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Tynan M, Afari N, Roesch S, Herbert MS. Psychometric Properties of the Weight Loss Readiness Test in Active Duty Military Personnel Enrolled in a Weight Management Trial. Mil Med 2024; 189:e2085-e2093. [PMID: 38771108 PMCID: PMC11363388 DOI: 10.1093/milmed/usae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/29/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The Weight Loss Readiness Test (WLRT) was developed to encourage consideration of factors influencing readiness to engage in weight loss. The WLRT is used clinically, most notably to assess motivation before initiating Navy weight management programs, yet little is known about its psychometric properties. MATERIALS AND METHODS This study examined the reliability, convergent and predictive validity, and factor structure of the WLRT in a sample of active duty service members enrolling in a Navy-based weight management program (N = 178, identified as female = 61%, mean age = 29.7 years, mean baseline body mass index = 33.1 kg/m2). All procedures were approved by the respective Institutional Review Boards and research committees. RESULTS Exploratory factor analysis revealed a 5-factor structure explaining 52% of the variance that best fit the data with low to moderate correlations between factors: (1) Motivation, (2) Exercise-Related Confidence, (3) Non-Exercise Confidence, (4) Cues, and (5) Anticipated Satisfaction. Internal reliability of subscales was acceptable to good (α = 0.755-0.903). Generally, convergent validity was found between the identified subscales and other measures of motivation, confidence, and disinhibited eating in expected directions. No relationships were found between the subscales and predictive validity outcomes (weight change, program attendance). CONCLUSIONS Results indicate adequate structural and convergent validity in the WLRT, but that weight loss readiness, as measured by the WLRT, does not provide predictive validity regarding weight loss or attendance outcomes in this sample. Nonetheless, this measure offers clinical utility in fostering thoughtful conversations about weight loss. The WLRT uniquely focuses on long-term maintenance of behavior change and differentiates between exercise-related and non-exercise confidence. Future studies should further probe the utility of this measure in other populations and the contexts in which it is being used.
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Affiliation(s)
- Mara Tynan
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA 92120, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
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Lucherini Angeletti L, Spinelli MC, Cassioli E, Rossi E, Castellini G, Brogioni G, Ricca V, Rotella F. From Restriction to Intuition: Evaluating Intuitive Eating in a Sample of the General Population. Nutrients 2024; 16:1240. [PMID: 38674930 PMCID: PMC11053871 DOI: 10.3390/nu16081240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Intuitive eating (IE) is a non-dieting approach that promotes listening to internal cues of hunger and satiety, rather than adhering to external dietary restrictions aimed at weight loss. However, the role of IE in dieting behaviors related to weight-loss approaches is still unclear. To address this issue, the aim of this study was to compare IE levels between dieting and non-dieting individuals, exploring the relationship between IE and dieting-related psychological and physical factors. A sample of 2059 females was recruited via social media and self-reported questionnaires were administered to measure IE, eating psychopathology, self-efficacy, and quality of life. Individuals with a history of dieting exhibited lower IE levels, a higher BMI, and a greater eating psychopathology, as well as a reduced self-efficacy and quality of life, compared to non-dieters. IE showed a protective effect against dieting behaviors, with higher IE levels being associated with a lower likelihood of dieting. Additionally, higher BMI and eating psychopathology were predictors of dieting. Promoting IE could represent a relevant clinical target strategy to address disordered eating and enhance overall well-being, underscoring the need for interventions that foster a healthier relationship with food and bodily internal sensations.
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Affiliation(s)
- Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
- The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON K1Z 7K4, Canada
| | - Maria Chiara Spinelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Giulietta Brogioni
- Psychiatry Unit, AOU Careggi Hospital, Largo Brambilla, 3, 50134 Florence, Italy;
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy; (L.L.A.); (M.C.S.); (E.C.); (G.C.); (V.R.)
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Robert M, Allès B, Gisch UA, Shankland R, Hercberg S, Touvier M, Leys C, Péneau S. Cross-sectional and longitudinal associations between self-esteem and BMI depends on baseline BMI category in a population-based study. BMC Public Health 2024; 24:230. [PMID: 38243225 PMCID: PMC10797749 DOI: 10.1186/s12889-024-17755-z] [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: 08/10/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Some studies have reported associations between self-esteem and weight status, but longitudinal data on adults remain scarce. The aim of this population-based study was to analyze the cross-sectional and longitudinal association between self-esteem and body mass index (BMI) and to investigate whether baseline BMI has an impact on this association. METHODS In 2016, 29,735 participants aged ≥ 18 years in the NutriNet-Santé cohort completed the Rosenberg Self-Esteem Scale. BMI was self-reported yearly over a 4-year period. Association between self-esteem and BMI was assessed using mixed models and logistic regressions. Analyses were stratified by BMI (categorical) at baseline and adjusted on sociodemographic and lifestyle characteristics. RESULTS At baseline, higher self-esteem was associated with higher BMI in normal weight individuals(p = 0.32), and with lower BMI in obese class II and III individuals (p = 0.13). In addition, higher baseline self-esteem was associated with BMI increase over time in normal weight individuals (p = 0.15). Among normal weight individuals, those with higher self-esteem were less likely to show a decrease in their BMI (p = 0.005), while no association was observed with BMI increase (p = 0.81). DISCUSSION Our findings suggest that the association between self-esteem and BMI depends on the initial category of BMI, with a negligible effect of self-esteem.
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Affiliation(s)
- Margaux Robert
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Benjamin Allès
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Ulrike A Gisch
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Department of Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
- Institute of Nutritional Science, Department of Nutritional Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Rebecca Shankland
- DIPHE Laboratory (Développement, Individu, Processus, Handicap, Education), University Lumière Lyon 2, Lyon, France
| | - Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Public Health Department, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
| | - Christophe Leys
- Service of Analysis of the Data (SAD), Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sandrine Péneau
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
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Wren GM, Koutoukidis DA, Scragg J, Whitman M, Jebb S. The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program. J Med Internet Res 2023; 25:e43869. [PMID: 37405833 DOI: 10.2196/43869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. OBJECTIVE We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. METHODS This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. RESULTS Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). CONCLUSIONS Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality.
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Affiliation(s)
- Gina M Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jadine Scragg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Gerber S, Folta SC. You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review. Nutrients 2022; 14:nu14173456. [PMID: 36079713 PMCID: PMC9458161 DOI: 10.3390/nu14173456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Identity is a major construct in the fields of psychology and anthropology that can relate to both the maintenance of eating behaviors and cultural sensitivity. However, there has not been any systematic effort to understand the role of identity in eating behaviors and the maintenance of eating behaviors, or to address multiple aspects of identity within an individual across scientific disciplines. This scoping review aims to understand and describe existing research relating identity to eating behaviors and to detail the measurement of identity. Methods: We conducted a systematic search of Ovid, PsychINFO, Embase, and Web of Science for articles on identity and eating behaviors published between January 1946 and March 2022. We utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, and search methods were developed with the assistance of a research librarian. We rated articles from 1 to 5 based on the depth, complexity, and multi-dimensionality of the identity measurement conducted. Scoring criteria included a review of the number of items directly querying or evaluating identity and the extent of measurement of identity domains. Results: In total, 100 articles were included, examining 10 different identities, 8 identity constructs, 11 eating behaviors, and construct contributions from 26 theories. The mean score of all articles was 2.9 on the scale from 1 to 5. A total of 10 studies scored a “1”; 30 scored a “2”, indicating the use of 1–2 basic questions about identity; 31 received a “3” for use of a common but non-complex identity instrument; 19 received a “4”, meaning they contained strong evaluation and included multiple types of identity but were lacking in terms of depth of measure and/or the comparison of identity effects to constructs; and 10 scored a “5” for their strong, in-depth measure of identity and inclusion of multiple types. Identity was found to be significantly related to eating behaviors in all but one study. Conclusion: Identity measurements seldom accounted for complexities such as multiple identities and identity shifting over time. Nonetheless, our findings indicate that multiple aspects of identity reciprocally reinforce behavior and that change maintenance is associated with identity salience and centrality. Identity is underutilized and heterogeneously applied in eating behavior research. The inclusion of identity assessments may lead to better outcomes being obtained within differing cultural, normative, and environmental scenarios.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Betty and Guy Beatty Liver and Obesity Research Program, Inova Medical System, Falls Church, VA 22043, USA
- Correspondence:
| | - Sara C. Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Chang AK, Kim SH. Predictors of Weight-Control Behavior in Healthy Weight and Overweight Korean Middle-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127546. [PMID: 35742793 PMCID: PMC9223894 DOI: 10.3390/ijerph19127546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
Although obesity level is considered to influence weight-control behavior, few studies have examined how predictors of weight-control behavior differ according to obesity level. We compared the predictors of weight-control behavior in healthy weight and overweight middle-aged Korean women. This study used a comparative cross-sectional design. In total, 352 middle-aged women (131 overweight and 221 healthy) who visited community centers in eight Korean cities participated in the study. Participants completed self-report questionnaires concerning perceived health, body dissatisfaction, health-related concerns, self-esteem, and weight-control behavior. Scores for weight-control behavior in the overweight group were higher than those in the healthy weight group. Stepwise multiple regression showed that health-related concerns, body dissatisfaction, socioeconomic status, and self-esteem predicted weight-control behavior in the overweight group. Perceived health, socioeconomic status, meal regularity, health-related concerns, and age predicted weight-control behavior in the healthy weight group. The findings indicate that nursing strategies should differ according to obesity level to improve weight-control behavior in middle-aged women. In community or clinical settings, nurses are advised to develop customized weight control programs based on obesity levels in middle-aged women.
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Affiliation(s)
- Ae-Kyung Chang
- College of Nursing Science, Kyung Hee University, Seoul 02447, Korea;
| | - Sun-Hui Kim
- Department of Nursing, Graduate School, Kyung Hee University, Seoul 02447, Korea
- Correspondence: ; Tel.: +82-61-270-2718
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Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study. Int J Obes (Lond) 2022; 46:935-942. [PMID: 35022546 PMCID: PMC9050593 DOI: 10.1038/s41366-021-01061-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/09/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
Abstract
Background Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as the frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D. Methods This study (n = 2684, 80% women) is a secondary analysis of the 1-year StopDia lifestyle intervention with digital intervention group, digital intervention + face-to-face counselling group, or control group. The frequency of prior weight loss attempts was categorized into five groups: no attempts/no attempts to lose weight, but trying to keep weight stable/1–2 attempts/3 or more attempts/ continuous attempts. Data on emotional eating and social/emotional nutrition self-efficacy were collected with a digital questionnaire. We assessed baseline differences between categories of weight loss history as well as the intervention effects. Results Altogether 84% of participants had attempted weight loss. Those with one or more weight loss attempts had higher BMI, larger waist circumference, and more emotional eating compared to ‘no attempts’ and ‘no attempts to lose weight, but trying to keep weight stable’ categories. The ‘no attempts’ category had the highest baseline fasting insulin, whereas it showed the largest decrease in this measure with the intervention. This change in fasting insulin in the ‘no attempts’ category was significantly different from all the other categories. Emotional nutrition self-efficacy slightly improved in the ‘no attempts’ category, which was significantly different from its concomitant decrease in the categories ‘1-2 attempts’ and ‘3 or more attempts’. The intervention group assignment did not affect the results. Conclusions Multiple attempts to lose weight may unfavourably affect T2D risk factors as well as lifestyle intervention outcomes. More research is needed on how weight loss frequency could affect T2D risk factors and how to design lifestyle interventions for individuals with frequent previous weight loss attempts.
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Lugones-Sanchez C, Crutzen R, Recio-Rodriguez JI, Garcia-Ortiz L. Establishing the relevance of psychological determinants regarding physical activity in people with overweight and obesity. Int J Clin Health Psychol 2021; 21:100250. [PMID: 33995540 PMCID: PMC8093885 DOI: 10.1016/j.ijchp.2021.100250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
To identify the most relevant determinants involved in Physical Activity (PA) changes in the EVIDENT 3 study population, measured by the International PA Questionnaire (IPAQ) and the Actigraph GT3X accelerometer. METHOD Exploratory study. Data used were collected from EVIDENT 3 study (N = 650). Items to measure psychological determinants were chosen from the baseline questionnaires. PA minutes/week were assessed by an accelerometer and IPAQ. The sample was analyzed by the control group (CG), the intervention group (IG) and Body Mass Index, using Confidence Interval-Based Estimation of Relevance (CIBER) analyses. RESULTS 486 participants, (IG: n = 251, CG: n = 235) were included. IG shows a positive association between PA assessed by accelerometer and self-efficacy. In IG, the overweight sample shows a positive association between PA assessed by accelerometer and motivation and self-efficacy. PA assessed by accelerometer obtained a higher explained variance (R2 ) in IG, both people with overweight (.10 - .55) and obesity (.03 - .19). In CG, IPAQ reached better results in people with overweight (.12 - .49). CONCLUSIONS Motivation and self-efficacy showed as relevant in increasing PA minutes/week, but only in the people with overweight in IG. There might be other factors not analyzed that could improve the low R2 obtained.
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Affiliation(s)
- Cristina Lugones-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands
| | - Jose I. Recio-Rodriguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Spain
| | - Luis Garcia-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castile and Leon (SACyL), Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Spain
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Altree TJ, Bartlett DJ, Marshall NS, Hoyos CM, Phillips CL, Birks C, Kanagaratnam A, Mullins A, Serinel Y, Wong KKH, Yee BJ, Grunstein RR, Cayanan EA. Predictors of weight loss in obese patients with obstructive sleep apnea. Sleep Breath 2021; 26:753-762. [PMID: 34357505 DOI: 10.1007/s11325-021-02455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Consistent predictors of weight loss outcomes with very low-energy diets (VLEDs) in obstructive sleep apnea (OSA) have not been identified. This study aimed to identify variables predictive of weight loss success in obese patients with OSA undertaking an intensive weight loss programme. METHODS We analysed biological, psychological, and behavioural variables as potential predictors of weight loss in obese patients with OSA after a 2-month VLED followed by one of two 10-month weight loss maintenance diets. Actigraphy, in-lab polysomnography, urinary catecholamines, and various psychological and behavioural variables were measured at baseline, 2, and 12 months. Spearman's correlations analysed baseline variables with 2-month weight loss, and 2-month variables with 2-12 month-weight change. RESULTS Forty-two patients completed the VLED and thirty-eight completed the maintenance diets. Actigraphy data revealed that late bedtime (rs = - 0.45, p = < 0.01) was correlated with 2-month weight loss. The change in the time that participants got out of bed (rise-time) from baseline to two months was also correlated with 2-month weight loss (rs = 0.36, p = 0.03). The Impact of Weight on Quality of Life-Lite questionnaire (IWQOL) Public Distress domain (rs = - 0.54, p = < 0.01) and total (rs = - 0.38, p = 0.02) scores were correlated with weight loss maintenance from 2 to 12 months. CONCLUSIONS Results from this small patient sample reveal correlations between actigraphy characteristics and weight loss in obese patients with OSA. We suggest the IWQOL may also be a useful clinical tool to identify OSA patients at risk of weight regain after initial weight loss. CLINICAL TRIAL REGISTRATION This clinical trial was prospectively registered on 18/02/2013 with the Australia and New Zealand Clinical Trials Registry (ACTRN12613000191796). PUBLIC REGISTRY TITLE Sleep, Lifestyle, Energy, Eating, Exercise Program for the management of sleep apnea patients indicated for weight loss treatment: A randomised, controlled pilot study. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363680.
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Affiliation(s)
- Thomas J Altree
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.
- Adelaide Institute for Sleep Health, Flinders University, Level 2, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia, 5049, Australia.
| | - Delwyn J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Camilla M Hoyos
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Callum Birks
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Aran Kanagaratnam
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Anna Mullins
- Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine, New York, NY, USA
| | - Yasmina Serinel
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Brendon J Yee
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia
| | - Elizabeth A Cayanan
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
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10
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Aronne LJ, Hall KD, Jakicic JM, Leibel RL, Lowe MR, Rosenbaum M, Klein S. Describing the Weight-Reduced State: Physiology, Behavior, and Interventions. Obesity (Silver Spring) 2021; 29 Suppl 1:S9-S24. [PMID: 33759395 PMCID: PMC9022199 DOI: 10.1002/oby.23086] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Although many persons with obesity can lose weight by lifestyle (diet and physical activity) therapy, successful long-term weight loss is difficult to achieve, and most people who lose weight regain their lost weight over time. The neurohormonal, physiological, and behavioral factors that promote weight recidivism are unclear and complex. The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop in June 2019, titled "The Physiology of the Weight-Reduced State," to explore the mechanisms and integrative physiology of adaptations in appetite, energy expenditure, and thermogenesis that occur in the weight-reduced state and that may oppose weight-loss maintenance. The proceedings from the first session of this workshop are presented here. Drs. Michael Rosenbaum, Kevin Hall, and Rudolph Leibel discussed the physiological factors that contribute to weight regain; Dr. Michael Lowe discussed the biobehavioral issues involved in weight-loss maintenance; Dr. John Jakicic discussed the influence of physical activity on long-term weight-loss maintenance; and Dr. Louis Aronne discussed the ability of drug therapy to maintain weight loss.
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Affiliation(s)
- Louis J. Aronne
- Weill Cornell Medicine Comprehensive Weight Control Center, New York, New York, USA
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - John M. Jakicic
- Healthy Lifestyle Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rudolph L. Leibel
- Departments of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University, New York, New York, USA
| | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael Rosenbaum
- Departments of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University, New York, New York, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Mitchell ES, Yang Q, Behr H, Ho A, DeLuca L, May CN, Michaelides A. Psychosocial Characteristics by Weight Loss and Engagement in a Digital Intervention Supporting Self-Management of Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041712. [PMID: 33578975 PMCID: PMC7916717 DOI: 10.3390/ijerph18041712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/01/2023]
Abstract
There is substantial variability in weight loss outcomes. Psychosocial characteristics underlying outcomes require better understanding, particularly on self-managed digital programs. This cross-sectional study examines differences in psychosocial characteristics by weight loss and engagement outcome, and which characteristics are most associated with weight loss, on a self-managed digital weight loss program. Some underexplored psychosocial characteristics are included, such as flourishing, or a sense of meaning and purpose in life. A questionnaire was emailed to a random sample of 10,000 current users at week 5 in the program and 10,000 current users at week 17. The questionnaire was completed by 2225 users, and their self-reported weight and recorded program engagement data were extracted from the program’s database. Multiple comparison tests indicated that mental health quality of life, depression, anxiety, work-life balance, and flourishing differed by weight loss outcome at program end (week 17; ≥5%, 2–5%, below 2%) and by engagement tertile at program beginning and end (weeks 5 and 17). Only anxiety was associated with weight loss in a backward stepwise regression controlling for engagement and sociodemographic characteristics. Flourishing did not predict weight loss overall but predicted the weight loss outcome group. Our findings have implications for creating more effective interventions for individuals based on psychosocial characteristics and highlight the potential importance of anxiety in underexplored self-managed digital programs.
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Affiliation(s)
- Ellen S. Mitchell
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Correspondence:
| | - Qiuchen Yang
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Heather Behr
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Department of Integrative Health, Saybrook University, 55 W Eureka St, Pasadena, CA 91103, USA
| | - Annabell Ho
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Laura DeLuca
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA
| | - Christine N. May
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Andreas Michaelides
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
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12
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Björkman S, Wallengren O, Laurenius A, Eliasson B, Larsson I. Nocturnal eating but not binge eating disorder is related to less 12 months' weight loss in men and women with severe obesity: A retrospective cohort study. Clin Obes 2020; 10:e12408. [PMID: 32851796 PMCID: PMC7685102 DOI: 10.1111/cob.12408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
There is a paucity of studies on the frequency of binge-eating disorder (BED) and nocturnal eating (NE) and their potential role as barriers in non-surgical weight loss treatment in subjects with severe obesity (body mass index [BMI] ≥35 kg m2 ). The aim was to identify BED and NE, and their effect on weight loss treatment. In total, 1132 (727 women, 405 men), BMI ~41 kg/m2 were patients in a 12-month weight loss programme at a specialist clinic. The questionnaire for eating and weight patterns-revised was completed by the patients before start of treatment. BED was diagnosed in 5.1% of men and 12.4% of women. NE prevalence was 13.5% and 12.7%, respectively. Mean (±SEM) 12-month weight loss was less in patients with NE compared to those without (-11.0 ± 1.5 vs -14.6 ± 0.7 kg, P = .008) but did not differ in patients with and without BED, (-12.3 ± 1.9 vs -14.2 ± 0.6 kg, P = .24). Factors associated with dropout were BED (odds ratio, OR 1.57, 95% confidence interval (CI) 1.14-2.17; P = .006) and previous weight loss attempts (OR 1.35, 95% CI 1.0-1.7; P = .02). BED did not seem to hinder weight loss whereas NE resulted in less weight loss in patients with severe obesity who completed a 12-month treatment programme. Previous weight loss attempts affect both dropout and ability to lose weight.
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Affiliation(s)
- Sofia Björkman
- Department of Gastroenterology and Hepatology, Unit of Clinical Nutrition and the Regional Obesity CenterSahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
| | - Ola Wallengren
- Department of Gastroenterology and Hepatology, Unit of Clinical NutritionSahlgrenska University HospitalGothenburgSweden
| | - Anna Laurenius
- Department of Gastroenterology and Hepatology, Unit of Clinical NutritionSahlgrenska University HospitalGothenburgSweden
- Department of Surgery, Institute of Clinical SciencesSahlgrenska Academy at the University of GothenburgGothenburgSweden
| | - Björn Eliasson
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Unit of Clinical Nutrition and the Regional Obesity CenterSahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska Academy at the University of GothenburgSahlgrenska University HospitalGothenburgSweden
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13
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Gilcharan Singh HK, Chee WSS, Hamdy O, Mechanick JI, Lee VKM, Barua A, Mohd Ali SZ, Hussein Z. Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial. PLoS One 2020; 15:e0242487. [PMID: 33253259 PMCID: PMC7703935 DOI: 10.1371/journal.pone.0242487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). METHODS Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months' post-intervention. RESULTS There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months' follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups. CONCLUSION Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. CLINICAL TRIAL This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.
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Affiliation(s)
- Harvinder Kaur Gilcharan Singh
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Winnie Siew Swee Chee
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Osama Hamdy
- Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, United States of America
| | - Jeffrey Ian Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Ankur Barua
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Siti Zubaidah Mohd Ali
- Department of Non-Communicable Diseases, Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
| | - Zanariah Hussein
- Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia
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14
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Comșa L, David O, David D. Outcomes and mechanisms of change in cognitive-behavioral interventions for weight loss: A meta-analysis of randomized clinical trials. Behav Res Ther 2020; 132:103654. [PMID: 32683134 DOI: 10.1016/j.brat.2020.103654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy of CBT in relation to weight loss and related psychological components and to analyze the relationship between alleged cognitive mechanisms of change and weight loss. METHODS The studies we considered eligible were the randomized clinical trials which included and reported a quantitative assessment of change in weight and of potential cognitive mechanisms of successful change in weight and comparing at least one active CBT intervention with a control for adults. RESULTS We included 16 studies (18 contrasts) with a total of 1.663 participants. The pooled ESs in which a CBT-intervention was compared to a control condition for weight loss, was Hedges' g= 0.31 (95% CI 0.04 to 0.58) favoring CBT and for cognitive factors was g = 0.37 (95% CI 0.22 to 0.45). Results indicated a significant association between motivation outcomes ESs (slope= 0.992, 95% CI 0.13 to 1.85, p =0.02) and selfefficacy ESs (slope= 1.59, 95% CI 0.24 to 2.94, p =0.02) and weight outcomes. DISCUSSION Current evidence suggests that CBT is effective in weight loss. Clinicians will be more effective if they add to their weight loss interventions components for increasing the motivation and self-efficacy of their patients.
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Affiliation(s)
- Loana Comșa
- Doctoral School of Evidence-based Assessment and Psychological Interventions, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Oana David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj- Napoca, Romania.
| | - Daniel David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj- Napoca, Romania; Icahn School of Medicine at Mount Sinai, New York, USA
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15
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Kim M, Kim Y, Go Y, Lee S, Na M, Lee Y, Choi S, Choi HJ. Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14817. [PMID: 32352391 PMCID: PMC7226050 DOI: 10.2196/14817] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 10/13/2019] [Accepted: 02/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem. Objective This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody. Methods This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m2 and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework. Results Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (–3.1%, SD 4.5, vs –0.7%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32% [12/38] vs 4% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (–6.3%, SD 8.8, vs –0.8%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (–15.8%, SD 29.9, vs 7.2%, SD 35.9, P=.01; and –7.1%, SD 35.1, vs 14.4%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (–2.8%, SD 34.4, vs 21.6%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes. Conclusions These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions. Trial Registration ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306
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Affiliation(s)
- Meelim Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychology, Duksung Women's University, Ssangmun-Dong, Dobong-Gu, Republic of Korea
| | - Youngin Kim
- Noom Inc, New York City, NY, United States.,Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoonjeong Go
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seokoh Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myeongjin Na
- Department of Psychology, Duksung Women's University, Ssangmun-Dong, Dobong-Gu, Republic of Korea
| | - Younghee Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungwon Choi
- Department of Psychology, Duksung Women's University, Ssangmun-Dong, Dobong-Gu, Republic of Korea
| | - Hyung Jin Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
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16
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Altamura M, Porcelli P, Fairfield B, Malerba S, Carnevale R, Balzotti A, Rossi G, Vendemiale G, Bellomo A. Alexithymia Predicts Attrition and Outcome in Weight-Loss Obesity Treatment. Front Psychol 2018; 9:2432. [PMID: 30564177 PMCID: PMC6288375 DOI: 10.3389/fpsyg.2018.02432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022] Open
Abstract
Obesity is a psychosomatic condition characterized by a complex interaction of biological and psychological factors and a large body of research has aimed to identify variables limiting efficacy and determining high attrition rates in weight loss programs. In this study, we used the Diagnostic Criteria for Psychosomatic Research (DCPR), designed to broaden the clinician's perspective on patients' problems by providing additional clinical information not found in the more traditional psychiatric classification, to predict psychosomatic variables that may limit efficacy and determine attrition in clinical interventions with people with obesity. We evaluated 82 consecutive participants with obesity at baseline for psychopathology, psychosomatic correlates, psychological distress, and eating-related symptoms before entering a weight loss program. Regression models were used to assess attrition and outcome at a 6-month follow-up and per-protocol and intention-to-treat analyses were performed. DPCR alexithymia significantly predicted attrition (OR = 6.9), and unsuccessful weight-loss (OR = 11.3). These findings suggest that the identification of psychosomatic factors, in addition to psychological and psychopathological factors, may predict adherence to weight-loss programs.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Beth Fairfield
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
- CeSI-Met, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Stefania Malerba
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Raffaella Carnevale
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Rossi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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17
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Motivators, barriers and strategies of weight management: A cross-sectional study among Finnish adults. Eat Behav 2018; 31:80-87. [PMID: 30195189 DOI: 10.1016/j.eatbeh.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Weight management (WM) is an ongoing global challenge. The purpose of this study was to analyze motivators, barriers, and strategies of WM among Finnish adults. METHODS Data were collected in the 'KULUMA' (Consumers at the Weight Management Market) project among 667 community-dwelling adults in Eastern and Central Finland (Kuopio and Jyväskylä). The self-reported questionnaire collected background information and responses to motivators, barriers, and strategy items. Principal component analysis (PCA) was used to extract components of motivators, barriers, and strategies of WM, along with K-means clustering to categorize the participants. RESULTS About 55% of the respondents were aiming to lose weight. The PCA resulted in a 3-component model for motivators (functional aspects, sociological aspects, and psychosocial aspects), a 4-component model for barriers (life situations, food environment, personal issues, and resources) and a 2-component model for the strategies of WM (dietary strategies and life-management strategies). The components had several relationships with demographic characteristics (especially with age) but only a few with weight-related characteristics (e.g. weight loss attempts). Three clusters of participants were formed: Struggling weight managers (WMs), Independent WMs, and Determined WMs. Barriers to WM had a key role in differentiating clusters and weight satisfaction. Determined WMs were the most satisfied with their weight, whereas Struggling WMs perceived the highest level of barriers to WM. CONCLUSIONS WM efforts are common among Finnish adults. Generally, weight-related activities and communication in society should focus more on barriers than merely on the motivation or strategies of WM in order to support individuals' WM efforts.
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18
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Rofey DL, El Nokali NE, Jackson Foster LJ, Seiler E, McCauley HL, Miller E. Weight Loss Trajectories and Adverse Childhood Experience among Obese Adolescents with Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2018. [PMID: 29526815 DOI: 10.1016/j.jpag.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To examine the effect of childhood trauma and family history of psychiatric illness on weight loss trajectories of obese, female adolescents with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING PCOS and adolescent medicine outpatient clinics. PARTICIPANTS Participants were, on average, 15.8 years of age, 80% Caucasian (39/49 participants), and had a body mass index of 36.8 ± 8.8. INTERVENTIONS Healthy Bodies, Healthy Minds is an evidence-based one-on-one intervention consisting of 4 weekly sessions, 4 biweekly sessions, and 3 monthly booster sessions. Each session was 45-60 minutes long with 15-30 minutes of physical activity with a lifestyle coach. MAIN OUTCOME MEASURES Paired sample t tests were used to assess group differences in pre- and post-treatment weight between participants reporting childhood trauma and body mass index-matched controls not endorsing trauma. One-way analysis of variance was performed to assess the influence of childhood trauma on weight loss between the 2 groups. RESULTS Adolescents without a family history of psychiatric illness lost more weight (mean, -1.28 kg; SD, 6.89) than those who had a family history of psychiatric illness (mean, -0.64 kg; SD, 4.7) from baseline to booster session completion (6 months). However, results of independent t tests did not reveal statistically significant group differences in weight loss from baseline to booster session completion (t21 = 0.51; P = .6). CONCLUSION Obese adolescents with PCOS who have experienced childhood trauma can lose weight and acquire its health benefits when enrolled in an intervention addressing weight, mood, and sleep. Family history of psychiatric illness emerged as a potential predictor of lesser weight loss.
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Affiliation(s)
- Dana L Rofey
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
| | - Nermeen E El Nokali
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lovie J Jackson Foster
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Seiler
- University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Carraça EV, Santos I, Mata J, Teixeira PJ. Psychosocial Pretreatment Predictors of Weight Control: A Systematic Review Update. Obes Facts 2018; 11:67-82. [PMID: 29439252 PMCID: PMC5869571 DOI: 10.1159/000485838] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/28/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Systematically identifying pretreatment characteristics that predict successful weight management is important to improve intervention efficacy and clinical practice. This study provides a comprehensive update of a 2005 review on pretreatment predictors of successful weight management. METHODS Results of 37 recent original studies from peer-reviewed journals were merged with the results from the 2005 review. A critical appraisal of the 66 studies included was provided, and meta-analyses were performed when feasible. RESULTS Fewer previous weight loss attempts were the most consistent pretreatment predictor of successful weight management, although with a small effect size. Importantly, several variables were identified as non-significant predictors of weight loss, showing trivial effects (e.g., eating self-efficacy). Many psychosocial factors remain too little studied to allow reliable conclusions regarding their predictive value. CONCLUSION Previous dieting attempts were identified as the soundest predictor of successful weight management. Several factors, previously considered barriers to successful weight management and now identified as non-predictors, require more investigation given the limitations identified in this review. Importantly, due to a comparably thin empirical basis for many predictors, further research is essential to move the field forward. Implications of the current state of research and necessary steps to improve intervention efficacy and clinical practice are discussed.
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Affiliation(s)
- Eliana V. Carraça
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Jutta Mata
- Faculty of Social Sciences (Health Psychology), University of Mannheim, Mannheim, Germany
| | - Pedro J. Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
- *Pedro J. Teixeira, PhD, Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, Cruz Quebrada, 1495-688 Cruz Quebrada, Portugal,
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Austin JL, Serier KN, Sarafin RE, Smith JE. Body dissatisfaction predicts poor behavioral weight loss treatment adherence in overweight Mexican American women. Body Image 2017; 23:155-161. [PMID: 29035748 DOI: 10.1016/j.bodyim.2017.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
Poor adherence poses a major barrier to the success of behavioral weight loss (BWL) programs, particularly for overweight Mexican American women. Given the high prevalence and costs of overweight/obesity, factors that contribute to attendance and adherence problems should be identified, especially in ethnic minority populations. The current study examined the role of pre-treatment body dissatisfaction and depression in predicting attendance and adherence in a BWL intervention. Ninety-nine overweight/obese Mexican American women enrolled in the intervention and completed baseline measures. Eighty-one of the women attended at least one treatment session and provided measures of dietary and physical activity adherence. Simultaneous linear regression analyses suggested that although higher levels of body dissatisfaction and depression each played unique roles in predicting poorer attendance, only body dissatisfaction predicted adherence. Specifically, higher body dissatisfaction predicted poorer treatment adherence. Findings highlight the importance of addressing body dissatisfaction early in BWL treatment to increase attendance and adherence.
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Affiliation(s)
- Julia L Austin
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Kelsey N Serier
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Ruth E Sarafin
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Jane Ellen Smith
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States.
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Sharpe EE, Karasouli E, Meyer C. Examining Factors of Engagement With Digital Interventions for Weight Management: Rapid Review. JMIR Res Protoc 2017; 6:e205. [PMID: 29061557 PMCID: PMC5673884 DOI: 10.2196/resprot.6059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/02/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital interventions for weight management provide a unique opportunity to target daily lifestyle choices and eating behaviors over a sustained period of time. However, recent evidence has demonstrated a lack of user engagement with digital health interventions, impacting on the levels of intervention effectiveness. Thus, it is critical to identify the factors that may facilitate user engagement with digital health interventions to encourage behavior change and weight management. OBJECTIVE The aim of this study was to identify and synthesize the available evidence to gain insights about users' perspectives on factors that affect engagement with digital interventions for weight management. METHODS A rapid review methodology was adopted. The search strategy was executed in the following databases: Web of Science, PsycINFO, and PubMed. Studies were eligible for inclusion if they investigated users' engagement with a digital weight management intervention and were published from 2000 onwards. A narrative synthesis of data was performed on all included studies. RESULTS A total of 11 studies were included in the review. The studies were qualitative, mixed-methods, or randomized controlled trials. Some of the studies explored features influencing engagement when using a Web-based digital intervention, others specifically explored engagement when accessing a mobile phone app, and some looked at engagement after text message (short message service, SMS) reminders. Factors influencing engagement with digital weight management interventions were found to be both user-related (eg, perceived health benefits) and digital intervention-related (eg, ease of use and the provision of personalized information). CONCLUSIONS The findings highlight the importance of incorporating user perspectives during the digital intervention development process to encourage engagement. The review contributes to our understanding of what facilitates user engagement and points toward a coproduction approach for developing digital interventions for weight management. Particularly, it highlights the importance of thinking about user-related and digital tool-related factors from the very early stages of the intervention development process.
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Affiliation(s)
| | - Eleni Karasouli
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Caroline Meyer
- Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
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22
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Reesor L, Vaughan EM, Hernandez DC, Johnston CA. Addressing Outcomes Expectancies in Behavior Change. Am J Lifestyle Med 2017; 11:430-432. [PMID: 29302249 DOI: 10.1177/1559827617722504] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals commonly seek help for problem health behaviors, such as excessive drinking, smoking, and weight gain. Yet, there is a high rate of recidivism in these behaviors because outcome expectancies are either too high, negative outcome expectancies are not considered, or outcome expectancies are not properly addressed. Healthcare providers are recommended to list the outcome expectancy for the problem behavior and corresponding treatment for their patient. Through the process it is important to acknowledge both the positive and negative outcomes of engaging in the problem behavior. Healthcare providers are then encouraged to have their patient identify the goals and objectives that will assist in achieving the desired outcome. By recognizing and addressing outcome expectancies, it is more likely that the patient will be less resistant to the healthcare provider's recommendations to change problematic behavior.
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Affiliation(s)
- Layton Reesor
- Department of Health and Human Performance, University of Houston
| | | | | | - Craig A Johnston
- Department of Health and Human Performance, University of Houston
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23
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Moreira H, Canavarro MC. Is body shame a significant mediator of the relationship between mindfulness skills and the quality of life of treatment-seeking children and adolescents with overweight and obesity? Body Image 2017; 20:49-57. [PMID: 27936409 DOI: 10.1016/j.bodyim.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
This study aimed to examine (a) whether mindfulness skills were associated with higher quality of life through lower body shame for treatment-seeking children/adolescents with overweight and obesity and (b) whether this indirect effect was moderated by children/adolescents' age and gender. The sample included 153 children/adolescents with overweight/obesity followed in individual nutrition consultations. Participants completed self-report measures of mindfulness, body shame, and quality of life. Moderated mediation analyses showed that higher levels of mindfulness were associated with better perceived quality of life through lower body shame, but only among girls. For boys, higher levels of body shame did not translate into a poorer perception of quality of life, and the indirect effect of mindfulness on quality of life via lower body shame was not significant. These results suggest that body shame is an important mechanism to explain why mindfulness may help girls with overweight/obesity perceive a better quality of life.
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Affiliation(s)
- Helena Moreira
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
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24
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Conroy MB, Bryce CL, McTigue KM, Tudorascu D, Gibbs BB, Comer D, Hess R, Huber K, Simkin-Silverman LR, Fischer GS. Promoting weight maintenance with electronic health record tools in a primary care setting: Baseline results from the MAINTAIN-pc trial. Contemp Clin Trials 2017; 54:60-67. [DOI: 10.1016/j.cct.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/26/2022]
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25
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Wilson KE, Harden SM, Almeida FA, You W, Hill JL, Goessl C, Estabrooks PA. Brief self-efficacy scales for use in weight-loss trials: Preliminary evidence of validity. Psychol Assess 2016; 28:1255-1264. [PMID: 26619093 PMCID: PMC5522615 DOI: 10.1037/pas0000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Self-efficacy is a commonly included cognitive variable in weight-loss trials, but there is little uniformity in its measurement. Weight-loss trials frequently focus on physical activity (PA) and eating behavior, as well as weight loss, but no survey is available that offers reliable measurement of self-efficacy as it relates to each of these targeted outcomes. The purpose of this study was to test the psychometric properties of brief, pragmatic self-efficacy scales specific to PA, healthful eating and weight-loss (4 items each). An adult sample (n = 1,790) from 28 worksites enrolled in a worksite weight-loss program completed the self-efficacy scales, as well as measures of PA, dietary fat intake, and weight, at baseline, 6-, and 12-months. Confirmatory factor analysis supported the hypothesized factor structure indicating, 3 latent self-efficacy factors, specific to PA, healthful eating, and weight-loss. Measurement equivalence/invariance between relevant demographic groups, and over time was also supported. Parallel growth processes in self-efficacy factors and outcomes (PA, fat intake, and weight) support the predictive validity of score interpretations. Overall, this initial series of psychometric analyses supports the interpretation that scores on these scales reflect self-efficacy for PA, healthful eating, and weight-loss. The use of this instrument in large-scale weight-loss trials is encouraged. (PsycINFO Database Record
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Affiliation(s)
- Kathryn E. Wilson
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Samantha M. Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Fabio A. Almeida
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Wen You
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
- Department of Agriculture and Applied Economics, Virginia Polytechnic Institute and State University
| | - Jennie L. Hill
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
| | - Cody Goessl
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
| | - Paul A. Estabrooks
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University
- Fralin Translational Obesity Research Center, Virginia Polytechnic Institute and State University
- Department of Family and Community Medicine, Carilion Clinic
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26
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Morgan PJ, Hollis JL, Young MD, Collins CE, Teixeira PJ. Workday Sitting Time and Marital Status: Novel Pretreatment Predictors of Weight Loss in Overweight and Obese Men. Am J Mens Health 2016; 12:1431-1438. [PMID: 27325207 DOI: 10.1177/1557988316654866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The evidence base for weight loss programs in men is limited. Gaining a greater understanding of which personal characteristics and pretreatment behaviors predict weight loss and attrition in male-only studies would be useful to inform the development of future interventions for men. In December 2010, 159 overweight/obese men (mean age = 47.5 years; body mass index = 32.7 kg/m2) from the Hunter Region of New South Wales, Australia, participated in a randomized controlled trial testing the effectiveness of two versions of a 3-month gender-targeted weight loss program. In the current analyses, social-cognitive, behavioral, and demographic pretreatment characteristics were examined to determine if they predicted weight loss and attrition in the participants over 6 months. Generalized linear mixed models (intention-to-treat) revealed weight change was associated with education level ( p = .02), marital status ( p = .03), fat mass ( p = .045), sitting time on nonwork ( p = .046), and workdays ( p = .03). Workday sitting time and marital status accounted for 6.5% ( p = .01) of the variance in the final model. Attrition was associated with level of education ( p = .01) and body fat percentage ( p = .01), accounting for 9.5% ( p = .002) of the variance in the final model. This study suggests men who spend a lot of time sitting at work, especially those who are not married, may require additional support to experience success in self-administered weight loss programs targeting males. Additional high-quality evidence is needed to improve the understanding which pretreatment behaviors and characteristics predict weight loss and attrition in men.
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Affiliation(s)
- Philip J Morgan
- 1 University of Newcastle, Callaghan, New South Wales, Australia
| | - Jenna L Hollis
- 1 University of Newcastle, Callaghan, New South Wales, Australia.,2 University of Southampton, United Kingdom
| | - Myles D Young
- 1 University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare E Collins
- 1 University of Newcastle, Callaghan, New South Wales, Australia
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Nezami BT, Lang W, Jakicic JM, Davis KK, Polzien K, Rickman AD, Hatley KE, Tate DF. The Effect of Self-Efficacy on Behavior and Weight in a Behavioral Weight-Loss Intervention. Health Psychol 2016; 35:2016-23894-001. [PMID: 27183306 PMCID: PMC5112140 DOI: 10.1037/hea0000378] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether eating self-efficacy (ESE) and physical activity self-efficacy (PASE) are predictive of dietary intake, physical activity, and weight change within a behavioral weight-loss intervention, and whether dietary intake and physical activity mediate relationships between self-efficacy and weight change. METHOD The study sample included 246 participants from a randomized trial with complete data on study variables at 12 months. ESE, PASE, calories consumed, minutes of moderate-to-vigorous physical activity (MVPA), and weight were measured at baseline, 6, and 12 months. RESULTS ESE at baseline was associated with 12-month percent weight loss (PWL), and was mediated by average calories consumed at 6 and 12 months. Change in ESE from baseline to 6 months was associated with calories consumed at 12 months and 12-month percent weight loss, but the mediated relationship was not significant. Baseline PASE was not associated with average MVPA at 6 and 12 months or 12-month PWL, but change in PASE from baseline to 6 months was associated with 12-month PWL through its effect on MVPA at 12 months. CONCLUSION Increases in ESE and PASE during the active phase of the intervention are predictive of dietary intake, physical activity and weight loss at later points, but further research should include explorations of the reciprocal relationship between behavior and self-efficacy to better inform intervention strategies that target self-efficacy and promote behavior change. (PsycINFO Database Record
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28
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Simpson SA, McNamara R, Shaw C, Kelson M, Moriarty Y, Randell E, Cohen D, Alam MF, Copeland L, Duncan D, Espinasse A, Gillespie D, Hill A, Owen-Jones E, Tapper K, Townson J, Williams S, Hood K. A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults. Health Technol Assess 2016; 19:v-vi, xix-xxv, 1-378. [PMID: 26168409 DOI: 10.3310/hta19500] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity has significant health and NHS cost implications. Relatively small reductions in weight have clinically important benefits, but long-term weight loss maintenance (WLM) is challenging. Behaviour change interventions have been identified as key for WLM. Motivation is crucial to supporting behaviour change, and motivational interviewing (MI) has been identified as a successful approach to changing health behaviours. The study was designed as an adequately powered, pragmatic randomised controlled trial (RCT); however, owing to recruitment issues, the study became a feasibility trial. OBJECTIVES To assess recruitment, retention, feasibility, acceptability, compliance and delivery of a 12-month intervention to support WLM. Secondary objectives were to assess the impact of the intervention on body mass index (BMI) and other secondary outcomes. DESIGN Three-arm individually randomised controlled trial comprising an intensive arm, a less intensive arm and a control arm. SETTING Community setting in South Wales and the East Midlands. PARTICIPANTS Individuals aged 18-70 years with a current or previous BMI of ≥ 30 kg/m(2) who could provide evidence of at least 5% weight loss during the previous 12 months. INTERVENTION Participants received individually tailored MI, which included planning and self-monitoring. The intensive arm received six face-to-face sessions followed by nine telephone sessions. The less intensive arm received two face-to-face sessions followed by two telephone sessions. The control arm received a leaflet advising them on healthy lifestyle. MAIN OUTCOME MEASURES Feasibility outcomes included numbers recruited, retention and adherence. The primary effectiveness outcome was BMI at 12 months post randomisation. Secondary outcomes included waist circumference, waist-to-hip ratio, physical activity, proportion maintaining weight loss, diet, quality of life, health service resource usage, binge eating and well-being. A process evaluation assessed intervention delivery, adherence, and participants' and practitioners' views. Economic analysis aimed to assess cost-effectiveness in terms of quality-adjusted life-years (QALYs). RESULTS A total of 170 participants were randomised. Retention was good (84%) and adherence was excellent (intensive, 83%; less intensive, 91%). The between-group difference in mean BMI indicated the intensive arm had BMIs 1.0 kg/m(2) lower than the controls [95% confidence interval (CI) -2.2 kg/m(2) to 0.2 kg/m(2)]. Similarly, a potential difference was found in weight (average difference of 2.8 kg, 95% CI -6.1 kg to 0.5 kg). The intensive arm had odds of maintaining on average 43% [odds ratio(OR) 1.4, 95% CI 0.6 to 3.5] higher than controls. None of these findings were statistically significant. Further analyses controlling for level of adherence indicated that average BMI was 1.2 kg/m(2) lower in the intensive arm than the control arm (95% CI -2.5 kg/m(2) to 0.0 kg/m(2)). The intensive intervention led to a statistically significant difference in weight (mean -3.7 kg, 95% CI -7.1 kg to -0.3 kg). The other secondary outcomes showed limited evidence of differences between groups. The intervention was delivered as planned, and both practitioners and participants were positive about the intervention and its impact. Although not powered to assess cost-effectiveness, results of this feasibility study suggest that neither intervention as currently delivered is likely to be cost-effective in routine practice. CONCLUSION This is the first trial of an intervention for WLM in the UK, the intervention is feasible and acceptable, and retention and adherence were high. The main effectiveness outcome showed a promising mean difference in the intensive arm. Owing to the small sample size, we are limited in the conclusions we can draw. However, findings suggest that the intensive intervention may facilitate long-term weight maintenance and, therefore, further testing in an effectiveness trial may be indicated. Research examining WLM is in its infancy, further research is needed to develop our understanding of WLM and to expand theory to inform the development of interventions to be tested in rigorously designed RCTs with cost-effectiveness assessed. TRIAL REGISTRATION Current Controlled Trials ISRCTN35774128. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel McNamara
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Christine Shaw
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Mark Kelson
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Yvonne Moriarty
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | | | - David Cohen
- Faculty of Health Sport and Science, University of South Wales, Pontypridd, UK
| | - M Fasihul Alam
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Lauren Copeland
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Donna Duncan
- Abertawe Bro Morgannwg University Health Board, Bridgend, UK
| | - Aude Espinasse
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - David Gillespie
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Andy Hill
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK
| | | | - Katy Tapper
- Department of Psychology, City University, London, UK
| | - Julia Townson
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Simon Williams
- Sport, Health and Exercise Science Research Unit, University of South Wales, Pontypridd, UK
| | - Kerry Hood
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
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Szabo-Reed AN, Lee J, Ptomey L, Willis E, Schubert M, Washburn R, Donnelly JE. Longitudinal Weight Loss Patterns and their Behavioral and Demographic Associations. Ann Behav Med 2016; 50:147-56. [PMID: 26423446 PMCID: PMC4744131 DOI: 10.1007/s12160-015-9740-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Identification of weight change patterns may allow tailored interventions to improve long-term weight loss. PURPOSE To identify patterns of weight change over 18 months, and assess participant characteristics and intervention adherence factors associated with weight change patterns in a sample of 359 overweight/obese adults. METHODS Weight loss (0-6 months) was achieved with reduced energy intake and increased physical activity (PA). Maintenance (7-18 months) provided adequate energy to maintain weight and continued PA. RESULTS Latent profile analysis identified three weight change profiles. During weight loss/maintenance, participants in profiles 2 and 3 (18-month weight loss ∼14 %) attended more behavioral sessions and performed more PA compared with profile 1 (18-month weight loss <1 %). Self-efficacy for both weight management and exercise barriers were higher in profiles 2 and 3 compared with profile 1 following weight loss and during maintenance. CONCLUSION Weight change patterns can be identified and are associated with both participant characteristics and intervention adherence.
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Affiliation(s)
- Amanda N Szabo-Reed
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Jaehoon Lee
- Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, Box 43150, Lubbock, TX, 79409, USA.
| | - Lauren Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Erik Willis
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Matt Schubert
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Richard Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Joseph E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
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Koritzky G, Rice C, Dieterle C, Bechara A. The Biggest Loser Thinks Long-Term: Recency as a Predictor of Success in Weight Management. Front Psychol 2015; 6:1864. [PMID: 26696930 PMCID: PMC4672063 DOI: 10.3389/fpsyg.2015.01864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023] Open
Abstract
Only a minority of participants in behavioral weight management lose weight significantly. The ability to predict who is likely to benefit from weight management can improve the efficiency of obesity treatment. Identifying predictors of weight loss can also reveal potential ways to improve existing treatments. We propose a neuro-psychological model that is focused on recency: the reliance on recent information at the expense of time-distant information. Forty-four weight-management patients completed a decision-making task and their recency level was estimated by a mathematical model. Impulsivity and risk-taking were also measured for comparison. Weight loss was measured in the end of the 16-week intervention. Consistent with our hypothesis, successful dieters (n = 12) had lower recency scores than unsuccessful ones (n = 32; p = 0.006). Successful and unsuccessful dieters were similar in their demographics, intelligence, risk taking, impulsivity, and delay of gratification. We conclude that dieters who process time-distant information in their decision making are more likely to lose weight than those who are high in recency. We argue that having low recency facilitates future-oriented thinking, and thereby contributes to behavior change treatment adherence. Our findings underline the importance of choosing the right treatment for every individual, and outline a way to improve weight-management processes for more patients.
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Affiliation(s)
- Gilly Koritzky
- American School of Professional Psychology, Argosy University, Orange County Orange, CA, USA
| | - Chantelle Rice
- Division of Occupational Science and Occupational Therapy, University of Southern California Los Angeles, CA, USA
| | - Camille Dieterle
- Division of Occupational Science and Occupational Therapy, University of Southern California Los Angeles, CA, USA
| | - Antoine Bechara
- American School of Professional Psychology, Argosy University, Orange County Orange, CA, USA ; Department of Psychology, University of Southern California, Los Angeles CA, USA ; Department of Neurology, University of Iowa Iowa City, IA, USA
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31
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Evans EH, Boothroyd LG, Muscariello E, Stephan BCM, Nasti G, Colantuoni A, Siervo M. Lower weight loss expectations and healthier eating attitudes in older overweight and obese women attempting weight loss. Clin Obes 2015; 5:136-44. [PMID: 25872866 DOI: 10.1111/cob.12093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/18/2015] [Accepted: 03/09/2015] [Indexed: 11/27/2022]
Abstract
Weight loss outcomes in overweight and obese individuals may be influenced by individual weight loss expectations (WLEs). Research on these phenomena in older women is lacking. This cross-sectional study compared groups of younger and older women on their WLEs and related attitudes (body dissatisfaction and disordered eating). Twenty-six younger (18-38 years) and 33 older (60-78 years) overweight and obese women were recruited from a weight loss clinic, prior to treatment. Disordered eating attitudes and body dissatisfaction were assessed using validated questionnaires and a pictorial figure-choice scale. Participants reported 10 WLEs categorized according to personal, lifestyle and social factors. Overall, women with a higher body mass index had greater WLEs. Older women reported lower WLEs than younger women (-14.5 kg vs. -22.4 kg) in all categories except past weight. Older women perceived that career success would necessitate the greatest level of weight loss (-18.5 kg), whereas younger women derived their greatest WLEs from mass media (-28.5 kg). Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss (-8.4 and -17.6 kg, respectively). The groups did not differ on body dissatisfaction, but younger women's disordered eating attitudes were significantly higher (p < .001). Older overweight and obese women have lower WLEs than younger women but experience similar levels of body dissatisfaction and healthier eating attitudes. The attitudinal constructs underlying these differences may be useful in clinical practice to tailor age-specific weight loss interventions.
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Affiliation(s)
- E H Evans
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - L G Boothroyd
- Department of Psychology, Durham University, Durham, UK
| | - E Muscariello
- Human Nutrition and Physiology, Department of Neuroscience, University of Naples, Naples, Italy
| | - B C M Stephan
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - G Nasti
- Human Nutrition and Physiology, Department of Neuroscience, University of Naples, Naples, Italy
| | - A Colantuoni
- Human Nutrition and Physiology, Department of Neuroscience, University of Naples, Naples, Italy
| | - M Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, UK
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Annesi JJ, Johnson PH. Theory-based psychosocial factors that discriminate between weight-loss success and failure over 6 months in women with morbid obesity receiving behavioral treatments. Eat Weight Disord 2015; 20:223-32. [PMID: 25332091 DOI: 10.1007/s40519-014-0159-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/05/2014] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To improve success rates of behavioral weight-loss treatments, a better understanding of psychosocial factors that discriminate between weight-loss success and failure is required. The inclusion of cognitive-behavioral methods and manageable amounts of exercise might induce greater improvements than traditional methods of education in healthy eating practices. METHODS Women with morbid obesity [body mass index (BMI) ≥40 kg/m(2)] were recruited for a treatment of supported exercise paired with either a cognitive-behavioral or an educational approach to eating change over 6 months. They were classified as either successful with (i.e., at least 5 % loss; n = 40) or failed at (no loss, or weight gain; n = 43) weight loss. Discriminate function analysis incorporated theory-based models of 1 (self-efficacy), 5 (self-efficacy, self-regulation, mood, physical self-concept, body satisfaction), and 3 (self-efficacy, self-regulation, mood) psychosocial predictors at both month 6, and change from baseline-month 6. RESULTS All three models significantly discriminated weight-loss success/failure (66, 88, and 87 % for success; and 81, 87, and 88 % for failure, respectively). Self-regulation had the strongest correlations within the multi-predictor models (0.90-0.96), and all variables entered were above the standard of 0.30 set for relevance. Participants in the cognitive-behavioral nutrition group demonstrated significantly greater improvements in all psychosocial variables and success with weight loss. Completing at least two sessions of exercise per week predicted success/failure with weight loss better than overall volume of exercise. CONCLUSIONS New and relevant findings regarding treatment-induced psychosocial changes might be useful in the architecture of more successful behavioral weight-loss interventions.
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Affiliation(s)
- James J Annesi
- YMCA of Metro Atlanta, 100 Edgewood Avenue NE, Suite 1100, Atlanta, GA, 30303, USA,
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Weight expectations, motivations for weight change and perceived factors influencing weight management in young Australian women: a cross-sectional study. Public Health Nutr 2015; 19:275-86. [PMID: 25945547 DOI: 10.1017/s1368980015000993] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income. DESIGN Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight. SETTING Online survey in Australia. SUBJECTS Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012. RESULTS Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management. CONCLUSIONS The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.
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Casazza K, Brown A, Astrup A, Bertz F, Baum C, Brown MB, Dawson J, Durant N, Dutton G, Fields DA, Fontaine KR, Heymsfield S, Levitsky D, Mehta T, Menachemi N, Newby PK, Pate R, Raynor H, Rolls BJ, Sen B, Smith DL, Thomas D, Wansink B, Allison DB. Weighing the Evidence of Common Beliefs in Obesity Research. Crit Rev Food Sci Nutr 2015; 55:2014-53. [PMID: 24950157 PMCID: PMC4272668 DOI: 10.1080/10408398.2014.922044] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.
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Affiliation(s)
- Krista Casazza
- a Department of Nutrition Sciences , University of Alabama at Birmingham , Birmingham , Alabama USA
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Bonsaksen T, Fagermoen MS, Lerdal A. Factors associated with self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease: a cross-sectional study. PSYCHOL HEALTH MED 2014; 20:431-42. [PMID: 25220791 DOI: 10.1080/13548506.2014.959529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Living with chronic illnesses can be stressful and may negatively impact persons' self-esteem. Personal factors, like self-efficacy and illness perceptions, and also factors related to the environment, activity, and participation may be associated with self-esteem in chronic illness populations. This cross-sectional comparative study explored sociodemographic variables, work, physical activity, illness perceptions, and general self-efficacy in relation to self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD). The study had a cross-sectional design. A total of 223 eligible participants were recruited from patient education courses, and data were collected at baseline. Self-esteem was measured with The Rosenberg self-esteem scale; the general self-efficacy scale was used to measure self-efficacy, and brief illness perception questionnaire was also used. This is an instrument assessing cognitions about the illness and emotional responses towards it. Multivariate linear regression was used in the statistical analyses. In obese participants (n = 134), higher self-esteem was associated with lower emotional response, a shorter timeline, and higher general self-efficacy. In COPD participants (n = 89), higher self-esteem was associated with higher general self-efficacy. The independent variables accounted for 42.9% (morbid obesity) and 49.4% (COPD) of the self-esteem variance. In participants in both illness groups, higher self-efficacy was associated with increased self-esteem. A shorter timeline and lower emotional response to illness was related to higher self-esteem only for the obese participants. The results indicate that believing in one's capacity to cope with everyday challenges is important for self-esteem in persons with morbid obesity and in persons with COPD, whereas illness perceptions related to the duration of illness and the coping with emotions also is important for self-esteem in persons with morbid obesity.
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Affiliation(s)
- Tore Bonsaksen
- a Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
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Ortner Hadžiabdić M, Mucalo I, Hrabač P, Matić T, Rahelić D, Božikov V. Factors predictive of drop-out and weight loss success in weight management of obese patients. J Hum Nutr Diet 2014; 28 Suppl 2:24-32. [DOI: 10.1111/jhn.12270] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ortner Hadžiabdić
- Centre for Applied Pharmacy; Faculty of Pharmacy and Biochemistry; University of Zagreb; Zagreb Croatia
| | - I. Mucalo
- Centre for Applied Pharmacy; Faculty of Pharmacy and Biochemistry; University of Zagreb; Zagreb Croatia
| | - P. Hrabač
- Croatian Institute for Brain Research; School of Medicine; University of Zagreb; Zagreb Croatia
| | - T. Matić
- Department of Endocrinology, Diabetes and Metabolism Disorders; Dubrava University Hospital; Zagreb Croatia
| | - D. Rahelić
- Department of Endocrinology, Diabetes and Metabolism Disorders; Dubrava University Hospital; Zagreb Croatia
| | - V. Božikov
- Department of Endocrinology, Diabetes and Metabolism Disorders; Dubrava University Hospital; Zagreb Croatia
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Karl JP, Cheatham RA, Das SK, Hyatt RR, Gilhooly CH, Pittas AG, Lieberman HR, Lerner D, Roberts SB, Saltzman E. Effect of glycemic load on eating behavior self-efficacy during weight loss. Appetite 2014; 80:204-11. [DOI: 10.1016/j.appet.2014.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 03/28/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
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López-Guimerà G, Dashti HS, Smith CE, Sánchez-Carracedo D, Ordovas JM, Garaulet M. CLOCK 3111 T/C SNP interacts with emotional eating behavior for weight-loss in a Mediterranean population. PLoS One 2014; 9:e99152. [PMID: 24905098 PMCID: PMC4048277 DOI: 10.1371/journal.pone.0099152] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 05/12/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goals of this research was (1) to analyze the role of emotional eating behavior on weight-loss progression during a 30-week weight-loss program in 1,272 individuals from a large Mediterranean population and (2) to test for interaction between CLOCK 3111 T/C SNP and emotional eating behavior on the effectiveness of the weight-loss program. DESIGN AND METHODS A total of 1,272 overweight and obese participants (BMI: 31±5 kg/m2), aged 20 to 65 years, attending outpatient weight-loss clinics were recruited for this analysis. Emotional eating behavior was assessed by the Emotional Eating Questionnaire (EEQ), a questionnaire validated for overweight and obese Spanish subjects. Anthropometric measures, dietary intake and weight-loss progression were assessed and analyzed throughout the 30-week program. Multivariate analysis and linear regression models were performed to test for gene-environment interaction. RESULTS Weight-loss progression during the 30-week program differed significantly according to the degree of emotional eating behavior. Participants classified as 'very emotional eaters' experienced more irregular (P = 0.007) weight-loss, with a lower rate of weight decline (-0.002 vs. -0.003, P<0.05) in comparison with less emotional eaters. The percentage of weight-loss was also significantly higher in 'non-emotional eaters' (P = 0.009). Additionally, we identified a significant gene-environment interaction associated with weight-loss at the CLOCK 3111 T/C locus (P = 0.017). By dichotomizing the emotional eating behavior score, linear regression analysis indicated that minor C allele carriers with a high emotional score (> = 11), lost significantly less weight than those C carriers with a low emotional score (<11) (P = 0.005). CONCLUSIONS Emotional eating behavior associates with weight-loss pattern, progression and total weight-loss. Additionally, CLOCK 3111 T/C SNP interacts with emotional eating behavior to modulate total weight loss. These results suggest that the assessment of this locus and emotional eating behavior could improve the development of effective, long-tern weight-management interventions.
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Affiliation(s)
- Gemma López-Guimerà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hassan S. Dashti
- Nutrition and Genomics Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, at Tufts University, Boston, Massachusetts, United States of America
| | - Caren E. Smith
- Nutrition and Genomics Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, at Tufts University, Boston, Massachusetts, United States of America
| | - David Sánchez-Carracedo
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose M. Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, at Tufts University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Centro Nacional Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Instituto Madrileño de Estudios Avanzados en Alimentación (IMDEA-FOOD), Madrid, Spain
| | - Marta Garaulet
- Department of Physiology, University of Murcia, Murcia, Spain
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Barte JCM, Veldwijk J, Teixeira PJ, Sacks FM, Bemelmans WJE. Differences in Weight Loss Across Different BMI Classes:A Meta-analysis of the Effects of Interventions with Diet and Exercise. Int J Behav Med 2014; 21:784-93. [DOI: 10.1007/s12529-013-9355-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brantley PJ, Stewart DW, Myers VH, Matthews-Ewald MR, Ard JD, Coughlin JW, Jerome GJ, Samuel-Hodge C, Lien LF, Gullion CM, Hollis JF, Svetkey LP, Stevens VJ. Psychosocial predictors of weight regain in the weight loss maintenance trial. J Behav Med 2014; 37:1155-68. [PMID: 24722826 DOI: 10.1007/s10865-014-9565-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
This study's purpose was to identify psychosocial predictors of weight loss maintenance in a multi-site clinical trial, following a group-based weight loss program. Participants (N = 1025) were predominately women (63%) and 38% were Black (mean age = 55.6 years; SD = 8.7). At 12 months, higher SF-36 mental health composite scores were associated with less weight regain (p < .01). For Black participants, an interaction existed between race and friends' encouragement for exercise, where higher exercise encouragement was related to more weight regain (p < .05). At 30 months, friends' encouragement for healthy eating was associated with more weight regain (p < .05), whereas higher SF-36 mental health composite scores were related to less weight regain (p < .0001). Perceived stress and select health-related quality of life indices were associated with weight regain; this relationship varied across gender, race, and treatment conditions. Temporal changes in these variables should be investigated for their impact on weight maintenance.
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Affiliation(s)
- Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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Colombo O, Ferretti VV, Ferraris C, Trentani C, Vinai P, Villani S, Tagliabue A. Is drop-out from obesity treatment a predictable and preventable event? Nutr J 2014; 13:13. [PMID: 24490952 PMCID: PMC3914843 DOI: 10.1186/1475-2891-13-13] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/28/2014] [Indexed: 11/16/2022] Open
Abstract
Background Attrition is an important but understudied issue that plays a vital role in the successful treatment of obesity. To date, most studies focusing on attrition rates and/or its predictors have been based on pretreatment data routinely collected for other purposes. Our study specifically aims at identifying the predictors of drop-out focusing on empirically or theoretically-based factors. Methods We conducted a retrospective observational study in an academic outpatient clinical nutrition service in Pavia, Italy. We examined a total of 98 adult obese patients (36 males, 62 females) who underwent a 6-month dietary behavioral weight-loss treatment at our Center. Pre-treatment and treatment-related variables were collected or calculated from clinical charts in order to discriminate those subjects who completed treatment from those who abandoned it before its completion. Multivariable regression analysis was used to identify the independent predictors of drop-out. Results The drop-out rates were 21% at 1 month and 57% at 6 months. Compared with completers, noncompleters were significantly younger in terms of age at first dieting attempt (24.0 ± 10.7 vs. 31.3 ± 11.2 years, P = 0.005), had lower diastolic blood pressure (87.8 ± 9.7 vs. 92.7 ± 11.4 mmHg, P = 0.022), had a lower baseline body fat percentage (38.5 ± 6.4 vs. 41.2 ± 4.4% weight, P = 0.015), and had a lower percentage of early weight loss (-1.8 ± 1.8% vs. -3.1 ± 2.1%, P = 0.035). Moreover, noncompleters significantly differed from completers with regard to type of referral (34.1% vs. 53.3% sent by a physician, P = 0.036) and SCL-90 anger-hostility subscale (0.83 ± 0.72 vs. 0.53 ± 0.51, P = 0.022). A multivariable logistic regression analysis including pre-treatment variables showed that body fat percentage (P = 0.030) and SCL-90 anger-hostility subscale (P = 0.021) were independently associated with attrition. In a multivariable model considering both pre-treatment and treatment-related factors, attrition was found to be independently related to the age at first dieting attempt (P = 0.016) and the achievement of early weight loss (P = 0.029). Conclusions Our data confirm that psychopathological tracts, early dieting attempts, and a poor initial treatment response are key independent predictors of drop-out from obesity treatment.
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Affiliation(s)
| | | | | | | | | | | | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, via A, Bassi, 21, I-27100 Pavia, Italy.
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Vilhena E, Pais-Ribeiro J, Silva I, Cardoso H, Mendonça D. Predictors of quality of life in Portuguese obese patients: a structural equation modeling application. J Obes 2014; 2014:684919. [PMID: 24693421 PMCID: PMC3945172 DOI: 10.1155/2014/684919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 01/26/2023] Open
Abstract
Living with obesity is an experience that may affect multiple aspects of an individual's life. Obesity is considered a relevant public health problem in modern societies. To determine the comparative efficacy of different treatments and to assess their impact on patients' everyday life, it is important to identify factors that are relevant to the quality of life of obese patients. The present study aims to evaluate, in Portuguese obese patients, the simultaneous impact of several psychosocial factors on quality of life. This study also explores the mediating role of stigma in the relationship between positive/negative affect and quality of life. A sample of 215 obese patients selected from the main hospitals in Portugal completed self-report questionnaires to assess sociodemographic, clinical, psychosocial, and quality of life variables. Data were analysed using structural equation modeling. The model fitted the data reasonably well, CFI = 0.9, RMSEA = 0.06. More enthusiastic and more active patients had a better quality of life. Those who reflect lower perception of stigma had a better physical and mental health. Partial mediation effects of stigma between positive affect and mental health and between negative affect and physical health were found. The stigma is pervasive and causes consequences for psychological and physical health.
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Affiliation(s)
- Estela Vilhena
- Polytechnic Institute of Cávado and Ave, 4750-810 Barcelos, Portugal
- ICBAS, University of Porto, 4050-313 Porto, Portugal
- ISPUP, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- *Estela Vilhena:
| | - José Pais-Ribeiro
- Faculty of Psychology and Educational Sciences, University of Porto, 4200-135 Porto, Portugal
- UIPES, 1140-041 Lisbon, Portugal
| | - Isabel Silva
- University of Fernando Pessoa, 4249-004 Porto, Portugal
| | - Helena Cardoso
- UMIB/ICBAS and Hospital Santo António/CHP, 4099-001 Porto, Portugal
| | - Denisa Mendonça
- ICBAS, University of Porto, 4050-313 Porto, Portugal
- ISPUP, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
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Steinsbekk S, Odegård R, Wichstrøm L. Treatment of obesity in children: Parent's perceived emotional barriers as predictor of change in body fat. Obes Res Clin Pract 2013; 5:e169-266. [PMID: 24331105 DOI: 10.1016/j.orcp.2011.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/17/2011] [Accepted: 03/03/2011] [Indexed: 01/01/2023]
Abstract
SUMMARY AIM Research supports the use of family-based interventions in the treatment of obesity in children, but there is a lack of knowledge about what factors affect parents' ability to carry out the lifestyle changes necessary to reduce their child's obesity. The aim of the present study was to examine whether parents' self-efficacy, perceived emotional barriers, subjective norms, and attitudes could predict change in their children's body fat at 6 month and 2 year follow-ups after a family-based treatment of obesity. METHODS Body Mass Index Standard Deviation Scores (BMI SDS) were calculated and body fat (dual-energy X-ray absorptiometry) were measured in 99 treatment-seeking children with obesity (ages 7-12; 48 girls, 51 boys; mean BMI SDS = 2.99) at baseline, after 6 month and after 2 year follow-up. Parental cognitions regarding diet and physical activity were examined by parent-completed questionnaires. Structural equation modeling (SEM) was used to test whether the selected health cognitions could predict treatment outcome. RESULTS Parental perceived emotional barriers was a significant predictor of change in body fat at 6 month (β = -.32, p = .001) and 2 year (β = -.38, p = .002) follow-up when the initial body fat values were controlled. Self-efficacy, subjective norms and attitudes did not improve the amount of variance explained. CONCLUSION Parents' perceived emotional barriers significantly predict change in total body fat in children treated for obesity. In order to increase treatment-efficacy, perceived emotional barriers should be addressed.
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Affiliation(s)
- Silje Steinsbekk
- Dept. of Child- and Adolescent Psychiatry, St. Olavs Hospital, Olav Kyrres gt 17, 7030 Trondheim, Norway.
| | - Rønnaug Odegård
- Dept. of Laboratory Medicine, Children's and Women's Health, 7433 Trondheim, Norway
| | - Lars Wichstrøm
- Dept. of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll, 7491 Trondheim, Norway
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Clum GA, Rice JC, Broussard M, Johnson CC, Webber LS. Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women. J Behav Med 2013; 37:577-86. [DOI: 10.1007/s10865-013-9526-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 07/16/2013] [Indexed: 11/28/2022]
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Durant NH, Joseph RP, Affuso OH, Dutton GR, Robertson HT, Allison DB. Empirical evidence does not support an association between less ambitious pre-treatment goals and better treatment outcomes: a meta-analysis. Obes Rev 2013; 14:532-40. [PMID: 23601605 PMCID: PMC4366879 DOI: 10.1111/obr.12038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/13/2013] [Accepted: 03/06/2013] [Indexed: 01/01/2023]
Abstract
Setting realistic weight loss goals may play a role in weight loss. We abstracted data from randomized controlled trials and observational studies conducted between 1998 and 2012 concerning the association of weight loss goals with weight loss. Studies included those that (i) were conducted in humans; (ii) delivered a weight loss intervention; (iii) lasted ≥6 weeks; (iv) assessed baseline weight loss goals; (vi) assessed pre- and post-weight either in the form of body mass index or some other measure that could be converted to weight loss based on information included in the original study or later provided by the author(s); and (vii) assessed the correlation between weight loss goals and final weight loss or provided data to calculate the correlation. Studies that included interventions to modify weight loss goals were excluded. Eleven studies met inclusion criteria. The overall correlation between goal weight and weight at intervention completion was small and statistically insignificant (ρ=0.0 5 ; P = 0.20). The current evidence does not demonstrate that setting realistic goals leads to more favourable weight loss outcomes. Thus, our field may wish to reconsider the value of setting realistic goals in successful weight loss.
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Affiliation(s)
- N H Durant
- School of Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Ehrmann DE, Sallinen BJ, IglayReger HB, Gordon PM, Woolford SJ. Slow and steady: readiness, pretreatment weekly strengthening activity, and pediatric weight management program completion. Child Obes 2013; 9:193-9. [PMID: 23635312 DOI: 10.1089/chi.2013.0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. METHODS A total of 146 obese (BMI≥95(th) percentile) pediatric (ages 11-18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. RESULTS The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51-6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06-5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74-13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45-15.14, p=0.010). No relationship was found between other forms of exercise and program completion. CONCLUSIONS Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.
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Niva M, Jauho M, Mäkelä J. “If I drink it anyway, then I rather take the light one”. Appropriation of foods and drinks designed for weight management among middle-aged and elderly Finns. Appetite 2013; 64:12-9. [DOI: 10.1016/j.appet.2012.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 12/19/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
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Incledon E, Gerner B, Hay M, Brennan L, Wake M. Psychosocial predictors of 4-year BMI change in overweight and obese children in primary care. Obesity (Silver Spring) 2013; 21:E262-70. [PMID: 23404919 DOI: 10.1002/oby.20050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 08/10/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to determine whether (1) initial and/or (2) changes in psychosocial functioning predict body mass index (BMI) z-score change over 4 years in overweight/mildly obese 5- to 9-year old children presenting to primary care. DESIGN AND METHODS Eligible participants (n = 258) were overweight/mildly obese children (IOTF criteria) recruited into the LEAP2 trial (ISRCTN52511065) from 3,958 children visiting general practitioners in Melbourne, Australia from May 2005 to July 2006. Predictors were change scores calculated from repeated measures of parent- and child-reported child health-related quality of life (PedsQL) and self-esteem; child-reported desire to be thinner; and parent-reported child weight concern. Outcome was measured BMI z-score change from baseline to 4 years. RESULTS The 189 respondents (61% female; 73% retention) showed little mean change in BMI z-score (-0.08) but wide variation (standard deviation 0.50, range -1.32 to 1.20). Only one baseline measure (better parent-reported PedsQL School Functioning) predicted improving BMI z-score. However, parents and children consistently reported that changes in psychosocial functioning (i.e., PedsQL Social and Global Self-esteem) were inversely related to BMI z-score change scores. The strongest predictors of decreases in BMI z-scores were changes in child-reported body-image variables, i.e., improvements in Physical Appearance Self-esteem (β =0.40, 95% CI -0.98 to -0.15, P < 0.01) and declines in Desire to be Thinner (β = 0.33, 95% CI 0.04 to 0.23, P < 0.01). CONCLUSIONS At presentation to primary care, it seems unlikely that targeting the psychosocial factors measured in this study would influence BMI z-score change in overweight/mildly obese children. Subsequent change in psychosocial well-being covaries with BMI z-score change and may have important adolescent ramifications; the causal directions for these associations require further research.
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Affiliation(s)
- Emily Incledon
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria 3800, Australia
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Latner JD, Ciao AC. Weight-loss history as a predictor of obesity treatment outcome: prospective, long-term results from behavioral, group self-help treatment. J Health Psychol 2013; 19:253-61. [PMID: 23297394 DOI: 10.1177/1359105312468191] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Weight-loss history was examined as a predictor of outcome in group self-help obesity treatment. Participants (n = 128; 83% women; mean body mass index = 34.2 kg/m(2); mean age = 47.2 years) in self-help, group behavioral weight-loss treatment reported a mean of 5.1 prior weight-loss attempts and lost 13.8 percent of initial weight in current treatment. A greater number of past attempts independently predicted greater 6-month, 18-month, and intent-to-treat weight losses. Greater magnitude of largest past loss predicted greater 18-month weight loss. In contrast to studies on professional treatment, group self-help participants might benefit from repeated weight-loss efforts despite previous failures.
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Toth-Capelli KM, Brawer R, Plumb J, Daskalakis C. Stage of change and other predictors of participant retention in a behavioral weight management program in primary care. Health Promot Pract 2012; 14:441-50. [PMID: 23091300 DOI: 10.1177/1524839912460871] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High attrition often limits the efficacy of weight management programs, particularly those that serve primary care patients. We investigated stage of change and other predictors of retention in a behavioral intervention program that enrolled adult obese patients at three primary care sites. The program included practice improvements and provider training, as well as individual lifestyle counseling and educational group classes for participants. We analyzed predictors of whether participants returned for counseling visits and whether they attended group classes. The 461 participants were mainly women (84%) and minorities (87%), and most of them were in the preparation stage for dietary and physical activity changes. A total of 134 (29%) participants returned for at least one follow-up visit with their counselor and 85 (18%) attended at least one class. Baseline stage of change was not significantly associated with either return visits or class attendance (p = .875 and .182, respectively). Men and participants with children in the household were less likely to return for subsequent counseling sessions (p = .012 and .027, respectively). Age and employment were associated with class attendance (p = .099 and .034, respectively). Focus groups with participants confirmed that reasons for dropout included physical limitations or health issues, family issues, stress, and lack of social support. We conclude that prescreening of patients for readiness to participate and attention to personal barriers related to family and work might improve program retention. More frequent contacts between visits and stronger provider engagement might also strengthen the intervention.
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