The decision to lose weight

The Role of Body Appreciation in the Decision to Complete Metabolic and Bariatric Surgery Among Ethnically Diverse Patients

PURPOSE

Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity.

METHODS

This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers.

RESULTS

The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37-124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82-86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55-71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96).

CONCLUSION

Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients.

Men's experiences of having osteoporosis vertebral fractures: a qualitative study using interpretative phenomenological analyses

Men and women with vertebral fractures due to osteoporosis are treated differently by society and health care professionals. This can lead to inequalities in health care and affects how men with fractures view themselves as people. We need to raise awareness that men get these fractures as well as women.

INTRODUCTION

There is a lack of research exploring the experience of osteoporosis from the male perspective. This study was undertaken to explore and describe the experiences of men with vertebral fractures due to osteoporosis, including their perceptions of diagnosis, treatment and changes in their sense of self.

METHODS

The study consists of in-depth semi-structured interviews with nine male participants of the PROVE (Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture) study. Interviews were digitally audio recorded and fully transcribed. Data were coded in accordance with an interpretative phenomenological analysis approach to analyses.

RESULTS

Three main themes are presented. (i) Osteoporosis is considered an old women's disease. (ii) Men are diagnosed and treated differently than women in the NHS. Health care inequalities exist. (iii) Changes in self can occur in men after vertebral fracture/s due to osteoporosis.

CONCLUSIONS

Greater awareness that men get this condition is needed in both society in general and also by health care professionals who often do not expect osteoporosis to affect men. Approaches to diagnosis and treatment need to be considered and improved to ensure that they become appropriate and effective for men as well as women.

Motivations of Males with Severe Obesity, Who Pursue Medical Weight Management or Bariatric Surgery

Background: Both medical weight management (MWM) and bariatric surgery are significantly underutilized by patients with severe obesity, particularly males. Less than 30% of participants in MWM programs are male, and only 20% of patients undergoing bariatric surgery are men. Objectives: To identify motivations of males who pursue either MWM or bariatric surgery. Setting: Interviews with males with severe obesity (body mass index ≥35 kg/m2), who participated in a Veteran Affairs weight loss program in the Midwest. Materials and Methods: Participants were asked to describe their experiences with MWM and bariatric surgery. Interviews were audio-recorded, transcribed, and uploaded to NVivo for data management and analysis. Five coders iteratively developed a codebook using inductive content analysis to identify relevant themes. We utilized theme matrices organized by type of motivation and treatment pathway to generate higher-level analysis and generate themes. Results: Twenty-five males participated. Participants were 58.7 (standard deviation 8.6) years old on average, and 24% were non-white. Motivations for pursuing MWM or surgery included a desire to improve physical or psychological health and to enhance quality of life. Patients seeking bariatric surgery were motivated by the fear of death and felt that they had exhausted all other weight loss options. MWM patients believed they had more time to pursue other weight loss options. Conclusion: The opportunity to improve health, optimize quality of life, and lengthen lifespan motivates males with severe obesity to pursue weight loss treatments. These factors should be considered when providers educate patients about obesity treatment options and outcomes.

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Background

Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status.

Methods

Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies.

Results

Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies.

Conclusions

Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.

Are Body Image Issues Affecting Our Adolescents? A Cross-sectional Study among College Going Adolescent Girls

BACKGROUND

Body image relates to how people think and feel about their own body. In today's society, with the growing sense of ideal body image, adolescents try to lose or gain body weight to attain that perfect body. Body image perception is still naive, and this research will try to understand these unexplored areas, where there is paucity of body image-related studies.

OBJECTIVES

The objective of the study is to find out the proportion of girls dissatisfied about body image, and the association of various factors with body image dissatisfaction and to ascertain the weight control behaviors adopted by adolescent college girls.

METHODOLOGY

A cross-sectional study was done among 1200 college girls in Coimbatore. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated.

RESULTS

Body image dissatisfaction was there among 77.6% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviors were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviors.

CONCLUSION

This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.

The duration of intermittent access to preferred sucrose-rich food affects binge-like intake, fat accumulation, and fasting glucose in male rats

Many people restrict their palatable food intake. In animal models, time-limiting access to palatable foods increases their intake while decreasing intake of less preferred alternatives; negative emotional withdrawal-like behavior is sometimes reported. In drug addiction models, intermittent extended access drives greater changes in use than brief access. When it comes to palatable food, the impact of briefer vs. longer access durations within intermittent access conditions remains unclear. Here, we provided male rats with chow or with weekday access to a preferred, sucrose-rich diet (PREF) (2, 4, or 8 h daily) with chow otherwise available. Despite normal energy intake, all restricted access conditions increased weight gain by 6 weeks and shifted diet acceptance within 1 week. They increased daily and 2-h intake of PREF with individual vulnerability and decreased chow intake. Rats with the briefest access had the greatest binge-like (2-h) intake, did not lose weight on weekends despite undereating chow, and were fattier by 12 weeks. Extended access rats (8 h) showed the greatest daily intake of preferred food and corresponding undereating of chow, slower weight gain when PREF was unavailable, and more variable daily energy intake from week to week. Increased fasting glucose was seen in 2-h and 8-h access rats. During acute withdrawal from PREF to chow diet, restricted access rats showed increased locomotor activity. Thus, intermittent access broadly promoted weight gain, fasting hyperglycemia and psychomotor arousal during early withdrawal. More restricted access promoted greater binge-like intake and fat accumulation, whereas longer access promoted evidence of greater food reward tolerance.

Intentions to Prevent Weight Gain in Older and Younger Adults; The Importance of Perceived Health and Appearance Consequences

OBJECTIVES

This study investigates whether health and appearance consequences predict intentions to prevent weight gain and whether these relationships differ in younger versus older adults and in men versus women.

METHODS

UK adults aged 18-26 years (younger adults; n = 584) or >45 years (older adults; n = 107) participated in an online survey. Logistic regression assessed associations between intentions to avoid gaining weight and age, gender as well as perceived negative consequences of weight gain for health and appearance. Co-variates were ethnicity, education, weight perception and perceived weight gain vulnerability. Interactions between age, gender and perceived health and appearance consequences of weight gain were also tested.

RESULTS

Perceived negative appearance consequences of weight gain predicted weight gain prevention intentions (OR = 9.3, p < 0.001). Health concerns were not a significant predictor of intentions overall but were a strong predictor for older adults (age × health concern interaction: OR = 13.6, p > 0.01).

CONCLUSION

Concerns about feeling unattractive predict intentions to prevent weight gain. However, health consequences of weight gain are only important motivators for older adults. Future research should identify ways to shift the focus of young people from appearance concerns towards the health benefits of maintaining a healthy weight.

Acceptability of a very-low-energy diet in Type 2 diabetes: patient experiences and behaviour regulation

AIMS

To evaluate the acceptability of an 8-week very-low-energy diet for remission of Type 2 diabetes, and to identify barriers and facilitators of adherence and behaviour-regulation strategies used by participants in the Counterbalance study.

METHODS

Eighteen of 30 participants in the Counterbalance study (ISRCTN88634530) took part in semi-structured interviews. Of these, 15 participants were interviewed before and after the 8-week very-low-energy diet intervention. Thematic analysis was used to analyse the narratives.

RESULTS

The prospect of diabetes remission, considerable weight loss, and long-term health improvement provided participants with substantial initial motivation. This motivation was sustained through the experience of rapid weight loss, improvements in blood glucose levels, social support and increased physical and psychological well-being. Overall, adherence to the very-low-energy diet for 8 weeks was perceived as much easier than anticipated, but required personal effort. Participants addressed challenges by removing food from the environment, planning, avoidance of tempting situations or places, and self-distraction. Weight loss and improvements in blood glucose levels lead to a sense of achievement and improvements in physical and psychological wellbeing.

CONCLUSIONS

Dietary treatment for reversal of Type 2 diabetes is acceptable and feasible in motivated participants, and the process is perceived as highly gratifying. Research outside of controlled trial settings is needed to gauge the generalisability of these findings.

Motivations for Weight Loss Among Active Duty Military Personnel

INTRODUCTION

Rates of overweight and obesity among Active Duty Military Personnel remain high despite fitness test requirements, negative consequences of fitness test failure, and emphasis on weight and appearance standards. Specific motivating factors for weight loss influence weight loss program interest and often differ by gender, race, ethnicity, or age. This study investigates the weight loss motivations endorsed by a diverse population of Active Duty Military Personnel initiating a behavioral weight loss study, to inform the development of future recruitment efforts and program development.

MATERIALS AND METHODS

Active Duty Military Personnel (n = 248) completed a 16-item questionnaire of weight loss motivations before initiating a behavioral weight loss study. We evaluated endorsement patterns by demographic characteristics (body mass index [BMI], gender, race, ethnicity, age, and military rank). Data collection for this study was approved by the Institutional Review Board of Wilford Hall Ambulatory Surgical Center and acknowledged by the Institutional Review Board of the University of Tennessee Health Science Center.

RESULTS

Results indicated that improved physical health, improved fitness, improved quality of life, and to live long were endorsed as "very important" motivations by at least three-fourths of the sample. "To pass the fitness test" was endorsed less frequently as a "very important" motivation, by 69% of the sample. A greater proportion of women as compared to men endorsed being very motivated by improving mood/well-being, quality of life, physical mobility, job performance, appearance, and sex life, as well as fitting into clothes. Participants categorized in the "Other" racial group and African Americans more frequently endorsed motivations to improve fitness and physical strength when compared to Caucasians. Moreover, participants in the "Other" race category were significantly more likely to rate their ability to physically defend themselves, improve physical mobility, and improve interactions with friends as motivators. Participants who identified as Hispanic endorsed significantly higher frequency of being motivated to improve their ability to physically defend themselves, interactions with friends, physical mobility, and sex life compared to those who identified as non-Hispanic. A significantly lower percentage of officers of lower rank (i.e., O1-3) endorsed being motivated to improve their quality of life. Improving confidence was a significant motivator for younger and lower ranking enlisted personnel (i.e., E1-4). Younger participants were also significantly more likely to want to improve their ability to physically defend themselves.

CONCLUSION

We conclude that overweight and obese Military Personnel are motivated by various reasons to engage in weight loss, including their military physical fitness test. Findings may assist the development of recruitment efforts or motivationally focused intervention materials for weight loss interventions tailored for the diverse population of Active Duty Military Personnel.

Predictors of diet failure: A multifactorial cognitive and behavioural model

Obesity is recognised as a multidetermined issue. However, research aimed at addressing diet failure has typically examined factors in isolation. Furthermore, previous research has included limited input from dieters themselves. A qualitative study identified a number of themes contributing to diet failure. This study aimed to test these themes with a larger sample ( n = 426) while also determining their fit within a multifactorial model. The results of this study supported the conceptualisation of diet failure using a multifactorial model while also illustrating correlational pathways to be more complex than currently understood in the literature.

A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers

Background

Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID. Aims: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers.

Methods

Prior to a multi-component weight management intervention, participants were asked “why do you want to lose weight?” Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher’s Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants’ level of ID, age, gender and BMI.

Results

Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m²; Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was “appearance.” Carers cited “health” most frequently and “appearance” least, rarely agreeing with participants. “Health” was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear.

Conclusions

Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.

Is Obesity Stigma Based on Perceptions of Appearance or Character? Theory, Evidence, and Directions for Further Study

Theoretical approaches to stigmatization have highlighted distinct psychological mechanisms underlying distinct instances of stigmatization. Some stigmas are based on inferences of substandard psychological character (e.g., individuals deemed untrustworthy), whereas others are based on perceptions of substandard physical appearance (e.g., individuals with physical deformities). These inferences and perceptions are associated with specific cognitive and motivational processes, which have implications for understanding specific instances of stigmatization. Recent theoretical approaches and empirical findings suggest that obesity stigma involves both inferences of substandard psychological character and perceptions of substandard physical appearance. We provide a review of the relevant evidence and discuss directions for future research.

Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool

OBJECTIVE

This study aims to assess middle-aged women's needs when making body weight management decisions and to evaluate a knowledge translation tool for addressing their needs.

METHODS

A mixed-methods study used an interview-guided theory-based survey of professional women aged 40 to 65 years. The tool summarized evidence to address their needs and enabled women to monitor actions taken. Acceptability and usability were reported descriptively.

RESULTS

Sixty female participants had a mean body mass index of 28.0 kg/m(2) (range, 17.0-44.9 kg/m(2)), and half were premenopausal. Common options for losing (82%) or maintaining (18%) weight included increasing physical activity (60%), eating healthier (57%), and getting support (40%). Decision-making involved getting information on options (52%), soliciting others' decisions/advice (20%), and being self-motivated (20%). Preferred information sources included written information (97%), counseling (90%), and social networking websites (43%). Five professionals (dietitian, personal trainer, occupational therapist, and two physicians) had similar responses. Of 53 women sent the tool, 27 provided acceptability feedback. They rated it as good to excellent for information on menopause (96%), body weight changes (85%), and managing body weight (85%). Most would tell others about it (81%). After 4 weeks of use, 25 women reported that the wording made sense (96%) and that the tool had clear instructions (92%) and was easy to use across time (88%). The amount of information was rated as just right (64%), but the tool had limited space for responding (72%).

CONCLUSIONS

When making decisions about body weight management, women's needs were "getting information" and "getting support." The knowledge translation tool was acceptable and usable, but further evaluation is required.

The monster in the mirror: reasons for wanting to change appearance

PURPOSE

Many adults are dissatisfied with their body, regardless of their weight, and weight loss is commonly perceived as an effective solution to this dissatisfaction. The main purpose of this study was to examine the reasons for wanting to modify one's bodily appearance (shape and weight), and to compare these reasons by sex, age, and weight group.

METHODS

The sample consisted of 796 French-speaking Canadian adults (100 men, 696 women; M age = 27.00 years, SD = 7.88, range 18-64; M body mass index = 24.99 kg/m(2), SD = 6.37, range 12.6-66.5 kg/m(2)) who were asked online whether or not they wanted to change their appearance and if so, why. Answers were subjected to a content analysis wherein recurrent themes were grouped and labeled.

RESULTS

Most participants (83.2%) wanted to change their appearance. Women, participants with a higher BMI, and older participants were significantly more likely to report this desire. The three most frequently evoked reasons were body dissatisfaction, well-being, and health/shape.

CONCLUSIONS

The results suggest that body dissatisfaction constitutes the primary motive for change for both men and women of all ages, especially for those who are of healthy weight or underweight. Women and younger adults seem to be under the impression that in changing their appearance they will be more comfortable in their own skin. Men, older adults, and overweight adults, on the other hand, are more preoccupied by their health/shape and seldom relate their appearance to their psychological balance.

Weight loss intention, dietary behaviors, and barriers to dietary change in veterans with lower extremity amputations

BACKGROUND

Obesity is thought to be highly prevalent in persons with lower extremity amputations (LEAs) and can impair physical and social functioning.

OBJECTIVE

The aim of this study was to determine the prevalence of weight loss intention, weight loss strategies, dietary patterns, and barriers to making dietary changes, and their associations with body mass index (BMI, kg/m(2)), amputation characteristics, health status, and socioeconomic factors.

METHODS

We conducted a cross-sectional study (n = 150) using data from a self-administered questionnaire.

RESULTS

43% of participants were obese and 48% were trying to lose weight; 83% of those trying to lose weight reported trying to "eat differently", but only 7% were following a comprehensive weight loss program involving dietary changes, physical activity, and behavioral counseling. 21% of participants reported ≥ 6 barriers to changing their eating habits (e.g., habit, too little money, stress/depression). Obesity was associated with younger age, lower physical health scores, hypertension, arthritis, and diabetes. Compared to those not trying to lose weight, a greater proportion of those trying to lose weight had a BMI ≥ 35 kg/m(2), age <55 years, higher physical and mental health scores, and more frequent consumption of vegetables, beans, chicken, and fish.

CONCLUSIONS

Though over half of overweight and obese individuals with LEA were trying to lose weight, few reported following a comprehensive program to lose weight, which may indicate an unmet need for services for this group. To be effective, these programs will need to address the complex physical and mental health challenges that many of these individuals face.

Bariatric surgery or lifestyle intervention? An exploratory study of severely obese patients' motivation for two different treatments

BACKGROUND

In the complex field of treating severe obesity, motivation is receiving increased attention. This explorative study aims to highlight what influences the preferences of severely obese patients deciding for either gastric bypass surgery or lifestyle treatment.

METHODS

Patients awaiting laparoscopic gastric bypass were presented with an 18-week inpatient lifestyle programme alternative to gastric bypass. Questionnaires provided qualitative data (reasons for choosing one treatment over another) and quantitative data (mental health assessment using the Hospital Anxiety and Depression Scale). The material was analysed according to a sequential exploratory design involving thematic analysis of patients' arguments, validation using HADS, and statistical computations (hypothesis testing) with one-way ANOVA followed by Dunnett's post hoc test.

RESULTS

159 participants (mean BMI 47.2 kg/m(2)) returned questionnaires of which 32% wanted the lifestyle treatment alternative to surgery. Reasons for choosing the two treatments varied widely as did also the corresponding data on mental health. Two subgroups stood out with particularly high mental symptom scores, namely patients choosing surgery due to reluctance to engage in social interaction in lifestyle treatment, and patients preferring lifestyle treatment due to the fear of dying during general anaesthesia. These two subgroups showed significantly higher symptom scores than other subgroups within their therapy-of-choice group. The number of comorbid diseases was also found to impact upon motivation.

CONCLUSIONS

Patients carry different incentives for choosing the same type of treatment. On a subgroup level, psychopathological symptoms seem to follow motivational patterns. Analysing motivation and mental health may provide measures for identifying subgroups with various prospects for therapy outcome.

Pregnancy

Pregnancy is a time when women are at increased risk to gain substantial weight. It is also a time when women are more health conscious and may be more likely to engage in healthier behaviors. Because of these factors, women are primed to engage in lifestyle strategies to promote healthy weight gain during pregnancy. Similarly, mothers of newborns also have an increased readiness for change, making infancy an ideal time to begin obesity prevention efforts in families. Health care providers are encouraged to take advantage of the increased health awareness and the behavioral momentum that is present surrounding pregnancy in order to promote healthy lifestyle changes for both pregnant women and new mothers.

Surviving breast cancer: women's experiences with their changed bodies

In this study, we explored women's experiences with their bodies following treatment for breast cancer. Eleven women who had been treated for the disease (M(time since treatment)=4.45 years) were interviewed. Data were collected and analyzed using interpretative phenomenological analysis (Smith et al., 2009). Four main themes emerged from the data: changing visibly and invisibly; experiencing intense thoughts and emotions; meaning of the body: a vehicle of health, well-being, and social expression; and managing and dealing with physical changes. Overall, the women experienced various physical changes that shaped, mostly in a negative way, their perceptions, thoughts, attitudes, feelings, and beliefs about their bodies. The women described attempts to make positive lifestyle behavior choices (e.g., diet, participate in physical activity), and used other strategies (e.g., wigs, make-up, clothes) to manage their appearances and restore positive body-related experiences. Based on these findings, it is important to be cognizant of women's body image concerns following breast cancer given the poignant and lasting effects they can have on their psychosocial and emotional well-being.

Obesity Research in Canada: Literature Overview of the Last 3 Decades

OBJECTIVE

To identify research published on obesity in Canada, to explore the range of areas studied, and to identify gaps and areas that merit future research attention.

RESEARCH METHODS AND PROCEDURES

Medline and International Pharmaceutical Abstracts databases were searched from 1970 onwards. Original articles were identified and categorized by areas of interest.

RESULTS

A total of 1186 relevant articles were identified: 17, 136, 687, and 346 articles during the 1970s, 1980s, 1990s, and 2000 to 2003, respectively. Of the articles, 816 were considered original studies and accepted for this analysis. Twelve research areas were identified: basic science involving animal experiments (29%), human experiments (16%), populations surveys (14%), obesity-related comorbidities (13%), diagnostic/surgical issues (11%), nonpharmacological approaches (7%), drug-related issues (4%), anthropometrics (2%), impact of weight loss (2%), cost/healthcare use (1%), attitudes/perceptions (0.9%), and models/procedures (0.5%). Two-thirds of all research was conducted in Quebec (34%) and Ontario (33%).

DISCUSSION

Given the multifactorial nature of obesity, Canadian obesity research covers a broad range of areas with a predominance of basic science but lesser emphasis on community and primary care studies. Furthermore, there was a paucity of research on either clinical management of medical conditions in obese patients or clinical aspects that go beyond weight loss. Thus, although Canada appears well represented in basic research, more attention to exploration of clinical issues and healthcare delivery for obese patients appears warranted.

Primary Goals for Weight Loss Questionnaire (PGWLQ): Development and Psychometric Evaluation in Overweight and Obese Adults

Cognitive behavioural models suggest that individuals abandon their weight loss efforts because they fail to achieve their weight loss goal, their perceived benefits of weight loss (primary goals), or both. There are currently no published tools available to adequately measure primary goals. The purpose of the current study was to explore the factor structure and to evaluate the psychometric properties of the Primary Goals for Weight Loss Questionnaire (PGWLQ). One hundred and twenty-seven overweight and obese adult females actively trying to lose weight completed the PGWLQ. A four-factor solution (Comfort & Mobility; Fitness; Health & Illness; Participation & Activity) provided the best fit for the physical items, and a five-factor solution (Body Image & Self-esteem; Clothing Options & Fashion; Work Productivity & Opportunity; Social Life & Desirability; Sexual Confidence) provided the best fit for the psychosocial items. All PGWLQ factors demonstrated good convergent and discriminant validity. The PGWLQ demonstrated excellent internal consistency and weak to moderate test–retest reliability. Results of the present study suggest that the PGWLQ may be a promising research and clinical tool and further refinement of the PGWLQ and investigation of its factor structure is warranted.

Using positive deviance for determining successful weight-control practices

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

Impact of addressing reasons for weight loss on behavioral weight-control outcome

BACKGROUND

One way to improve weight control may be to place greater emphasis on the main reasons why individuals want to lose weight.

PURPOSE

To evaluate the effects of emphasizing physical appearance, health, or both on behavioral weight-control outcome.

DESIGN

RCT. Data were collected from 2003 to 2005 and analyzed in 2009.

SETTING/PARTICIPANTS

203 women aged 18-55 years (M=41.8, SD=9.2) and BMI>27 and <40 (M=34.2, SD=3.7) who rated both appearance and health as important reasons for weight loss, enrolled at a university medical center.

INTERVENTION

A 6-month weekly behavioral intervention alone (Standard) was compared to an enhanced focus on physical appearance (Appearance), health benefits of weight loss (Health), or both appearance and health (Combined). The 6-month period of acute intervention was followed by six monthly booster sessions.

MAIN OUTCOME MEASURES

The primary outcome was change in body weight (kg). Additional outcomes included the Multidimensional Body-Self Relations Questionnaire, Medical Outcomes Study Short Form-36, and questions about satisfaction with weight, appearance, and health. Assessments were conducted at 0, 6, 12, and 18 months.

RESULTS

Appearance demonstrated significantly greater weight loss compared to Standard at 6 months (p=0.0107). Combined demonstrated greater weight loss compared to Standard at 6 and 12 months (p's=0.0034 and 0.0270, respectively). Although addressing motivators differentially affected satisfaction at 6 months, satisfaction was unrelated to weight outcome over the following year.

CONCLUSIONS

Behavioral interventions incorporating components with a focus on physical appearance were associated with improved short-term weight loss. The mechanism for this effect is unclear and warrants further study.

Satisfaction with a weight loss program: what matters?

PURPOSE

Satisfaction is understudied in weight loss programs. The purpose of this study was to examine the association between participant/program experiences and satisfaction with a weight loss intervention.

DESIGN

A prospective cohort design was utilized.

SETTING

The study was conducted in the Minneapolis metro area.

SAMPLE

Participants were obese employees of a managed care organization. One hundred were enrolled, and 78 had complete data available.

INTERVENTION

Treatment included telephone counseling along with a home telemonitoring scale and instructions to self-weigh daily.

MEASURES

Outcomes included overall program satisfaction and willingness to refer the program to others. Predictors included demographics, treatment group, participation in other programs, expected weight, general health, body mass index, diet quality, physical activity, body image, mental health, counseling, and self-weighing.

ANALYSIS

Quantitative predictor-outcome associations were examined using multiple logistic regressions. Qualitative satisfaction responses were analyzed using a general inductive approach.

RESULTS

Weight loss (odds ratio [OR] = 1.83, p = .008), improved diet (OR = 1.27, p = .092), increased physical activity (OR = 1.05, p = .034), and improved body image (OR = 1.38, p = .051) were independent predictors of overall satisfaction. Treatment group (OR = 14.83, p = .015) and number of counseling calls (OR = 1.49, p = .009) were predictors of willingness to refer the program. Qualitative themes indicated desire to integrate counseling on emotional issues.

CONCLUSION

Health progress explained overall satisfaction, whereas treatment characteristics explained willingness to endorse the intervention. Concentrating on these factors may improve retention. Limitations included self-reported measures.

Initial development and reliability of a motivation for weight loss scale

OBJECTIVE

We aimed at developing and evaluating a questionnaire assessing health and appearance as the two main reasons for weight loss in overweight and obese individuals.

METHODS

Using data from two representative telephone surveys in Switzerland, the factorial structure of this questionnaire was analyzed by exploratory and confirmatory factor analysis. The model obtained was cross-validated with data from a second representative Swiss survey and multigroup analyses according to sex, age, BMI and regional language subgroups were performed.

RESULTS

This lead to a 24-item, 3-factor solution, with factors labeled 'health', 'appearance in relation to others', and 'appearance in relation to oneself'. Internal consistency and test-retest reliability were good.

CONCLUSIONS

To the best of our knowledge, this is the first validated questionnaire assessing overweight and obese individuals' reasons for weight loss. It should be further tested whether using this questionnaire as a pretreatment assessment device will help in tailoring treatments to individuals, thereby increasing treatment adherence and success.

Long-term weight loss maintenance in the United States

CONTEXT

Although the rise in overweight and obesity in the United States is well documented, long-term weight loss maintenance (LTWLM) has been minimally explored.

OBJECTIVE

The aim of this study is to estimate the prevalence and correlates of LTWLM among US adults.

DESIGN, SETTING AND PARTICIPANTS

We examined weight data from 14 306 participants (age 20-84 years) in the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We defined LTWLM as weight loss maintained for at least 1 year. We excluded individuals who were not overweight or obese at their maximum weight.

RESULTS

Among US adults who had ever been overweight or obese, 36.6, 17.3, 8.5 and 4.4% reported LTWLM of at least 5, 10, 15 and 20%, respectively. Among the 17.3% of individuals who reported an LTWLM of at least 10%, the average and median weight loss maintained was 19.1 kg (42.1 pounds) and 15.5 kg (34.1 pounds), respectively. LTWLM of at least 10% was higher among adults of ages 75-84 years (vs ages 20-34, adjusted odds ratio (OR): 1.5; 95% confidence interval (CI): 1.2, 1.8), among those who were non-Hispanic white (vs Hispanic, adjusted OR: 1.6; 95% CI: 1.3, 2.0) and among those who were female (vs male, adjusted OR: 1.2; 95% CI: 1.1, 1.3).

CONCLUSIONS

More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM of at least 10%. This rate is significantly higher than those reported in clinical trials and many other observational studies, suggesting that US adults may be more successful at sustaining weight loss than previously thought.

Evaluating the role of life events and sustaining conditions in weight loss maintenance

Background. Recent qualitative research indicates that life events can enhance behaviour change maintenance. if a number of sustaining conditions are met. This study aimed to quantitatively test this theory in the context of weight loss maintenance. Method. Based upon their weight histories participants were classified as either successful (n = 431) or unsuccessful (n = 592) dieters and all completed questionnaires relating to life events, choice, the function of eating and exercise and the model of their weight problem. Findings. Successful dieters reported a higher number of life events than unsuccessful dieters particularly for events such as "clothes did not fit me", "doctor's recommendation" and "reached my heaviest weight". Successful participants also indicated reduced choice over their previous unhealthy diet, more choice over their exercise behaviours and more benefits from the new healthy behaviours. They were also less likely to attribute their previous increased weight to any medical and psychological factors. This was accompanied by a belief about the effectiveness of behavioural solutions to their weight problem. Discussion. Life events can promote behaviour change for some individuals. This change is facilitated by a reduction in choice and disruption of function over the unhealthy behaviours, and a belief that behavioural solutions will be effective.

Competition affects food choice in women

OBJECTIVE

To examine women's food choices after exposure to a threatening upward social comparison in an achievement situation.

METHOD

Female university students performed three tasks in the presence of a confederate; for some, the situation was competitive and they were made to feel the confederate was likely to outperform them, whereas the remainder performed under noncompetitive circumstances. After completing the tasks, all participants chose a food to eat in a supposedly unrelated taste test.

RESULTS

It was expected and found that participants in the high threat condition, in comparison with those in a low threat condition, would be highly motivated to restore their sense of self-worth by successfully competing in an area unrelated to the original inferiority and would, therefore, choose a lower calorie/more nutritious food. A secondary analysis revealed that it was primarily dieters whose food choices were affected by the threat.

DISCUSSION

For dieters, competition by means of food choice can provide a means of restoring self-regard when self-esteem has been threatened in some other domain.

Competing motivational discourses for weight loss: means to ends and the nexus of beauty and health

Western cultural discourses generally deem fat unhealthy and unattractive, providing strong motivation for body nonconformists to lose weight. Semistructured interviews with 42 overweight and obese participants illuminate how individuals understand health and beauty weight-loss motivations and the relationship between the two. Interviews indicate that health and beauty motivate because they are seen as means to various ends. Specifically, participants aspire to health to fulfill various social roles and to live long, meaningful lives. Moreover, they aspire to conventional beauty ideals hoping that aesthetic conformity will elicit benefits, both psychological and social. Interviews also illustrate an intertwining of discourses in which participants conflate beauty and health in three ways: indicating that depictions of the beauty ideal are depictions of the health ideal; using beauty indicators as health indicators; and employing beauty as a motivator for health goals. This article concludes with a discussion of the health, social, and policy implications of these findings.

Motivation, readiness to change, and weight loss following adjustable gastric band surgery

High levels of readiness to change (RTC) are considered critical to the long-term success of weight management programs including bariatric surgery. However, there are no data to support this assertion. We hypothesize that RTC level will not influence weight outcomes following surgery. In 227 consecutive patients undergoing adjustable gastric banding surgery, we recorded reasons for seeking surgery, and RTC measured with the University of Rhode Island Change Assessment. Scores were blinded until study completion. The primary outcome measure was percentage of excess BMI loss at 2 years (%EBMIL-2); others included compliance and surgical complications. Of 227 subjects, 204 (90%) had weight measurement at 2 years. There was no significant correlation between RTC score and %EBMIL-2 (r = 0.047, P = 0.5). Using the median split for RTC score the lowest 102 subjects mean %EBMIL-2 was 52.9 +/- 26.9% and the highest 52.2 +/- 28.3%, P = 0.869. There was no weight loss difference between highest and lowest quartiles, or a nonlinear relationship between weight loss and RTC score. There was no significant relationship between RCT score and compliance, or likelihood of complications. Those motivated by appearance were more likely to be younger women who lost more weight at 2 years. Poor attendance at follow-up visits was associated with less weight loss, especially in men. Measures of RTC did not predict weight loss, compliance, or surgical complications. Caution is advised when using assessments of RTC to predict outcomes of bariatric surgery.

Perceived health risk of excess body weight among overweight and obese men and women: differences by sex

OBJECTIVES

To describe perceptions of health risk from excess body weight among adults, and assess if lack of perceived risk was associated with trying to lose weight.

METHODS

Sex-specific logistic regression models were used to determine odds of disagreement that one's weight is a health risk and odds of trying to lose weight among overweight (BMI=25.0-29.9 kg/m(2), n=1296) and obese (BMI> or =30 kg/m(2), n=1335) adult participants in the 2004 Styles' surveys.

RESULTS

Men were more likely than women to disagree their body weight was a health risk (among the overweight, 62% vs. 43%; the obese 20% vs. 14% obese). Disagreement with risk was associated with good health status and race/ethnicity among both sexes and lower education and income among women. Odds of currently trying to lose weight were significantly lower among obese men who disagreed, and overweight men and women who were neutral or disagreed that their body weight was a health risk.

CONCLUSIONS

Many overweight and obese adults do not perceive their weight to be a health risk; this perception was associated with lower prevalence of trying to lose weight, particularly among men. Discussion by clinicians about the health risks of excess weight may alter perceived risk and help promote weight loss efforts.

Effects of a reimbursement incentive on enrollment in a weight control program

OBJECTIVE

The objective was to examine the effect of offering a reimbursement incentive on the percentage of inquirers who enrolled in a weight control program and on weight loss and program attendance among enrollees.

RESEARCH METHODS AND PROCEDURES

We used a sequential control-intervention design to observe how inquirers of the University of Alabama at Birmingham EatRight Lifestyle Program responded to an enrollment incentive for potential 50% ($150) reimbursement of the total program fee if they attended 10 of 12 classes and lost at least 6% of their current body weight. Inquirers had to be adults with a BMI >or=30 kg/m(2), seeking information about a weight control program, and informed of the program cost. Outcomes included proportion of inquirers enrolled, overall number of classes attended, and weight loss.

RESULTS

Of the 401 people who inquired during the study periods, 24.5% and 25.0% enrolled in the intervention and control periods, respectively. There was a trend toward higher attendance in the intervention group, compared with the control group; there were no differences in percentage of weight loss. The odds of attending >or=10 classes were 2.4 times as high, and both losing >6% body weight and attending >or=10 classes were three times as high in the intervention subjects compared with controls, although non-significant.

DISCUSSION

The potential of earning a performance-based reimbursement incentive did not affect enrollment in the EatRight Lifestyle Program. Performance-based incentives may be an ideal mechanism for extending coverage of weight-loss interventions by insurers because of limited financial risk and improved adherence.

An evolutionary psychology perspective on sex differences in exercise behaviors and motivations

Researchers have found that men and women pursue sex-appropriate strategies to attract mates. On the basis of intrasexual competition, men should be more likely to enact behaviors to look larger, whereas women should be more likely to enact behaviors to look smaller. The types of exercises that each performs should reflect this expectation. The present study replicates and extends work by L. Mealey (1997) on sex differences in exercise behavior. In the present study, male participants focused their energy on gaining muscle mass and enhancing their upper body definition, whereas female participants focused their energy on losing weight with emphasis on their lower body. Both sexes reported efforts to improve their abdominal region. It appears that men and women adopt sex-appropriate exercise behavior as a method of self-enhancement for intrasexual competition.

Taking action to lose weight: toward an understanding of individual differences

The purpose of the present study was to understand differences in obese/overweight individuals who do and do not seek ongoing external assistance for weight loss. Help-seeking was examined as a dichotomous and as a continuous variable. Measures of body mass index, comorbid medical conditions, socioeconomic status, psychological distress, disordered eating behavior, body image, and obesity-related knowledge were administered to a community sample of 120 overweight women (age: 22-65 y, BMI: 25-63 kg/m(2)). Fewer predictors of help-seeking were identified when measuring help-seeking as a dichotomy than when measuring it as a continuum. All predictors were from psychosocial domains, with obesity-related knowledge being the strongest, most consistent predictor. Help-seeking for weight control in a community sample of overweight and obese individuals appears to be motivated by psychological aspects of obesity, rather than obesity's physical or medical burden.

What can the National Weight Control Registry teach us?

Given the high obesity rate and its economic burden, it is critical to better understand weight loss and maintenance. The National Weight Control Registry (NWCR) provides useful information about the strategies used by successful weight maintainers long term; recent data suggest that a diet with less food group variety will provide a lower calorie intake and that medical triggers have been associated with better initial weight loss and maintenance. The NWCR data suggest that long-term weight loss maintenance can be achieved and that health care practitioners may need to adjust weight control programs accordingly.

Role of personal factors in women's self-reported weight management behaviour

The aim of this study was to investigate the role of motivation, anxiety and self-efficacy in self-reported behaviour that may be important for weight loss and weight maintenance. One hundred and twenty-nine females aged 18-81 years were recruited from a variety of social, sporting venues and work places within a local community. Participants completed questionnaires assessing their levels of participation and perseverance in weight management activities, their motivation levels, their anxiety levels (State Anxiety Inventory) and their levels of self-efficacy for weight management behaviours. Motivation was found to play a major role in participation in weight management activities. Anxiety and self-efficacy played no significant role. The findings are discussed in relation to previous studies, and directions for future studies are indicated. It is argued that the level of motivation is a key factor that should be taken into account for each individual engaging in women's weight management programmes, and that further research should be undertaken to identify other relevant factors.

Obesity: America’s Epidemic

The health risks of overweight and obesity have been well documented. For example, even a 15-lb. weight gain increases a person's risk of diabetes by 50%. In turn, losing as little as 11 lbs. can reduce a person's risk of diabetes by the same percentage. Why, then, aren't more Americans losing weight? This article explores the rising incidence of overweight and obesity in the United States, the reasons so many people fail to lose weight or maintain a weight loss, and the potential for nurses to turn the tide on this epidemic.

Medical triggers are associated with better short- and long-term weight loss outcomes

BACKGROUND

Medical events are often reported as triggers for weight loss, but it is unknown whether medical triggers result in better short- and long-term weight control.

METHODS

The relationship between medical triggers and weight loss was examined in the National Weight Control Registry (NWCR), a database of individuals who have lost > or =30 lbs and kept it off for > or =1 year. Recall of weight loss triggers may become difficult over time, thus participants were limited to those reporting weight loss <5 years ago. Three groups were examined: (1) participants with medical triggers (N = 207), (2) participants with nonmedical triggers (N = 539), and (3) participants with no trigger (N = 171).

RESULTS

Participants with medical triggers were older than those with nonmedical triggers or no trigger (50.5 +/- 11.7, 44.9 +/- 11.8, 46.7 +/- 13.3 years; P = 0.0001), had a higher initial BMI at entry into the NWCR (26.1 +/- 5.0, 25.0 +/- 4.3, 24.8 +/- 4.4 kg/m2; P = 0.004), and were more likely to be male (37.1%, 18%, 17.2%; P = 0.0001). Participants with medical triggers reported greater initial weight loss than those with nonmedical triggers or no trigger (36.5 +/- 25.0, 31.8 +/- 16.6, 31.8 +/- 17.1 kg; P = 0.01). Participants with medical triggers also gained less weight over 2 years of follow-up than those with nonmedical triggers or no trigger (P = 0.003).

CONCLUSIONS

Medical triggers may produce a teachable moment for weight control, resulting in better initial weight loss and long-term maintenance.

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.

Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men

OBJECTIVE

To identify the reasons for seeking weight loss in overweight or obese but otherwise healthy men.

DESIGN

Interviews, prior to intervention, with subjects who had volunteered to participate in a work-site-based weight loss study.

SUBJECTS

Ninety-one overweight/obese male workers. Mean age 41, range 18-55 y, mean body mass index (BMI) 31.0, range 26.2-41.6 kg/m(2).

MEASUREMENTS

Anthropometric measurements; body weight and height. Body mass index calculated. A short interview using open questions to determine the individuals reason for seeking weight loss.

RESULTS

The message that weight loss is beneficial to health for the overweight was recognized by all subjects regardless of BMI, and was reported as the main factor for attempting weight loss. Improved fitness and effects on appearance and well-being were reported half as often as the primary reason for weight loss.

CONCLUSION

Overweight lay members of the public have accepted the health education message that weight loss can improve health. Overweight but otherwise healthy men who responded, of their own accord, to an electronic mail message offering help to lose weight did not regard obesity and overweight as primarily a cosmetic issue. This is still, however, important, especially to younger people. doi:10.1038/sj.ijo.0801999

Childhood memories about food: the Successful Dieters Project

PURPOSE

The Successful Dieters Project explored and described the characteristics of dieters. This paper reports the results of a content analysis of one question about childhood memories surrounding food.

METHODS

All subjects were interviewed once with an intensive interview guide, were weighed, and were measured for height and waist-hip ratios.

SUBJECTS

Subjects (N = 162) were 76 men and 86 women, who ranged in age from 21 to 84 years.

FINDINGS

Gender and weight history differences were noted in the areas of food rules, the age at which dieting to control weight began, family food rules, positive versus negative memories, and the use of food as a reward or punishment. Parental experience with food deprivation was a strong force in shaping children's attitudes toward food.

CONCLUSIONS

Childhood memories about food appear to contribute to differences among the obese, the always-normal-weight, and the successful dieter. Further research into this area of investigation is warranted.

New directions for the study of overweight

In this issue, three authors contribute to our knowledge of triggers or cues to weight-related behavior. Two of these authors focus on the effect of emotion on eating behavior. Popkess-Vawter, Wendel, Schmoll, and O'Connell (1998, in this issue) explicate reversal theory as a way to account for feelings and stress that trigger weight cyclers to overeat. Timmerman (1998, in this issue), in a study of nonpurge binge eaters, reports the relationship between caloric intake patterns and binge eating. Both researchers have added to our knowledge about triggers to eating behavior. Finally, Brink and Ferguson (1998), in their study of male and female successful dieters, add to the limited knowledge concerning triggers to weight loss. They describe reasons for deciding to lose weight among a population of successful underweight, normal weight, and obese dieters. Three authors contribute to the new weight research thrust of prevention. Two of the authors report the results of intervention studies. Reifsnider (1998, in this issue), in the only article on children, presents a follow-up study of a family-focused, community-based nursing intervention for growth-deficient, low-income Euro-American and Mexican American preschool children. Her work is an example of the context- and lifestyle-sensitive prevention-focused studies needed in weight research. Ciliska (1998, in this issue) reports findings from a randomized trial of a psycho-educational intervention with obese healthy women aimed at increasing self-esteem and decreasing restrained eating patterns. Her work follows some new thinking in the area of weight control that recognizes the dangers of chronic dieting and proposes a focus on self-acceptance, better nutrition, regular physical activity, and the prevention of further weight gain triggered by chronic dieting (Brownell & Cohen, 1995). Walker (1998, in this issue), the third author, in a multiethnic study of new mothers, explores the concept of weight-related distress and associations of anthropometric and psychosocial variables with feelings about weight. Her work adds to our understanding about critical periods and risks for weight gain. Allan (1998, in this issue), in a study of African American, Euro-American, and Mexican American women, reports women's explanatory models of overweight and the congruence of these models with professional models and recommendations for treatment for overweight. Her research contributes needed understandings of how high-risk populations view overweight, how participants' lifestyles and situations influence their ideas about weight, and how these perspectives influence efforts to control weight. Nursing needs to continue to refine and rethink what constitutes research on weight. This special issue offers some examples of scholars attempting to trailblaze new directions in nursing weight research. One thrust has been the significant attention on weight as a focus of investigation and not just as one of several health behaviors. A second and equally compelling area of inquiry has been the explicit attention directed to studying people of color, especially women, within the social context of their lives. Because ethnicity, social status, and gender are inextricably intertwined with health, one challenge is to try to understand weight issues through an ethnic, gender, and social status lens. Researchers who embrace this paradigm refuse to look at weight as a homogeneous condition but focus their attention instead on specific subgroups in the population without making middle-class Euro-Americans the norm. The number of researchers who are examining connections between ethnicity and social status and weight is growing. The complexity of weight-health promotion requires that we not only boldly examine weight in relationship to the individual in context but also explicate the macroenvironmental influences on weight. More needs to be done to translate findings from this body of research into better models