Recidivism and self-cure of obesity: a test of Schacter's hypothesis in diabetic patients

Schacter (1982) suggested that, given a lifetime perspective, a significant number of people "cure" themselves of their obesity. He supported this contention with retrospective self-report data from community residents that reveal that the majority of once-obese study participants are no longer overweight. The current study investigated the weight histories of obese diabetic outpatients. Retrospective self-reports (N = 152) indicated that about one third could be classified as "cured" of their obesity, and an additional 26%, although still obese, weighed 10% less than they had at their maximum. Medical records (N = 219), however, revealed that less than 10% could be considered "cured" and only another 12% "partially cured." Although some support was found for the hypothesized relationship between weight-loss success and time in treatment, it is possible that this reflects a tendency for those initially successful to remain in treatment longer. Finally, maximum weights of at least 30% over ideal were associated with more success, but primarily in achieving a 10% weight loss, not in being "cured" of obesity.     

Association between Inhibitory Control Capacity and Body Weight in Overweight and Obese Children and Adolescents: Dependence on Age and Inhibitory Control Component

It has been assumed that overweight individuals show weak inhibitory control capacity leading to a failure to resist external cues for palatable food and that this deficit underlies the recently reported empirical association between obesity and attention deficit/hyperactivity disorder (ADHD). In childhood and adolescence, empirical research on this issue is scarce. Here, the hypothesis is tested that high body weight is associated with weak inhibitory control performance and that this association is moderated by age.

The sample included 177 overweight and obese children and adolescents (BMI: M = 29.2, SD = 4.33; BMI-SDS: M = 2.45, SD = 0.43) between 8 and 15 years. Inhibitory control was assessed by a Go/No-Go task and an Interference Task. A principal component analysis yielded two components: impulsivity (fast but invalid responses) and inattention (highly variable reaction times).

While controlling for age, gender, and maternal education level, we found that more obese children/adolescents showed more inattention. As indicated by a significant interaction effect, exclusively at younger ages, high impulsivity was associated with high body weight.

The results thus confirm a link between low inhibitory control capacity and high body weight and might point to a developmental period with heightened significance of impulsivity for weight gain.     

Maternal Weight Control Behaviors for Preschoolers Related to Children’s Gender

The purpose of this study was to identify significant factors associated with Korean mothers’ behaviors in controlling their preschool children’s weight and to examine gender differences among the significant associated factors. This study involved a convenience sample of 223 pairs of mothers and their preschool children (114 boys and 109 girls) in South Korea. Maternal desire for their children to lose weight, concern about children being overweight or obese, and interaction between gender and concern about children being overweight or obese were significant factors associated with maternal behaviors to control children’s weight. Regarding the interaction between gender and concern about children being overweight or obese, mothers who were concerned about their daughter being overweight or obese were more likely to control their child’s weight than those who were concerned about their son being overweight or obese. Additionally, mothers with concerns about their daughter being overweight or obese were more likely to conduct weight control behaviors for their child than mothers of girls without such concern. However, among mothers of boys, there was no difference in maternal behaviors to control their child’s weight between those with concern and without concern. Therefore, health care providers should understand gender specific maternal concerns regarding their child’s weight and provide tailored weight control interventions for mother and child pairs considering the child’s gender.     

Obesity and body image

Modern western culture emphasizes thinness, denigrates excess weight, and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about the physical presence that brands them. There is clear evidence that obesity is linked with poor body image, but not all obese persons suffer from this problem or are equally vulnerable. Risk factors identified thus far are degree of overweight, being female, and binge eating, with some evidence of risk increasing with early age of onset of obesity, race, and several additional factors. Treatments do exist for improving body image in overweight individuals. Key questions are how to identify those in need of body image intervention, how such programs can be integrated with weight loss treatments, and ultimately, how body image distress can be prevented.     

Early executive control and risk for overweight and obesity in elementary school

An emerging literature suggests that poor executive control (EC) may be associated with clinical weight problems, e.g., body mass index (BMI) for age percentile ≥85 in children. However, our understanding of the impact of EC on overweight and obesity in childhood is limited by the lack of longitudinal studies spanning critical developmental periods and assessing EC using comprehensive performance-based batteries. The current study addresses these limitations in a longitudinal examination of 212 children who completed an extensive laboratory-based EC task battery in preschool (age 4 years and 6 months) and were followed through elementary school (Grades 1 through 4) with objective measures of weight status. The logistic regression results indicate that poorer EC in preschool is associated with significantly greater risk for clinical weight problems (either overweight or obese status, as defined by BMI-for-age percentile ≥ 85) in elementary school, controlling for maternal education. EC in preschool was not significantly associated with risk for obese status, specifically (defined by BMI-for-age percentile ≥ 95), but the trend was in the expected direction. The results suggest that early executive abilities are relevant for children’s subsequent health status, with deficits in EC in the critical period of preschool conferring risk for later problems with weight. Based on these findings, early interventions to promote stronger EC may be a promising, yet currently overlooked, component in pediatric obesity prevention efforts.     

Preventing weight gain in adults: a pound of prevention

This study evaluated the feasibility and effectiveness of a program for weight gain prevention in normal-weight adults. Two hundred nineteen participants were randomized to either weight gain prevention treatment or no treatment for a period of 12 months. Those in the treatment group received monthly newsletters relating to weight management, participated in a financial incentive system, and were offered an optional four-session education course in the sixth month of the program. Results demonstrated high interest in weight gain prevention among individuals who were not objectively overweight. Participation, as measured by return of postcards sent with each newsletter, was approximately 75%. Results after 1 year showed a net weight loss in the group receiving the program of 1.8 lb compared to those in the control group. Eighty-two percent of program participants maintained or lost weight, compared to 56% of the control group. It is concluded that programs for weight gain prevention are feasible in adults and may be more effective than weight loss treatment programs in addressing the problem of community-wide obesity.     

Childhood Overweight and Obesity: Maternal and Family Factors

Treatment programs for childhood overweight and obesity have highlighted the importance of the family in treatment. Considering this, it is surprising that few studies have examined the role of family factors in the development of childhood overweight and obesity. The objective of this study was to examine which family and maternal factors predict increases in weight in boys and girls during middle to late childhood. This study used longitudinal data from the childhood growth and development (GAD) Study. The GAD Study involved 286 healthy weight, overweight and obese children, aged 6–13 years at baseline, who completed baseline, 1-year follow-up and 2-year follow-up assessments. Overweight/obese children were recruited from clinical and community settings. A broad range of maternal and family factors were assessed. Linear mixed models were used to identify which factors predicted child Body Mass Index (BMI) z-scores over time. For community-based children, maternal BMI and single-parent family structure were significant longitudinal predictors of child BMI z-scores. For the clinical participants, low family income was the only significant multivariate predictor of child BMI z-scores. The strong association between child BMI, maternal BMI and family structure confirms the need to target prevention and intervention efforts for childhood overweight and obesity towards families with overweight parents, particularly single-parent families.     

Factors associated with mothers' obesity stigma and young children's weight stereotypes

Parents and children hold negative attitudes about obesity, but little is known about individual differences in obesity stigma. The current study examined authoritarian parenting style, beliefs about the controllability of weight and fear of fat in relation to mothers' dislike of overweight individuals. Factors related to children's weight stereotypes were also investigated. Forty-nine mothers and children (43% girls) participated. Mothers showed more dislike and blame toward adults who are overweight than children who are overweight; parents were most often blamed for children's weight status. Authoritarian parenting and beliefs about controllability were related to mothers' anti-fat attitudes, but fear of fat was not. However, mothers' fear of fat was the best predictor of children's negative stereotypes toward overweight peers. The current study provides some preliminary insight into the role of mothers in children's attitudes about weight. Examining individual difference factors is also useful in planning targeted interventions to lessen obesity stigma.     

Low temporal precision for high impulsive individuals

Previous studies have shown that impulsive people perceive time differently from non-impulsive people. However, these studies either recruited participants from the clinical population or used impulsive behavior (rather than impulsivity trait itself) as the index of impulsivity. We investigated the relationship between time perception and self-report impulsivity trait (measured by the Barratt Impulsiveness Scale; BIS-11) in non-patient participants. We used the oddball paradigm to measure subjective duration and discrimination precision in high- and low-impulsive groups. Results show that high impulsive participants’ discrimination precision was lower than low impulsive participants (Experiment 1). The possibility that this is due to high impulsive participants having weaker attentional maintenance of the task was excluded (Experiment 2). By removing potentially confounding factors that existed in previous studies, our results demonstrate a more convincing relationship between temporal precision and the impulsivity trait in healthy participants.     

Problematic eating behaviors and nutritional status in 7 to 12 year-old Chilean children

Overweight and obesity are medical conditions that require a multidisciplinary analysis of their causes and treatment. In Chile a sustained increase in the presence of obesity and excess weight has been observed in children. However, the amount and the dynamics of the aforementioned problematic eating behaviours in Chilean children are unknown. The aim of this study was to assess the relationship between restrained, external, and emotional eating, and variations in body mass index (BMI) in Chilean children. Consequently, 453 children from 7 to 12 years of age responded to the Children's Dutch Eating Behaviour Questionnaire, Spanish version. In addition, their anthropometric data were obtained. A positive association was found between restrained eating and BMI, and a negative correlation between external eating and BMI. Emotional eating demonstrated a modest inverse relationship with BMI. A significant interaction between problematic behaviour and nutritional status (normal-weight, overweight, obese) was revealed. Restrained eating was characteristic of obese children whereas external eating of normal-weight children. These results suggest that problematic eating behaviours and their relationship with body weight are similar to those described in studies in Europe.     

Clinical Effectiveness of the LE<Superscript>3</Superscript>AN Program: A Military Healthy Lifestyle Program

For several decades, obesity has been a major health concern within the general population of the United States as well as within the unique military population. Unlike the civilian sector, military service requires individuals to meet weight and body fat standards. In order to assist overweight military personnel return to standards, Tripler Army Medical Center initiated the LE³AN Program. LE³AN is a one-week, day-treatment, cognitive-behavioral weight management program coupled with 12 months of weekly follow-up. Baseline data was collected on 387 consecutive participants. Despite physical fitness training and required standards in each military service, the average BMIs for men and women were in the obese range, with male participants’ BMIs significantly higher than women’s (34.3 vs 31.9, p<.005). One year outcome data was collected from 167 participants, i.e. 43.2% of treatment initiators. Among participants who completed treatment, men maintained a 6.56% loss of their initial weight while women maintained a 7.35% loss. Over a quarter, 26.6%, of those who started the program (but did not complete it) maintained at least a 5% weight loss at one year, while 61.6% of treatment completers maintained 5% weight losses. The opinions expressed in this article reflect the views of the authors and not those of the Department of Defense or the U.S. Army.     

Parents May Hold the Keys to Success in Immersion Treatment of Adolescent Obesity

This study examined the potential impact of parents on the long-term results of an immersion program for the treatment of adolescent obesity. Teenagers participated in a 4- to 8-week therapeutic camp. Those who continued losing weight 8- to 12-months postcamp were identified as “Losers”; those who regained weight were considered “Gainers.” Parents from both groups were interviewed about their own current lifestyle habits 1 to 1.5 years after camp ended. Results indicate that more of the initially overweight parents from the Loser group lost weight during the follow-up period than the overweight parents of Gainers. Losers' parents also reported better implementation of several aspects of the weight control program. The present results suggest that helping parents adopt lifestyle changes for themselves, even within the context of relatively short immersion treatments, may maximize outcomes for obese teenagers.     

Food Cravings Questionnaire–Trait (FCQ–T) Discriminates Between Obese and Overweight Patients With and Without Binge Eating Tendencies: The Italian Version of the FCQ–T

Food craving (FC) might play an important role in the course of eating disorders and obesity. The question of its measurement has particular importance in relation to the dramatic growth in obesity rates and its relevance for public health. The aim of this study was to investigate the psychometric properties of the Italian version of the Food Cravings Questionnaire–Trait (FCQ–T) in overweight and obese patients who were attending weight loss programs, and its efficiency in discriminating patients with binge eating. Participants were 497 (411 women, 86 men) overweight and obese patients in treatment with low-energy diet therapy. We used structural equation modeling to compare 3 factor models tested in previous studies (a 6-factor model, an 8-factor model, and a 9-factor model), which indicated that the 9-factor model has a better fit over the competing models. The FCQ–T had good internal consistency (Cronbach's α of.96 for the total score, and between.76 and.92 for subfactors), and was able to discriminate patients with clinical-level binge eating from those with probable and without binge eating with an efficiency of.74 (sensitivity =.64, specificity =.78). FCQ–T scores were sensitive to changes associated with treatment only for patients who started dietary restriction between the baseline and the follow-up assessment, but not for patients who were already observing dietary restrictions at the time of the baseline assessment. These results suggest that the FCQ–T could be a potentially useful measure for the screening of binge eating problems in overweight and obese patients while in treatment.     

Making snacking less sinful: (Counter-)moralising obesity in the public discourse differentially affects food choices of individuals with high and low perceived body mass

Objective: As public discourse surrounding obesity highlights the societal costs of obesity and individual’s own responsibility for their weight, being overweight is often framed as immoral. Such ‘moralizing’ messages about being overweight may be a psychological threat for those with high body mass. Attempting to counter-moralise the public discourse (i.e. actively arguing that there is nothing ‘immoral’ about being overweight) may relieve this threat, inducing people, especially those with higher (perceived) weight, to engage in healthier behaviours.

Method: Two experiments were performed among Dutch and US participants. (Counter-)moralisation was manipulated. Body mass and weight-related self-perceptions were measured. The dependent variable was healthy vs. unhealthy snack choice.

Results: (Counter-)moralisation and (perceived) overweight jointly predicted snack choice: counter-moralising messages induced healthy snacking, but only among those who regarded themselves to have a high body mass.

Conclusions: The effects of moralising vs. counter-moralising obesity depended on one’s (perceived) overweight. This suggests that, for people with relatively high weight, the current moralising public discourse on obesity works in counterproductive ways. Campaigns that ‘counter-moralize’ obesity (i.e. that refute moralising messages) are more productive, although they should be tailored to those who see themselves as being overweight.     

Effect of dichotomous thinking on the association of depression with BMI and weight change among obese females

This study tested whether a dichotomous thinking style moderates the association of depression with body mass, and investigated the effect of dichotomous thinking and depression on weight loss during a cognitive behavioural therapy (CBT) intervention.Overweight and obese females (n = 76) participated in CBT for weight management for 12 weeks. Before treatment, dichotomous thinking moderated the association of depression with BMI, such that depression was positively associated with BMI among those with low dichotomous thinking, but was not associated among those with high dichotomous thinking. Weight loss was negatively associated with pre-treatment depression and frequency of treatment attendance, but not with dichotomous thinking. Females who regard their weight as unacceptably high and who think dichotomously may experience high levels of depression irrespective of their actual weight, while depression may be proportionate to the degree of obesity among those who do not think dichotomously. Depression, but not dichotomous thinking, is likely to interfere with the ability to adhere to short-term weight loss strategies.     

Obesity, cardiovascular fitness, and physically active adolescents’ motivations for activity: A self-determination theory approach

Objectives

Overweight and obesity pose significant health problems for adolescents. Rates of overweight and obesity in children have increased 45% in the last decade and have increased three-fold since 1980. Because children who are physically active are at lower risk for the development of obesity, it is important to understand some of the factors that influence children’s physical activity patterns. The purpose of this study was to examine the relationship between motivation, cardiorespiratory fitness, and weight status, defined as obese or non-obese. We predicted that the association between motivation and weight status would become non-significant when controlling for cardiorespiratory fitness.

Design

The study employed a correlational, cross-sectional design.

Method

Participants included physically active middle school students (N = 82. 51% female) of aged 12–14 years, who participated in the Teen Eating and Activity Mentoring in Schools (TEAMS) study aimed at improving health and preventing obesity among middle school students. Students completed attitudinal questionnaires about physical activity and self-determination on a computer-based system and participated in a number of fitness performance, health behavior, and anthropometric assessments.

Results

Non-obese adolescents showed higher intrinsic motivation scores than obese adolescents. Mediational analyses showed that cardiorespiratory fitness mediated the relationship between motivation and weight status.

Conclusions

The results of this study demonstrate differences in physical activity motivation as a function of adolescent weight status, but only for intrinsic motivation. As predicted, adolescents who were intrinsically motivated for physical activity were more fit and thereby less likely to be obese. The findings are consistent with self-determination theory.     

Behavioral treatment of obesity: a two-year follow-up

Data obtained from a two-year follow-up of 10 obese women treated via behavioral methods is presented. Failure to obtain lasting results was noted, and reasons for this failure suggested. Implications of these data for investigators in the area of obesity were discussed.A review of the recent literature indicates a number of studies with encouraging results obtained via the behavioral treatment of obesity (Hall and Hall, unpublished). However, long-term follow-up data are generally lacking. This lack of long-term data is especially troublesome in the area of obesity. With regard to traditional treatment methods, such as drugs, psychotherapy, and nutritional counseling, it has generally been noted that those overweight individuals who complete a course of treatment, and who lose weight, regain the weight lost (Stunkard and McClaren-Hume, 1958) Within the literature on the behavioral treatment of obesity, only one study (Stuart, 1967) has provided weight data for as long as 1 year after initiation of treatment Stuart's data indicated a gradual loss of weight over the year. However, these data did not reflect S's ability to control weight following termination of treatment, for during the year, follow-up sessions were scheduled monthly, and thus, therapist contact was available.The present paper, in an attempt to fill the need for long-term follow-up data, presents data obtained 2 years after the termination of a behavioral treatment program. None of the Ss had been in contact with the therapist since the termination of the study 2 years earlier.     

An acceptance-based behavioral intervention for weight loss: a pilot study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.     

Behaviour change among overweight and socially disadvantaged adults: A longitudinal study of the NHS Health Trainer Service

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre–post changes in Body Mass Index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008–2009; N?=?4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.