Barriers and Approaches to Weight Loss and Activity Delahanty et al 1 Linda M. Delahanty, MS, RD Paula M. Trief, PhD Donald A. Cibula, PhD Ruth S. Weinstock, MD, PhD From Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Ms Delahanty); Department of Psychiatry and Behavioral Sciences, State University of New York (SUNY) Upstate Medical University, Syracuse, New York (Dr Trief); Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York (Dr Cibula); and Department of Medicine, SUNY Upstate Medical University, Syracuse, New York (Dr Weinstock). Correspondence to Paula M. Trief, PhD, Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, 750 E. Adams St, Syracuse NY 13210, USA (triefp@upstate.edu). Acknowledgments: The authors gratefully acknowledge the contributions of the SHINE coaches, whose professional efforts provided the data analyzed here, and of all of the SHINE participants and educators. Funding: The SHINE Study was funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Conflict of Interest: The authors have no potential conflicts of interests to report. DOI: 10.1177/0145721719883615 © 2019 The Author(s) Purpose The purpose of this study is to identify barriers to weight loss and physical activity, as well as approaches used by coaches, in a real-world, community sample of adults with metabolic syndrome (at risk for type 2 diabetes) who participated in a Diabetes Prevention Program (DPP)– adapted weight loss intervention and compare findings to data from the screened and highly selected DPP sample. Methods SHINE (Support, Health Information, Nutrition, and Exercise) was a telephonic DPP adaptation. Primary care staff delivered the DPP curriculum, and lifestyle coaches provided monthly direction to achieve weight loss. For this substudy, barriers to weight loss and physical activity described by participants, as well as approaches coaches used to address them, were gathered. Groupings of barriers (DPP defined) were analyzed in relation to demographic characteristics and compared to data from the DPP sample. Results Top weight loss barriers were problems with self- monitoring, too little physical activity, internal thought/ mood cues, vacation/holidays, and social cues. Percentages reporting a barrier were much higher in SHINE. Top physical activity barriers were problems with self-monitoring, access/weather, time management, 883615TDE XX X 10.1177/0145721719883615Barriers and Approaches to Weight Loss and ActivityDelahanty et al research-article 2019 Barriers to Weight Loss and Physical Activity, and Coach Approaches to Addressing Barriers, in a Real-World Adaptation of the DPP Lifestyle Intervention A Process Analysis