Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss

Temporal Aspects of Psychosocial Mediators of the Exercise-Weight Loss Maintenance Relationship Within Scalable Behavior-Change Treatments

STUDY BACKGROUND

Limited knowledge of psychological correlates of weight loss is associated with continuing failures of behavioral obesity treatments beyond the short term.

PURPOSE

This study aimed to inform health professionals' obesity interventions via an increased knowledge of mediators of the exercise-weight loss maintenance relationship.

METHODS

Women participated in 6-month obesity treatments within community settings emphasizing moderate exercise and self-regulation skills development via primarily in-person (n = 54) or primarily written (n = 54) means. Changes in mood, self-regulating eating, and weight over 6, 12, and 24 months were assessed. A moderated mediation model was tested using the PROCESS macro instruction.

RESULTS

Improvements in mood, self-regulating eating, and weight were significantly greater in the in-person group. The relationship between a dichotomous measure of completing at least 3 sessions of exercise per week (or not) and change in weight over 6 months was no longer significant when the mediators of changes in negative mood and self-regulation of eating were sequentially entered. Paths of exercise→negative mood reduction→eating self-regulation increase→weight loss over 6, 12 and 24 months were significant. Exercise self-regulation at Month 3 significantly moderated the mood change→eating self-regulation change relationship.

CONCLUSIONS

Based on the identified paths, scalable obesity-treatment content and emphases were informed. This could help guide health professionals' actions concerning the management of obesity.

Impacts of early psychological changes on correlates of weight-loss maintenance: Seeking increased precision for sustained behavioural obesity treatment effects

ISSUE ADDRESSED

Obesity is an increasing worldwide health issue. In affluent English-speaking countries, obesity ranges from ~28% (Australia) to ~42% (United States) of the adult population. Enabling weight loss beyond an initial 6 months is an unresolved challenge.

METHODS

Women with obesity participated in community-based obesity treatments incorporating either cognitive-behavioural methods emphasizing self-regulatory skills development (n = 106) or typical information/education processes (n = 47). Psychosocial, behavioural, and weight changes were measured.

RESULTS

Significant overall improvements in exercise-related self-regulation and self-efficacy, mood, physical activity/exercise (PA/exercise), diet, and weight were found from baseline-month 6 (weight-loss phase) and baseline-month 12, but not from months 6-12 (weight-loss maintenance phase). Significantly greater improvements were found in the cognitive-behavioural group. Within the weight-loss phase, changes in both PA/exercise and diet significantly contributed to the explained variance in weight loss, whereas within the weight-loss maintenance phase, only change in PA/exercise was a significant predictor. There was no significant relationship of weight loss across phases. Months 6-12 change in PA/exercise significantly mediated relationships of changes in self-regulation→weight, mood→weight, and self-efficacy→weight. Earlier scores and score changes in mood and self-efficacy significantly impacted the subsequent parallel relationships.

CONCLUSIONS

Cognitive-behavioural methods affect psychosocial changes leading to initial changes in diet, PA/exercise, and weight. Those changes then impact subsequent changes in PA/exercise-a primary malleable correlate of maintained weight loss. SO WHAT?: This research extended previous findings to better-inform behavioural obesity-treatment foci to address the pervasive public health problem of attaining and sustaining weight loss. Findings related to PA/exercise will help impact health-promotion outcomes.

Effects of cardiovascular exercise on eating behaviours: Accounting for effects on stress, depression-, and anger-related emotional eating in women with obesity

Obesity remains a medical issue of great concern. Behavioural methods attempting to induce weight loss have largely failed because of a minimal understanding of stress- and depression-associated psychosocial correlates. This study extended research into the effects of exercise on weight loss through psychological pathways to improve treatments. Women with obesity (N = 108), participating in an original theory-driven cognitive-behavioural treatment within community-based health promotion centres, were evaluated over 24 months. Their mean scores on anxiety, depression, and anger at baseline were significantly higher than normative data from a general sample of United States women. Three serial mediation models were specified assessing mediation of the significant exercise→dietary change relationship. These yielded two significant paths: changes in exercise→anxiety→anxiety-associated emotional eating→self-efficacy→diet, and changes in exercise→depression→depression-associated emotional eating→self-efficacy→diet; and one non-significant path: changes in exercise→anger→anger-associated emotional eating→self-efficacy→diet. In a subsequent moderated moderation model, change in eating-related self-regulation moderated the relationship between changes in anxiety and anxiety-associated emotional eating, where exercise-associated self-regulation moderated effects from eating-related self-regulation. Dietary improvement was significantly related to weight loss over 6 (β = -0.40), 12 (β = -0.42), and 24 (β = -0.33) months. Findings indicated an increased treatment focus on the completion of moderate amounts of exercise for weight loss and, following that, attention to improvements in anxiety, depression, anxiety- and depression-associated emotional eating, self-efficacy for controlled eating, and the transfer of exercise-related self-regulation to eating-related self-regulation. Given the scope of the obesity problem, extensions of this research within field settings are warranted to accelerate application opportunities.

Obesity treatment-associated transfer of exercise-related self-regulation to eating-related self-regulation changes in women

Obesity in the United States has risen to 42 percent of its adult population and is similarly problematic in many other countries. Although the U.S. government has provided education on healthy eating and the need to exercise regularly, behavioral obesity treatments have largely failed to sustain reductions in weight. Self-regulation, and the incorporation of exercise for its psychological impacts on eating, has sometimes been targeted. While there has been sporadic investigation into the carry-over of exercise-related self-regulation to eating-related self-regulation, the present aim is to further inquiry in that area to inform future treatment content for improved effects. Women enrolled in community-based obesity treatments with either a self-regulation (n = 106) or education (n = 54) focus were assessed on changes in exercise- and eating-related self-regulation, negative mood, completed exercise, and weight. Improvements were significantly greater in the self-regulation-focused group. After controlling for initial change in eating-related self-regulation, change in that measure from Month 3 to 6 was significantly predicted by change in exercise-related self-regulation during the initial 3 treatment months. This suggested a carry-over effect. A stronger predictive relationship was associated with the self-regulation-focused treatment. In further analyses, paths from changes in exercise→negative mood→self-regulation of both exercise and eating were significant. Increase in eating-related self-regulation was significantly associated with weight loss over 6, 12, and 24 months. The self-regulation-focused group had stronger relationships, again. Findings suggested utility in targeting exercise-related self-regulation to impact later change in eating-related self-regulation, and the use of exercise-associated mood improvement to bolster participants' self-regulation capabilities.

Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants' change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants' changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

Behavioral and Psychosocial Mediators of the Effects of Increased Self-Regulation on Short- and Long-Term Weight Loss in Women Within Community-Based Obesity Treatments

The aim of this study was to evaluate behavioral mediators of relationships between increased self-regulation of eating and weight loss so that findings on psychosocial correlates of treatment-associated weight change could be extended. Participants were women enrolled in 6-month community-based obesity treatments using primarily self-regulatory (SR-treatment, n = 52) or education-focused (Didactic training, n = 54) methods. Changes from baseline in self-regulation of eating, self-efficacy for controlled eating, emotional eating propensity, exercise, and the diet were first calculated. There were significant overall improvements in each psychosocial and behavioral measure, and weight. Except for emotional eating change from baseline-Month 12, improvements were each significantly greater in the SR-treatment group. Mediation of the relationships of change in self-regulation with 6-, 12-, and 24-month weight changes, by changes in self-efficacy and emotional eating, were significant, R2s = .19-.26, ps < .001. Only changes in emotional eating over 6 and 12 months were significant mediators. Mediations of the same self-regulation-weight change relationships by changes in exercise and the diet were also significant, R2s = .19-.28, ps < .001, and only changes in exercise over 12 and 24 months were significant mediators. Although group membership did not moderate effects on weight, substitution of sweets for the (composite) diet demonstrated it to be a significant mediator over 6 and 12 months. In women with obesity, self-regulation improvement was associated with short- and longer-term weight loss through changes in emotional eating, exercise, and sweets consumption. Thus, behavioral treatments will benefit from targeting those variables.

Self-regulatory and self-efficacy mechanisms of weight loss in women within a community-based behavioral obesity treatment

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy-primary targets of that intervention-with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12 months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested.

Carry-Over of Exercise-Related Self-Regulation to Eating-Related Self-Regulation in Women Participating in Behavioral Obesity Treatments

Purpose: Because obesity has not responded well to instructing affected adults in healthier eating behaviors and increased physical activity/exercise, enhanced research on psychosocial determinants of those behavioral changes is needed. Intervention foci on self-regulation have been suggested, but targeted research is required. Method: Women with obesity participated in community-based treatments that were either self-regulation-focused (self-regulation emphasis group; n = 52) or typical instruction-based (education [treatment-as-usual] group; n = 54). Results: There were overall significant increases in exercise-related self-regulation, physical activity/exercise, exercise-related self-efficacy, and eating-related self-regulation that were each significantly more pronounced in the self-regulation emphasis group. Increase in exercise-related self-regulation over 3 months predicted eating-related self-regulation over 6 months; however, sequential entry of changes in physical activity and exercise-related self-efficacy significantly mediated that relationship. However, only the path from changes in exercise-related self-regulation to exercise self-efficacy to eating-related self-regulation was significant. In a revised model where change in exercise self-efficacy was the sole mediator, treatment group did not significantly moderate the exercise self-regulation to eating self-regulation change relationship, but full mediation of that relationship occurred. Conclusion: Findings indicated salience for perceived ability/self-efficacy for physical activity, over actual physical activity progress, and its role in the transfer of self-regulatory skills from an exercise to eating context. Increased eating self-regulation significantly predicted weight loss over 6, 12, and 24 months. In the self-regulation emphasis group that translated to meaningful weight loss/weight-loss maintenance of greater than 5% of initial weight. Findings contributed to an increased understanding of psychosocial-change processes within obesity treatment research.

The Role of Change in Self-efficacy in Maintaining Exercise-Associated Improvements in Mood Beyond the Initial 6 Months of Expected Weight Loss in Women with Obesity

BACKGROUND

Although mechanisms are unclear, there is a robust association between exercise and mood improvements. However, beyond ~ 6 months of expected weight loss, weight-management behaviors such as exercise wane as weight gradually regains in most adults. The amount of exercise required to maintain mood improvement is unknown, as is the possible role of theory-based psychosocial changes associated with treatment such as in self-efficacy.

METHODS

Women who volunteered for a community-based cognitive-behavioral obesity treatment emphasizing exercise and building self-efficacy via self-regulating through lifestyle challenges/barriers, and were of the 86% who reduced their negative mood during its initial 6 months, were allocated into groups who either maintained their negative mood reduction (Sustain group, n = 43) or reverted toward initial levels of negative mood (Revert group, n = 73) during months 6-24. A binary stepwise logistic regression analysis assessed whether exercise amount and/or change in self-efficacy significantly classified Sustain vs. Revert group membership.

RESULTS

Change in exercise amount was not significantly associated with group membership. However, after additional entry of change in exercise self-efficacy, a significant association was found - successfully classifying 70% and 42% of the Revert and Sustain group participants, respectively. When self-efficacy change was entered as the sole independent variable, group membership was classified with 62% accuracy, overall (96% in the Revert group).

CONCLUSIONS

Consistent with behavioral explanations of the exercise-mood change relationship, it was interpreted that self-efficacy, rather than exercise amount, was an important correlate of mood change beyond month 6. Suggestions for bolstering self-efficacy later in behavioral obesity treatments were provided.

Coaction of Exercise and Eating Improvements Within a Behavioral Obesity Treatment: Directionality and Psychological Mechanisms

Purpose: Because coaction (a favorable change in one behavior increasing the probability of a similarly favorable change in another behavior) associated with health behaviors has been identified, directionalities of such relationships within weight-loss behaviors (e.g., exercise, healthy eating) and their theory-based psychological mechanisms requires more investigation. Method: Women with obesity and either disturbed mood (n = 61) or normal mood (n = 58) participated in a cogntive-behavioral weight-management treatment within a community setting. Analyses of both group differences, and mediation models using aggregate data of behavioral and psychological variables, were conducted. Results: Improvements in measures of self-regulation, self-efficacy, mood, exercise, and fruit/vegetable intake were significant overall; with fruit/vegetable increase greater in the disturbed mood group. The prediction of increase in fruits/vegetables from baseline-Month 6 by increase in exercise from bascline-Month 3 (β = .24) was stronger than effects of change in fruit/vegetabe intake on exercise (β = .16). Overall mediation models were significant where changes in self-regulation and self-efficacy were entered as serial mediators of predictions of fruit/vegetable change by change in exercise (R2= .35 and .32), and vice versa (R2= .24 and .23). Paths demonstrating effects through self-regulation change and self-efficacy change were significant in the prediction of eating and exercise changes, respectively. Conclusion: Contributions to advancements in behavioral theory and treatment curricula targeting self-regulation and self-efficacy to improve exercse-eating change relationships were suggested.  .

Theory to treatment to theory: Evolving a community-based obesity intervention

Within weight-loss treatments, a better understanding of psychosocial correlates of exercise and controlled eating is required to improve lagging outcomes. Within this two-phase study, women with obesity participating in community-based treatments with educational (Phase 1 n = 57, Phase 2 n = 44) and behavioral (Phase 1 n = 80, Phase 2 n = 53) formats were contrasted on psychosocial variables over 3 and 6 months and their interrelations based on the mood-behavior-model and coaction theory. Phase 1 findings informed curricular extensions in Phase 2. In Phase 1, there were significant overall improvements in total mood disturbance, self-regulation of exercise, self-regulation of eating, and weight, which were more pronounced in the behavioral vs. educational format group (-3.5 % vs. -1.4 % weight loss, respectively). Mediation analyses indicated that change in self-regulation of exercise mediated the prediction of change in self-regulation of eating by mood change. Phase 2 findings were similar; however, effect sizes were greater (-6.2 % vs. -2.9 % weight loss, respectively). Within both phases, increased self-regulation of eating significantly predicted weight reduction. Paths from changes in mood→self-regulation of exercise→self-regulation of eating suggested future program attention focus on treatment-associated mood change reinforcing self-regulation, and self-regulation generalizing from an exercise to eating context. Methods of progressing treatment curricula via theory-testing were suggested.

Effects of women's age on their emotional eating changes within a self-regulation-focused obesity treatment

Results of behavioral obesity treatments have generally been unsuccessful. Reduction of participants' emotional eating (EE) might be essential. Women with obesity within age-groups of emerging adult, young adult, and middle-aged adult - participating in a community-based obesity treatment centered around self-regulatory skills to control eating - were evaluated over 6 months. There were significant reductions in participants' EE and eating-related self-regulation. Participants' change in self-regulation significantly predicted their changes in depression-related, anxiety-related, and total EE. Participants' age group did not significantly affect either their degree of improvement or self-regulation-EE change relationships. Emphasizing self-regulatory skills development for the control of EE, regardless of age-group in women, was suggested by the study authors.

Emotional Eating: Psychosocial Bases, Accordingly Directed Treatment Design, and Longitudinal Effects in Women with Obesity

Emotional eating (eating triggered by adverse mood) might be an important psychosocial variable to address to improve overwhelmingly deficient obesity treatment outcomes in women. However, emotional eating has rarely been focused upon in a systematic, evidence-based manner. Within Part 1 of this field-based study completed within community health-promotion centers the United States, a treatment protocol was developed targeting negative mood, body satisfaction, and self-efficacy to resist negative emotion-related eating (SE-NegEm), which were the significant psychosocial predictors of emotional eating found at baseline in the women participants with obesity. A comparison condition consisted of matched treatment time, but focused upon typical processes of providing education in healthy eating and exercise. Cluster sampling allocated participants to either the treatment group (n = 100) or comparison group (n = 86). In Part 2, overall improvements in mood, body satisfaction, SE-NegEm, and emotional eating were found to be significant, and significantly more pronounced in the treatment group. In parallel multiple mediation analyses incorporating aggregated data, changes from baseline-Month 3 and baseline-Month 6 in negative mood, body satisfaction, and SE-NegEm significantly mediated relationships between group and changes in emotional eating from baseline-Month 6 and baseline-Month 12, respectively. Changes in body satisfaction and SE-NegEm were significant independent mediators for 6-month change, with negative mood change additionally significant for 12-month change. Reduced emotional eating significantly predicted lost weight, which was greater in the treatment group (- 5.8% vs. - 0.9%). The present process of tailoring and testing treatment content based on earlier-identified predictors of emotional eating was supported.

Contrasts of Initial and Gain Scores in Obesity Treatment-Targeted Psychosocial Variables by Women Participants' Weight Change Patterns Over 2 Years

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model-based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity- and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model-based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24-a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.

You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review

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.

Psychological Mechanisms of Interactions between Improvements in Exercise and Healthy Eating Behaviors (Coaction) within a Community-Based Obesity Treatment Setting

Coaction refers to positive change in one behavior increasing the probability of positive change in a second behavior. Because mechanisms of coaction have not been well studied, and its improved comprehension might optimize architectures of multi-component behavioral obesity interventions, this research aimed to incorporate theory to assess whether treatment-associated changes in self-regulation and self-efficacy sequentially mediate an association between increased exercise and improved eating. Women with obesity (Mean age = 47.9 years) were randomized into community-based obesity treatments with either a self-regulatory skills emphasis (n = 47), or a more equal focus on education and self-management (n = 52). Each treatment aimed to foster weight loss and reductions in health risks. Over 6 months, there were significant improvements in exercise outputs, fruit/vegetable consumption, sweets intake, exercise- and eating-related self-regulation, and exercise- and eating-related self-efficacy that were significantly greater in the high self-regulation group. Using aggregated data, bivariate relationships between changes in exercise, and fruit/vegetable and sweets intake, were significant. Serial mediation analyses indicated that increased exercise outputs were associated with improved eating through the sequential relationships of eating-related self-regulation and self-efficacy, while improved eating was associated with increased exercise more directly through exercise-related self-regulation. Moderation analyses demonstrated stronger associations in the high self-regulation group for relationships between changes in exercise and eating-related self-regulation and self-efficacy only. Results initiated analyses into mechanisms of coaction among exercise and eating behaviors, and reinforced the value of self-regulatory skills enhancement directly and through its effects on domain-specific self-efficacy in behavioral obesity treatments.

Effects of Increased Physical Activity/Exercise on Long-Term Losses in Weight and Waist Circumference: Serial Mediation from Changes in Exercise-Related to Eating-Related Self-Regulation

BACKGROUND

Behavioral obesity treatments have generally been unsuccessful at facilitating long-term weight reductions. Increased physical activity/exercise is a strong predictor of maintained weight loss. It has been proposed this is more linked to increases in exercise-related self-regulation carrying-over to eating-related self-regulation than through direct energy expenditures.

METHODS

Women with obesity participated in 10-month community-based behavioral treatments that had theory-based foci on either self-regulation skills building (n = 59) or knowledge of weight loss methods (n = 54). Physical activity/exercise, exercise-related self-regulation, and eating-related self-regulation were assessed at baseline and months 3, 6, and 12 in the prediction of weight and waist circumference changes over 24 months.

RESULTS

Significant overall improvements on all measures were found, which were significantly greater in the self-regulation-focused group than the knowledge-focused group. Mean reductions in waist circumference/weight were - 4.64 cm/ - 5.17 kg (- 5.5% of baseline weight) and - 0.66 cm/ - 1.19 kg (- 1.2% of baseline weight), respectively. Aggregated data indicated that early increase in physical activity/exercise significantly predicted 24-month reductions in both weight and waist circumference. Serial mediation analyses indicated that a sequential path from exercise-related self-regulation (baseline-month 3) → eating-related self-regulation (baseline-month 6) → eating-related self-regulation (baseline-month 12) fully mediated the physical activity/exercise-weight/waist circumference change relationships. Energy expenditures from physical activity/exercise accounted for 21% of lost weight.

CONCLUSIONS

Findings of this field research supported benefits of progressively building self-regulation skills, first for physical activity/exercise then controlled eating, through accordingly focused behavioral treatments. Opportunities for tailoring large-scale community-based interventions grounded in theory were enhanced.

Effects of mood on self-regulating physical activity and sweets intake within obesity treatments

Background: Although emotional eating is associated with obesity in women, psychological correlates of their treatment-based weight-reduction behaviors are unclear. Aim: To test new model-based propositions of effects of mood on self-regulating physical activity and eating to inform interventions. Methods: Women in community-based obesity treatments with emphases on either self-regulation (n = 56) or weight-management education (n = 54) were assessed on psychological and behavioral variables over 12 months. Results: Emotional eating scores were significantly higher than general samples. Overall significant improvements were found in physical activity- and eating-related self-regulation, mood, physical activity, and sweets consumption. Improvements were more pronounced in the self-regulation-emphasis group. Mood significantly moderated self-regulation-behavior change relationships. Increased physical activity predicted improved mood. Discussion: Findings (a) suggested propensities for emotional eating in women with obesity seeking behavioral treatment, (b) clarified treatment effects and the effect of mood in the self-regulation of physical activity and eating behaviors, and (c) supported model-based treatment targets.

Exercise Amounts and Short- to Long-Term Weight Loss: Psychological Implications for Behavioral Treatments of Obesity

Purpose: Although exercise is typically included in behavioral weight-loss programs, the amount associated with meaningful short- to long-term weight reduction required investigation. Indirect paths between exercise-associated psychological changes and weight loss might be more relevant than the direct effect of exercise on energy expenditure-related weight loss in deconditioned/obese individuals. Method: Sedentary women with obesity (N = 97; M_age = 47.2 years) participated in a year-long cognitive-behavioral weight-loss treatment that emphasized building self-regulatory skills to maintain exercise in advance of transferring those skills to controlled eating. Results: There was a significant increase in exercise (metabolic equivalents/week or leisure score index; LSI), and significant improvements in mood, self-regulation for exercise, and self-regulation for eating from baseline to Months 6, 12, and 24. There were 5.9%, 5.8%, and 5.8% reductions in weight, respectively. Completion of 15-20 LSI did not significantly differ from greater amounts on associated weight losses except for the rare occurrence of ≥ 30 LSI over the full 24-month study period. There were significant bivariate relationships between completion of ≥ 15 LSI and weight loss over 6, 12, and 24 months. Within serial mediation analyses assessing changes from baseline-Months 6 and 24, there were significant indirect paths from ≥ 15 LSI→self-regulation for exercise→self-regulation for eating→weight loss, and ≥ 15 LSI→negative mood→self-regulation for exercise→self-regulation for eating→weight loss. Those paths were not significant when baseline-Month 12 changes were entered. Conclusion: Findings suggested the value of even manageable exercise amounts because of their association with psychosocial correlates of weight loss, and informed behavioral obesity treatments.

Reciprocal relationship of mood and emotional eating changes through self-regulation of weight-loss behaviors

Emotional eating is a considerable problem in women, and holds a great risk for obesity. Negative mood has been identified as a predictor of emotional eating, and vice versa. However, associated research has generally been cross-sectional, lacking sensitivity to dynamic changes and interactions occurring in psychological variables during a behavioral obesity treatment. The aim of the present study was to assess if physical activity-associated improvement in mood is significantly related to a subsequent reduction in emotional eating in women, and whether a reciprocal relationship is also present. Because improved mood has been posited to positively impact self-regulation, and physical activity-related self-regulation has been shown to transfer to eating-related self-regulation, they were also tested as possible mediators of mood-emotional eating relationships. A treatment focused on physical activity and self-regulation (n = 57) demonstrated greater improvements in mood, emotional eating, physical activity- and eating-related self-regulation, and physical activity than a treatment with a more typical focus on primarily providing information on healthy eating (n = 57). Reduction in negative mood over 3 months significantly predicted a 6-month reduction in emotional eating, and vice versa (i.e., a reciprocal relationship). Models with sequential entry of changes in physical activity-related self-regulation, then eating-related self-regulation, as mediators were significant. However, paths through the self-regulation changes were significant only in the model where change in mood predicted emotional eating change. Findings supported the role of physical activity in mood change, and the benefits of also addressing self-regulatory skills development within behavioral obesity treatments so that emotional eating is reduced.

Effects of Increased Exercise on Propensity for Emotional Eating Through Associated Psychological Changes

OBJECTIVE

To assess the effects of exercise on emotional eating via its impact on self-regulation, mood, and body satisfaction and to evaluate the association of change in emotional eating with weight.

METHODS

Women participated in either manual-based (n = 44) or in-person-based (n = 50) behavioral obesity treatments with similar theory-based content and were assessed on changes in exercise outputs, self-regulatory skills usage, negative mood, body image, propensity for emotional eating, eating behaviors, and weight.

RESULTS

Significant overall improvements were found in all study variables (P < 0.001), with significantly greater improvements in the in-person group (P < 0.02). Changes in self-regulation (95% confidence interval [CI], -0.010 to -0.002), mood (95% CI, -0.011 to -0.003), and body image (95% CI, -0.011, -0.002) significantly mediated the exercise-emotional eating relationship. Relationships between changes in emotional eating and weight over both 6 and 12 months were significantly mediated by changes in intakes of both sweets (95% CI, 0.118-1.024 and 0.066-1.092, respectively) and fruits/vegetables (95% CI, 0.130-1.010 and 0.167-1.139, respectively).

CONCLUSIONS AND IMPLICATIONS

Mechanisms of the effect of exercise on emotional eating may serve to inform future weight-loss treatments.

Additional Effects of Reduced Emotional Eating on Associations of Weight Loss via Changes in Social Cognitive Theory Variables

BACKGROUND

Improvements in the theory-based psychosocial variables of eating self-regulation, mood, and self-efficacy for controlled eating significantly predicted weight loss in community-based obesity treatments. However, in women, additional effects from reductions in emotional eating, and age and race/ethnicity are unclear.

METHODS

Women (N = 130) participating in a community-based cognitive-behavioral obesity treatment were assessed on changes in theory-based psychosocial variables and weight.

RESULTS

Treatment-associated improvements in self-regulation, mood, and self-efficacy over 3 months significantly predicted 6-month weight loss (R² = 0.26), with self-regulation change being the strongest individual predictor. Entry of change in emotional eating into the prediction model significantly added to the variance in weight change explained. Age and race/ethnicity did not further improve the predictive strength.

CONCLUSIONS

In addition to targeting self-regulation skill development and, to a lesser extent addressing mood and self-efficacy improvements, behavioral obesity treatments should focus on emotional eating to maximize their large-scale effects on excess weight.

Psychosocial Correlates of Emotional Eating and Their Interrelations: Implications for Obesity Treatment Research and Development

We tested the effects of emotional eating in long-term weight-loss so that both treatment processes and theory could be improved. Women with obesity participated in treatments of either high interpersonal contact and behavioral methods (n = 39) or low interpersonal contact and educational methods (n = 36) through community-based settings. We assessed mood, emotional eating, self-regulation, self-efficacy, and weight. Changes in the psychosocial measures were significantly greater in the high interpersonal contact/behavioral methods group. That group had a mean weight reduction of 6.5% and 6.8% over 6 and 24 months, respectively, which was significantly greater than the 2.9% and 1.8% loss in the low interpersonal contact/educational methods group at the same time points. Using aggregate data, change in eating self-regulation significantly mediated the prediction of reduced anxiety- and depression-related emotional eating over 6 months by improvements in tension and depression, respectively. The emotional eating reductions were significantly associated with weight loss over both 6 and 24 months. Increased physical activity was significantly associated with reduced tension and depression. We also found that the relationship between changes in physical activity and tension was significantly mediated by a change in exercise-related self-efficacy. Increased exercise self-regulation significantly predicted improved eating regulation, with eating-related self-efficacy change being a significant mediator. Our findings suggest an array of psychosocial targets for behavioral weight-management treatments that have large-scale applications.

Effect of exercise training on psychological outcomes in adults with overweight or obesity: A systematic review and meta-analysis

This study systematically identified the effects of exercise on multiple psychological outcomes among adults with overweight/obesity, also assessing whether these effects differed across exercise types, genders, age, and body mass index (BMI) categories. Pubmed, Web of Science, PsychInfo, and SportDiscus were searched up to October 2019 for peer-reviewed papers assessing exercise training effects on psychosocial outcomes in adults with overweight/obesity. Thirty-six articles, 32 randomized controlled trials (RCTs), were included in this review. Most interventions were supervised (65%), ranging between 6 and 76 weeks (median = 12). Sixteen psychological outcomes were studied. Exercise induced positive changes in quality of life but did not reduce depression. Large effect sizes were observed on quality of life's physical component, but exercise was also able to improve vitality and mental health. Most psychological outcomes (e.g., body image, anxiety, and perceived stress) are poorly studied, evidencing either conflicting or null exercise effects. Exercise self-efficacy and autonomous motivations were also consistently improved. Exercise types and gender seem to moderate exercise psychological effects. Exercise training programs might lead to positive changes in some psychological outcomes, especially in quality of life, in adults with overweight and obesity, but more studies, with greater systematization in program characteristics, and longer follow-ups are still required to allow more solid conclusions.

Evaluation of a new causal chain model for predicting embedded psychosocial and behavioral relationships in a community-based obesity treatment seeking maintained weight loss

A new causal chain model positing theory- and research-based interrelationships among psychosocial and behavioral variables leading to weight loss and its maintenance was assessed. Two samples of women participating in community-based cognitive-behavioral obesity treatments were assessed over either 6 months (weight loss phase; N = 103), or additionally including Months 6-12 (weight-loss maintenance phase; N = 101). Analyses first evaluated whether baseline physical, demographic, behavioral (physical activity, fruit/vegetable intake), and/or psychosocial (self-regulation, self-efficacy, negative mood) variables significantly predicted weight change. Further analyses assessed whether changes in model-based behavioral and psychosocial variables significantly differed by groupings of participants based on their short-term weight loss and weight-loss maintenance/further loss. The predictive value of changes in the psychosocial variables on behavioral changes was next assessed, also accounting for group. Finally, mediation, moderation, and moderated mediation analyses tested proposed causal chain-based interrelationships among variables. Of the 12 variables assessed at baseline, only weight was inversely associated with lost weight, and only fruit/vegetable intake was positively associated with effects during the weight-loss maintenance phase. Overall improvements in behavioral and psychosocial variables were significantly greater in participant groupings with better weight loss and weight-loss maintenance results. Changes in self-regulation, self-efficacy, and mood significantly predicted the weight-loss behavior changes, unaffected by group. Results from the five mediation, moderation, and moderated mediation analyses supported hypotheses based on the new causal chain model. The field testing indicated adequacy of the new causal chain model and informed architectures of behavioral obesity treatments concerned with long-term reductions in excess weight.

Effects of Behaviorally Supported Exercise and Exercise-Induced Mood Changes on Elevated Blood Pressure and Hypertension in African American Adults with Severe Obesity

African Americans with obesity have high rates of hypertension. Exercise has been shown to significantly reduce high blood pressure; however, effects through associated reductions in anxiety and depression are unclear. African American adults with either class 2 or 3 obesity (n = 86; M_age = 43.4 years) and either elevated blood pressure (n = 16) or stage 1 (n = 33) or stage 2 (n = 37) hypertension participated in a theoretically driven community-based weight-management program. There were significant increases in exercise outputs; while systolic and diastolic blood pressure, anxiety, and depression significantly decreased from baseline-month 6. Increased exercise significantly predicted reduced anxiety, depression, and diastolic blood pressure. Change in anxiety significantly mediated the relationship between exercise and both systolic and diastolic blood pressure changes. Increasing exercise from the equivalent of 1.5 to 4.5 moderate bouts/week reduced elevated blood pressure/hypertension in African American adults with severe obesity largely through their exercise-associated improvement in anxiety.

Mitigation of the effects of emotional eating on sweets consumption by treatment-associated self-regulatory skills usage in emerging adult and middle-age women with obesity

An urge to eat in response to negative emotions or mood (emotional eating) is associated with an overconsumption of unhealthy foods such as sweets. Propensities for emotional eating is most prevalent in women, but its effects might differ by age. Within behavioral obesity treatments, it is unclear whether learned self-regulatory skills mitigate the effects of emotional eating susceptibilities on sweets intake, or if expected exercise-induced mood improvements affect the emotional eating-sweets intake relationship. Emerging adult (18-25 years-of-age; n = 43) and middle-age (45-65 years-of-age; n = 79) women with obesity participating in the same cognitive-behavioral treatment that emphasized exercise prior to eating-behavior changes were assessed on levels of propensities for emotional eating, self-regulatory skills usage, mood, and intake of sweets. There were overall significant improvements in self-regulation for eating, overall mood, and daily intake of sweets; with a significantly greater reduction in sweets in the emerging adult women. Self-regulation for eating at Month 3 significantly mediated the prediction of sweets intake at Month 6 by overall emotional eating and emotional eating related to depression. When dimensions of mood (i.e., total negative mood, depression, anxiety, anger) at Month 3 were entered into the models as possible moderators of relationships between a corresponding dimension of emotional eating and sweets intake, anxiety was found to be a significant moderator. Because sweets intake was affected by age, it should be considered in behavioral obesity interventions. Findings suggested advantages of fostering self-regulatory skills and reductions in anxiety, possibly through supported exercise, to mitigate unhealthy eating behaviors associated with propensities for emotional eating.

Adaptation and validation of the Portuguese version of the regulation of eating behavior scale (REBSp)

The aim of present study was two-fold: i) to translate and adapt the Regulation of Eating Behavior Scale to Portuguese (REBSp), and ii) to analyze its psychometrics properties (factorial validity with gender invariance analyses, reliability and construct validity). The study sample was composed by 471 Portuguese participants (68.4% females) with a mean age of 30.5 years (SD = 11.2). Structural equation modeling was used to verify the psychometric properties of the scale using SPSS v. 23.0 and AMOS 24.0 software. The analysis showed that the Portuguese 24-item scale presented a good fit, achieving good reliability and convergent validity. Some issues arose with discriminant validity within autonomous and controlled regulations, discussed in light of the simplex pattern expected by self-determination theory literature. Additionally, the scale presented concurrent validity and evidence of gender measurement invariance. Latent mean analysis between genders showed that women presented higher means for intrinsic motivation and integrated regulation when compared to men. In conclusion, analyses suggest that the 24-item Portuguese version of REBS can be used safely to assess the eating regulation in both genders.

Contrasting Personal Characteristics and Psychosocial Correlates of Exercise and Eating Behavior Changes in Women Successful vs. Unsuccessful with Weight Loss and Maintenance

BACKGROUND

There is great variability in individuals' responses to behavioral weight-loss treatments. Beyond attaining meaningful weight loss in the initial several weeks, little is known of the characteristics of participants successful vs. unsuccessful with short- and long-term weight loss.

METHODS

Separate samples of women with obesity enrolled in cognitive-behavioral weight-loss treatments were assessed over 6 months (Study 1: successful weight-loss group, n = 83; unsuccessful group, n = 158), and over 24 months (Study 2: sustained initially lost weight, n = 25; regained weight, n = 19), on personal characteristics and theory-driven psychosocial variables.

RESULTS

In Study 1, significantly older age and greater eating self-regulation at baseline were found in the successful group. Significantly greater improvements in exercise- and eating-related self-regulation, mood, exercise- and eating-related self-efficacy, physical self-concept, and body satisfaction were found in the successful group. In Study 2, the sustainer group had significantly more favorable changes over 2 years in exercise- and eating-related self-regulation, and mood. During Months 6-24, the psychosocial correlates of both exercise and eating behaviors regressed, with more pronounced reversions in the regainer group.

CONCLUSION

Increasing the magnitude of treatment-associated improvement in each of the tested theory-based psychosocial factors is warranted to increase probabilities for success with attaining and maintaining meaningful weight loss.

Sequential Changes Advancing from Exercise-Induced Psychological Improvements to Controlled Eating and Sustained Weight Loss: A Treatment-Focused Causal Chain Model

INTRODUCTION

Behavioral (nonsurgical/nonpharmacologic) weight loss treatments have been overwhelmingly unsuccessful beyond the short term. Rather than incorporating accepted behavioral change theory, most have inadequately relied on providing exercise and nutrition information. Although adherence is a challenge, exercise has emerged as the most robust predictor of sustained weight reduction. However, exercise might be more associated with long-term weight loss through the relationship of its associated psychological changes with improved nutrition than through direct effects of energy expenditures, which are typically minimal in deconditioned individuals.

OBJECTIVE

To facilitate improved helping methods through a proposed theory-based causal chain model in which supported exercise predicts sustained weight loss through successive changes in exercise-related, then eating-related, self-regulation, self-efficacy, and mood.

RESULTS

Segments of the model predict that 1) exercise and eating behaviors will be sequentially improved through increased self-regulatory skill use and self-efficacy and 2) exercise-induced mood improvements will foster greater self-regulation and reduced emotional eating. Short-term psychosocial changes can be leveraged to carry over to longer-term changes and maintained weight reductions. Suggested interventions emerging from the model and supporting research include using self-regulation to enable a habit of regular moderate exercise, facilitating a transfer of self-regulatory skills from an exercise to eating context, and leveraging mood improvements associated with manageable volumes of exercise to improve eating behaviors.

CONCLUSION

The model presents an evidence-based explanation of the exercise-weight loss association through psychosocial mechanisms. It also informs the development of practical methods to facilitate sustainable reductions in weight and health risks in adults with obesity.

Coaction Between Physical Activity and Fruit and Vegetable Intake in Racially Diverse, Obese Adults

PURPOSE

There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults.

DESIGN

This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03674229.

SAMPLE

Obese adults who completed baseline and 6-month follow-up assessments.

MEASURES

For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up.

ANALYSIS

We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression.

RESULTS

The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17).

CONCLUSION

Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.

Predicting 2-year weight loss through temporally specific earlier losses, relevant behaviors, and their psychological correlates: Implications for behavioral treatment architectures

Maintaining loss of weight beyond an initial 6-9 months remains problematic, with research indicating little recent progress. A poor understanding of how and when prior weight loss, behavioral changes, and psychosocial predictors are associated with long-term weight changes persists. To better-inform behavioral treatments for long-term success with weight loss, women with obesity (N = 86; M_age  = 48.6 years) volunteered for research incorporating community-based weight-management treatments. They were assessed at months 6, 12, and 24 on theory-based psychosocial and behavioral factors, and over 24 months on weight. Considering the included times and temporal ranges, it was found that change in weight from month 6-24 was the strongest predictor of 24-month weight change, and physical activity and fruit/vegetable intake at month 24 best predicted that change in weight. Self-regulation, self-efficacy, and mood at month 24 best predicted both physical activity and fruit/vegetable intake at month 24, with body satisfaction also a significant predictor of physical activity. From these data, mediation analyses found that the predictions of long-term weight loss by scores of self-regulation, self-efficacy, body satisfaction, and mood at month 24 were significantly mediated by fruit/vegetable intake and physical activity in separate equations. Findings indicated both psychosocial and behavioral targets, and timing for those targets, most indicative of long-term success with weight loss.

Effects of a naturally occurring stressor on health behaviors and their psychosocial correlates

Demands of a university semester and approaching final academic examinations could induce increased anxiety and fatigue, which might prompt deteriorations in health behaviors. Female undergraduate nursing and health promotion students (M_age = 23.8 years) with overweight/obesity (n = 30) and without overweight/obesity (n = 62) completed validated measures just prior to final exams, and after recalling behaviors and perceptions at semester start. There were significant increases in tension, fatigue, anxiety-related emotional eating, and sweets; and significant decreases in eating- and exercise-related self-regulation, fruit/vegetable intake, and physical activity. Overweight/obese participants had significantly more reductions in self-regulation, and increases in sweets. Self-regulation significantly mediated relationships between changes in tension and the consumption of both fruits/vegetables and sweets, and change in anxiety-related emotional eating was not a significant moderator of the mood-behavior change relationships. Change in self-regulation significantly mediated the relationship between increase in fatigue and reduction in physical activity. Changes in fruit/vegetable intake, sweets consumption, and physical activity significantly predicted weight change during the semester when participants' initial BMI was entered into the regression equation. Results suggested that the mood-related changes in fruit/vegetable intake, sweets consumption, and physical activity were largely through changes in participants' self-regulatory processes. Possible interventions were suggested.

Change in behavioral exercise program-associated self-regulation enhances self-regulation-induced eating improvements across levels of obesity severity

Architects of behavioral weight-loss programs require improved understandings of psychosocial correlates of healthy eating behaviors to improve overwhelmingly poor outcomes. Exercise might benefit eating changes through a transfer of self-regulatory skill improvements. However, related research is minimal, and degrees of obesity might influence the utilization and efficacy of self-regulatory processes. Women of Class 1 obesity (body mass index [BMI] = 30-34.9 kg/m²; n = 53), Class 2 obesity (BMI = 35-39.9 kg/m²; n = 41), and Class 3 obesity (BMI ≥ 40 kg/m²; n = 53) enrolled in a community-based cognitive-behavioral weight-management program were assessed over 6 months on changes in exercise, self-regulation for both exercise and eating, and the consumption of fruits/vegetables and sweets. Within-group improvements were all significant, with the greater self-regulation changes consistent with lower degrees of obesity. Within serial multiple mediation analyses, the hypothesized path from exercise change→self-regulation for exercise change→self-regulation for eating change→eating behavior change was supported in both the prediction of changes in fruit/vegetable intake and sweets consumption. However, the direct effect of increased exercise on improved eating was not significant. BMI score or obesity class did not significantly moderate embedded relationships among variables. Findings suggested weight-loss programs incorporate supported exercise, and dedicate high proportions of their curricula to the development of self-regulatory skills.

Moderation of Mood in the Transfer of Self-Regulation From an Exercise to an Eating Context: Short- and Long-Term Effects on Dietary Change and Obesity in Women

BACKGROUND

Behavioral obesity treatments require an improved understanding of the dynamics of associated psychological changes. This study aimed to clarify previous research on self-regulatory skills' transfer from an exercise to eating context, effects of mood on self-regulatory strength, and related effects on a targeted eating behavior.

METHODS

Women with obesity participated in a yearlong community-based cognitive-behavioral treatment that first focused on self-regulatory skills development for exercise maintenance, then use of similar self-regulatory skills and improved mood to facilitate short- and long-term increases in fruit/vegetable intake and reduction in weight. Groups were based on high (≥ 5% of baseline weight; n = 51) and low (< 5%; n = 49) weight reduction 2 years post-initiation.

RESULTS

Improvements in eating self-regulation and fruit/vegetable intake were greatest in the high weight-reduction group. Using lagged variable analyses to assess directionality, mood significantly moderated the prediction of eating self-regulation change by exercise self-regulation change. The effect of increased exercise self-regulation on fruit/vegetable intake change over 6 months was significantly mediated by eating self-regulation change. Participants' initial weight moderated the effect of eating self-regulation change on fruit/vegetable intake. Change in eating self-regulation over 6 months predicted self-regulation at 24 months. Short-term change in fruit/vegetable intake predicted weight change over 2 years through its association with long-term fruit/vegetable consumption.

CONCLUSIONS

Findings supported the expected carry-over of self-regulation from an exercise to eating context, mood effects on self-regulatory strength, and associations of exercise with eating and weight changes via effects on psychological variables. Results have implications for sustained effects associated with behavioral treatments.

Relations of change in fruit and vegetable intake with overall energy reduction and physical activity with weight change: Assessing theory-based psychosocial mediators

BACKGROUND

Increased physical activity and fruit and vegetable (FV) intake are typically suggested to counter obesity. Sustained behavior change in those areas has, however, been poor, possibly because of a lack of understanding of the effects of psychosocial factors. Using data from previous research, this study aimed to better define the role of physical activity and FV intake in short- and long-term weight loss via changes in malleable psychosocial mediators and moderators.

METHODS

Women who were obese (n = 183; age = 50.0 ± 7.9 years; body mass index = 35.2 ± 3.2 kg/m², mean ± SD) and who previously participated in 3 different community-based behavioral weight-loss treatments were assessed over 2 years. Changes in FV intake, physical activity, self-regulation of physical activity and eating (aggregated), negative mood, and weight were measured over 6 and 24 months.

RESULTS

Changes in each variable over both 6 and 24 months were significant (all p values <0.001). The FV intake to the weight-related caloric intake relationship (β = -0.30, p < 0.001) was significantly mediated by self-regulation change over 6 months. The physical activity to weight-change relationship (β = -0.46, p < 0.001) was significantly mediated by both self-regulation and mood change over 24 months. Physical activity, itself, accounted for only 16% of weight-related caloric expenditure differences. Changes in physical activity and FV intake were each independent predictors of weight change over 24 months (overall R ² = 0.50, p < 0.001).

CONCLUSION

Findings clarified theory-based targets for weight-management treatments and suggested that future weight-loss treatments strongly focus on developing self-regulatory skills to address barriers to behavioral changes.

Self-regulation foci and mood affect healthy and unhealthy eating behaviours differently in successful weight-loss treatment participants

An increased understanding of how self-regulation and mood affects both healthy and unhealthy eating behaviours is required to improve weight-loss intervention architectures. Women with obesity (N = 54, M_BMI  = 34.80 kg/m² ), who obtained ≥5% weight loss over 12 months (M = -9.01 kg) within a community-based behavioural weight-loss treatment, were assessed. Improvements in exercise- and eating-focused self-regulation (over 3 and 6 months), and the consumption of fruits/vegetables and sweets (over 6 and 12 months), were each significant. Multiple regression analyses indicated that changes in (a) aggregated (exercise-focused + eating-focused) self-regulation, (b) eating-focused self-regulation alone and (c) eating self-regulation that carried over from exercise-focused self-regulation, each significantly predicted fruit/vegetable consumption changes (R²  = .15-.28). Entry of overall mood did not significantly increase those models' predictive strength. Conversely, mood was the most salient predictor of change in sweets intake. There were significant inverse relationships between changes in fruits/vegetables and sweets consumption. Implications for self-regulation theory and treatment improvements were suggested.

Effects of a Group Protocol on Physical Activity and Associated Changes in Mood and Health Locus of Control in Adults with Parkinson Disease and Reduced Mobility

BACKGROUND

Parkinson disease (PD) is a degenerative nervous disorder that affects motor functioning. Although physical activity is beneficial, it often is reduced, and psychosocial issues persist such as low mood and perceptions of loss of control over health.

OBJECTIVE

To determine the extent to which a community-based physical activity/self-regulatory skills intervention affects overall physical activity and changes in psychosocial factors in adults with PD and in adults with reduced mobility without PD.

METHODS

Existing participants (N = 45, mean age = 71 years) of community-based PD group movement classes, who also participated in an individualized 6-session protocol for exercise support that emphasized self-regulation through barriers, completed validated self-report surveys. Participants' mean length of movement class participation was 11.8 months at the time of survey administration.

RESULTS

Mixed-model repeated-measures analysis of variance indicated significant improvements in physical activity, self-regulation, exercise self-efficacy, negative mood, and task social cohesion but not internal health locus of control. Improvement in social cohesion was significantly greater in the PD group (n = 27) than in the non-PD (n = 18) group. Changes in exercise self-efficacy mediated a significant relationship between changes in self-regulation and physical activity. Changes in social cohesion mediated a significant relationship between changes in physical activity and mood. Changes in mood and social cohesion had a reciprocal, mutually reinforcing relationship. For the PD group, length of program involvement predicted vigor change (r = 0.52, p = 0.006).

CONCLUSION

The intervention demonstrated positive effects on physical activity and psychosocial factors in adults with PD and with reduced mobility. Effects on social cohesion were important. Such programming should be considered as an adjunct to traditional medical treatment.

Effects of Treatment-Associated Increases in Fruit and Vegetable Intake on the Consumption of Other Food Groups and Weight Through Self-Regulatory Processes

CONTEXT

Increased intake of fruits and vegetables (FV) may be useful for weight loss.

OBJECTIVE

This study was designed to evaluate the effects of changes in FV intake on the overall diet and to determine if self-regulation affects the association between changes in FV intake and weight.

METHODS

Women with obesity (N = 74, mean age = 47.7 years) participating in a year-long behavioral weight-loss treatment were assessed regarding changes in consumption of various food groups, physical activity, and eating self-regulation over 6, 12, and 24 months.

RESULTS

FV intake change significantly predicted changes in weight and consumption of dairy and bread products and sweets. The only other notable relationships were among changes in sweets, bread, and dairy consumption over 24 months. Over 6, 12, and 24 months, changes in self-regulation significantly mediated the FV intake-weight change relationship. The overall mediation models were significant (R² values = 0.19, 0.13, and 0.32, respectively). A reciprocal relationship between changes in FV intake and self-regulation also was found. Significant increases in physical activity outputs did not influence weight changes.

CONCLUSION

Findings supported a relationship between FV intake and weight loss occurring through self-regulatory skills. Associations between FV intake and reduced consumption of other food groups provided data useful for improving the architecture of behavioral weight-loss treatments and the foci of medical practitioners' helping methods.

Moderating Effects of Depression, Food Cravings, and Weight-Related Quality-of-Life on Associations of Treatment-Targeted Psychosocial Changes and Physical Activity in Adolescent Candidates for Bariatric Surgery

BACKGROUND

Physical activity is a strong predictor of sustaining weight loss. Yet physical activity has been challenging to maintain. Adolescent bariatric surgery is increasing, and there is typically an initial 6-month period when improving health behaviors such as physical activity are addressed by a clinic-based team. However, there is minimal understanding of how to target psychosocial factors relevant for behavioral changes.

METHODS

A group of 15 adolescent candidates for bariatric surgery (mean age = 15.1 y; mean body mass index = 55.9 kg/m2) were assessed on changes in 3 theory-based predictors of physical activity from baseline-month 3 and baseline-month 6.

RESULTS

Changes in physical activity-related self-regulation and self-efficacy over 3 months significantly predicted change in physical activity over 6 months. Reciprocal relationships were also significant, including the prediction of physical activity change by change in negative mood. The clinical psychology-based factor of weight-related quality-of-life significantly moderated the prediction of self-regulation via physical activity, and degree of depressive symptoms significantly moderated the prediction of changes in physical activity through self-efficacy changes.

CONCLUSIONS

Because improvements in several theory-based psychosocial variables related to physical activity have demonstrated a carry-over to controlling eating, the improved understanding of those variables for treating adolescents with severe obesity was useful.

Exercise effects on mood, and its associations with self-regulatory skills, self-efficacy, and eating changes during the year following weight-loss treatment

Maintaining weight loss beyond an initial year of behavioral treatment is of concern, and understanding interrelationships of theory-based psychosocial correlates is minimal. Although exercise is universally suggested, its indirect impacts on long-term nutritional changes are unclear. Data from women with obesity (N= 129), who participated in the treatment groups of two initial trials of a new social cognitive theory-based weight-loss protocol during 2016-2017, were incorporated. The intervention emphasized exercise adherence for two months prior to the next 12 months of biweekly meetings for nutritional change. Effects of exercise-induced changes in mood, and the role of self-regulatory skills in facilitating self-efficacy and improved eating 12-24 months after treatment initiation, were assessed. Change in mood significantly moderated changes in self-regulation for controlled eating by exercise-related self-regulation. During Months 12 to 24, changes in both fruit/vegetable and sweets intake, by self-regulation for eating change, was significantly mediated by change in self-efficacy for controlled eating. Mood change from Months 12 to 24 was significantly associated with change in exercise, with indications that maintaining an equivalent of three days/week had critical value. Findings suggest the importance of bolstering self-regulatory skill usage beyond an initial year of treatment in women.

Relationship of Emotional Eating and Mood Changes Through Self-Regulation Within Three Behavioral Treatments for Obesity

An enhanced understanding of the dynamics of psychosocial change processes within behavioral weight loss treatments is required to improve their generally poor results. Based on social cognitive theory, self-regulation of eating has the possibility of affecting interrelations between psychosocial correlates of inappropriate eating behaviors such as emotional eating and negative mood. Within behavioral interventions, physical activity, treatment foci, and the length of treatment might moderate those relationships. The aim of this research was to contrast intervention effects based on treatment type, and evaluate interrelations of changes in theory-based psychosocial variables. Adult females with obesity (overall Mage = 48.6 years; overall MBMI = 35.3 kg/m2) were block randomized into groups of 28 weeks of phone-supported manual-based education (Group 1, n = 52), 58 weeks of cognitive-behavioral group treatment (Group 2, n = 52), and 99 weeks of cognitive-behavioral group treatment followed by phone-based reviews of intervention materials (Group 3, n = 48). Significant improvements in measures of emotional eating, negative mood, self-regulation for controlling eating, physical activity, and body composition were found in each group over 3, 6, 12, and 24 months, with generally larger effect sizes detected in Groups 2 and 3. Reciprocal, mutually reinforcing, relationships were found between changes in emotional eating and mood, which were significantly mediated by self-regulation changes. Physical activity level significantly moderated mood changes, treatment foci on emotional eating significantly moderated changes in emotional eating, and treatment length significantly moderated long-term changes in emotional eating, but not mood. Findings support a treatment duration of at least one year that emphasizes physical activity and self-regulatory skills usage, and interrelations between changes in emotional eating, self-regulation, mood, and physical activity.

Effects of self-regulatory skill usage on weight management behaviours: Mediating effects of induced self-efficacy changes in non-obese through morbidly obese women

OBJECTIVES

Self-regulation is thought to play a role in overcoming barriers to weight management behaviour changes. This research assessed the extent that relationship is manifested through associated changes in self-efficacy, and effects based on degree of obesity.

DESIGN

Data sets from three previous studies of the present research group were utilized. After assessment of change scores using repeated-measures ANOVA, mediation and moderation analyses assessed effects of changes in self-regulatory skill usage on changes in physical activity and fruit/vegetable intake through self-efficacy changes. Moderating effects of BMI were then assessed.

METHODS

Women with body compositions ranging from non-obese (BMI < 30 kg/m² ) to those with morbid obesity (BMI ≥ 40 kg/m² ) were administered similar cognitive-behavioural treatments, and assessed on theory-based psychosocial and behavioural measures over 6 months.

RESULTS

From baseline to Month 6, changes in self-regulation for physical activity and eating, physical activity behaviours, fruit/vegetable intake, and self-efficacy for controlled eating were significant in non-obese women (n = 48) and women with Class 1 (n = 43), Class 2 (n = 70), and Class 3 (n = 48) obesity. Positive effects were smaller in exercise self-efficacy. For each of the BMI-based groups, changes in self-efficacy significantly mediated the prediction of physical activity and fruit/vegetable intake by changes in self-regulation. In aggregated data, BMI significantly moderated the prediction of change in physical activity (higher BMI associated with a stronger association), but not fruit/vegetable intake, within those models.

CONCLUSION

Increasing self-regulatory skills to overcome lifestyle barriers was found to be important for fostering improved weight loss behaviours, especially in the treatment of higher degrees of obesity in women. Statement of contribution What is already known on this subject? Self-efficacy is a malleable factor that predicts behaviour change within multiple theories. Learned self-regulatory skills may effectively deal with lifestyle barriers associated with improvements in weight management behaviours. Increased physical activity and fruit/vegetable consumption predicts success with weight loss. What does this study add? Much of self-regulation's effect on physical activity and eating behaviours is through its impact on self-efficacy. Weight management treatments should emphasize self-regulatory skills development over simply health education. Effects of interrelations of self-regulation and self-efficacy are more effective as female weight increases.

Changes in weight, physical activity and its theory-based psychosocial correlates within an adolescent bariatric clinic: contrasts with adults with extreme obesity

Albeit their practical implications, psychosocial correlates of physical activity and related weight loss in the treatment of extreme obesity have been only sparsely addressed in adults; and even more minimally focused upon in adolescents. This research contrasted results of a 6-month social cognitive theory-based physical activity-support protocol along with standard nutrition counseling in groups of adolescents (n = 19; age_mean = 15.4 years) and adults (n = 26, age_mean = 44.7 years) with class 3 (extreme) obesity [overall body mass index (BMI)_mean = 53.4 kg/m², standard deviation (SD) = 8.2]. Although baseline total mood disturbance scores were significantly greater in both groups when contrasted with age-corresponding normative values, between-group scores did not significantly differ. BMI and physical activity changes over 3 and 6 months were significantly more favorable in the adult group. There were significant overall improvements in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, however, the self-efficacy and self-regulation increases were significant in only the adult group. Inverse relationships between changes in physical activity and BMI were stronger in the adult group. Regardless of group, simultaneous entry of changes in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, over both 3 and 6 months, significantly predicted physical activity changes (R²-values = 0.45-0.75, p-values < 0.001). In each model, self-regulation change was the most salient of those three psychosocial predictors. Although findings suggested that psychosocial correlates of physical activity, leading to weight change, are similar in adolescents and adults with extreme obesity, facilitation of larger effect sizes and/or foci on additional theory-based determinants may be required for clinically meaningful treatment outcomes in adolescents.