Sleep During Weight Loss and Weight Loss Maintenance

Primary outcomes

1. Change in sleep duration

   Time frame: Week 1 and 16th week

   Sleep parameters measured by the ActiGraph model wGT3X-BT, a wrist-accelerometer. Measured in minutes of sleep per night. Higher number indicating longer sleep duration. Change from week 1 to week 16 will be measured.

2. Changes in physical activity

   Time frame: Week 1 and 16th week

   Measured by the Actigraph model wGT3X-BT, a wrist accelerometer. Measured in minutes of moderate to vigorous activity.

3. Change in sleep quality

   Time frame: Week 1, 8th week, and 16th week

   Pittsburgh Sleep Quality Index (PSQI) will be used to assess a range of sleep disturbances including insomnia, sleep-related breathing difficulties, and use of sleep aids. A total score of 5 or more is indicative of poor sleep quality. Possible score range is 0-21.

4. Change in Severity of Insomnia

   Time frame: Week 1, 8th week, and 16th week

   Insomnia Severity Index (ISI) will be used to assess the severity of insomnia symptoms and subjective daytime impairments.The total score ranges from 0 to 63, with higher scores indicating more severe anxiety symptoms.

5. Change in Risk for sleep apnea

   Time frame: Week 1, 8th week, and 16th week

   The STOP-BANG Questionnaire will be used to assess the patient's risk for sleep apnea. Scores range from 0-8. The higher the score indicates an increase in the probability of sleep apnea.

6. Change in Peak alertness

   Time frame: Week 1, 8th week, and 16th week

   The Morningness-Eveningness Questionnaire (MEQ) will be used to assess whether the patient's circadian rhythm produces peak alertness in the morning or the evening. Multiple choice, 4-5 point scale. The sum gives a score ranging from 16 to 86; scores of 41 and below indicate "evening types", scores of 59 and above indicate "morning types", scores between 42-58 indicate "intermediate types".

7. Change in self-efficacy in one's ability to lose or maintain weight

   Time frame: Week 1, 8th week, and 16th week

   The Weight Loss Self-Efficacy Scale will be used to assess self-efficacy in one's ability to lose or maintain weight. Measured by subjective rating percentages of confidence, 0-100%. The higher the percentage the higher the ability to maintain or lose weight.

8. Change in strategies to lose weight

   Time frame: Week 1, 8th week, and 16th week

   The Weight Control Strategies Scale will be used to assess strategies used to lose weight. The sum of scores ranges from 0-120. The higher the scores the more strategies being used to lose weight.

9. Change in emotional and disinhibited eating

   Time frame: Week 1, 8th week, and 16th week

   Three Factors Eating Questionnaire will be used to measure emotional and disinhibited eating. Comprised of 18 items , which are aggregated to three separate scale scores. A 4-point response format is used.

10. Mood symptoms

    Time frame: Week 1, 8th week, and 16th week

    will be assessed using the Patient Healthy Questionnaire (PHQ9). The PHQ9 scores range from 0-27, with lower numbers indicating minimal to no depression and higher numbers indicating severe depression.

11. Change in Delayed Discounting Index

    Time frame: Week 1, 8th week, and 16th week

    Executive functioning will be assessed using the delay discounting task and the response disinhibition task. K index corresponding to the degree to which a participant discounts future rewards compared to immediate rewards. Will be computed based on a validated algorithm.

12. Change in social isolation

    Time frame: Week 1, 8th week, and 16th week

    Social isolation will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) isolation scale. The PROMIS scale has six items each with a response options ranging in value from one to five. The lowest possible score is 6 and highest possible score is 30.

13. Anxiety symptoms

    Time frame: Week 1, 8th week, and 16th week

    will be assessed using the Generalized Anxiety Disorder-7 (GAD7). The GAD7 scores range from 5-21, with 5-9 indicating mild, 10-14 moderate, and greater than 15 severe anxiety.