Rebecca A Krukowski*, University of Tennessee Health Science Center, Memphis, United States Delia West*, University of South Carolina, Columbia, United States Jean Harvey*, University of Vermont, Burlington, United States Track: Research Presentation Topic: Web 2.0 approaches for behaviour change, public health and biosurveillance Presentation Type: Oral presentation Submission Type: Single Presentation Building: Sheraton Maui Resort Room: B - Kapalua Date: 2014-11-14 11:00 AM – 11:45 AM Last modified: 2014-09-04

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Background: The strong facilitative role of social factors on weight loss outcomes has been well established, but minimal attention has been focused on the relationship between participants and interventionists in behavioral weight control programs. Little is currently known about the impact of the relationship built between interventionists and participants on early treatment engagement. This may be of particular interest for online weight control programs, which do not have the benefit of face-to-face contact for establishing rapport. Objective: To determine if early (four weeks) or later (six month) working alliance perceived by the participant about his/her online interventionist is associated with six-month weight loss success, group chat session attendance, and dietary and exercise self-monitoring. Methods: 495 participants (24% African American; body mass index: mean=35.7) received an online group behavioral weight control program, which included weekly synchronous chat sessions and online self-monitoring. Weight and height were measured at baseline and at six months. At four weeks and six months, participants completed the Working Alliance bonding subscale (collaborative bond with the group interventionist; higher scores= more positive alliance). Group chat attendance and self-monitoring diary submissions were recorded by the interventionists. There were 10 interventionists that facilitated the group chat sessions. Results: Four-week working alliance was significantly correlated with six-month working alliance (r=0.55; p<0.0001). Four-week working alliance was a significant predictor of six-month weight loss (r=0.12; p<0.01), and six-month working alliance was also significantly associated with six-month weight loss (r=0.23; p<0.0001). While four-week working alliance trended toward predicting the proportion of sessions attended over six months (r=0.09; p=0.053), six-month working alliance was significantly associated with the proportion of sessions attended over the previous six months (r=0.24; p<0.0001). Furthermore, four-week working alliance was a significant predictor of the proportion of self-monitoring diaries completed at six months (r=0.13; p<0.01), and six-month working alliance was also significantly associated with the proportion of self-monitoring diaries completed at six months (r=0.26; p<0.0001). The proportion of sessions attended at six months was a significant mediator of the effect of six-month working alliance on six-month weight loss (z=3.94; p<0.001). The proportion of self-monitoring diaries completed at six months was also a significant mediator of the effect of six-month working alliance on six-month weight loss (z=4.42; p<0.001). Conclusions: The strength of participants’ early relationship with their interventionist in a weight loss program was strongly correlated with the strength of this relationship at a later stage, indicating that it may be important to have early engagement between the interventionist and participant. Developing this relationship at an early stage may be particularly important because the strength of the relationship predicted longer-term weight loss and treatment adherence. Moreover, the strength of the interventionist-participant relationship at six-months was even more strongly associated with six-month weight loss and treatment adherence. Both session attendance and self-monitoring were significant mediators of the effect of working alliance on six-month weight loss, suggesting that a strong relationship with one’s interventionist may facilitate these aspects of treatment adherence, which in turn leads to weight loss.