Table 2

Cognitive adaptations in the ACHIEVE intervention


-Tracker: participants mark fruits/vegetables, sugar drinks, junk food, smart portions, smart snacks and exercise. Detailed food and calorie log not required so complexity of recording is simplified.

-Weigh-in one time per week during the intensive phase, and once per month during the maintenance phase. Frequent weigh-ins provide opportunity for reinforcement and repetition.

Group weight-management sessions

-Highly structured, emphasis on behavioral rehearsal.

-Material taught in small content units. Frequent meetings (1 session per week during the intensive phase, 1 session per month during the maintenance phase) allow repetition of concepts.

-Program materials are written at 5th-8th grade reading level.

-Hands-on activities emphasized. Taste testing, label reading, portion measuring.

- Role-playing emphasized. Practicing saying no to junk food, or choosing smarter portions at a birthday party. Increases self-efficacy to adhere to healthier eating habits.

-Worksheets review topic of the week.

Individual sessions

-Allow for individualized cognitive tailoring as needed.

-Opportunity to emphasize an individualized high impact behavior based upon the concepts learned in groups.

Physical activity classes

-Provide opportunity for modeling and building physical activity skills in supportive setting to increase cardiovascular fitness and exercise self efficacy

Environmental prompts

-Refrigerator magnets, preprinted grocery lists, watches, water bottle, measuring cups, lunch bag as reminders to be used at home.


-Participation is rewarded with varying levels of gifts relative to the number of classes attended.

Casagrande et al. BMC Psychiatry 2010 10:108   doi:10.1186/1471-244X-10-108

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