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

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program

BACKGROUND

Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear.

OBJECTIVE

We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period.

METHODS

This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m², and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss.

RESULTS

Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively).

CONCLUSIONS

Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality.

Bio-citizens online: A content analysis of pro-ana and weight loss blogs

Current neoliberal ideology in Western society encourages individuals to self-monitor their body to control population health. The resulting self-surveillance includes weight management, promoted as a marker of health. Disordered eating, like anorexia, is framed as a health disorder. However, weight loss is framed as a health initiative; we argue that these framings are engaging with the same body project, encouraging thinness as a marker of health and good bio-citizenry. Using content analysis to compare online blog context created by individuals engaged in weight loss and individuals who identify as pro-anorexia, we argue and evidence that both groups are engaged in body projects with shared parameters. Findings suggest each group is striving to embody a thin ideal through weight management. Specifically, weight loss bloggers and pro-ana bloggers demonstrate similar diet and exercise behaviours in online diaries detailing their weight loss experiences. Thus, weight loss and anorexia exist on the same spectrum of responsible bio-citizenry.

Restrained eaters' consumption of dietary forbidden and permitted foods after exposure to incidental fitness cues

The purpose of this research is to investigate the influence of incidental fitness cues on caloric food intake in restrained (vs. unrestrained) eaters. The authors show that the effect of incidental fitness cues (made salient via a priming procedure in a seemingly unrelated study prior to the main study) on caloric food intake differs between dietary forbidden and permitted foods. For food that is perceived as dietary forbidden, calorie intake decreases if restrained eaters are incidentally primed with fitness. In contrast, calorie intake of dietary permitted food increases for restrained eaters in response to incidental fitness primes. The study extends prior research on priming effects on eating behavior and derives important implications on how to help restrained eaters control energy intake.

Participant experiences of a low-energy total diet replacement programme: A descriptive qualitative study

Introduction

The participants’ experience of low-energy total diet replacement (TDR) programmes delivered by lay counsellors in the community for the routine treatment of obesity is currently unclear. We interviewed a sample of twelve participants who took part in the Doctor Referral of Overweight People to Low-Energy total diet replacement Treatment (DROPLET) trial and were randomised to the TDR programme.

Methods

We purposively sampled twelve patients who took part in the DROPLET trial, and conducted in-depth telephone interviews, which were audio-recorded and transcribed verbatim. Interview questions focused on participants’ experiences and perceptions of the TDR programme. We conducted a thematic analysis, actively developing themes from the data, and used the one sheet of paper (OSOP) technique to develop higher-level concepts.

Results

Nine key themes were identified; Reasons for taking part, Expectations, Support and guidance from the counsellor, Time to build a personal relationship, Following the TDR Programme, Adverse events, Outcomes from the TDR, Weight Loss Maintenance, Recommending TDR to others. The relationship between participants and the counsellor was central to many of the themes. Close relationships with counsellors facilitated TDR adherence through providing one-to-one support (including during difficult times), sharing expert knowledge, and building a close relationship. Adherence was also supported by the rapid weight loss that patients reported experiencing. Overall participants reported positive experiences of the TDR, and emphasised the positive impact on their wellbeing.

Discussion

Patients reported that a TDR programme delivered by lay counsellors in the community was a positive experience and effective in helping them to lose weight. Future trials should consider the central role of the person providing support and advice as a key component in the programme.

Investigating lay beliefs regarding the effect of weight loss on health

OBJECTIVE

Individuals with obesity are often recommended weight loss for their health; however, the amount of weight loss that is recommended varies. Lay people's beliefs about weight loss could influence the types of behaviours they view as necessary for people with obesity. The present study explored lay beliefs regarding the health benefits of varying degrees of weight loss.

DESIGN

Participants (379 community members and 235 students) read information about an obese target who lost varying amounts of weight (none vs. modest vs. substantial) following behaviour changes.

MAIN OUTCOME

Participants evaluated the target's health and recommended health-related behaviours to the target.

RESULTS

The substantial weight-loss target, but not the modest weight-loss target, was perceived as being healthier than the no weight-loss target. There were no differences in behaviour recommendations made to the no weight-loss and modest weight-loss targets, with most participants recommending further weight loss to both targets.

CONCLUSIONS

Lay people appear to view substantial, but not modest, weight loss as beneficial to health, and they recommend further, more unrealistic amounts of weight loss to obese individuals who have already achieved modest weight loss. A failure to recognise the health benefits of modest weight loss may contribute to unrealistic weight loss goals.

Perceptions of weight in relation to health, hunger, and belonging among women in periurban South Africa

Obesity among South African women represents an important dimension of noncommunicable disease (NCD) risk. Experiences of weight are an under-explored frame of reference for intervention. Using three-part in-depth interviews with 20 women and 9 focus groups with a total of 57 women (N = 77) in one low-income neighborhood, I relate women's positive perceptions of fatness to belonging and experiences of hunger. Aware of public health obesity messaging, participants tried to lose weight, yet stress and food scarcity impacted weight gain. Whereas public health interventions focus on behavior, responses to NCDs must recognize the role of food systems and poverty in shaping risk profiles.

An Experimental Test of the Effects of a Target Person's Body Weight and Engagement with Health Behaviours on Perceptions of Overall Health

BACKGROUND

Public health campaigns commonly emphasise the association between excess weight and poor health. The present study aimed to examine the effect of information about weight and engagement with health behaviours on judgements of a person's health.

METHOD

In two experimental studies, participants were asked to evaluate a target person's health and to make recommendations about that person's health-related behaviours. In Study 1 (n = 306), we manipulated the target's behaviours (healthy, unhealthy) and body weight (normal, overweight, obese); in Study 2 (n = 192), we manipulated the behaviour of an overweight target (healthy, unhealthy).

RESULTS

Study 1 found that the obese target was consistently rated as less healthy than the normal-weight target, whereas the overweight target was only rated as less healthy when her behaviours were unhealthy. Study 2 found that the overweight target's weight was viewed as being more harmful to her health when she engaged in unhealthy behaviours. Recommendations to lose weight were most common for the obese targets (with healthy or unhealthy behaviours), and for the overweight target with unhealthy behaviours.

CONCLUSIONS

Whereas obesity appears to be viewed as harmful to health independent of health behaviours, the extent to which overweight is perceived as harmful depends on the overweight individual's diet and exercise behaviours.

"The Weight Is Even Worse Than the Cancer": Exploring Weight Preoccupation in Women Treated for Breast Cancer

Cancer-related changes in body weight are problematic given that excess weight is associated with an increased risk of cancer reoccurrence and mortality. The purpose of this qualitative study was to explore the experiences of weight-concerned women treated for early-stage breast cancer. A purposeful sample of women were selected based on criteria for high weight and body image concerns ( n = 11; M_age = 65.31 ± 10.96 years). Each participant engaged in a one-on-one semi-structured interview. Five themes were identified: weight concerns contributed to psychological distress, prevalent history of weight cycling and ongoing quest to manage weight, shifting psychological impact of cancer versus weight, perceptions of failure around goal-oriented weight management behaviors, and internalized and explicit social pressures for weight loss in the context of risk reduction. In light of the fundamental challenges of weight management, and the present findings, improving weight-related distress should be a clinical priority to improve the well-being of women in survivorship.

Aging and exercise: Perceptions of the active lived-body

Exploring older people's evocation of their positive experiences of aging has been proposed as a counterweight to the Western stereotype of aging as a process of decline. The aim of this article is to explore how aging women, who participate regularly in group exercise classes, perceive their own bodies and the bodies of others. This article reports on the findings from interviews with 16 women between the age of 70 and 85. We analyzed the data using qualitative content analysis. Two overarching and interrelated themes concerning body perception emerged from the interviews: "The aging body and appearance" and "The body as subject and object." The binary discourse of old age, as either a decline or a success appears in our findings. The training contributes to a sense of well-being experienced through perceived increased physical abilities, self- image and self-esteem. Physical ability was perceived as being more important than appearance by the participants in this study, considering their preconception of an association between declining health, abilities, and older age. Involvement in physical activity appears to play a significant role in the perception of the women's own aging. Although physical attractiveness is a desirable outcome, the most important positive impact of the group exercise was related to increased social belonging and well-being, physical abilities, and capabilities. Thus implications for practice suggests that an intensive group training contributes to the opinion that an aging body is not necessarily a barrier to positive and successful aging.

Life course, sociocultural factors and disordered eating in adult Mexican women

Disordered eating (DE) can appear in women of all ages and in diverse sociocultural contexts, however most research focuses on younger women in higher income countries. The purpose of this article was to explore the association of life course markers with DE, considering the effects of sociocultural factors, in a sample of adult women in Tijuana, Mexico. We employed data from a household survey (n = 2322) conducted in 2014, to evaluate the associations of DE with age, occupation, marital status and having children (life course markers), and indicators of social position and exposure to modernization (sociocultural factors). The prevalence of weight preoccupation was 69.2% (CI95% 67.3,71.1), the prevalence of dieting 24.8% (CI95% 22.4,27.3), and 2.0% (CI95% 1.4,3.0) had a probable eating disorder according to the questionnaire cutoff score. In the adjusted model, younger age, being employed, higher social position and indicators of exposure to modernization had positive associations with DE. There were interactions between marital status and body mass index, and between age and region of birth. The interaction terms showed that overweight was positively associated with DE among single and cohabiting participants, but not among the married ones; and that the negative association between DE and age was apparent from younger age groups in women born in less developed regions of Mexico. Our results replicate others in showing DE to be present in women through the life course, and point to at-risk groups in the confluences of life course, social position and modernization.

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.

Obese But Fit: The Relationship of Fitness to Metabolically Healthy But Obese Status among Sexual Minority Women

PURPOSE

The purpose of this study was to describe fitness characteristics of metabolically healthy sexual minority women who are obese.

METHODS

As part of the Healthy Weight in Lesbian and Bisexual Women Initiative funded by the U.S. Office on Women's Health, one site enrolled self-identified lesbian or bisexual women age 40 and older in a randomized controlled trial that evaluated interventions to improve health. Women with waist-to-height ratio of 0.5 or greater were classified as obese. Women without diabetes or cardiovascular disease and with normal range fasting blood level measurements of glucose, triglycerides, high-density cholesterol, and blood pressure were classified as metabolically healthy but obese (MHO). Otherwise, women were classified as metabolically unhealthy obese (MUHO). Fitness measurements included predicted VO2 maximum, 1-minute heart rate recovery, and strength (single maximal leg lift and chest press). Self-reported demographic and physical activity level data were obtained by standardized questionnaires.

RESULTS

Of the 53 participants who completed the eligibility screener in Columbia, Missouri, 47 were enrolled in the study (89% participation proportion) with 45 categorized as obese. Approximately one-third (38%) were MHO. The majority of MHO and MUHO participants ranked poor or very poor on a composite fitness score that included measures of strength, flexibility, and aerobic fitness (75.0% and 77.8%, respectively). In the logistic regression models, better 1-minute heart rate recovery after peak exercise performance was significantly associated with MHO individuals (odds ratio, 2.92; 95% CI, 1.13-9.10) compared with MUHO. No other fitness measure was significantly different between the two groups.

CONCLUSION

Consistent with other studies, we identified more than one-third of our obese sexual minority women as MHO. Fitness measures may be potential predictors of MHO status because one measure, heart rate recovery, was significantly associated with MHO status. With the population prevalence of obesity high and even higher among lesbian or bisexual women, sexual minority women are an ideal population for a longitudinal study to better understand MHO characteristics.

Healthy habits are no fun: How Dutch youth negotiate discourses about food, fit, fat, and fun

In this article, we use the notion of "biopedagogical practices" to explore how Dutch youth respond to health messages that focus on body weight. Previous studies suggest that such health messages encourage body dissatisfaction in youth. Few studies, however, focus on the local/cultural specificity of youth's responses to these biopedagogical practices. In this article, we address questions about the re-interpretation of and resistance to health messages that Dutch youth engage in and how these can be understood in their local context. The data were drawn from two previously conducted studies in which a total of 64 Dutch teenagers (aged 12-18 years) took part. We employed a variety of qualitative data collection methods and a feminist poststructuralist perspective to analyze how Dutch youth negotiate biopedagogical practices about health. The results show that our participants constructed health in terms of appearance and reproduced negative constructions regarding fat embodiment. Yet they also often circumvented "healthy" lifestyle behaviors prescribed by biopedagogies of health. They did so first by avoiding physical activities because they were afraid of displaying fat embodiment in the settings of sport and physical education where surveillance is omnipresent. Second, they disregarded advice about healthy eating by drawing on having fun as an alternative discursive resource. We argue that having fun is both part of youth culture and characteristic of the discourse about sociability ( gezelligheid) that is a central element of Dutch culture.

Social factors, weight perception, and weight control practices among adolescents in Mexico

We evaluated the association of social factors and weight control practices in adolescents, and the mediation of this association by weight perception, in a national survey of students in Mexico ( n = 28,266). We employed multinomial and Poisson regression models and Sobel's test to assess mediation. Students whose mothers had a higher level of education were more likely to perceive themselves as overweight and also to engage in weight control practices. After adjusting for body weight perception, the effect of maternal education on weight control practices remained significant. Mediation tests were significant for boys and non-significant for girls.

Weight expectations, motivations for weight change and perceived factors influencing weight management in young Australian women: a cross-sectional study

OBJECTIVE

To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income.

DESIGN

Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight.

SETTING

Online survey in Australia.

SUBJECTS

Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012.

RESULTS

Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management.

CONCLUSIONS

The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

"Judging a body by its cover": young Lebanese-Canadian women's discursive constructions of the "healthy" body and "health" practices

Our interest stems from the dramatic increase in the number of obesity studies, which expose Canadian women to a huge amount of information that links health to weight. Using feminist poststructuralist and postcolonial lenses, this paper investigates young Lebanese-Canadian women's constructions of the body and "health" practices within the context of the dominant obesity discourse. Participant-centered conversations were held with 20 young Christian Lebanese-Canadian women. A thematic analysis was first conducted and was followed by a poststructuralist discourse analysis to further our understanding of how the participants construct themselves as subjects within various discourses surrounding health, obesity, and the body. Our findings reveal that most participants conflate the "healthy" body and the "ideal" body, both of which they ultimately portray as thin. The young women construct the "healthy"/"ideal" body as a solely individual responsibility, thus reinforcing the idea of "docile bodies." The majority of participants report their frequent involvement in disciplinary practices such as rigorous physical activity and dietary restrictions, and a few young women mention the use of other extreme forms of bodily monitoring such as detoxes, dieting pills, and compulsive exercise. We discuss the language employed by participants to construct their multiple and shifting subjectivities. For instance, many of these Lebanese-Canadian women use the term "us" to dissociate themselves from Lebanese women ("them"), whom they portray as overly focused on thinness and beauty and engaged in physical activity and other bodily practices for "superficial" purposes. The participants also use the "us/them" trope to distance themselves from "Canadian" women (read: white Euro-Canadian women), whom they portray as very physically active for purposes beyond the improvement of the physical appearance of the body. We discuss the impacts of the young Christian Lebanese-Canadian women's hybrid cultural identities and diasporic spaces on their discursive constructions of the body and "health" practices. Finally, we examine the participants' fluid subject-positions: On one hand, they construct themselves as neoliberal subjects re-citing elements of dominant neoliberal discourses (self-responsibility for health, traditional femininity, and obesity) but, on the other hand, they at times construct themselves as "timid" poststructuralist subjects expressing awareness of, and "micro-resistance" to such discourses.

Transformative Lifestyle Change: key to sustainable weight loss among women in a post-partum diet and exercise intervention

The increase in overweight and obesity among women is a growing concern, and reproduction is associated with persistent weight gain. We have shown that dietary behavioural modification treatment, with or without exercise, results in weight loss and maintenance of weight loss. The aim of this study was to provide an explanatory model of how overweight and obese women achieve weight loss during, and after, participating in a post-partum diet and/or exercise intervention. Using Grounded Theory, we performed and analysed 29 interviews with 21 women in a 12-week Swedish post-partum lifestyle intervention with a 9-month follow-up. Interviews were made after the intervention and at the 9-month follow-up. To overcome initial barriers to weight loss, the women needed a 'Catalytic Interaction' (CI) from the care provider. It depended on individualised, concrete, specific and useful information, and an emotional bond through joint commitment, trust and accountability. Weight loss was underpinned by gradual introduction of conventional health behaviours. However, the implementation depended on the experience of the core category process 'Transformative Lifestyle Change' (TLC). This developed through a transformative process of reciprocal changes in cognitions, emotions, body, environment, behaviours and perceived self. Women accomplishing the stages of the TLC process were successful in weight loss, in contrast to those who did not. The TLC process, dependent on initiation through CI, led to implementation and integration of recognised health behaviours, resulting in sustainable weight loss. The TLC model, including the CI construct and definition of barriers, facilitators and strategies provides an explanatory model of this process.

Another body project: The thin ideal, motherhood, and body dissatisfaction among Mexican women

In this article, we examine the bodily experiences of Mexican women, to investigate their acceptance of the thin ideal and resulting body dissatisfaction. We conducted semi-structured individual interviews with 30 adult participants in Mexico City. Interviewees accepted the thin body ideal, but experiencing their bodies as signifiers of motherhood protected them from body dissatisfaction. Instead of a personal body project, they engaged in a project of caring for their children’s bodies. We suggest that health campaigns directed to adult women should consider the relational aspects of their lives.

Exploring media representations of weight-loss surgery

Scholars have problematized popular culture and media (re)presentations of obesity/overweight. However, few have considered the ways bariatric surgery, a rapidly growing treatment for morbid obesity, fits within the discussion. In this article, we explore news media (re)presentations of bariatric surgery using an eclectic approach to critical discourse analysis. Our findings reveal dominant discourses about bariatric surgery and the surgical population, providing an understanding of media (re)presentations as possible contributors to bias, stigmatization, and discrimination. Novel in our findings was our identification of subject positions in the dominant discourses (which were biomedical and benevolent government). We argue that existing (re)presentations of bariatric surgery are highly problematic because they reinforce oversimplistic and binary understandings of weight-loss surgery and obesity, weaving a highly gendered fairy-tale narrative and ultimately promoting weight-based stigmatization.

A qualitative exploration of whether lesbian and bisexual women are ‘protected’ from sociocultural pressure to be thin

Heterosexual women in Western cultures are known to experience body image concerns, dieting and disordered eating as a result of intense social pressures to be thin. However, it is theorised that lesbian and bisexual women belong to a subculture that is ‘protective’ of such demands. Fifteen non-heterosexual women were interviewed about their experiences of social pressure. Thematic analysis of their accounts suggests that such theorising may be inaccurate, because these lesbian and bisexual women did not feel ‘protected’ from social pressures and experienced body dissatisfaction. While they might attempt to resist thin idealisation, resistance is not centred around their sexuality.

Healthy appearances – distorted body images? Young adults negotiating body motives

Drawing on focus group discussions, this article explores how young, Finnish university students view the cultural ideals of health and appearance. The young adults noted how body practices aiming at health can turn into unhealthy obsessions. As a result, a healthy-looking body may serve to cover an underlying body image distortion. Health and well-being were defined as appropriate motives for engaging in body projects, while appearance as a motive was questioned. I argue that the current promotion of health may cause individuals to experience pressure to outwardly appear healthy at the cost of neglecting the subjective experience of well-being, and that this may especially influence young women.

Empowerment and bariatric surgery: negotiations of credibility and control

Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to "empower" patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals' identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents' identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants "trapped" within the ambivalence of freedom and control.

A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults

Background

Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults.

Methods

Grounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives.

Results

Several categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively.

Conclusions

The model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.

Physical activity advertisements that feature daily well-being improve autonomy and body image in overweight women but not men

The reasons for exercising that are featured in health communications brand exercise and socialize individuals about why they should be physically active. Discovering which reasons for exercising are associated with high-quality motivation and behavioral regulation is essential to promoting physical activity and weight control that can be sustained over time. This study investigates whether framing physical activity in advertisements featuring distinct types of goals differentially influences body image and behavioral regulations based on self-determination theory among overweight and obese individuals. Using a three-arm randomized trial, overweight and obese women and men (aged 40-60 yr, n = 1690) read one of three ads framing physical activity as a way to achieve (1) better health, (2) weight loss, or (3) daily well-being. Framing effects were estimated in an ANOVA model with pairwise comparisons using the Bonferroni correction. This study showed that there are immediate framing effects on physical activity behavioral regulations and body image from reading a one-page advertisement about physical activity and that gender and BMI moderate these effects. Framing physical activity as a way to enhance daily well-being positively influenced participants' perceptions about the experience of being physically active and enhanced body image among overweight women, but not men. The experiment had less impact among the obese study participants compared to those who were overweight. These findings support a growing body of research suggesting that, compared to weight loss, framing physical activity for daily well-being is a better gain-frame message for overweight women in midlife.

"Most girls want to be skinny": body (dis)satisfaction among ethnically diverse women

In this article, I present the findings from an ethnographic study of 18 women college students living in the northeastern United States. I examine how ethnically diverse women dealt with the messages of the dominant White society's obsession with thinness, and whether it affected their perceptions of an ideal body image. From the analysis of the interviews, I identified and extracted several themes related to ethnicity, aesthetic body ideals, body dissatisfaction, and disturbed eating. Grounded in the women's narratives, I found that ethnically diverse women coming of age in American society experience anxieties and emotional stress as they related to others in their daily lives. Their stories shed light on how the body is a vehicle for social mobility and is used by women from marginalized identities to strategically negotiate social inequalities embedded in daily social relationships and interactions that more privileged women do not encounter.