Factors differentiating women and men who successfully maintain weight loss from women and men who do not

Preoperative medically supervised weight loss programs and weight loss outcomes following bariatric surgery - a prospective analysis

BACKGROUND

Prior to undergoing bariatric surgery, many insurance companies require patients to attend medically supervised weight management visits for 3-6 months to be eligible for surgery. There have been few studies that have looked specifically at the relationship between medically supervised weight management visit attendance and postoperative outcomes, and the current literature reports discrepant findings.

OBJECTIVES

This project aimed to better characterize the relationship between preoperative medically supervised weight management visit attendance and postoperative weight loss outcomes by examining weight loss up to 5 years postbariatric surgery, and by stratifying findings according to the type of surgery undergone.

SETTING

University Hospital.

METHODS

Participants were recruited during presurgical bariatric surgery clinic visits at a bariatric and metabolic weight loss center. As part of standard of care all participants were required to participate in monthly medically supervised weight management visits before surgery. Participants who completed bariatric surgical procedures participated in postsurgical follow-up at 3 weeks, 3 months, 6 months, and then annually for 5 years. Weight outcomes measured were percentage of total weight lost.

RESULTS

The results do not indicate a significant association between number of group visits attended and percent total weight loss at 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, or 5 years postbariatric surgery.

CONCLUSIONS

These data do not suggest a relationship between engagement in a medically supervised weight loss program prior to bariatric surgery and weight loss after surgery in either the short- or the long-term.

A systematic review of ecological momentary assessment studies of appetite and affect in the experience of temptations and lapses during weight loss dieting

Dietary temptations and lapses challenge control over eating and act as barriers toward successful weight loss. These are difficult to assess in laboratory settings or with retrospective measures as they occur momentarily and driven by the current environment. A better understanding of how these experiences unfold within real-world dieting attempts could help inform strategies to increase the capacity to cope with the changes in appetitive and affective factors that surround these experiences. We performed a narrative synthesis on the empirical evidence of appetitive and affective outcomes measured using ecological momentary assessment (EMA) during dieting in individuals with obesity and their association with dietary temptations and lapses. A search of three databases (Scopus, Medline, and PsycInfo) identified 10 studies. Within-person changes in appetite and affect accompany temptations and lapses and are observable in the moments precipitating a lapse. Lapsing in response to these may be mediated through the strength of a temptation. Negative abstinence-violation effects occur following a lapse, which negatively impact self-attitudes. Engagement in coping strategies during temptations is effective for preventing lapses. These findings indicate that monitoring changes in sensations during dieting could help identify the crucial moments when coping strategies are most effective for aiding with dietary adherence.

Does self-compassion help to deal with dietary lapses among overweight and obese adults who pursue weight-loss goals?

Objectives

Self‐compassion can facilitate self‐improvement motivation. We examined the effects of self‐compassion in response to dietary lapses on outcomes relevant to weight‐loss strivings using a longitudinal design. The indirect effects of self‐compassion via guilt and shame were also explored.

Design

An Ecological Momentary Assessment methodology was employed with a sample of adults who were overweight or obese attempting to lose weight via dietary restriction (N = 56; M_age = 34.88; SD = 13.93; M_BMI = 32.50; SD = 6.88) and who responded to brief surveys sent to their mobile phones twice daily for two weeks.

Methods

Dietary temptations and lapses were assessed at each diary entry, and self‐compassion in response to dietary lapses, intention to continue dieting, weight‐loss‐related self‐efficacy, negative reactions to the lapse, and self‐conscious emotions were surveyed on occasions when participants reported having experienced a dietary lapse. The participants were also weighed in a laboratory prior to the EMA phase and via self‐report straight after the EMA phase. Weight was measured again in the laboratory 12 weeks after the EMA period.

Results

Bayesian multilevel path analyses showed that self‐compassion did not predict weight loss. However, at the within‐person level, self‐compassion was positively related to intentions and self‐efficacy to continue dieting, and negatively related to negative affective reactions to the lapses. Guilt mediated the associations of self‐compassion with intention, self‐efficacy, and negative reactions.

Conclusion

Self‐compassion may be a powerful internal resource to cultivate when dieters experience inevitable setbacks during weight‐loss strivings which could facilitate weight‐loss perseverance.

Hypnotherapy for overweight and obese patients: A narrative review

Obesity and overweight problems are serious global health issues today and despite many efforts, the prevalence has continued to rise for decades. Interestingly, hypnotherapy has been gaining recognition as an effective treatment for obesity and overweight problems. This review compiles contemporary scientific research on the effectiveness of hypnotherapy for weight reduction. Scopus, PubMed and EBSCO Host databases were applied in the study. The search identified 119 articles, of which seven met the inclusion criteria. A total of 539 respondents (82.7% women and 17.3% men) between the ages of 17 and 67 years were represented in the seven studies. Most studies incorporated lifestyle changes, such as changes of dietary habit and behavioral recommendations in the hypnotic procedure. Their results suggested that the use of hypnotherapy not only promoted weight reduction during the treatment period but also after treatment cessation, and in some cases, one to ten kilograms were lost during follow-up periods. In addition, one study even showed increased physical activity among the hypnotised individuals. This use of hypnotherapy also improved respondents' eating behavior and quality of life. However, a definitive conclusion could not be drawn due to several methodological flaws and the limited number of published studies in this area. Therefore, further well-designed studies are needed to substantiate the effectiveness of hypnotherapy for this modern-day health problem.

Associations Between Approach and Avoidance Coping, Psychological Distress, and Disordered Eating Among Candidates for Bariatric Surgery

BACKGROUND

Individuals seeking bariatric surgery evidence risk for binge and disordered eating behaviors, which can lead to poorer post-surgical weight loss outcomes. Use of avoidant coping strategies to manage stress, along with symptoms of depression, are associated with disordered eating in the general population. However, the role of coping has not been examined among candidates for bariatric surgery, and coping and depression have rarely been considered in combination. Given the emerging standard that psychologists are involved in evaluations and treatment before and after surgery, consideration of these variables is clinically relevant.

METHODS

Participants were 399 patients undergoing pre-surgical bariatric psychological assessment. Hierarchical linear regression analyses tested whether gender, age, and BMI; approach and avoidance coping; and depression and anxiety were associated with disordered eating (binge eating, restraint, eating concerns, shape concerns, weight concerns) in a cross-sectional study design.

RESULTS

In initial steps of the model controlling demographic variables, approach coping predicted less and avoidance coping predicted more disordered eating across most outcomes examined. In models including depression and anxiety, avoidance (but not approach) coping remained a relevant predictor. The effects of depression were also quite robust, such that participants who were more depressed reported more disordered eating. More anxious participants reported more restrained eating.

CONCLUSIONS

Avoidance coping and depressive symptoms emerged as key variables in understanding recent disordered eating among patients considering bariatric surgery. Pre-surgical psychological evaluations and treatment approaches could be enhanced with consideration of patient coping strategies, particularly avoidant coping responses to stress, independent of psychological distress.

Potential role of insulin on the pathogenesis of depression

The regulation of insulin on depression and depression-like behaviour has been widely reported. Insulin and activation of its receptor can promote learning and memory, affect the hypothalamic-pituitary-adrenal axis (HPA) balance, regulate the secretion of neurotrophic factors and neurotransmitters, interact with gastrointestinal microbiome, exert neuroprotective effects and have an impact on depression. However, the role of insulin on depression remains largely unclear. Therefore, in this review, we summarized the potential role of insulin on depression. It may provide new insight for clarifying role of insulin on the pathogenesis of depression.

Weight loss drugs and lifestyle modification: Perceptions among a diverse adult sample

OBJECTIVES

Explore how adults from diverse racial and socioeconomic backgrounds perceive the use of weight loss drugs (prescription, over-the counter, herbals and supplements) and lifestyle modification.

METHODS

Individual, face-to-face, semi-structured interviews were conducted with persons presenting to an academic hospital-affiliated outpatient pharmacy serving ethnic minorities and low income individuals.

RESULTS

Fifty persons were interviewed, including 21 African Americans, 11 Hispanics and 17 low-income individuals (annual income <$20,000), of whom 33 self-reported as overweight or obese. Ever-users (14/50) and nonusers (36/50) of weight loss drugs expressed a belief in the importance of diet and exercise, but were not necessarily doing so themselves. Fear of side effects and skepticism towards efficacy of drugs deterred use. Some expressed concern over herbal product safety; others perceived herbals as natural and safe. Drugs were often viewed as a short-cut and not a long-term weight management solution.

CONCLUSION

A range of concerns related to the safety and efficacy of weight loss drugs were expressed by this lower income, ethnically diverse population of underweight to obese adults.

PRACTICE IMPLICATIONS

There is need and opportunity for healthcare providers to provide weight loss advice and accurate information regarding the safety and efficacy of various types of weight loss approaches.

The impact of coping strategies on weight control in the aftermath of dietary lapses in a high impulsivity group

OBJECTIVE

Individuals with high impulsivity tend to overeat on impulse. The objective of this study was to examine methods of weight control, focusing on coping with the aftermath of dietary lapses, among those who have high impulsivity.

METHODS

Eight hundred adults aged 20-59 years, who were registered with a research company completed a self-reported cross-sectional questionnaire. They were classified into low and high impulsivity groups using the median impulsivity score measured with the Barratt Impulsiveness Scale. We compared coping strategies in the aftermath of dietary lapses between the two groups. We also examined the correlation between coping methods and body mass index (BMI) using multiple regression analysis in the low and high impulsivity groups.

RESULTS

The high impulsivity group used more coping strategies, such as self-monitoring, self-reflective thoughts, and positive thoughts. The main finding of this study was that compensation by healthy eating was negatively correlated with BMI in the high impulsivity group. Additionally, positive thoughts were positively correlated with BMI.

CONCLUSIONS

The results suggest that compensation with healthy eating in the aftermath of dietary lapses is important to control weight in those with high impulsivity.

Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme

BACKGROUND

Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented.

SUBJECTS/METHODS

The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m(2) with comorbidity or ≥40 kg/m(2) without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data.

RESULTS

Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m(2)) with 87.2% of patients having a BMI≥40 kg/m(2) and 12.4% with BMI≥60 kg/m(2). The mean weight change of all patients enrolled was -4.1 kg (95% CI -3.6 to -4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving -5.5 kg (95% CI -4.2 to -6.2 kg, p=0.0001) and non-completers achieving -2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss.

CONCLUSIONS

The SLiM programme is an effective group intervention for the management of severe and complex obesity.

Weight rhythms: weight increases during weekends and decreases during weekdays

BACKGROUND/AIMS

The week's cycle influences sleep, exercise, and eating habits. An accurate description of weekly weight rhythms has not been reported yet - especially across people who lose weight versus those who maintain or gain weight.

METHODS

The daily weight in 80 adults (BMI 20.0-33.5 kg/m(2); age, 25-62 years) was recorded and analysed to determine if a group-level weekly weight fluctuation exists. This was a retrospective study of 4,657 measurements during 15-330 monitoring days. Semi-parametric regression was used to model the rhythm.

RESULTS

A pattern of daily weight changes was found (p < 0.05), with higher weight early in the week (Sunday and Monday) and decreasing weight during the week. Increases begin on Saturday and decreases begin on Tuesday. This compensation pattern was strongest for those who lost or maintained weight and weakest for those who slowly gained weight.

CONCLUSION

Weight variations between weekends and weekdays should be considered as normal instead of signs of weight gain. Those who compensate the most are most likely to either lose or maintain weight over time. Long-term habits may make more of a difference than short-term splurges. People prone to weight gain could be counselled about the importance of weekday compensation.

The role of self-efficacy, coping, and lapses in weight maintenance

PURPOSE

Successful weight maintenance after weight loss is exceedingly rare. The present study aimed to identify psychological predictors of lapses and weight maintenance.

METHODS

Self-efficacy, coping, and perceptions of lapses were examined as potential predictors of lapse frequency and weight maintenance (percentage weight loss maintained). Participants included 67 adults (85.3 % women) who had intentionally lost a mean of 16 % of their body weight and had stopped losing weight at least 6 months prior to data collection. Participants completed a 7-day lapse diary tracking the frequency and perceived severity of their dietary and activity lapses, along with questionnaires on self-efficacy, coping, and characteristics of their weight loss.

RESULTS

Participants had lost a mean of 13.9 kg, 20.4 months prior to data collection. More frequent lapsing was correlated with lower self-efficacy and greater perceived lapse severity. Lower percentage of weight loss maintained was correlated with lower self-efficacy, poorer coping, greater perceived lapse severity, and longer time since weight loss ended. “Regainers,” who maintained <90 % of their weight loss, had poorer self-efficacy, poorer coping, greater lapse frequency, and greater perceived lapse severity, than “maintainers,” who maintained at least 90 % of their weight loss.

CONCLUSIONS

The results suggest that self-efficacy, coping, and perceived lapse severity are significant predictors of weight maintenance, consistent with the relapse prevention model. The goals of improving self-efficacy and coping skills might be important additions to weight maintenance programs.

Addressing weight loss recidivism: a clinical focus on metabolic rate and the psychological aspects of obesity

Obesity in the United States has reached epidemic proportions and has become an unprecedented public health burden. This paper returns to the evidence for metabolic rate set points and emphasizes the clinical importance of addressing changes in metabolic rate throughout the weight loss process. In addition to the importance of clinically attending to the modulation of metabolic rate, the psychological aspects of obesity are addressed as part of the need to holistically treat obesity.

Similarities and differences between weight loss maintainers and regainers: a qualitative analysis

Obesity is remarkably refractory to treatment. Despite a plethora of quantitative studies, little qualitative research has been conducted on the topic of weight loss maintenance. This study used six focus groups to explore which factors promoted or prevented maintaining weight loss among a diverse, urban population. Eligible participants were those who had intentionally lost ≥10% of their body weight in the past 2 years and were categorized as either "regainers" or "maintainers" using self-reported length of weight maintenance and amount (%) regained. Regainers had regained ≥33% of their weight loss and maintainers had regained ≤15%. Participants (n=29) were predominantly African-American (58.6%) females (65.6%) with a mean age of 46.9±11.2 years. Four themes reflected similarities between regainers and maintainers, and four reflected differences between the groups. Both groups experienced lapses, used clothing fit for feedback on weight status, desired greater support during maintenance, and decreased self-monitoring of food intake over time. When compared with regainers, maintainers more often continued strategies used during weight loss, weighed themselves regularly, and used productive problem-solving skills and positive self-talk. Regainers experienced greater difficulty independently continuing food and exercise behaviors during maintenance, identifying decreased accountability and waning motivation as barriers. These findings suggest that weight loss maintenance efforts can be improved by addressing challenges such as long-term self-monitoring and problem-solving skills, and that maintenance success might depend on how people think as much as what they do.

A preliminary investigation of sex differences and the mediational role of food thought suppression in the relationship between stress and weight cycling

Despite improvements in weight loss treatment efficacy, research demonstrates that most people are unable to maintain weight loss over time. Individuals who utilize avoidant coping methods are less successful at maintaining weight loss than those who directly cope with stressors. Thought suppression, or trying to avoid certain thoughts, could be considered cognitive avoidance. Therefore, the current study evaluated the unexplored relationship among stress, food thought suppression, and weight cycling. Overweight and obese community individuals (N=347) completed self-report measures of thought suppression, weight history, and stress. Food thought suppression fully mediated the relationship between stress and weight cycling in women and approached significance for men. Results have implications for improving weight loss maintenance and support further exploration of third wave interventions, such as Acceptance and Commitment Therapy and Mindfulness, in the treatment of obesity.

Psychodynamic mechanism and weight reduction in obesity group therapy - first observations with different attachment styles

Objectives: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated.

Methods: This paper focuses on the attachment styles of obese subjects and their effects on psychodynamic group therapy within the context of a weight-reduction program.

Results: The attachment styles are characterized in 107 pre-obese and obese patients, and their effects on patients and therapists in group therapy are described.

Conclusion: The paper surveys the motivational situation, clinical pictures, and repeated group topics.

What distinguishes weight-loss maintainers from the treatment-seeking obese? Analysis of environmental, behavioral, and psychosocial variables in diverse populations

BACKGROUND

Understanding the factors that influence successful weight control is critical for developing interventions.

PURPOSE

The purpose of the study was to provide a comprehensive understanding of the role of psychosocial, environmental, and behavioral variables in distinguishing weight-loss maintainers (WLM) from treatment-seeking obese (TSO).

METHODS

WLM (n = 167) had lost > or =10% of their maximum body weight, had kept the weight off for > or =5 years, and were now of normal weight. TSO-1 and TSO-2 had a history of dieting and body mass index > or =25. TSO-1 was predominantly Caucasian; TSO-2 was predominantly African-American. Bayesian model averaging was used to identify the variables that distinguished WLM from TSO-1 and TSO-2.

RESULTS

The variables that most consistently discriminated WLM from TSO were more physical activity (ORs = 3.95 and 2.85), more dietary restraint (ORs = 1.63 and 1.41), and less dietary disinhibition (ORs = 0.69 and 0.83). Environmental variables, including the availability of physical activity equipment, TVs, and high-fat foods in the home, also distinguished WLM from TSO.

CONCLUSIONS

Obesity treatment should focus on increasing conscious control over eating, engaging in physical activity, and reducing disinhibition. Changes in the home environment may help facilitate these behavioral changes.

The Irrational Food Beliefs Scale: development and validation

This article reports the development and validation of a measure of Irrational Food Beliefs (IFB), defined as cognitively distorted and unhealthy attitudes and beliefs pertaining to food, which is proposed to be a factor that undermines success at weight loss and maintenance. Studies 1 and 2 demonstrated that the Irrational Food Beliefs Scale (IFBS) contains ecologically valid items and is comprised of two primary factors (irrational and rational food beliefs) whose items are internally consistent. Study 3 established that irrational subscale scores were positively associated with first semester weight gain in college freshmen. In Study 4, irrational food belief scores related predictably to measures of recent weight gain, poor weight loss maintenance, and bulimic symptoms in another college sample. In addition, IFB scores were not unduly influenced by test-taking response sets, and they were positively associated with depression and phobic anxiety and negatively correlated with self-esteem and need for cognition. Study 5 revealed strong positive associations between irrational food beliefs and bulimic symptoms, as well as number of previous diets in an obese community sample. The role irrational food beliefs may play in poor weight loss outcomes and maintenance is discussed.

The Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire: Development and Validation

OBJECTIVE

To develop and validate the Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire that was created to measure how one uses food to cope with stress and emotions.

DESIGN

Data were collected from a cross-sectional study using the EADES Questionnaire.

SUBJECTS/SETTING

Convenience sample (response rate 22%) from a southeastern public university, including staff and faculty (n=854) with ages ranging from 18 to 83 years and a mean body mass index of 27.3+/-6.4.

STATISTICAL ANALYSIS PERFORMED

Exploratory factor analysis was completed on 54 items that were originally meant to describe constructs from the Transactional Model of Stress and Coping. Reliability of scales was estimated using Cronbach's alpha. Total sum scores were given to each factor. Pearson correlation coefficients assessed linear associations between factors.

RESULTS

Three factors accounting for 43.5% of the variance were retained with a total Cronbach's alpha=.949. The factors did not represent the theoretical constructs from the Transactional Model of Stress and Coping as anticipated. A new model was created, including Emotion- and Stress-Related Eating, Appraisal of Resources and Ability to Cope, Appraisal of Outside Stressors and Influences with Cronbach's alpha being .949, .869, and .652, respectively. These factors were significantly correlated with one another.

CONCLUSIONS

The EADES model provides a viable conceptual model to help explain variables that may contribute to overeating, whereas the EADES Questionnaire provides a measurement tool for evaluating these variables that have not traditionally been explored in weight management efforts.

The National Weight Control Registry: is it useful in helping deal with our obesity epidemic?

The National Weight Control Registry (NWCR) consists of over 4800 individuals who have been successful in long-term weight loss maintenance. The purpose of establishing the NWCR was to identify the common characteristics of those who succeed in long-term weight loss maintenance. We found very little similarity in how these individuals lost weight but some common behaviors in how they are keeping their weight off. To maintain their weight loss NWCR participants report eating a relatively low-fat diet, eating breakfast almost every day, weighing themselves regularly, and engaging in high levels (about 1 hour/day) of physical activity. Because this is not a random sample of those who attempt weight loss, the results have limited generalizability to the entire population of overweight and obese individuals. The value of this project lies in identifying potential strategies that may help others be more successful in keeping weight off.

Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.

The early identification of poor treatment outcome in a women's weight loss program

Research examining factors associated with program attrition or failure to lose weight during active treatment has yielded mixed findings. The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of attrition and failure to lose weight during treatment. This investigation examined whether baseline characteristics, early weight loss, attendance, weight-related quality of life, confidence and difficulties with eating and exercise, and diet-related thoughts and feelings during the final week of treatment were associated with percentage change in body weight. Forty-four, obese, sedentary, postmenopausal women were recruited to participate in a 24-session weight loss intervention. Poor treatment outcome (i.e., percentage change in body weight) was significantly associated with several baseline characteristics including higher body mass index (BMI), greater fat and lower carbohydrate consumption, poor body image, and greater expectations for program success. Poor treatment outcome was also significantly associated with poor program attendance, unsatisfactory early weight loss, unsatisfactory improvements in weight-related quality of life, and lower self-control and self-confidence. By the end of active treatment, women with poor treatment outcome evidenced significantly higher levels of guilt and feelings of failure. The need for early identification and intervention with participants at risk for treatment failure is discussed.

Does the Y chromosome make a difference? Gender differences in attempts to change cardiovascular disease risk factors

PURPOSE

The purpose of this study was to determine if gender differences exist in attempts to change cardiovascular disease (CVD) risk factor behaviors, specifically cigarette smoking, sedentary lifestyle, and overweight, and if the success of these attempted behavior changes also differs by gender in the Pawtucket Heart Health Program (PHHP).

METHODS

The risk factors were considered in reference to individuals who needed to change a particular risk factor behavior. Data were gathered from three different sources within the PHHP (the contact card registry of participants and both cross-sectional and cohort household surveys).

RESULTS

Women were much more likely than men to participate in PHHP risk factor programs related to smoking, exercise, or weight loss. Women were also more likely than men to self-report making attempts to change these risk factor behaviors. Men self-reported to have a greater percentage of long-term smoking cessation success than women, although men and women had similar success rates related to weight loss and increasing physical activity. Men who reported being at least 20% overweight at baseline achieved significantly greater self-reported weight loss when followed up about 8.5 years later than women who were overweight at baseline.

CONCLUSIONS

More research needs to be done to find ways to help women become more successful at modifying CVD risk factor behaviors. In addition, emphasis must be placed on ways to help men initiate and increase the number of attempts they make to change these same risk factor behaviors.