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Reinka MA, Quinn DM, Puhl RM. Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI. Appetite 2021; 164:105257. [PMID: 33864861 DOI: 10.1016/j.appet.2021.105257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/31/2023]
Abstract
Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, β = 0.135, p < .001, and more disinhibited eating, β = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.
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Affiliation(s)
- Mora A Reinka
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA; Department of Psychology, Ursinus College, 601 E. Main St., P.O. Box 1000, Collegeville, PA, 19426-1000, USA.
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Obesity; Department of Human Development and Family Sciences, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA
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Tavares IM, Moura CV, Nobre PJ. The Role of Cognitive Processing Factors in Sexual Function and Dysfunction in Women and Men: A Systematic Review. Sex Med Rev 2020; 8:403-430. [DOI: 10.1016/j.sxmr.2020.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
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Daigle KM, Gang CH, Kopping MF, Gadde KM. Relationship Between Perceptions of Obesity Causes and Weight Loss Expectations Among Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:86-90. [PMID: 30318272 PMCID: PMC6352733 DOI: 10.1016/j.jneb.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine relationships between the demographic characteristics of subjects with obesity seeking pharmaceutical-assisted weight loss and their weight loss expectations and perceptions of the causes of their obesity. METHODS A total of 225 adults with obesity completed an obesity perceptions questionnaire (OPQ), which included 4 attribution subscales: biological, psychological, environmental, and lifestyle. Relations were analyzed among OPQ subscales, subject characteristics, and self-perceived ideal 12-month weight loss. RESULTS Subjects desired to lose 26.4% (SD, 7.7%) of their body weight (ideal weight loss). Ideal weight loss correlated positively with the OPQ biological subscale (P = .008), body mass index (P < .001), female sex (P < .001), and past weight loss attempts (P < .001). Cronbach α was good (>.70) only for the psychological subscale. White race (P = .02), married status (P = .01), and high school or higher education (P = .02) were negatively correlated with ideal weight loss. CONCLUSIONS AND IMPLICATIONS When designing interventions for preventing and treating obesity, patient perceptions should be considered.
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Affiliation(s)
- Katelyn M Daigle
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Catherine H Gang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Kishore M Gadde
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
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Edlind M, Mitra N, Grande D, Barg FK, Carter T, Turr L, Glanz K, Long JA, Kangovi S. Why Effective Interventions Do Not Work for All Patients: Exploring Variation in Response to a Chronic Disease Management Intervention. Med Care 2018; 56:719-726. [PMID: 29939912 PMCID: PMC6041152 DOI: 10.1097/mlr.0000000000000939] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Half of all Americans have a chronic disease. Promoting healthy behaviors to decrease this burden is a national priority. A number of behavioral interventions have proven efficacy; yet even the most effective of these has high levels of nonresponse. OBJECTIVES In this study, we explore variation in response to an evidence-based community health worker (CHW) intervention for chronic disease management. RESEARCH DESIGN We used a convergent parallel design that combined a randomized controlled trial with a qualitative process evaluation that triangulated chart abstraction, in-depth interviews and participant observation. SUBJECTS Eligible patients lived in a high-poverty region and were diagnosed with 2 or more of the following chronic diseases: diabetes, obesity, hypertension or tobacco dependence. There were 302 patients in the trial, 150 of whom were randomly assigned to the CHW intervention. Twenty patients and their CHWs were included in the qualitative evaluation. RESULTS We found minimal differences between responders and nonresponders by sociodemographic or clinical characteristics. A qualitative process evaluation revealed that health behavior change was challenging for all patients and most experienced failure (ie, gaining weight or relapsing with cigarettes) along the way. Responders seemed to increase their resolve after failed attempts at health behavior change, while nonresponders became discouraged and "shut down." CONCLUSIONS Failure is a common and consequential aspect of health behavior change; a deeper understanding of failure should inform chronic disease interventions.
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Affiliation(s)
| | | | | | - Frances K Barg
- Family Medicine, University of Pennsylvania Perelman School of Medicine
| | - Tamala Carter
- Penn Center for Community Health Workers, University of Pennsylvania Health System, Philadelphia, PA
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Kangovi S, Barg FK, Carter T, Levy K, Sellman J, Long JA, Grande D. Challenges faced by patients with low socioeconomic status during the post-hospital transition. J Gen Intern Med 2014; 29:283-9. [PMID: 23918162 PMCID: PMC3912302 DOI: 10.1007/s11606-013-2571-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/03/2013] [Accepted: 07/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with low socioeconomic status (low-SES) are at risk for poor outcomes during the post-hospital transition. Few prior studies explore perceived reasons for poor outcomes from the perspectives of these high-risk patients. OBJECTIVE We explored low-SES patients' perceptions of hospitalization, discharge and post-hospital transition in order to generate hypotheses and identify common experiences during this transition. DESIGN We conducted a qualitative study using in-depth semi-structured interviewing. PARTICIPANTS We interviewed 65 patients who were: 1) uninsured, insured by Medicaid or dually eligible for Medicaid and Medicare; 2) residents of five low-income ZIP codes; 3) had capacity or a caregiver who could be interviewed as a proxy; and 4) hospitalized on the general medicine or cardiology services of two academically affiliated urban hospitals. APPROACH Our interview guide investigated patients' perceptions of hospitalization, discharge and the post-hospital transition, and their performance of recommended post-hospital health behaviors related to: 1) experience of hospitalization and discharge; 2) external constraints on patients' ability to execute discharge instructions; 3) salience of health behaviors; and 4) self-efficacy to execute discharge instructions. We used a modified grounded theory approach to analysis. KEY RESULTS We identified six themes that low-SES patients shared in their narratives of hospitalization, discharge and post-hospital transition. These were: 1) powerlessness during hospitalization due to illness and socioeconomic factors; 2) misalignment of patient and care team goals; 3) lack of saliency of health behaviors due to competing issues; 4) socioeconomic constraints on patients' ability to perform recommended behaviors; 5) abandonment after discharge; and 6) loss of self-efficacy resulting from failure to perform recommended behaviors. CONCLUSIONS Low-SES patients describe discharge goals that are confusing, unrealistic in the face of significant socioeconomic constraints, and in conflict with their own immediate goals. We hypothesize that this goal misalignment leads to a cycle of low achievement and loss of self-efficacy that may underlie poor post-hospital outcomes among low-SES patients.
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Affiliation(s)
- Shreya Kangovi
- Philadelphia Veterans Affairs Medical Center, , Philadelphia, PA, USA,
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Brogan A, Hevey D. The structure of the causal attribution belief network of patients with obesity. Br J Health Psychol 2011; 14:35-48. [DOI: 10.1348/135910708x292788] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Genugten L, van Empelen P, Flink I, Oenema A. Systematic development of a self-regulation weight-management intervention for overweight adults. BMC Public Health 2010; 10:649. [PMID: 20979603 PMCID: PMC2988733 DOI: 10.1186/1471-2458-10-649] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/27/2010] [Indexed: 11/10/2022] Open
Abstract
Background This paper describes the systematic development of an intervention for the prevention of obesity among overweight adults. Its development was guided by the six steps of Intervention Mapping (IM), in which the establishment of program needs, objectives and methods is followed by development of the intervention and an implementation and evaluation plan. Methods Weight gain prevention can be achieved by making small changes in dietary intake (DI) or physical activity (PA). The intervention objectives, derived from self-regulation theory, were to establish goal-oriented behaviour. They were translated into a computer-tailored Internet-delivered intervention consisting of four modules. The intervention includes strategies to target the main determinants of self-regulation, such as feedback and action planning. The first module is intended to ensure adults' commitment to preventing weight gain, choosing behaviour change and action initiation. The second and third modules are intended to evaluate behaviour change, and to adapt action and coping plans. The fourth module is intended to maintain self-regulation of body weight without use of the program. The intervention is being evaluated for its efficacy in an RCT, whose protocol is described in this paper. Primary outcomes are weight, waist circumference and skin-fold thickness. Other outcomes are DI, PA, cognitive mediators and self-regulation skills. Discussion The IM protocol helped us integrating insights from various theories. The performance objectives and methods were guided by self-regulation theory but empirical evidence with regard to the effectiveness of theoretical methods was limited. Sometimes, feasibility issues made it necessary to deviate from the original, theory-based plans. With this paper, we provide transparency with regard to intervention development and evaluation. Trial registration NTR1862
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Affiliation(s)
- Lenneke van Genugten
- Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Hinman MR. Causal Attributions of Falls in Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v15n03_05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rothert K, Strecher VJ, Doyle LA, Caplan WM, Joyce JS, Jimison HB, Karm LM, Mims AD, Roth MA. Web-based weight management programs in an integrated health care setting: a randomized, controlled trial. Obesity (Silver Spring) 2006; 14:266-72. [PMID: 16571852 DOI: 10.1038/oby.2006.34] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the efficacy of a Web-based tailored behavioral weight management program compared with Web-based information-only weight management materials. RESEARCH METHODS AND PROCEDURES Participants, 2862 eligible overweight and obese (BMI = 27 to 40 kg/m2) members from four regions of Kaiser Permanente's integrated health care delivery system, were randomized to receive either a tailored expert system or information-only Web-based weight management materials. Weight change and program satisfaction were assessed by self-report through an Internet-based survey at 3- and 6-month follow-up periods. RESULTS Significantly greater weight loss at follow-up was found among participants assigned to the tailored expert system than among those assigned to the information-only condition. Subjects in the tailored expert system lost a mean of 3 +/- 0.3% of their baseline weight, whereas subjects in the information-only condition lost a mean of 1.2 +/- 0.4% (p < 0.0004). Participants were also more likely to report that the tailored expert system was personally relevant, helpful, and easy to understand. Notably, 36% of enrollees were African-American, with enrollment rates higher than the general proportion of African Americans in any of the study regions. DISCUSSION The results of this large, randomized control trial show the potential benefit of the Web-based tailored expert system for weight management compared with a Web-based information-only weight management program.
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Affiliation(s)
- Kendra Rothert
- Kaiser Permanente Care Management Institute, Oakland, California, USA.
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Weisberg RB, Brown TA, Wincze JP, Barlow DH. Causal attributions and male sexual arousal: The impact of attributions for a bogus erectile difficulty on sexual arousal, cognitions, and affect. JOURNAL OF ABNORMAL PSYCHOLOGY 2001; 110:324-34. [PMID: 11358026 DOI: 10.1037/0021-843x.110.2.324] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
After viewing 2 sexually explicit films, 52 sexually functional participants were given bogus feedback indicating a low erectile response. The men were given either an external, fluctuating attribution (i.e., poor films) or an internal, stable attribution (i.e., problematic thoughts about sex) for the low arousal. As hypothesized, participants in the external, fluctuating group evidenced greater erectile response and subjective arousal during a 3rd film than did participants given the internal, stable attribution. This may indicate that after an occasion of erectile difficulty, the cause to which the difficulty is attributed plays an important role in future sexual functioning.
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Affiliation(s)
- R B Weisberg
- Department of Psychology, University at Albany, State University of New York, USA.
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Bartholomew LK, Shegog R, Parcel GS, Gold RS, Fernandez M, Czyzewski DI, Sockrider MM, Berlin N. Watch, Discover, Think, and Act: a model for patient education program development. PATIENT EDUCATION AND COUNSELING 2000; 39:253-268. [PMID: 11040725 DOI: 10.1016/s0738-3991(99)00045-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this report we describe the development of the Watch, Discover, Think and Act asthma self-management computer program for inner-city children with asthma. The intervention focused on teaching two categories of behaviors--asthma specific behaviors such as taking preventive medication and self-regulatory processes such as monitoring symptoms and solving asthma problems. These asthma self-management behaviors were then linked with empirical and theoretical determinants such as skills and self-efficacy. We then further used behavioral science theory to develop methods such as role modeling and skill training linked to the determinants. We matched these theoretical methods to practical strategies within the computer simulation and created a culturally competent program for inner-city minority youth. Finally, we planned a program evaluation that linked program impact and outcomes to the theoretical assumptions on which the intervention was based.
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Affiliation(s)
- L K Bartholomew
- Center for Health Promotion Research and Development, University of Texas Health Science Center at Houston 77225, USA.
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Strecher VJ, Seijts GH, Kok GJ, Latham GP, Glasgow R, DeVellis B, Meertens RM, Bulger DW. Goal setting as a strategy for health behavior change. HEALTH EDUCATION QUARTERLY 1995; 22:190-200. [PMID: 7622387 DOI: 10.1177/109019819502200207] [Citation(s) in RCA: 223] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article discusses the beneficial effects of setting goals in health behavior change and maintenance interventions. Goal setting theory predicts that, under certain conditions, setting specific difficult goals leads to higher performance when compared with no goals or vague, nonquantitative goals, such as "do your best." In contrast to the graduated, easy goals often set in health behavior change programs, goal setting theory asserts a positive linear relationship between degree of goal difficulty and level of performance. Research on goal setting has typically been conducted in organizational and laboratory settings. Although goal setting procedures are used in many health behavior change programs, they rarely have been the focus of systematic research. Therefore, many research questions still need to be answered regarding goal setting in the context of health behavior change. Finally, initial recommendations for the successful integration of goal setting theory in health behavior change programs are offered.
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Affiliation(s)
- V J Strecher
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA
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