The adoption of eating behaviors conducive to weight loss

Psychometric Properties of the Persian Version of the Weight Control Strategies Scale (WCSS)

Objective: The purpose of the present study was to examine the validity and reliability of the Persian version of the Weight Control Strategies Scale among individuals engaged in weight loss or weight maintenance.

Method: This descriptive study conducted from October 2019 to February 2020 on social media networks. A total of 420 men and women were selected using consecutive sampling. They completed the Persian version of the Weight Control Strategies Scale and the Self-Compassion Scale. Data were analyzed using descriptive statistics, Cronbach’s α, confirmatory factor analysis, and Pearson product-moment correlations.

Results: Internal consistency for the total score of the Persian version of Weight Control Strategies Scale was excellent and acceptable to good for all 4 subscales (in all cases over α = 0.70). Confirmatory factor analysis supported the factor structure of the original model of the scale, but, it was different from the model at the item level. Moreover, the Persian version of Weight Control Strategies Scale had good convergent validity.

Conclusion: Psychometrically speaking, the Persian version of the Weight Control Strategies Scale is a valid and reliable tool to assess the psychological and behavioral profile of individuals engaging in losing or maintaining weight, both for clinical and research purposes.

A brief behavioural intervention to promote regular self-weighing to prevent weight regain after weight loss: a RCT

Background

Although behavioural weight loss treatments can be effective, long-term maintenance of this weight loss remains a critical challenge because the vast majority of people will regain their lost weight over time. The period after initial weight loss is the time when people are at the highest risk of weight regain.

Objective

The primary aim of this study was to evaluate the effectiveness and cost-effectiveness of a brief behavioural intervention delivered by non-specialist call centre staff to promote regular self-weighing to prevent weight regain after intentional weight loss.

Design

Randomised controlled trial.

Setting

West Midlands, UK.

Participants

Adults were recruited if they had attended a local authority-funded weight management programme and had lost ≥ 5% of their starting weight by the end of their weight loss programme.

Interventions

The intervention group received three brief support telephone calls, delivered by non-specialist call centre staff (from a third-sector community organisation), that encouraged setting a weight maintenance target of ≤ 1 kg of weight gain from current weight, which was to be assessed by daily self-weighing and recording weight on a record card, together with regular text messages. Participants were asked to return to their weight loss plan if they gained > 1 kg above their target weight. The usual-care group received a standard weight maintenance leaflet, the infographic EatWell Plate and a list of useful websites pertaining to weight management.

Main outcome measures

The primary outcome was the difference between the groups in mean weight change (kg) from baseline to 12 months. The secondary outcomes included the proportion of participants in each group who had regained < 1 kg in weight at the 3- and 12-month follow-up points.

Results

A total of 813 potential participants were screened, 583 of whom were eligible and randomised (usual care,n = 292; intervention,n = 291). A total of 94% and 89% of participants completed follow-up at 3 and 12 months, respectively. At 12 months, the mean unadjusted weight change was +0.39 kg for the intervention group and –0.17 kg for the usual-care group, an adjusted difference of 0.53 kg [95% confidence interval (CI) –0.64 to 1.71 kg]. At 12 months, 134 (45.9%) and 130 (44.7%) participants regained ≤ 1 kg of their baseline weight in the usual-care and intervention groups, respectively (odds ratio 0.96, 95% CI 0.69 to 1.33). As the intervention was ineffective, we did not pursue a cost-effectiveness analysis.

Conclusions

Brief behavioural telephone support delivered by non-specialist workers to promote target-setting and daily self-weighing and recording of weight does not prevent weight regain after intentional weight loss. Specifically, as target-setting and daily self-weighing did not increase conscious cognitive restraint, people may need more intensive interventions to promote the use of behavioural techniques that help people maintain lost weight.

Trial registration

Current Controlled Trials ISRCTN52341938.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information.

Speech2Health: A Mobile Framework for Monitoring Dietary Composition From Spoken Data

Diet and physical activity are known as important lifestyle factors in self-management and prevention of many chronic diseases. Mobile sensors such as accelerometers have been used to measure physical activity or detect eating time. In many intervention studies, however, stringent monitoring of overall dietary composition and energy intake is needed. Currently, such a monitoring relies on self-reported data by either entering text or taking an image that represents food intake. These approaches suffer from limitations such as low adherence in technology adoption and time sensitivity to the diet intake context. In order to address these limitations, we introduce development and validation of Speech2Health, a voice-based mobile nutrition monitoring system that devises speech processing, natural language processing (NLP), and text mining techniques in a unified platform to facilitate nutrition monitoring. After converting the spoken data to text, nutrition-specific data are identified within the text using an NLP-based approach that combines standard NLP with our introduced pattern mapping technique. We then develop a tiered matching algorithm to search the food name in our nutrition database and accurately compute calorie intake values. We evaluate Speech2Health using real data collected with 30 participants. Our experimental results show that Speech2Health achieves an accuracy of 92.2% in computing calorie intake. Furthermore, our user study demonstrates that Speech2Health achieves significantly higher scores on technology adoption metrics compared to text-based and image-based nutrition monitoring. Our research demonstrates that new sensor modalities such as voice can be used either standalone or as a complementary source of information to existing modalities to improve the accuracy and acceptability of mobile health technologies for dietary composition monitoring.

A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial

Background

Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy.

Objective

The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes.

Methods

This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight).

Results

WaznApp was funded in June 2017, and recruitment started in March 2018.

Conclusions

This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups.

Trial Registration

ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5)

Registered Report Identifier

RR1-10.2196/9793

What is the psychological impact of self-weighing? A meta-analysis

Many people self-weigh and many interventions addressing weight-related problems such as obesity promote self-weighing. However, while self-weighing has been associated with weight loss, there is mixed evidence regarding the psychological impact of this behaviour. The present review aimed to quantify the relationship between self-weighing and: (i) affect (e.g., anxiety, depression); (ii) psychological functioning (e.g., self-esteem); (iii) body-related attitudes and (iv) disordered eating. A computerized search of scientific databases in September 2014 and subsequent ancestry and citation searches identified 29 independent tests of the relationship between self-weighing on psychological outcomes. Meta-analysis was used to quantify the size of the association across the tests. Results indicated that there was no association between self-weighing and affect, body-related attitudes or disordered eating. There was, however, a small-sized negative association between self-weighing and psychological functioning. The age of participants, obesity status, the extent of weight loss, duration of self-weighing and study design (RCT versus correlational) were found to influence at least some of the psychological outcomes of self-weighing. The findings suggest that, for the most part, self-weighing is not associated with adverse psychological outcomes. However, in some cases the association between self-weighing and psychological outcomes may be more negative than in others.

Daily weight monitoring as a method of weight gain prevention in healthy weight and overweight young adult women

Experimental research is needed to examine whether weight monitoring impacts weight and whether it has unintended harmful effects. This study randomly assigned 49 first-year university women (body mass index: 20-30 kg/m²) to daily weight monitoring or a control condition and measured weight, mood, body dissatisfaction, and unhealthy weight control behaviors at baseline and 8 weeks, and weight at 20-week follow-up. No harmful effects of daily weighing were detected; acceptability and adherence were high. Weight monitoring did not impact weight; both groups showed little weight gain. Results suggest that weight monitoring has minimal harmful effects and may be useful for preventing weight gain.

Using a Grocery List Is Associated With a Healthier Diet and Lower BMI Among Very High-Risk Adults

OBJECTIVE

Examine whether use of a grocery list is associated with healthier diet and weight among food desert residents.

METHODS

Cross-sectional analysis of in-person interview data from randomly selected household food shoppers in 2 low-income, primarily African American urban neighborhoods in Pittsburgh, PA with limited access to healthy foods.

RESULTS

Multivariate ordinary least-square regressions conducted among 1,372 participants and controlling for sociodemographic factors and other potential confounding variables indicated that although most of the sample (78%) was overweight or obese, consistently using a list was associated with lower body mass index (based on measured height and weight) (adjusted multivariant coefficient = 0.095) and higher dietary quality (based on the Healthy Eating Index-2005) (adjusted multivariant coefficient = 0.103) (P < .05).

CONCLUSIONS AND IMPLICATIONS

Shopping with a list may be a useful tool for low-income individuals to improve diet or decrease body mass index.

Development and validation of the weight control strategies scale

OBJECTIVE

To develop and validate the Weight Control Strategies Scale (WCSS), a self-report instrument to assess the use of specific behaviors thought to facilitate weight loss.

DESIGN AND METHODS

Factor analysis was conducted on 323 overweight and obese adults (mean age = 48.7 ± 10.9 years, mean body mass index = 35.4 ± 4.9 kg/m(2) , 74% female) enrolled in three different behavioral weight loss trials who completed the WCSS prior to starting treatment. To evaluate construct validity, additional data on dietary intake, physical activity, treatment session attendance, and weight change were obtained from a subsample of participants before and after participation in a 48-week weight loss program.

RESULTS

Principal components analysis with varimax rotation revealed a four-component solution for the WCSS, representing the following subscales: Dietary Choices, Self-monitoring Strategies, Physical Activity, and Psychological Coping (α from 0.79 to 0.89). Longitudinal analyses showed that WCSS subscale scores increased during treatment (P < 0.01). In adjusted models, changes in WCSS total and subscale scores were associated with post-treatment weight loss (P < 0.01). Additionally, changes in WCSS Dietary Choices and Physical Activity subscales were related to post-treatment changes in total daily kilocalorie consumption (P = 0.019) and weekly kilocalorie expenditure through physical activity (P < 0.001), respectively.

CONCLUSIONS

Findings support the validity and reliability of the WCSS in a weight loss treatment-seeking sample.

The Eating Habits Confidence Survey: Reliability and Validity in Overweight and Obese Postmenopausal Women

Background and Purpose: Psychometric properties of the Eating Habits Confidence Survey (EC) were evaluated in a sample of 86 overweight and obese postmenopausal women. Methods: Inter-item correlations and coefficient alphas of the total and subscale scores were conducted. Correlations of the EC to the Eating Self-Efficacy Scale (ESES), Eating Behavior Inventory (EBI), and Binge Eating Scale (BES) were examined as approaches to concurrent and contrast validity. Results: Cronbach’s alphas were adequate for total (.83) and subscale (.64–.80) scores. Only the EC subscale “sticking to it” correlated with the other eating scales. This correlation demonstrates concurrent validity with the other scales that reflected persistence in healthy eating, and contrast validity with them in that the other scales measured different issues under the rubric of eating self-efficacy and behaviors. Conclusions: Thus, the EC performed well among a different demographic than those used during its development. This inexpensive and easily administered survey manifests credible validity and reliability. Nevertheless, evidence for its validity and reliability needs to be accrued when it is used in diverse populations.

Fruit and vegetable intake and eating behaviors mediate the effect of a randomized text-message based weight loss program

INTRODUCTION

We hypothesized that fruit/vegetable intake and eating behaviors mediate the relationship between experimental condition and weight loss in a randomized trial evaluating a text-message based weight loss program.

METHODS

Overweight/obese individuals from San Diego, CA (N = 52 with complete data) were randomly assigned in 2007 into one of two groups for four months: 1) the intervention group that received 2-5 weight management text-messages p/day; 2) the usual-care comparison group. Three 24-hour recalls assessed fruit/vegetable intake change and the eating behavior inventory (EBI) measured change in eating behaviors. Regression path models tested intervention mediation.

RESULTS

Direct effects of the intervention were found for change in body weight (b = -3.84, R(2) = 0.074), fruit/vegetable intake (b = 2.00, R(2) = 0.083), and EBI scores (b = 7.15, R(2) = 0.229) (ps < 0.05). The treatment group to weight change path was not statistically significant (b = -0.673, R(2) = 0.208) when fruit/vegetable intake change and EBI score change were specified as intervention mediators in the model. The total indirect effect was 3.17 lb indicating that the indirect paths explained 82.6% of the total effect on weight change.

DISCUSSION

Fruit/vegetable intake and eating behaviors mediated the intervention's effect on weight change. The findings suggest that sending text-messages that promote healthy eating strategies resulted in moderate short-term weight loss.

Changes in weight control behaviors and hedonic hunger during a 12-week commercial weight loss program

Greater use of key self-regulatory behaviors (e.g., self-monitoring of food intake and weight) is associated with greater weight loss within behavioral weight loss treatments, although this association is less established within widely-available commercial weight loss programs. Further, high hedonic hunger (i.e., susceptibility to environmental food cues) may present a barrier to successful behavior change and weight loss, although this has not yet been examined. Adult men and women (N=111, body mass index M±SD=31.5±2.7kg/m(2)) were assessed before and after participating in a 12-week commercial weight loss program. From pre- to post-treatment, reported usage of weight control behaviors improved and hedonic hunger decreased, and these changes were inversely associated. A decrease in hedonic hunger was associated with better weight loss. An improvement in reported weight control behaviors (e.g., self-regulatory behaviors) was associated with better weight loss, and this association was even stronger among individuals with high baseline hedonic hunger. Findings highlight the importance of specific self-regulatory behaviors within weight loss treatment, including a commercial weight loss program developed for widespread community implementation. Assessment of weight control behavioral skills usage and hedonic hunger may be useful to further identify mediators of weight loss within commercial weight loss programs. Future interventions might specifically target high hedonic hunger and prospectively examine changes in hedonic hunger during other types of weight loss treatment to inform its potential impact on sustained behavior change and weight control.

The influence of a behavior modification interventional program on body mass index in obese adolescents

BACKGROUND/PURPOSE

The prevalence of obesity and overweight among children and adolescents is increasing rapidly. The present research was performed to determine the influence of a ''behavior modification'' program on body mass index (BMI) in obese public high school students in Iran.

METHODS

In this study, 152 adolescence and their parents were selected from 12 high schools of Khorram Abad from 2004 to 2006, and they were randomly assigned to either the intervention or the control groups. The "behavior modification" interventional program consisted of nutritional education, modifying dietary habits, teaching exercise programs, teaching nutritional facts to the parents, and performing exercises 3 days a week. The height and weight as well as waist, hip, and wrist circumferences of the participants were measured before and after implementing the interventional program. BMI and waist to hip ratio (WHR) were calculated. The adolescents and parents completed a nutrition knowledge questionnaire. Adolescents also completed the Beck's Depression Questionnaire.

RESULTS

Adolescent's mean weight, BMI, and waist and hip circumferences decreased significantly after implementing the interventional program, in the intervention group (p≤0.001). In addition, the students' and parents' nutrition knowledge increased in the intervention group after implementing the interventional program (p<0.046). The symptoms of depression decreased and the frequency of students without symptoms of depression increased in the case group, but it did not reveal a statistically significant difference between case and control groups.

CONCLUSION

The ''behavior modification'' interventional program is effective in reducing BMI in obese students, and therefore, school principals and planners can play an important role in controlling obesity by implementing this program via the students, their parents, and the school staff.

Practices associated with weight loss versus weight-loss maintenance results of a national survey

BACKGROUND

Few studies have examined the weight-control practices that promote weight loss and weight-loss maintenance in the same sample.

PURPOSE

To examine whether the weight control practices associated with weight loss differ from those associated with weight-loss maintenance.

METHODS

Cross-sectional survey of a random sample of 1165 U.S. adults. The adjusted associations of the use of 36 weight-control practices in the past week with success in weight loss (≥10% lost in the past year) and success in weight-loss maintenance (≥10% lost and maintained for ≥1 year) were examined.

RESULTS

Of the 36 practices, only 8 (22%) were associated with both weight loss and weight-loss maintenance. Overall, there was poor agreement (kappa=0.22) between the practices associated with weight loss and/or weight-loss maintenance. For example, those who reported more often following a consistent exercise routine or eating plenty of low-fat sources of protein were 1.97 (95% CI=1.33, 2.94) and 1.76 (95% CI=1.25, 2.50) times more likely, respectively, to report weight-loss maintenance but not weight loss. Alternatively, those who reported more often doing different kinds of exercises or planning meals ahead of time were 2.56 (95% CI=1.44, 4.55) and 1.68 (95% CI=1.03, 2.74) times more likely, respectively, to report weight loss but not weight-loss maintenance.

CONCLUSIONS

Successful weight loss and weight-loss maintenance may require two different sets of practices. Designing interventions with this premise may inform the design of more effective weight-loss maintenance interventions.

Using positive deviance for determining successful weight-control practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

A text message-based intervention for weight loss: randomized controlled trial

Background

To our knowledge, no studies have evaluated whether weight loss can be promoted in overweight adults through the use of an intervention that is largely based on daily SMS (Short Message Service: text) and MMS (Multimedia Message Service: small picture) messages transmitted via mobile phones.

Objective

This paper describes the development and evaluation of a text message–based intervention designed to help individuals lose or maintain weight over 4 months.

Methods

The study was a randomized controlled trial, with participants being exposed to one of the following two conditions, lasting 16 weeks: (1) receipt of monthly printed materials about weight control; (2) an intervention that included personalized SMS and MMS messages sent two to five times daily, printed materials, and brief monthly phone calls from a health counselor. The primary outcome was weight at the end of the intervention. A mixed-model repeated-measures analysis compared the effect of the intervention group to the comparison group on weight status over the 4-month intervention period. Analysis of covariance (ANCOVA) models examined weight change between baseline and 4 months after adjusting for baseline weight, sex, and age.

Results

A total of 75 overweight men and women were randomized into one of the two groups, and 65 signed the consent form, completed the baseline questionnaire, and were included in the analysis. At the end of 4 months, the intervention group (n = 33) lost more weight than the comparison group (−1.97 kg difference, 95% CI −0.34 to −3.60 kg, P = .02) after adjusting for sex and age. Intervention participants’ adjusted average weight loss was 2.88 kg (3.16%). At the end of the study, 22 of 24 (92%) intervention participants stated that they would recommend the intervention for weight control to friends and family.

Conclusions

Text messages might prove to be a productive channel of communication to promote behaviors that support weight loss in overweight adults.

Trial Registration

Clinicaltrials.gov NCT00415870; http://clinicaltrials.gov/ct2/show/NCT00415870 (Archived by WebCite at http://www.webcitation.org/5dnolbkFt)

The impact of regular self-weighing on weight management: a systematic literature review

Background

Regular self-weighing has been a focus of attention recently in the obesity literature. It has received conflicting endorsement in that some researchers and practitioners recommend it as a key behavioral strategy for weight management, while others caution against its use due to its potential to cause negative psychological consequences associated with weight management failure. The evidence on frequent self-weighing, however, has not yet been synthesized. The purpose of this paper is to evaluate the evidence regarding the use of regular self-weighing for both weight loss and weight maintenance.

Methods

A systematic literature review was conducted using the MEDLINE, CINAHL, and PsycINFO online databases. Reviewed studies were broken down by sample characteristics, predictors/conditions, dependent measures, findings, and evidence grade.

Results

Twelve studies met the inclusion/exclusion criteria, but nearly half received low evidence grades in terms of methodological quality. Findings from 11 of the 12 reviewed studies indicated that more frequent self-weighing was associated with greater weight loss or weight gain prevention. Specifically, individuals who reported self-weighing weekly or daily, typically over a period of several months, held a 1 to 3 kg/m² (current) advantage over individuals who did not self-weigh frequently. The effects of self-weighing in experimental studies, especially those where self-weighing behaviors could be isolated, were less clear.

Conclusion

Based on the consistency of the evidence reviewed, frequent self-weighing, at the very least, seems to be a good predictor of moderate weight loss, less weight regain, or the avoidance of initial weight gain in adults. More targeted research is needed in this area to determine the causal role of frequent self-weighing in weight loss/weight gain prevention programs. Other open questions to be pursued include the optimal dose of self-weighing, as well as the risks posed for negative psychological consequences.

Situations influencing habits in diet and exercise among nurses working night shift

OBJECTIVES

The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift.

METHODS

A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses.

RESULTS

A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work.

CONCLUSIONS

By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence.

Monitoring of weight in weight loss programs: a double-edged sword?

Body size feedback is commonly provided to clients in weight loss programs. The attention focused on one's current, and presumably undesirable, body size can be motivating for those who want to modify a pattern of unhealthful behaviors. For others, this feedback may result in psychological distress and could lead to outcomes that are, in fact, counter to a weight loss strategy, such as attrition from programs, misreporting of dietary intake, and emotional states associated with binge eating. Dietitians and weight loss professionals should provide weight feedback judiciously, especially to vulnerable clients, and perhaps soften the emphasis on body size altogether.

Weighing the evidence: benefits of regular weight monitoring for weight control

We address the assertion that weighing obese patients in weight loss programs can be a source of distress and can lead to unfavorable outcomes. Examination of the relevant literature suggests that there is no evidence that weighing by weight loss participants is a cause of negative mood or of body dissatisfaction. Further, there is little evidence that negative mood states or body dissatisfaction lead to a poor outcome in weight loss programs. To the contrary, a number of studies consistently show that more frequent weighing is associated with better weight loss and maintenance. We offer suggestions for dealing with this issue in clinical practice.

Utility and validity of the eating behavior inventory in clinical obesity research: a review of the literature

The Eating Behavior Inventory (EBI) is a questionnaire designed to assess behaviours associated with weight loss and weight management. In the 25 years since it was first published, the EBI has been used to examine weight management behaviours of adults and children in more than 20 weight loss investigations. This paper systematically reviews the use of the EBI in these studies. Results indicate that baseline EBI scores have remained quite consistent over time and are generally not influenced by patient variables. The EBI has also been shown to be consistently sensitive to behavioural weight management interventions, but it appears that the amount of change in EBI scores has decreased slightly over time. Finally, the amount of change in EBI score with treatment typically correlates positively with the amount of weight subjects lose. Overall, the research that has used the EBI has provided solid and consistent evidence of the utility of the EBI as a valid tool for assessing weight management behaviours.

Weight management in women

With 61% of the American population overweight or obese, the need for treatment far exceeds the capacity of the health care system to provide care on an individual basis. Moreover, the most effective method for the delivery of treatment, and the best ways to induce and sustain client adherence to such a program, remain elusive. Obesity stands in the ignominious position of being the only epidemic in the latter decades of the twentieth century and into the new millennium that nurses--clinicians, academicians, and investigators alike seem to have virtually ignored. There are few past or present clinical descriptions, curriculum examples, or research results that have been presented or published by nurses that demonstrate the discipline's recognition of and commitment to this pervasive health problem. With the ever-increasing prevalence of obesity and obesity-related diseases, the burgeoning expansion of health care delivery in outpatient care, and the growing emphasis on health promotion, it is imperative that nurses in all roles give their long overdue and concerted attention to grappling with this unrelenting epidemic.