BACKGROUND: One way to improve weight control may be to place greater emphasis on the main reasons why individuals want to lose weight. PURPOSE: To evaluate the effects of emphasizing physical appearance, health, or both on behavioral weight-control outcome. DESIGN: RCT. Data were collected from 2003 to 2005 and analyzed in 2009. SETTING/PARTICIPANTS: 203 women aged 18 to 55 years (mean 41.8, SD 9.2) and BMI > 27 and < 40 (mean 34.2, SD 3.7) who rated both appearance and health as important reasons for weight loss, enrolled at a university medical center. INTERVENTION: A 6-month weekly behavioral intervention alone (standard) was compared to an enhanced focus on physical appearance (appearance), health benefits of weight loss (health), or both appearance and health (combined). The 6-month period of acute intervention was followed by six monthly booster sessions. MAIN OUTCOME MEASURES: The primary outcome was change in body weight (kg). Additional outcomes included the Multidimensional Body-Self Relations Questionnaire, Medical Outcomes Study Short Form-36, and questions about satisfaction with weight, appearance, and health. Assessments were conducted at 0, 6, 12, and 18 months. RESULTS: Appearance demonstrated significantly greater weight loss compared to standard at 6 months (p = 0.0107). Combined demonstrated greater weight loss compared to standard at 6 and 12 months (p's = 0.0034 and 0.0270, respectively). Although addressing motivators differentially affected satisfaction at 6 months, satisfaction was unrelated to weight outcome over the following year. CONCLUSIONS: Behavioral interventions incorporating components with a focus on physical appearance were associated with improved short-term weight loss. The mechanism for this effect is unclear and warrants further study.

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