the maintenance of increased caloric intake via disinhibited eating (e.g., binge eating, emotional eating, or overeating),8 poor body image,9 increased fears of weight gain, onset of other compensatory behaviors (e.g., inappropriate dietary restriction), and increased risk for developing an eating disorder.

Importantly, existing behavioral interventions for weight management do not provide direct guidance for clinicians on how to promote non-compensatory exercise in this vulnerable population. To fill this need, we aim to develop a stakeholder-informed exercise promotion intervention which also reduces risk for compensatory exercise. In Phase 1, our team of five interdisciplinary experts will integrate existing evidence-based exercise promotion interventions with their own relevant expertise to develop a group-based intervention which aims to promote non-compensatory exercise. Phase 2 will include a proof-of-concept intervention pilot with 12 patients in the Weight Center at Dartmouth-Hitchcock Medical Center and collect both quantitative and qualitative data on outcomes of interest.

Role: Principal Investigator
Funding: Dartmouth Health Center for Digestive Health SPrinG Award