Restructuring: an emerging theory on the process of losing weight

Weighing in on the body knowledge questionnaire: initial development and pilot testing

PURPOSE

The purpose of this research was to develop and pilot test the Body Knowledge Questionnaire (BKQ), an instrument that measures weight management integration, and to determine its reliability and validity.

METHODS

The 27 items of the BKQ were developed through review of the literature on integration and weight management/obesity. The resulting BKQ was pilot tested with 4 groups of individuals with and without type 2 diabetes. Exploratory factor analysis was used to assess the construct validity of the BKQ, and discriminant function analysis and logistic regression were used to establish criterion-related validity. Scale reliability analysis was used to determine the internal consistency of the BKQ and its subscales.

RESULTS

Exploratory factor analysis yielded a 2-factor solution, with factor loadings that were fair to excellent (.45-.81). Discriminant function analysis determined that the BKQ subscales could accurately predict the classification of participants into normal- and obese-weight groups. Results of the logistic regression showed that the BKQ could reliably distinguish between normal- and obese-weight participants. Internal consistency of the overall BKQ was .87, .89, and .73 for the subscales, Food Centricity and Psychosomatic Awareness.

CONCLUSIONS

This research provided preliminary evidence of the validity (content, construct, and criterion) and reliability (internal consistency) of the BKQ. With additional psychometric testing, the BKQ instrument has great potential for use in weight management practice areas, such as diabetes education, dietetics, nursing, and psychology, for use in individual or group weight management programs and program evaluation; or in the development of novel weight management interventions.

A synthesis of qualitative research on overweight and obese people's views and experiences of weight management

The effectiveness of existing weight management programmes may be improved by understanding overweight and obese people's perceptions of the reasons for successful and unsuccessful weight management. Many qualitative studies have investigated overweight and obese adults' experiences with weight management. This paper presents findings of a meta-ethnography that synthesized 17 qualitative studies of overweight and obese adults' weight management experiences, principally in the context of behavioural weight management programmes. Twelve themes were derived describing factors that overweight and obese people identify as relevant to weight management: health concerns, expectations towards weight management, attributions for weight gain, psychological barriers, psychological facilitators, self-perception and body image, stigmatization, socio-cultural factors, environmental barriers, environmental facilitators, experiences with weight management programmes and positive outcomes of programme participation. Interventions that address all of the modifiable factors identified in this review are likely to appear credible to participants and will engage with the intra- and extra-individual factors that they perceive as affecting their weight management efforts.

Successful weight loss maintenance and a shift in identity: from restriction to a new liberated self

The present qualitative study aims to explore the experiences of dieters who successfully maintain their weight loss with a focus on the transition in perception of self from their heaviest to their current reduced weight. Ten successful women from a slimming club who had lost at least 10 per cent of their weight for a minimum of one year participated in the study. The results showed an identity shift from a previous restrained self towards a liberated individual, regarding their social interactions, dietary habits, emotional regulation and self-appraisal. The results are discussed in terms of the process of reinvention and the impact of stigma on an obese person's self-identity.

A health protection model for Hispanic adults with Type 2 diabetes

AIMS

The Hispanic Health Protection Model (HHPM) was designed to assist practitioners' systematic assessment of Hispanic people to establish baselines and evaluate the success of early diabetes treatment. This article provides the research basis of the HHPM and related assessment tools.

BACKGROUND

The treatment of diabetes incorporates lifestyle change, and this adjustment is particularly important to follow with vulnerable groups. One such group is the Hispanic population, since the impact of diabetes is greatest on economically disadvantaged segments of this population, who suffer disproportionately higher Type 2 diabetes prevalence and higher levels of morbidity and mortality as compared with other populations. Traditional Hispanic health beliefs are often in conflict with Western medicine, so the adjustments to the lifestyle demands of this disease need to be evaluated.

METHODS

To understand this discrepancy fully in patient outcomes, a culturally sensitive assessment framework was developed based on health protection theories and research with Hispanic people with diabetes and, based on this framework, assessment tools were translated for use during interviews with low literacy, Spanish-speaking patients.

CONCLUSIONS

The HHPM translated measures of premorbid lifestyle, health beliefs, support, self-efficacy, quality of life, knowledge of diabetes, and physiological parameters can be used during consecutive clinic visits during the first six months of therapy to map the success of patients' understanding of and psychological adjustment to diabetes.

RELEVANCE TO CLINICAL PRACTICE

The HHPM is a culturally-relevant, systematic, and holistic approach to assessing adjustment of Hispanic people to a new diagnosis of diabetes, including their psychological, cognitive, and physiological outcomes. Using this type of systematic approach will allow practitioners to target barriers to therapy, such as a lack of self-efficacy or incomplete knowledge of the disease and its treatment in a strategic manner to improve patient success in managing the complex lifestyle changes of diabetes mellitus.

Identity shifts as turning points in health behavior change

The authors used a grounded formal theory approach to synthesize the findings of 14 studies, with the goal of identifying common elements in qualitative studies of individuals' efforts to change a variety of unhealthy behaviors. The combined sample of 399 participants had experiences of weight loss, smoking cessation, and alcohol and drug-abuse recovery. Data were extracted from published reports and analyzed using grounded-theory techniques. In the provisional model, a value conflict in response to distressing accumulated evidence prompts a small step toward behavior change. If successful, an identity shift begins. Increased self-awareness and self-confidence fuel continued change. Numerous constraints to success are noted at each step. The links to previous conceptions of identity shift are discussed.

Influences on older women's adherence to a low-fat diet in the Women's Health Initiative

OBJECTIVE

Most studies of dietary change during aging have focused on maintaining adequate intake by impaired elderly, and little is known about factors affecting dietary change for preventive purposes in older individuals. The purpose of this exploratory study was to determine the major behavioral influences on older women's adherence to a dietary fat reduction intervention.

METHOD

A diverse sample of 92 women aged 55 to 80 was recruited from two East Coast sites of the Women's Health Initiative. All the women were participating in the dietary modification arm of WHI, had received the same dietary instruction, and were in the maintenance phase of the intervention. The women were classified by nutritionists as adherent or nonadherent to a diet limiting fat intake to <20% of total calories. Focus groups and telephone interviews were conducted, and textual data were coded and sorted using content analysis techniques within the four categories of the Stimuli-Organismic Factors-Response Repertoire-Consequences (SORC) behavioral model. Frequencies of responses within categories were tabulated and compared qualitatively.

RESULTS

Adherent women were more likely to report assertiveness, a lifelong commitment to reduced dietary fat, satisfaction with their lifestyle changes, and having applicable knowledge and skills. Nonadherent women reported more difficulty resisting negative emotions and prior food preferences and habits; they were also more concerned about negative responses from others.

CONCLUSIONS

Enhancing adherence of older women to a dietary fat reduction program will require shifting priorities away from conforming to social pressure and using high-fat foods for personal satisfaction and moving toward enhancing motivation and commitment to long-term health.

Hoping to maintain a balance: the concept of hope and the discontinuation of anorexiant medications

The secondary analysis of transcripts from a study of 9 women who used prescription anorexiant medications described in this article was conducted to discover the role that hope played in the women's weight-loss initiatives. It was found that hope grew throughout the women's weight-loss initiative but peaked once the medications were discontinued. Seven components of the concept of hope were described in the context of the women's weight-loss experiences. Characteristics of hope in women who have discontinued anorexiant medications are different than those associated with hope in other contexts. A unique pattern of hope, hoping to maintain a balance, describes the women's experiences as they strove to maintain the weight they had lost.

Stage theory and research on tobacco, alcohol, and other drug use

The purpose of this article was to examine the conceptual and empirical foundations of individual drug use stage development and progression related to tobacco, alcohol, and drugs. This review indicated that while greater acceptance of the idea that drug use is a complex process, the majority of stage conceptualizations suffer from significant limitations. Although limited, research conducted to date is supportive of the existence of intra-drug use stages of acquisition for cigarettes and other drugs. Research examining inter-drug use progression among youth supports the idea of a generally invariant sequence at a macro-sequential level, involving nonuse to legal drug use, marijuana use, and finally other illegal drug use.