Table 3

Differences between two active intervention conditions in SNAP
Key intervention concepts Small changes Large changes
Dietary changes recommended for maintaining weight (green zone) Instructed to make one small change in diet every day (roughly equivalent to 100 calories) Start with 1200–1800 kcal/day diet to create weight loss buffer in first 8 weeks. After buffer created, gradually increase caloric intake until maintaining weight loss, but continue to consume low calorie, low fat healthy diet
Physical activity changes recommended for maintaining weight (green zone) Given pedometers and instructed to increase steps by 2000 steps per day over baseline levels and maintain this level Instructed to exercise to 250 min/week (50 min/day on 5 days/week) throughout the entire program.
Self-monitoring of behavior changes During first 16 weeks and during refresher courses, record number of steps per day and check off whether or not a small change in diet was made every day. Self-monitor weight daily throughout the entire program. Self-monitor food intake (calories and fat grams) for first 16 weeks of the program, throughout the refresher course, and if they experience weight regain. Self-monitor weight daily throughout the entire program.
What to do if regain 1 pound or more above the weight they achieve at the end of the initial 8 week program and enter yellow zone, but remain at or below baseline Taught to resume self-monitoring of steps and small changes to diet. Use problem-solving skills, with an emphasis on changing surrounding environment to support small changes. Taught to resume self-monitoring of food intake for several days to help identify problem areas and get back on track. Use problem-solving skills, with an emphasis on changing surrounding environment to support large changes.
What to do if exceed baseline or starting weight (red zone) Instructed to implement additional small change(s) in both eating and exercise (e.g. make at least 1 small change at each meal, each day and increase steps by 3000 over baseline level). Instructed to reinitiate large changes – return to 1200–1800 kcal/day diet, continue 250 min/week of activity, and self-monitor intake and activity until they are back in the green zone.

Wing et al.

Wing et al. BMC Public Health 2013 13:300   doi:10.1186/1471-2458-13-300

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