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Graham H, Madigan C, Daley AJ. A randomised controlled trial to investigate the feasibility and acceptability of a small change approach to prevent weight gain. J Behav Med 2024; 47:232-243. [PMID: 37932643 PMCID: PMC10944418 DOI: 10.1007/s10865-023-00455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
A weight gain prevention strategy showing merit is a small change approach (increase energy expenditure and/or decrease energy intake by 100-200 kcal/day). Studies have tested a small change approach in intensive interventions involving multiple contacts, unsuitable for delivery at scale. The aim here was to assess the feasibility and acceptability of a remote small change weight gain prevention intervention. A randomised controlled trial of 122 participants was conducted. The intervention was a remote 12-week small change weight gain prevention programme (targeting dietary and/or physical activity behaviours). The comparator group received a healthy lifestyle leaflet. Data were collected at baseline and 12-weeks. The primary outcome was the feasibility and acceptability, assessed against three stop-go traffic light criteria: retention, number of participants randomised per month and adherence to a small change approach. Participants' opinions of a small change approach and weight change were also measured. The traffic light stop-go criteria results were green for recruitment (122 participants recruited in three months) and retention (91%) and red for intervention adherence. Most participants (62%) found a small change approach helpful for weight management and the mean difference in weight was - 1.1 kg (95% CI - 1.7, - 0.4), favouring the intervention group. Excluding intervention adherence, the trial was feasible and acceptable to participants. Despite adherence being lower than expected, participants found a small change approach useful for weight management and gained less weight than comparators. With refinement to increase intervention adherence, progress to an effectiveness trial is warranted.ISRCTN18309466: 12/04/2022 (retrospectively registered).
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Affiliation(s)
- Henrietta Graham
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Claire Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour (CLIMB), School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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2
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Kusinski LC, Tobolska P, Jones DL, Atta N, Turner EH, Lewis HB, Oude Griep LM, Gribble FM, Meek CL. Towards Novel Nutritional Strategies in Gestational Diabetes: Eating Behaviour and Obesity in Women with Gestational Diabetes Compared with Non-Pregnant Adults. Nutrients 2023; 15:4141. [PMID: 37836424 PMCID: PMC10574012 DOI: 10.3390/nu15194141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Gestational diabetes is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Effective nutritional strategies are needed to reduce BMI and improve long-term maternal cardiometabolic health, but the relative contribution of maternal eating behaviour, a potential barrier to dietary change, has not been explored. We compared eating behaviour in women with gestational diabetes with that of men and non-pregnant women with comparable risk factors, and tested associations between eating behaviour traits and BMI in women with gestational diabetes. We hypothesized that eating behaviour would be unfavourable in gestational diabetes and would be associated with BMI. METHODS Participants (n = 417) including 53 men, 164 non-pregnant women and 200 women with gestational diabetes (singleton pregnancy; 29 weeks' gestation) were recruited into three prospective studies assessing weight loss interventions, with similar entry criteria. The three-factor eating questionnaire (TFEQ-R18) assessed uncontrolled eating, emotional eating and cognitive restraint at study enrolment. Associations between BMI at study enrolment and TFEQ-R18 (% maximum score) were assessed using linear regression. RESULTS Women with gestational diabetes had significantly lower uncontrolled eating scores vs. men (53% vs. 65%; p < 0.001) and non-pregnant women (53% vs. 66%; p < 0.001), lower emotional eating scores vs. non-pregnant women (60% vs. 71%; p < 0.001) and higher cognitive restraint (p < 0.001 vs. men and non-pregnant women). In women with gestational diabetes, emotional eating scores were positively associated with BMI at study enrolment (beta coefficient 7.8 (95% CI 3.9 to 11.7), p < 0.001). CONCLUSIONS Women with gestational diabetes have favourable eating behaviour compared with other population groups. Because BMI at study enrolment was associated with emotional eating, nutritional strategies which reduce emotional eating may provide new opportunities to improve long-term maternal health after gestational diabetes.
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Affiliation(s)
- Laura C. Kusinski
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Patrycja Tobolska
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Danielle L. Jones
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Nooria Atta
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Elizabeth H. Turner
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Hannah B. Lewis
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | | | - Fiona M. Gribble
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
| | - Claire L. Meek
- Wellcome-Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.K.); (P.T.); (D.L.J.); (N.A.); (E.H.T.)
- Cambridge Universities NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Delestre F, Lehéricey G, Estellat C, Diallo MH, Hansel B, Giral P. Hypnosis reduces food impulsivity in patients with obesity and high levels of disinhibition: HYPNODIET randomized controlled clinical trial. Am J Clin Nutr 2022; 115:1637-1645. [PMID: 35170724 DOI: 10.1093/ajcn/nqac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The obesogenic environment of Western countries raises questions about its current management. Some clinical studies have explored hypnosis, although the current state of knowledge does not lead to definitive conclusions about its efficacy. OBJECTIVES We assessed the impact of Ericksonian hypnosis and self-hypnosis on disinhibition of eating in adults with obesity and high food impulsivity levels, compared with standard nutritional education. METHODS From September 2014 to July 2015, adults with BMI (in kg/m2) of 30-40 and a high disinhibition score [>8 on the Three Factor Eating Questionnaire (TFEQ-51)] were included in a randomized controlled trial. The control and hypnosis groups received the same standard nutrition education in 8 workshops. In the hypnosis group, subjects had 8 sessions of hypnosis combined with training in self-hypnosis. Disinhibition (primary outcome) and other scores from the TFEQ-51 as well as anthropometric, food intake, cardiometabolic, and physical activity variables were collected at inclusion and at 8 mo. RESULTS Of 82 randomly assigned adults, 70 participated in all sessions; 80 participated in ≥1 session and were included in the main analysis (hypnosis group, n = 41; control group, n = 39). After 8 mo of follow-up, disinhibition scores adjusted for baseline values were lower in the hypnosis group, with a mean between-group difference of 4.2 (95% CI: 2.8, 5.5; P < 0.001); 67.7% of adults in the hypnosis group had normalized their disinhibition (compared with 11.1% in control; P < 0.0001). Differences for weight (1.8 kg; 95% CI: -0.1, 3.7 kg; P = 0.052), BMI (0.8; 95% CI: 0.1, 1.4; P = 0.028), susceptibility to hunger score (2.2; 95% CI: 1.0, 3.3; P < 0.001), and its 2 subscales also favored the hypnosis group. CONCLUSIONS In the management of adults with obesity and a high disinhibition score, hypnosis and self-hypnosis can significantly improve the deep mechanisms of eating behaviors and seem to have a beneficial effect on weight loss.This trial was registered at clinicaltrials.gov as NCT02292108.
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Affiliation(s)
- Fabienne Delestre
- Dietetics Department, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Guillaume Lehéricey
- Dietetics Department, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Candice Estellat
- PEPITES team, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM, Paris, France.,Clinical Research Unit (URC), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Pharmacoepidemiology Center (Cephepi), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Hassimiou Diallo
- Clinical Research Unit (URC), Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Boris Hansel
- INSERM U1148, University of Paris, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Giral
- Endocrinology-Metabolism Department, Pitié Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
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Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
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Hicks-Roof K, Xu J, Fults AK, Latortue KY. Beyond the clinical walls: registered dietitian nutritionists providing medical nutrition therapy in the home setting. Nutr Res Pract 2021; 15:789-797. [PMID: 34858555 PMCID: PMC8601946 DOI: 10.4162/nrp.2021.15.6.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUD/OBJECTIVES Registered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security. SUBJECTS/METHODS This is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m2. Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table. RESULTS Baseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (−0.27), fruit (−0.32), dairy (−0.80) and fish (−0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security. CONCLUSIONS This study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants' needs and personal goals.
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Affiliation(s)
- Kristen Hicks-Roof
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
| | - Jing Xu
- Department of Health Administration, University of North Florida, Jacksonville, FL 32224, USA
| | - Amanda K Fults
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE 19713, USA
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Roake J, Phelan S, Alarcon N, Keadle SK, Rethorst CD, Foster GD. Sitting Time, Type, and Context Among Long-Term Weight-Loss Maintainers. Obesity (Silver Spring) 2021; 29:1067-1073. [PMID: 34029443 DOI: 10.1002/oby.23148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight-loss maintainers in WW (formerly Weight Watchers). METHODS Participants were 4,305 weight-loss maintainers who had maintained ≥9.1 kg of weight loss (24.7 kg on average) for 3.3 years and had an average current BMI of 27.6 kg/m2 . A control group of weight-stable individuals with obesity (n = 619) had an average BMI of 38.9 kg/m2 . The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered. RESULTS Weight-loss maintainers versus controls spent 3 hours less per day sitting during the week (10.9 vs. 13.9; η p 2 = 0.039; P = 0.0001) and weekends (9.7 vs. 12.6; η p 2 = 0.038). Weight-loss maintainers versus controls spent 1 hour less per day in non-work-related sitting using a computer or video games during the week (1.4 vs. 2.3; η p 2 = 0.03; P = 0.0001) and weekends (1.5 vs. 2.5; η p 2 = 0.03; P = 0.0001). Weight-loss maintainers versus controls had similar numbers of sedentary-promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; η p 2 = 0.036; P = 0.0001). CONCLUSIONS Weight-loss maintainers reported less time sitting than weight-stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long-term weight-loss maintenance.
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Affiliation(s)
- James Roake
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Noemi Alarcon
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Sarah K Keadle
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | | | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rhee KE, Herrera L, Strong D, DeBenedetto AM, Shi Y, Boutelle KN. Design of the GOT Doc study: A randomized controlled trial comparing a Guided Self-Help obesity treatment program for childhood obesity in the primary care setting to traditional family-based behavioral weight loss. Contemp Clin Trials Commun 2021; 22:100771. [PMID: 33997462 PMCID: PMC8095104 DOI: 10.1016/j.conctc.2021.100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity. Effective childhood obesity treatment is not widely available or easily accessible. Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. GSH is easier to implement and can be delivered in the primary care setting. GSH can increase access to much needed treatment. Evaluation of its effectiveness in the primary care setting is needed.
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Key Words
- Childhood obesity
- Community-based intervention
- Early and Periodic Screening, Diagnosis, and Treatment program, EPSDT
- Electronic health record, EHR
- Family-Based Behavioral Therapy, FBT
- Family-based behavioral therapy
- Guided Self-Help, GSH
- Guided self-help
- Guided self-help Obesity Treatment in the primary care setting, GOT Doc
- Overweight or obesity, OW/OB
- Primary care
- Primary care provider, PCP
- Quality of Lifev, QOL
- Treatment
- U.S. Preventive Services Task Force, USPSTF
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Affiliation(s)
- Kyung E Rhee
- University of California, San Diego, Department of Pediatrics, United States
| | - Lourdes Herrera
- University of California, San Diego, Department of Pediatrics, United States.,Wake Forrest University, Department of Pediatrics, United States
| | - David Strong
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | | | - Yuyan Shi
- University of California, San Diego, Department of Family Medicine and Public Health, United States
| | - Kerri N Boutelle
- University of California, San Diego, Department of Pediatrics, Department of Family Medicine and Public Health, And Department of Psychiatry, United States
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The association between pre-conception intuitive eating and gestational weight gain. Eat Weight Disord 2021; 26:467-474. [PMID: 32125687 DOI: 10.1007/s40519-020-00878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine if pre-conception intuitive eating, an adaptive eating behavior, was related to gestational weight gain (GWG) and the likelihood of exceeding GWG recommendations. METHODS This prospective survey study took place in an outpatient obstetric clinic. Participants completed the pre-conception Intuitive Eating Scale for Pregnancy during a prenatal check-up appointment and total GWG was collected from the medical record. The pre-conception Intuitive Eating Scale for Pregnancy assesses unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety to inform what, when, and how much to eat. Hierarchical linear multiple regression and logistic multiple regression analyses determined associations between pre-conception intuitive eating and GWG on the total sample and stratified by weight status (normal/underweight, overweight, and obese). RESULTS The majority of the sample (n = 253) was white, married, employed, had annual household income > $50,000, and had a college degree. No aspects of pre-conception intuitive eating predicted the likelihood of excess GWG. However, in the total sample, unconditional permission to eat (subscale) was inversely related to total GWG (B = -0.16, p < 0.05). Among women with obesity (n = 36), eating for physical rather than emotional reasons (subscale) was inversely related to total GWG (B = -0.47, p < 0.05). DISCUSSION Some aspects of intuitive eating during the pre-conception period were related to total GWG, particularly for women with obesity. However, intuitive eating scores did not increase or decrease the likelihood of excess GWG. More research is needed to understand the mechanisms for this association before clinical recommendations can be made. LEVEL OF EVIDENCE Level III (Evidence obtained from well-designed cohort or case-control analytic studies).
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Vera DA, Baez GR, García HA, Iriarte DI, Pomarico JA. A comparison between plausible models in layered turbid media with geometrical variations applying a Bayesian selection criterion. Biomed Phys Eng Express 2020; 6:055020. [PMID: 33444251 DOI: 10.1088/2057-1976/abae48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One possible application of Near Infrared techniques is to analyze human brain metabolic activity. Currently used models take into account the layered structure of the human head but, usually, they do not consider the non-planar surface of some of the boundaries, i.e. gray matter, which results in a much more complex structure, thus leading to more sophisticated models and longer calculation times. The main objective of this work is to determine if it is worth to replace a planar layered structure by a non-planar one. To this end we implement a Bayesian-based quantitative methodology for choosing between two competitive models describing light propagation in layered turbid media. Experiments of time-resolved diffuse reflectance measurements are performed in layered phantoms and complemented with numerical calculations. The resulting Distributions of Time of Flight of both models are compared using Bayesian model selection analysis. The non-planar interface was introduced in the simulations by a simple surface parametrization. Results suggest that, under certain conditions, a multilayer model with planar boundaries is good enough.
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Affiliation(s)
- Demián A Vera
- Centro de Investigaciones en Física e Ingeniería del Centro de la Provincia de Buenos Aires (CIFICEN, UNCPBA-CICPBA - CONICET) Pinto 399, B7000GHG-Tandil, Buenos Aires, Argentina
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10
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Beatty JA, Greene GW, Blissmer BJ, Delmonico MJ, Melanson KJ. Effects of a novel bites, steps and eating rate-focused weight loss randomised controlled trial intervention on body weight and eating behaviours. J Hum Nutr Diet 2019; 33:330-341. [PMID: 31642130 DOI: 10.1111/jhn.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eating rate (ER), comprising the amount of food consumed per unit of time, is associated with obesity and energy intake (EI). METHODS The present study tested whether adding a self-monitoring wearable device to a multifaceted 8-week weight loss intervention increased weight loss. In addition, the device's effect on secondary change outcomes in EI, ER and estimated energy expenditure was explored. Tertiary outcomes included examining eating behaviours measured by the Weight-Related Eating Questionnaire (WREQ). Seventy-two adults who were overweight or obese [mean (SD) age, 37.7 (15.3) years; body mass index, 31.3 (3.2) kg m-2 ] were randomised into two groups: intervention workbook plus device (WD) or intervention workbook only (WO). Three 24-h dietary recalls were obtained before weeks 0 and 8. Participants were weighed, consumed a test meal and completed 7-day Physical Activity Recall and WREQ at weeks 0 and 8. RESULTS There was no significant difference between WD and WO groups with respect to weight change [-0.46 (1.11) vs. 0.26 (0.82) kg, respectively], ER, EI, energy expenditure or WREQ scores, although there were significant changes over time, and within-group changes on all of these variables. At week 8, participants were dichotomised into weight loss or weight stable/gainers groups. A significant time by group change was seen in susceptibility to external cues scores, with significant time effects for susceptibility and restraint. CONCLUSIONS An intervention focused on reducing ER, energy density and increasing steps was effective for weight loss, although the wearable device provided no additional benefit. Participants with higher susceptibility to external eating may be more responsive to this intervention.
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Affiliation(s)
- J A Beatty
- Department of Nutrition and Food Sciences, The University of Rhode Island, Kingston, RI, USA
| | - G W Greene
- Department of Nutrition and Food Sciences, The University of Rhode Island, Kingston, RI, USA
| | - B J Blissmer
- Department of Kinesiology, The University of Rhode Island, Kingston, RI, USA
| | - M J Delmonico
- Department of Kinesiology, The University of Rhode Island, Kingston, RI, USA
| | - K J Melanson
- Department of Nutrition and Food Sciences, The University of Rhode Island, Kingston, RI, USA
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McDermott KD, Williams SE, Espeland MA, Erickson K, Neiberg R, Wadden TA, Bryan RN, Desiderio L, Leckie RL, Falconbridge LH, Jakicic JM, Alonso-Alonso M, Wing RR. Impact of Intensive Lifestyle Intervention on Neural Food Cue Reactivity: Action for Health in Diabetes Brain Ancillary Study. Obesity (Silver Spring) 2019; 27:1076-1084. [PMID: 31112370 PMCID: PMC6591068 DOI: 10.1002/oby.22496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/06/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Action for Health in Diabetes (Look AHEAD) research study was a randomized trial comparing the effects of an intensive lifestyle intervention (ILI) versus a diabetes support and education (DSE) control group in adults with type 2 diabetes and overweight or obesity. Functional magnetic resonance imaging was used to determine whether neural food cue reactivity differed for these groups 10 years after randomization. METHODS A total of 232 participants (ILI, n = 125, 72% female; DSE, n = 107, 64% female) were recruited at three of the Look AHEAD sites for functional magnetic resonance imaging. Neural response to high-calorie foods compared with nonfoods was assessed in DSE versus ILI. Exploratory correlations were conducted within ILI to identify regions in which activity was associated with degree of weight loss. RESULTS Voxel-wise whole-brain comparisons revealed greater reward-processing activity in left caudate for DSE compared with ILI and greater activity in attention- and visual-processing regions for ILI than DSE (P < 0.05, family-wise error corrected). Exploratory analyses revealed that greater weight loss among ILI participants from baseline was associated with brain activation indicative of increased cognitive control and attention and visual processing in response to high-calorie food cues (P < 0.001, uncorrected). CONCLUSIONS These findings suggest there may be legacy effects of participation in a behavioral weight loss intervention, with reduced reward-related activity and enhanced attention or visual processing in response to high-calorie foods.
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Affiliation(s)
- Kathryn Demos McDermott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
| | - Samantha E Williams
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Neiberg
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Thomas A Wadden
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R Nick Bryan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Desiderio
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Regina L Leckie
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Lucy H Falconbridge
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miguel Alonso-Alonso
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
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12
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Kliemann N, Croker H, Johnson F, Beeken RJ. Starting university with high eating self-regulatory skills protects students against unhealthy dietary intake and substantial weight gain over 6 months. Eat Behav 2018; 31:105-112. [PMID: 30243053 PMCID: PMC6234330 DOI: 10.1016/j.eatbeh.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/10/2018] [Accepted: 09/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is consistent evidence that suggests first year students are at risk of weight gain, but the reasons for this vulnerability are still unclear. This study aimed to explore whether the ability to regulate eating behaviours is a predictor of weight and dietary changes in first year undergraduate students. METHODS First year undergraduate students from universities situated in London were invited to complete a survey at the beginning of the academic year and at 6-month follow-up. Each survey included the Self-Regulation of Eating Behaviour Questionnaire, food frequency questions, socio-demographic questions and anthropometric questions. Linear and logistic regressions were performed to explore the associations between baseline eating self-regulatory skills and weight and dietary changes. RESULTS 481 first year undergraduate students took part in the study. Students who entered university with higher eating self-regulatory skills were more likely to maintain or achieve a higher fruit and vegetable (OR = 1.8, p = 0.007) and a lower sweet and salty snack (OR = 1.9, p = 0.001) intake over the course of the first 6 months in university. Higher baseline eating self-regulatory skills were also related to lower weight changes (β = -0.15, p = 0.018) and lower likelihood of gaining 5% initial body weight (OR = 0.52, p = 0.006) at 6-month. Additionally, self-regulatory skills moderated the relationship between baseline BMI and weight changes (β = -0.25, p ≤0.001) and between baseline BMI and 5% weight gain (OR = 0.82, p = 0.008). CONCLUSIONS Starting university with higher eating self-regulatory skills may help students to maintain or achieve a healthy diet and protect them against substantial weight gain, especially among students with overweight.
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Affiliation(s)
- Nathalie Kliemann
- Department of Behavioural Science & Health, University College London, London, UK
| | - Helen Croker
- Department of Behavioural Science & Health, University College London, London, UK
| | - Fiona Johnson
- Department of Behavioural Science & Health, University College London, London, UK
| | - Rebecca J. Beeken
- Department of Behavioural Science & Health, University College London, London, UK,Leeds Institute of Health Sciences, University of Leeds, Leeds, UK,Corresponding author at: Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
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13
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Neumann M, Holzapfel C, Müller A, Hilbert A, Crosby RD, de Zwaan M. Features and Trajectories of Eating Behavior in Weight-Loss Maintenance: Results from the German Weight Control Registry. Obesity (Silver Spring) 2018; 26:1501-1508. [PMID: 30230246 DOI: 10.1002/oby.22270] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Eating behaviors such as dietary restraint and disinhibition caused by emotional and external cues play a relevant role in weight-loss maintenance. METHODS Four hundred forty individuals with successful weight-loss maintenance included in the prospective German Weight Control Registry completed the Dutch Eating Behavior Questionnaire. Participants were categorized into the following two weight groups: stable weight trajectory (WS) (n = 280) and unstable weight trajectory (WUS) (n = 160) over the 2-year assessment period. RESULTS Those with successful weight-loss maintenance had significantly higher scores on the restrained and emotional eating subscales compared with a general population (GP) sample. At baseline, the WS individuals had lower restrained, emotional, and external eating scores compared with the WUS individuals. Over the 2-year follow-up period, the trajectories of the restraint scores decreased in both groups but stayed elevated compared with the GP sample. Scores of the emotional and external eating subscales remained stable in the WS group but increased in the WUS group. CONCLUSIONS A certain degree of restraint seems to be necessary for successful weight-loss maintenance; however, high emotional and external eating may counteract this effect, resulting in weight regain in the long run.
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Affiliation(s)
- Maria Neumann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Technical University of Munich, University Hospital "Klinikum rechts der Isar,", Munich, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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14
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Smith KE, Mason TB, Crosby RD, Engel SG, Crow SJ, Wonderlich SA, Peterson CB. State and trait positive and negative affectivity in relation to restraint intention and binge eating among adults with obesity. Appetite 2018; 120:327-334. [PMID: 28943474 PMCID: PMC5969992 DOI: 10.1016/j.appet.2017.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/16/2017] [Accepted: 09/20/2017] [Indexed: 02/05/2023]
Abstract
Restraint and binge eating are cognitive and behavioral processes that are particularly important in the context of obesity. While extensive research has focused on negative affect (NA) in relation to binge eating, it is unclear whether affective valence (i.e., positive versus negative) and stability (i.e., state versus trait) differentially predict binge eating and restraint among individuals with obesity. Distinguishing between valence and stability helps elucidate under which affective contexts, and among which individuals, restraint and binge eating are likely to occur. Therefore, the present study examined relationships between trait and state levels of NA and positive affect (PA), binge eating, and restraint intention among 50 adults with obesity (BMI ≥ 30). Participants completed baseline assessments followed by a two-week ecological momentary assessment (EMA) protocol. Structural equation modeling assessed a trait model of person-level measures of affect in relation to overall levels of binge eating and restraint intention, while general estimating equations (GEEs) assessed state models examining relationships between momentary affect and subsequent binge eating and restraint. The trait model indicated higher overall NA was related to more binge eating episodes, but was unrelated to overall restraint intention. Higher overall PA was related to higher overall restraint intention, but was unrelated to binge eating. State models indicated momentary NA was associated with a greater likelihood of subsequent binge eating and lower restraint intention. Momentary PA was unrelated to subsequent binge eating or restraint intention. Together, findings demonstrate important distinctions between the valence and stability of affect in relationship to binge eating and restraint intention among individuals with obesity. While NA is a more salient predictor of binge eating than PA, both overall PA and momentary NA are predictors of restraint intention.
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Affiliation(s)
- Kathryn E Smith
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, ND, United States.
| | - Tyler B Mason
- Department of Preventative Medicine, University of Southern California, United States
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, ND, United States
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, ND, United States
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, ND, United States
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
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15
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Fragoso TM, Bertoli W, Louzada F. Bayesian Model Averaging: A Systematic Review and Conceptual Classification. Int Stat Rev 2017. [DOI: 10.1111/insr.12243] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tiago M. Fragoso
- Fundação CESGRANRIO; Rua Santa Alexandrina, 1011 Rio de Janeiro 20261-903 Brazil
| | - Wesley Bertoli
- Departamento Acadêmico de Matemática - Universidade Tecnológica Federal do Paraná; Avenida Sete de Setembro, 3165 Curitiba 80230-901 Brazil
| | - Francisco Louzada
- Instituto de Ciências Matemáticas e de Computação - Universidade de São Paulo; Avenida Trabalhador São-carlense, 400 São Carlos 13566-590 Brazil
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16
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Duarte C, Ferreira C, Pinto-Gouveia J, Trindade I, Martinho A. What makes dietary restraint problematic? Development and validation of the Inflexible Eating Questionnaire. Appetite 2017; 114:146-154. [DOI: 10.1016/j.appet.2017.03.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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17
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Attenuating the Biologic Drive for Weight Regain Following Weight Loss: Must What Goes Down Always Go Back Up? Nutrients 2017; 9:nu9050468. [PMID: 28481261 PMCID: PMC5452198 DOI: 10.3390/nu9050468] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 01/01/2023] Open
Abstract
Metabolic adaptations occur with weight loss that result in increased hunger with discordant simultaneous reductions in energy requirements—producing the so-called energy gap in which more energy is desired than is required. The increased hunger is associated with elevation of the orexigenic hormone ghrelin and decrements in anorexigenic hormones. The lower total daily energy expenditure with diet-induced weight loss results from (1) a disproportionately greater decrease in circulating leptin and resting metabolic rate (RMR) than would be predicted based on the decline in body mass, (2) decreased thermic effect of food (TEF), and (3) increased energy efficiency at work intensities characteristic of activities of daily living. These metabolic adaptations can readily promote weight regain. While more experimental research is needed to identify effective strategies to narrow the energy gap and attenuate weight regain, some factors contributing to long-term weight loss maintenance have been identified. Less hunger and greater satiation have been associated with higher intakes of protein and dietary fiber, and lower glycemic load diets. High levels of physical activity are characteristic of most successful weight maintainers. A high energy flux state characterized by high daily energy expenditure and matching energy intake may attenuate the declines in RMR and TEF, and may also result in more accurate regulation of energy intake to match daily energy expenditure.
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18
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Abstract
Obesity is a risk factor for a plethora of severe morbidities and premature death. Most supporting evidence comes from observational studies that are prone to chance, bias and confounding. Even data on the protective effects of weight loss from randomized controlled trials will be susceptible to confounding and bias if treatment assignment cannot be masked, which is usually the case with lifestyle and surgical interventions. Thus, whilst obesity is widely considered the major modifiable risk factor for many chronic diseases, its causes and consequences are often difficult to determine. Addressing this is important, as the prevention and treatment of any disease requires that interventions focus on causal risk factors. Disease prediction, although not dependent on knowing the causes, is nevertheless enhanced by such knowledge. Here, we provide an overview of some of the barriers to causal inference in obesity research and discuss analytical approaches, such as Mendelian randomization, that can help to overcome these obstacles. In a systematic review of the literature in this field, we found: (i) probable causal relationships between adiposity and bone health/disease, cancers (colorectal, lung and kidney cancers), cardiometabolic traits (blood pressure, fasting insulin, inflammatory markers and lipids), uric acid concentrations, coronary heart disease and venous thrombosis (in the presence of pulmonary embolism), (ii) possible causal relationships between adiposity and gray matter volume, depression and common mental disorders, oesophageal cancer, macroalbuminuria, end-stage renal disease, diabetic kidney disease, nuclear cataract and gall stone disease, and (iii) no evidence for causal relationships between adiposity and Alzheimer's disease, pancreatic cancer, venous thrombosis (in the absence of pulmonary embolism), liver function and periodontitis.
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Affiliation(s)
- P W Franks
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden.,Unit of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - N Atabaki-Pasdar
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden
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19
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Gettens KM, Gorin AA. Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control. J Behav Med 2017; 40:687-701. [PMID: 28160229 DOI: 10.1007/s10865-017-9831-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.
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20
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Review of multimodal therapies for obesity treatment: Including dietary, counseling strategies, and pharmacologic interventions. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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21
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Schaumberg K, Anderson DA, Anderson LM, Reilly EE, Gorrell S. Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology. Clin Obes 2016; 6:89-100. [PMID: 26841705 DOI: 10.1111/cob.12134] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 11/22/2015] [Indexed: 02/05/2023]
Abstract
Dietary restraint has historically been implicated as a risk factor for the development of eating pathology. Despite existing findings, recent research suggests that many individuals are capable of practicing dietary restraint without negative effects. In order to successfully incorporate the positive aspects of dietary restraint into interventions for healthy weight management, a nuanced examination of the relationship between dietary restraint and resulting eating patterns is necessary. Accordingly, the current review seeks to clarify the existing literature with regard to dietary restraint. First, this review examines the construct of dietary restraint and differentiates dietary restraint from related constructs, such as weight loss dieting. Second, it identifies situations in which dietary restraint has been linked with positive outcomes, such as healthy weight management and prevention of eating pathology. Altogether, it appears that dietary restraint can prove a beneficial strategy for those attempting to control their weight, as it does not relate to increased levels of eating pathology when practiced as part of a well-validated weight management programme.
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Affiliation(s)
- K Schaumberg
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - D A Anderson
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - L M Anderson
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - E E Reilly
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - S Gorrell
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
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22
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Kase CA, Piers AD, Schaumberg K, Forman EM, Butryn ML. The relationship of alcohol use to weight loss in the context of behavioral weight loss treatment. Appetite 2016; 99:105-111. [PMID: 26792773 DOI: 10.1016/j.appet.2016.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 11/19/2022]
Abstract
Despite common wisdom that reducing alcohol intake will facilitate weight loss, little research has examined whether participants in behavioral weight loss treatments actually decrease their alcohol intake, or whether reduced alcohol intake relates to weight loss outcomes in this context. This study examined the relationship of alcohol use to energy intake excluding alcohol and to weight in 283 overweight and obese adults participating in a 26-session behavioral weight loss treatment. The majority of participants consumed low to moderate levels of alcohol at baseline. Participants who consumed alcohol at baseline meaningfully reduced their alcohol intake by end-of-treatment. Alcohol use did not relate to weight at baseline or end-of-treatment when controlling for relevant demographic variables, and change in alcohol use was unrelated to weight change in the overall sample during treatment. However, end-of-treatment alcohol intake did relate to end-of-treatment energy intake excluding alcohol. In addition, behavioral impulsivity and change in alcohol intake interacted to predict weight loss, such that decreases in alcohol intake were associated with greater percent weight loss at end-of-treatment for participants with higher levels of impulsivity. Alcohol consumption may lead to overeating episodes, and highly impulsive individuals may be at risk for increased energy intake during or after episodes of drinking. Therefore, the recommendation to reduce alcohol intake in the context of behavioral weight loss treatment seems warranted, particularly for individuals with high levels of impulsivity.
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Affiliation(s)
- Colleen A Kase
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA.
| | - Amani D Piers
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | | | - Evan M Forman
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Meghan L Butryn
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
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23
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Emery CF, Olson KL, Lee VS, Habash DL, Nasar JL, Bodine A. Home environment and psychosocial predictors of obesity status among community-residing men and women. Int J Obes (Lond) 2015; 39:1401-7. [PMID: 25916909 PMCID: PMC4632497 DOI: 10.1038/ijo.2015.70] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/09/2015] [Accepted: 02/17/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Prior research indicates that features of the home environment (for example, televisions, exercise equipment) may be associated with obesity, but no prior study has examined objective features of the home food environment (for example, location of food) in combination with behavioral (for example, food purchasing), psychological (for example, self-efficacy) and social factors among obese adults. This study identified factors associated with obesity status from measures of home environment, food purchasing behavior, eating behavior and psychosocial functioning. SUBJECTS/METHODS One hundred community-residing obese (mean body mass index (BMI)=36.8, s.e.=0.60) and nonobese (mean BMI=23.7, s.e.=0.57) adults (mean age=42.7, s.e.=1.50; range=20-78 years) completed an observational study with 2-h home interview/assessment and 2-week follow-up evaluation of food purchases and physical activity. Data were analyzed with analysis of variance and logistic regression, controlling for sex. RESULTS Univariate analyses revealed that homes of obese individuals had less healthy food available than homes of nonobese (F(1,97)=6.49, P=0.012), with food distributed across a greater number of highly visible locations (F(1,96)=6.20, P=0.01). Although there was no group difference in household income or size, obese individuals reported greater food insecurity (F(1,97)=9.70, P<0.001), more reliance on fast food (F(1,97)=7.63, P=0.01) and more long-term food storage capacity in number of refrigerators (F(1,97)=3.79, P=0.05) and freezers (F(1,97)=5.11, P=0.03). Obese individuals also reported greater depressive symptoms (F(1,97)=10.41, P=0.002) and lower ability to control eating in various situations (F(1,97)=20.62, P<0.001). Multiple logistic regression revealed that obesity status was associated with lower self-esteem (odds ratio (OR) 0.58, P=0.011), less healthy food consumption (OR 0.94, P=0.048) and more food available in the home (OR 1.04, P=0.036). CONCLUSIONS The overall pattern of results reflected that home food environment and psychosocial functioning of obese individuals differed in meaningful ways from that of nonobese individuals. In particular, lower self-esteem may be an important psychosocial aspect of obesity, especially in the context of greater food consumption and food storage/availability.
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Affiliation(s)
- CF Emery
- Department of Psychology, Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, Ohio State University, Columbus, OH, USA
- Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, USA
| | - KL Olson
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - VS Lee
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - DL Habash
- Department of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - JL Nasar
- School of Architecture, Ohio State University, Columbus, OH, USA
| | - A Bodine
- Department of Psychology, Ohio State University, Columbus, OH, USA
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Schaumberg K, Anderson DA, Kirschenbaum DS, Earleywine M. Participation as a leader in immersion weight loss treatment may benefit, not harm, young adult staff members. Clin Obes 2015; 5:226-35. [PMID: 26129749 DOI: 10.1111/cob.12106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/13/2015] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Abstract
Despite the success of weight-management programmes, some researchers caution that participation in an aggressive approach to weight management could promote the development of eating pathology. The current study evaluated the risks and benefits for young adults of serving as staff members in an immersion treatment of adolescent obesity over the course of a summer. Participants included weight loss staff members (n = 108) along with a comparison group of young adults with similar demographic characteristics (n = 136). Participants completed assessments of eating disorder and obesity risk at three time points: the beginning of the summer, the end of the summer and a 6-week follow-up. Weight loss leadership participants who were initially overweight lost weight over the course of the summer, but those at healthy weights maintained their weight. Comparison participants also maintained their weight during the summer. Weight loss staff members also increased dietary restraint over the summer, and increases in dietary restraint appeared to facilitate appropriate weight reduction. Participation as a leader in an immersion weight loss programme seemed to benefit, not harm, young adults; this suggests potential advantages for using weight controlling interventions in a wide range of individuals, including as an obesity prevention strategy.
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Affiliation(s)
- K Schaumberg
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - D A Anderson
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - D S Kirschenbaum
- Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School, Chicago, IL, USA
| | - M Earleywine
- Department of Psychology, University at Albany - State University of New York, Albany, NY, USA
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25
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Feller S, Müller A, Mayr A, Engeli S, Hilbert A, de Zwaan M. What distinguishes weight loss maintainers of the German Weight Control Registry from the general population? Obesity (Silver Spring) 2015; 23:1112-8. [PMID: 25864871 DOI: 10.1002/oby.21054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Differences between successful long-term weight loss maintainers and the general population with regard to eating and weighing habits, non-normative eating behaviors, and eating-related and general psychopathological parameters are unknown. METHODS Self-identified weight loss maintainers from the German Weight Control Registry (GWCR, n = 494) were compared with a representative sample of the general German population (n = 2,129). The samples did not differ in current BMI. Using the same assessment instruments in both cohorts, a variety of eating-related and psychological variables were determined. RESULTS The GWCR participants reported more self-weighing and higher eating frequency but less hot meal consumption and more eating-out-of-home. Binge eating, compensatory behaviors, and concerns about shape and weight were reported more often by successful weight loss maintainers. Scores of depression and worrying about health were slightly higher whereas severity of somatic symptoms was less pronounced in the GWCR participants. CONCLUSIONS Overall, our data suggest that successful weight loss maintainers are characterized by more concerns about shape and weight, greater binge eating frequency, and higher use of compensatory behaviors. The latter suggests that weight loss maintenance might not only be achieved by healthy strategies but also by non-normative behaviors which might increase the vulnerability for weight regain.
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Affiliation(s)
- Silke Feller
- German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Epidemiology, Nuthetal, Germany
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Abstract
OBJECTIVE Mindfulness training has been incorporated increasingly into weight loss programs to facilitate dietary and physical activity changes. This systematic review of studies using mindfulness-based programs for weight loss evaluated study methodologies with the goal of determining the current evidence in support of mindfulness interventions for weight loss. METHODS Published studies of mindfulness-based interventions for weight loss were identified through systematic review including a comprehensive search of online databases. Studies were reviewed and graded according to methodological strengths and weaknesses. RESULTS A total of 19 studies, including 13 randomized controlled trials and 6 observational studies, evaluated the effects of mindfulness-based interventions on weight among individuals attempting weight loss. Twelve of the studies were published in peer-reviewed journals and seven were unpublished dissertations. Among the eight randomized controlled trials published in peer-reviewed journals, six documented significant weight loss among participants in the mindfulness condition, one reported no significant change, and one failed to report body mass index at program completion. None of the studies documented a relationship between changes in mindfulness and weight loss. CONCLUSION Significant weight loss was documented among participants in mindfulness interventions for 13 of the 19 studies identified for review. However, studies do not clarify the degree to which changes in mindfulness are a mechanism responsible for weight loss in mindfulness interventions. Methodological weaknesses and variability across studies limit the strength of the evidence. Further research is needed to document and evaluate the psychological, behavioral, and biological mechanisms involved in the relationship between mindfulness and weight loss.
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Caraher KJ, Kirschenbaum DS. "I see inspiration everywhere": potential keys to nurturing healthy obsessions by very successful young weight controllers. Child Obes 2014; 10:518-32. [PMID: 25325775 DOI: 10.1089/chi.2014.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Healthy Obsession Model posits that committed weight controllers develop preoccupations with the planning and execution of target behaviors to reach healthy goals. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions, negative reactions to lapses, and constructive responses to high-risk situations. We also expected to find differential sources of commitment between losers and gainers, including a greater emphasis on emotional and experiential consequences by losers, as documented in the authors' 2012 study. METHODS Sixteen adolescent participants who had completed cognitive-behavior therapy immersion treatment for obesity at least 1 year before the interviews (8 successful and 8 unsuccessful weight controllers) completed in-depth interviews based on the Scanlan Collaborative Interview Method. A qualitative analysis followed in which two coders identified themes within the interviews. RESULTS Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers nurture strong healthy obsessions. Successful weight controllers also reported using significantly more helpful motivators than did unsuccessful weight controllers. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model. CONCLUSIONS Clinical implications include focusing weight loss interventions on nurturing healthy obsessions in general and, more specifically, on helping weight controllers use more diverse sources of commitment.
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Affiliation(s)
- Kristen J Caraher
- 1 Department of Psychology, Illinois School of Professional Psychology at Argosy University , Chicago, IL
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Flølo TN, Andersen JR, Nielsen HJ, Natvig GK. Translation, adaptation, validation and performance of the American Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) to a Norwegian version: a cross-sectional study. PeerJ 2014; 2:e565. [PMID: 25276501 PMCID: PMC4178457 DOI: 10.7717/peerj.565] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/18/2014] [Indexed: 01/08/2023] Open
Abstract
Background. Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients' adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes. Objectives. We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions' psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery. Design. Cross-sectional Methods. A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach's alpha and alpha if item deleted. Results. The PCA resulted in one factor with eigenvalue > 1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p < 0.001). The WEL-SF was associated with body mass index (BMI) (p < 0.001) and changes in BMI (p = 0.026). A very high item response was obtained with only one missing value (0.4%). The ceiling effect was in average 0.9 and 17.1% in the non-operated and operated sample, respectively. Strong internal consistency (r = 0.92) was obtained, and Cronbach's alpha remained high (0.86-0.92) if single items were deleted. Conclusion. The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients.
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Affiliation(s)
- Tone N. Flølo
- Voss Hospital, Haukeland University Hospital, The Western Norway Region Health Authority, Voss, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - John R. Andersen
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
- Department of Surgery, Førde Central Hospital, Førde, Norway
| | - Hans J. Nielsen
- Voss Hospital, Haukeland University Hospital, The Western Norway Region Health Authority, Voss, Bergen, Norway
| | - Gerd K. Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Orsama AL, Mattila E, Ermes M, van Gils M, Wansink B, Korhonen I. Weight rhythms: weight increases during weekends and decreases during weekdays. Obes Facts 2014; 7:36-47. [PMID: 24504358 PMCID: PMC5644907 DOI: 10.1159/000356147] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/04/2013] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Anna-Leena Orsama
- VTT Technical Research Centre of Finland, Tampere, Finland, Tampere, Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland, Tampere, Finland
| | - Miikka Ermes
- VTT Technical Research Centre of Finland, Tampere, Finland, Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland, Tampere, Finland, Tampere, Finland
| | - Brian Wansink
- Charles S. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, USA
- *Dr. Brian Wansink, Charles S. Dyson School of Applied Economics and Management, Cornell University, 15 Warren Hall, Ithaca, NY 14850 (USA)
| | - Ilkka Korhonen
- Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland
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A systematic review of baseline psychosocial characterisation in dietary randomised controlled trials for weight loss. Eur J Clin Nutr 2013; 67:697-702. [PMID: 23612509 DOI: 10.1038/ejcn.2013.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/10/2013] [Accepted: 03/13/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVE To investigate the extent of baseline psychosocial characterisation of subjects in published dietary randomised controlled trials (RCTs) for weight loss. SUBJECTS/METHODS Systematic review of adequately sized (n ≥ 10) RCTs comprising ≥ 1 diet-alone arm for weight loss were included for this systematic review. More specifically, trials included overweight (body mass index >25 kg/m(2)) adults, were of duration ≥ 8 weeks and had body weight as the primary outcome. Exclusion criteria included specific psychological intervention (for example, Cognitive Behaviour Therapy (CBT)), use of web-based tools, use of supplements, liquid diets, replacement meals and very-low calorie diets. Physical activity intervention was restricted to general exercise only (not supervised or prescribed, for example, VO2 maximum level). RESULTS Of 176 weight-loss RCTs published during 2008-2010, 15 met selection criteria and were assessed for reported psychological characterisation of subjects. All studies reported standard characterisation of clinical and biochemical characteristics of subjects. Eleven studies reported no psychological attributes of subjects (three of these did exclude those taking psychoactive medication). Three studies collected data on particular aspects of psychology related to specific research objectives (figure scale rating, satiety and quality-of-life). Only one study provided a comprehensive background on psychological attributes of subjects. CONCLUSION Better characterisation in behaviour-change interventions will reduce potential confounding and enhance generalisability of such studies.
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Eating self-efficacy: development of a short-form WEL. Eat Behav 2012; 13:375-8. [PMID: 23121791 DOI: 10.1016/j.eatbeh.2012.03.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/29/2012] [Accepted: 03/23/2012] [Indexed: 11/24/2022]
Abstract
Self-efficacy for eating is an important predictor of the successful adoption and maintenance of weight management behaviors. The Weight Efficacy Lifestyle Questionnaire (WEL) is a commonly used measure of eating self-efficacy consisting of 20-items and five situational factors. The aim of this study was to develop a short-form WEL (WEL-SF) for use in clinical practice and research. Factor analysis methodology was used with a sample of obese patients (N=1012) seeking weight loss treatment to develop the WEL-SF. The hypothesis was that the WEL would contain highly correlated items within the factors, and consequently could be shortened with minimal loss of clinically important information. Results revealed a one-factor solution. Given this unexpected finding, factor analysis was abandoned and alternative selection criteria were implemented. WEL-SF items were selected based upon: (1) lack of a ceiling effect for individual items, (2) high variability in patient responses, (3) lack of a strong correlation with other WEL items, (4) strong correlation with total WEL score, and (5) clinical judgment regarding importance and interpretability of individual items. These criteria resulted in an 8-item measure. The correlation between the WEL-SF total score and WEL total score was extremely strong, with a Pearson's r value of 0.968 and corresponding r(2) value of 0.937. Based on these findings, the 8-item WEL-SF appears to be a psychometrically valid measure of eating self-efficacy that accounts for 94% of the variability in the original version.
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Barone Gibbs B, Kinzel LS, Pettee Gabriel K, Chang YF, Kuller LH. Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study. J Acad Nutr Diet 2012; 112:1347-1355.e2. [PMID: 22939439 DOI: 10.1016/j.jand.2012.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Standard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control. OBJECTIVE Our aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months. DESIGN We performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up. PARTICIPANTS We studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study. MAIN OUTCOME MEASURES We measured changes in weight from baseline to 6 and 48 months. STATISTICAL ANALYSES PERFORMED Linear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group. RESULTS At 6 months in the combined population, weight loss was independently associated with decreased desserts (P<0.001), restaurant eating (P=0.042), sugar-sweetened beverages (P=0.009), and fried foods (P<0.001), and increased fish consumption (P=0.003). Results were similar in intervention participants; only reduced desserts and fried foods associated with weight loss in controls. At 48 months in the combined population, weight loss was again associated with decreased desserts (P=0.003) and sugar-sweetened beverages (P=0.011), but also decreased meats/cheeses (P=0.024) and increased fruits/vegetables (P<0.001). Decreased meats/cheeses predicted weight loss in intervention participants; desserts, sugar-sweetened beverages, and fruits/vegetables were independently associated in controls. CONCLUSIONS Changes in eating behaviors were associated with weight change, although important behaviors differed for short- and long-term weight change and by randomization group. Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes.
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Gierut KJ, Pecora KM, Kirschenbaum DS. Highly successful weight control by formerly obese adolescents: a qualitative test of the healthy obsession model. Child Obes 2012; 8:455-65. [PMID: 23061500 DOI: 10.1089/chi.2012.0101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Healthy Obsession Model (HOM) suggests that successful weight controllers must develop a preoccupation with the planning and execution of target behaviors to reach and maintain healthy weights (e.g., controlled eating, consistent selfmonitoring). This model further posits that committed weight controllers will feel substantial anxiety or frustration when lapses occur, which, in turn, will motivate them to reinstate target behaviors. METHODS The present study tested the HOM by examining the perceptions and attitudes of four very successful and four relatively unsuccessful adolescent weight controllers 1 year after completing immersion treatment. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions and describe more negative reactions to potential and actual lapses. In-depth interviews were conducted using a version of the Scanlan Collaborative Interview Method. RESULTS AND CONCLUSIONS Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers seem to nurture strong healthy obsessions, including clear definitions of healthy obsessions, heightened commitment based on the emotional impact of excess weight, and negative reactions to lapses. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model (e.g., Emotional and Experiential Consequences; Social Support of Parents, Friends, and Peers; Institutional Influences; and Valuable Opportunities).
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Affiliation(s)
- Kristen J Gierut
- Illinois School of Professional Psychology at Argosy University, Chicago, USA.
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Gierut KJ, Pecora KM, Kirschenbaum DS. Highly Successful Weight Control by Formerly Obese Adolescents: A Qualitative Test of the Healthy Obsession Model. Child Obes 2012. [DOI: 10.1089/chi.2011.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Correlates of health-related quality of life, psychological well-being, and eating self-regulation after successful weight loss maintenance. J Behav Med 2012; 36:601-10. [DOI: 10.1007/s10865-012-9454-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 08/21/2012] [Indexed: 11/25/2022]
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Svetkey LP, Ard JD, Stevens VJ, Loria CM, Young DY, Hollis JF, Appel LJ, Brantley PJ, Kennedy BM, Kumanyika SK, Batch BC, Corsino L, Lien LF, Vollmer WM. Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity (Silver Spring) 2012; 20:1820-8. [PMID: 21527896 PMCID: PMC3830958 DOI: 10.1038/oby.2011.88] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective weight management interventions could reduce race-sex disparities in cardiovascular disease (CVD), yet little is known about factors associated with successful weight loss maintenance in race-sex subgroups. In the Weight Loss Maintenance trial (WLM), overweight/obese (BMI 25-45 kg/m(2)) adults who lost ≥4 kg in a 6-month behavioral weight loss intervention (phase I) were randomized into one of three 30-month maintenance interventions (phase II). To investigate predictors in subgroups, randomized groups were combined for this analysis. Of 1,685 phase I participants, 1,032 (61%) entered phase II, including 12% black men (BM), 26% black women (BW), 25% white men (WM), and 37% white women (WW). Weight change over the 36-month study ranged from -2.3% (95% confidence interval = -3.1 to -1.5%) in BW to -4.5% (95% confidence interval = -5.7 to -4.0%) in WM, the result of differential weight loss during phase I. Within race, men lost significantly more weight than women, but within sex group, weight loss did not differ significantly between races. Although participants regained weight during phase II, regain did not differ by race-sex group, and mean weight at the end of the study was significantly lower than phase I entry weight for each subgroup. In regression models, phase I weight loss predicted overall 36-month weight loss in all race-sex groups. Healthy dietary pattern at entry, improvement in dietary pattern, or both were predictive in three of four race-sex groups. Few other variables other than initial weight loss and dietary pattern were predictive. Future research should identify additional modifiable influences on long-term maintenance after a modest weight loss.
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Affiliation(s)
- Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.
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Abstract
The majority of US adults are overweight or obese, which is a primary risk factor for type 2 diabetes and other chronic diseases. Recent advances in behavioral treatment of obesity have produced significant short- and long-term weight losses that reduce the risk of type 2 diabetes and cardiovascular disease. This article reviews key components of effective behavioral treatment interventions, including diet, exercise, and behavioral and psychosocial strategies. The authors review newer treatment modalities that may enhance dissemination (Internet, smartphone) and discuss applications to clinical practice. Practitioners face multiple barriers to effectively delivering lifestyle interventions in today’s health care setting but, nonetheless, remain powerful motivators in helping patients initiate and maintain weight loss efforts that reduce the risk of type 2 diabetes and other chronic diseases.
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Affiliation(s)
- Todd Alan Hagobian
- California Polytechnic State University, Kinesiology Department, San Luis Obispo, CA
| | - Suzanne Phelan
- California Polytechnic State University, Kinesiology Department, San Luis Obispo, CA
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Berge JM, MacLehose R, Eisenberg ME, Laska MN, Neumark-Sztainer D. How significant is the 'significant other'? Associations between significant others' health behaviors and attitudes and young adults' health outcomes. Int J Behav Nutr Phys Act 2012; 9:35. [PMID: 22469471 PMCID: PMC3410807 DOI: 10.1186/1479-5868-9-35] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background Having a significant other has been shown to be protective against physical and psychological health conditions for adults. Less is known about the period of emerging young adulthood and associations between significant others’ weight and weight-related health behaviors (e.g. healthy dietary intake, the frequency of physical activity, weight status). This study examined the association between significant others’ health attitudes and behaviors regarding eating and physical activity and young adults’ weight status, dietary intake, and physical activity. Methods This study uses data from Project EAT-III, a population-based cohort study with emerging young adults from diverse ethnic and socioeconomic backgrounds (n = 1212). Logistic regression models examining cross-sectional associations, adjusted for sociodemographics and health behaviors five years earlier, were used to estimate predicted probabilities and calculate prevalence differences. Results Young adult women whose significant others had health promoting attitudes/behaviors were significantly less likely to be overweight/obese and were more likely to eat ≥ 5 fruits/vegetables per day and engage in ≥ 3.5 hours/week of physical activity, compared to women whose significant others did not have health promoting behaviors/attitudes. Young adult men whose significant other had health promoting behaviors/attitudes were more likely to engage in ≥ 3.5 hours/week of physical activity compared to men whose significant others did not have health promoting behaviors/attitudes. Conclusions Findings suggest the protective nature of the significant other with regard to weight-related health behaviors of young adults, particularly for young adult women. Obesity prevention efforts should consider the importance of including the significant other in intervention efforts with young adult women and potentially men.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, MN, USA.
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Phelan S, Jankovitz K, Hagobian T, Abrams B. Reducing excessive gestational weight gain: lessons from the weight control literature and avenues for future research. ACTA ACUST UNITED AC 2012; 7:641-61. [PMID: 22040207 DOI: 10.2217/whe.11.70] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient-provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, CA 93407-0386, USA.
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Gorin AA, Raynor HA, Fava J, Maguire K, Robichaud E, Trautvetter J, Crane M, Wing RR. Randomized controlled trial of a comprehensive home environment-focused weight-loss program for adults. Health Psychol 2012; 32:128-37. [PMID: 22309885 DOI: 10.1037/a0026959] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Behavioral weight-loss programs (BWL) provide limited instruction on how to change the environmental context of weight-regulating behaviors, perhaps contributing to regain. Drawing on social ecological models, this trial evaluated a comprehensive weight-loss program that targeted both an individual's behavior and his or her physical and social home environment. METHOD Overweight and obese adults (N = 201; 48.9 ± 10.5 years; 78.1% women) were randomized to BWL or to BWL plus home-environment changes (BWL + H). Groups met weekly for 6 months and bimonthly for 12 months. BWL + H participants were given items to facilitate healthy choices in their homes (e.g., exercise equipment, portion plates) and attended treatment with a household partner. Weight loss at 6 and 18 months was the primary outcome. RESULTS BWL + H changed many aspects of the home environment and produced better 6-month weight losses than BWL (p = .017). At 18 months, no weight-loss differences were observed (p = .19) and rates of regain were equivalent (p = .30). Treatment response was moderated by gender (6 months, p = .011; 18 months, p = .006). Women lost more weight in BWL + H than BWL at 6 and 18 months, whereas men in BWL lost more weight than those in BWL + H at 18 months. Partners, regardless of gender, lost more weight in BWL + H than BWL at both time points (ps < .0001). CONCLUSION The home food and exercise environment is malleable and targeting this microenvironment appears to improve initial weight loss, and in women, 18-month outcomes. Research is needed to understand this gender difference and to develop home-focused strategies with more powerful and sustained weight-loss effects.
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Affiliation(s)
- Amy A Gorin
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT 06269-1248, USA.
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Improving psychological treatment for obesity. Which eating behaviours should we target? Appetite 2012; 58:1063-9. [PMID: 22306789 DOI: 10.1016/j.appet.2012.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 12/04/2011] [Accepted: 01/17/2012] [Indexed: 11/20/2022]
Abstract
People who are obese and want to lose weight without surgery deserve the best treatment that we can offer. In the absence of robust and enduring treatment effects for psychological interventions for obesity, it is useful to return to first principles. From a behavioural perspective, the first task is to identify the full range of target eating behaviours involved in obesity. Surprisingly, a consensus on the key target eating behaviours typically involved in obesity does not seem to currently exist. In this opinion piece, we discuss which eating behaviours might be important to consider when treating obesity, and provide a self-report questionnaire that aims to identify these behaviours (see Supplementary material). We believe that it is important to be aware of the full range of eating behaviours that are potentially relevant to obesity, as different eating behaviours may be problematic for different people. Target eating behaviours associated with obesity may also be different from those of key relevance to eating disorders. Factors that should be taken into account when assessing target eating behaviours and developing effective treatments for obesity are also discussed. Particular attention is paid to 'grazing,' a relatively neglected high risk eating behaviour for weight gain.
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Teixeira PJ, Mata J, Williams GC, Gorin AA, Lemieux S. Self-regulation, motivation, and psychosocial factors in weight management. J Obes 2012; 2012:582348. [PMID: 23209888 PMCID: PMC3503363 DOI: 10.1155/2012/582348] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 01/05/2023] Open
Affiliation(s)
- Pedro J. Teixeira
- Department of Exercise and Health, Faculty of Human Kinetics, Technical University of Lisbon, 1495-688 Cruz Quebrada, Portugal
- *Pedro J. Teixeira:
| | - Jutta Mata
- Adaptive Rationality Center, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Geoffrey C. Williams
- Department of Medicine, Center for Community Health, University of Rochester, Rochester, NY 14607, USA
| | - Amy A. Gorin
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, USA
| | - Simone Lemieux
- Institute of Nutraceuticals and Functional Foods (INAF), Laval University, Québec, Canada G1V 0A6
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Glasgow RE, Dickinson P, Fisher L, Christiansen S, Toobert DJ, Bender BG, Dickinson LM, Jortberg B, Estabrooks PA. Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home. Implement Sci 2011; 6:118. [PMID: 22017791 PMCID: PMC3229439 DOI: 10.1186/1748-5908-6-118] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/21/2011] [Indexed: 12/18/2022] Open
Abstract
Background Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. Methods The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care. Results The Connection to Health Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (e.g., allowing input and output via choice of different modalities), effectiveness (e.g., using evidence-based intervention strategies), adoption (e.g., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams), implementation (e.g., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams), and maintenance/sustainability (e.g., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care). Connection to Health can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the Connection to Health program could be customized to their office. Conclusions This primary care practice tool based on an implementation science model has the potential to guide patients to more healthful behaviors and improved self-management of chronic conditions, while fostering effective and efficient communication between patients and their healthcare team. RE-AIM and similar models can help clinicians and media developers create practical products more likely to be widely adopted, feasible in busy medical practices, and able to produce public health impact.
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Affiliation(s)
- Russell E Glasgow
- Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd,, Room 6144, Rockville, MD 20852, USA.
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Appelhans BM, Whited MC, Schneider KL, Pagoto SL. Time to abandon the notion of personal choice in dietary counseling for obesity? ACTA ACUST UNITED AC 2011; 111:1130-6. [PMID: 21802557 DOI: 10.1016/j.jada.2011.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/27/2011] [Indexed: 11/16/2022]
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Byrne S, Kirschenbaum DS. Helping young weight controllers develop healthy obsessions: preliminary test of the Healthy Obsession Model. Clin Obes 2011; 1:85-91. [PMID: 25585573 DOI: 10.1111/j.1758-8111.2011.00018.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Healthy Obsession Model posits that successful weight controllers must develop a preoccupation with the planning and execution of target behaviours, including eating on programme, consistent activity and self-monitoring. When barriers emerge, committed weight controllers are expected to feel distressed (e.g. anxious or frustrated), which should motivate them to reinstate these behaviours. This study investigated the effects on moods of sudden withdrawal of self-monitoring among obese adolescents within an immersion treatment programme. Fifty-five (55% female) adolescents participated in a weight loss camp and received four weekly cognitive-behaviour therapy sessions focused on maximizing commitment to programme behaviours. During the fourth week, campers and staff completed daily mood ratings using the Positive and Negative Affect Schedule. After 3 d of ratings, campers' self-monitoring journals were removed without warning for 1 d. As expected, journal removal resulted in decreased positive affect for the campers, according to staff ratings. Also in accord with hypotheses, campers who demonstrated heightened commitment to the programme based on higher levels of activity and more writing in their journals reacted more negatively to the withdrawal of the opportunity to self-monitor. Mood ratings by campers did not show the effects hypothesized by the Healthy Obsession Model. These results provide preliminary support for the Healthy Obsession Model by showing some of the anticipated negative reactions to the removal of access to self-monitoring, especially among those who demonstrated strong commitments to the process.
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Affiliation(s)
- S Byrne
- Fairleigh Dickinson University, Teaneck, NJ, USANorthwestern University Medical School, Chicago, IL, USAWellspring Division of CRC Health Group, Chicago, IL, USA
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Keep it off: a phone-based intervention for long-term weight-loss maintenance. Contemp Clin Trials 2011; 32:551-60. [PMID: 21453791 DOI: 10.1016/j.cct.2011.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 11/21/2022]
Abstract
Long-term weight-loss maintenance is notoriously difficult to achieve and promote. As the novelty of weight loss treatment fades, enthusiasm for diet and exercise tends to wane in the maintenance phase. Given the recognition of obesity as a chronic disorder requiring continued engagement in weight-control behaviors, there is a need to identify cost-effective and supportive therapies that can sustain motivation. In this paper, we describe the study design and baseline characteristics of participants enrolled in a trial to evaluate a program (Keep It Off) developed specifically for weight-loss maintenance using therapeutic phone contact with recent weight losers throughout the period in which they are at highest risk for weight regain. In the Keep It Off randomized clinical trial we are evaluating this phone-based intervention that focuses on key weight-loss maintenance behaviors followed by continued self-monitoring, reporting of weight, feedback, and outreach in members of a Minnesota managed-care organization. The goal of the intervention is to flatten the typical relapse curve. Moreover, data from this trial will inform our understanding of weight-loss maintenance, including predictors and behaviors that increase the likelihood of success over the long term.
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Napolitano MA, Hayes S. Behavioral and psychological factors associated with 12-month weight change in a physical activity trial. J Obes 2011; 2011:515803. [PMID: 21234326 PMCID: PMC3018653 DOI: 10.1155/2011/515803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 10/16/2010] [Accepted: 11/09/2010] [Indexed: 11/17/2022] Open
Abstract
Examining behavioral and psychological factors relating to weight stability over a 1-year period is of public health importance. We conducted a physical activity (PA) intervention trial for women (N = 247; mean age = 47.5 ± 10.7; mean BMI = 28.6 ± 5.3) in which participants were assigned to one of three groups (two PA and one contact-control). By Month 12, participants achieved 140.4 ± 14.82 min of PA/week, with no group differences. Weight status change from baseline to Month 12 was categorized: no change (N = 154; 62.4%); increase (N = 34; 13.8%); decrease (N = 59; 23.9%). Discriminant function analyses indentified two statistically significant dimensions associated with weight change. Dimension 1 was positively weighted by mood (0.73) and self-efficacy (0.79); dimension 2 was positively weighted to change in physical activity (0.58) and fat consumption (0.55). Results provide further evidence for the importance of behavior in long-term weight maintenance, particularly physical activity and dietary fat. These findings also provide evidence for the importance of addressing psychosocial variables, in particular depressed mood and self-efficacy.
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Affiliation(s)
- Melissa A. Napolitano
- Departments of Kinesiology and Public Health and Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA
- *Melissa A. Napolitano:
| | - Sharon Hayes
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA
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