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.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment.

OBJECTIVE: Family-based treatments for pediatric obesity were developed over 25 years ago. Over that time, youth have become more obese and the environment more obesiogenic, which may influence efficacy of pediatric weight control. Mixed-effects regression models were used to compare the efficacy of programs initiated 20 to 25 years ago to current programs through 24-month follow-up, as well as to reanalyze 10-year outcomes of previous research using contemporary measures and analytic strategies. MAIN OUTCOME MEASURES: z-BMI and percent overweight. RESULTS: Results showed significant reductions over time, with no differences in z-BMI change for older versus contemporary studies. Age was a predictor of z-BMI up to 24 months, with younger children showing larger change. Mixed-effects regression models replicated previous long-term effects of family-based interventions. Gender was a predictor of long-term z-BMI change, with girls benefiting more over time than did boys. CONCLUSION: The efficacy of the family-based behavioral approach to treating pediatric obesity replicates over a 25-year period. Challenges in evaluating treatment effects over time are discussed. Ideas for studying choice of treatments that vary in effect size and for strengthening family-based behavioral treatments are noted.     

Differences in locus of control between obese adult and adolescent females undergoing weight reduction

Rotter's (1966) Internal-External (I-E) Scale was administered to 65 adult and adolescent females in two outpatient obesity treatment programs. The adults were significantly higher in internal locus of control (LOC) and the adolescents higher in external LOC. These differences suggest that although the adults felt limited control over their weight and eating behavior, this did not reflect a lack of perceived control over other factors in their lives. In contrast, the adolescents appeared to feel that they had limited control over an array of factors in their lives.     

Elements of effective weight control programs: Implications for exercise and sport psychology

Abstract

Research on elements of effective weight control programs may have important implications for applied exercise and sport psychology. Eight of 11 elements were derived from the scientific literature: (1) quality of the initial assessment; (2) completeness of the cognitive-behavior therapy component; (3) completeness of the nutritional component; (4) emphasis on exercise; (5) training and skills of staff; (6) frequency of sessions and duration of the program; (7) management of the weight losers' social environments; (8) use of protein sparing modified fasting. The remaining 3 elements were selected based on clinical judgment; (9) reasonableness of costs; (10) ethics (including the use of scientific knowledge); and (11) flexibility of treatment. The gestalt of these elements represents a very comprehensive, intensive, and long-term approach to treating obesity. When all of these elements are operational, a treatment program can help many obese clients develop the super-normal self-regulatory skills that seem necessary to overcome the formidable psychological and behavioral barriers to permanent weight control. The implications of this perspective for cognitive-behavioral interventions designed to promote adherence to exercise and training regimens and to improve sport performance are considered. The primary conclusion is that more complete assessments and much longer and more intensive interventions and evaluations may be needed to promote robust changes in applied exercise and sport contexts.     

Obesity in America: Implications for Clinical and Health Psychologists

The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.     

A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work

This meta-analytic review summarizes obesity prevention programs and their effects and investigates participant, intervention, delivery, and design features associated with larger effects. A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects that were typically pre- to post effects. Larger effects emerged for programs that targeted children and adolescents (vs. preadolescents) and females, programs that were relatively brief, programs that solely targeted weight control versus other health behaviors (e.g., smoking), programs evaluated in pilot trials, and programs wherein participants must have self-selected into the intervention. Other factors, including mandated improvements in diet and exercise, sedentary behavior reduction, delivery by trained interventionists, and parental involvement, were not associated with significantly larger effects.     

Smoking in College Women: The Role of Thinness Pressures, Media Exposure, and Critical Consciousness

There are strong social pressures for U.S. females, particularly those of European heritage, to achieve and maintain an extremely low body weight. These pressures are reflected in a variety of media sources, including advertising. We argue that valuing thinness, exposure to thinness-depicting media, and lacking skepticism about tobacco advertisements have adverse effects on young women's decisions about smoking, particularly smoking for weight control. We tested these hypotheses in a study of 188 female undergraduates, both never-smokers and daily smokers. Believing that smoking controls weight, exposure to thinness-depicting media, and low levels of skepticism about tobacco advertising were associated with being a smoker. Among smokers, believing that smoking controls weight, internalizing thinness pressures, and low levels of feminist consciousness were associated with smoking for weight control. Results are discussed with the aim of encouraging public health anti-smoking campaigns targeted at women, and smoking cessation programs that are responsive to the needs of weight-concerned female smokers.     

Considering J.Lo and Ugly Betty: a qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women

Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed cultural aspects of body image, eating disorders, and obesity. Thematic analysis identified four main themes: (a) cultural disparities in body-ideal, including the influence of the media and acculturation issues; (b) messages about body shape and weight received by family, peers, and society; (c) difficulties making healthy eating and physical activity choices as a function of college life; and (d) the influence of peers and potential male partners on body satisfaction and body-ideals. These results have implications for the development of programs targeting body dissatisfaction and risk for eating disorders and obesity in Latina college women.     

Behavioral weight reduction program for mentally retarded adult females

Behavioral treatment approaches to obesity in 17 mild-to-moderate retarded female adults were assigned to one of two experimental conditions, (a) behavioral self-control along with a physical activity component and (b) behavioral self-control. No significant differences were noted between groups on the indices of body weight and tricep skinfold thickness. A one-way analysis of variance with a repeated measure yielded a significant main effect of time for change in weight for both groups at the end of the 8-week treatment. Questions were raised about the possible role of nonspecific motivational factors versus cognitive factors in behavioral-weight reduction programs.     

Considering Weight Loss Programs and Public Health Partnerships in American Evangelical Protestant Churches

The obesity epidemic is a critical public health threat facing the USA. With the advent of American Evangelical Protestant (AEP) weight loss guides and narratives, AEP churches could potentially aid public health agencies in combatting obesity, and some scholars have called for investment in partnerships between public health agencies and religious institutions. This paper examines the theological and social underpinnings of AEP weight loss programs and considers the potential benefits and risks of public health partnerships with AEP churches to combat obesity. While AEP churches may be successful at empowering people to lose weight, AEP weight loss also carries several risks. These risks include reinforcing gendered bodily norms, stigmatizing both overweight bodies and unhealthy behaviors deemed to be sinful (for example, overeating), and failing to acknowledge social factors that promote obesity. These risks must be assessed and minimized to create appropriate public health weight loss partnerships with AEP communities.     

Cognitive Behavioral Therapy for Bariatric Surgery Patients: Preliminary Evidence for Feasibility,Acceptability, and Effectiveness

Bariatric surgery is the most effective treatment for extreme obesity; however, 20% to 50% of patients begin to regain their weight within the first 1.5 to 2 years following surgery. Despite some psychosocial factors predicting postoperative weight loss and weight regain, psychosocial interventions are not routinely offered in bariatric surgery programs. In this paper, we describe a 6-session cognitive behavioral therapy (CBT) intervention for preoperative and postoperative bariatric surgery patients with maladaptive eating behaviors or thought patterns, which can be delivered either in person or by telephone. In addition, we describe a small pilot study (n = 8) designed to examine the feasibility and acceptability of the CBT intervention, as well as its effectiveness in improving eating pathology and psychosocial functioning. Most pilot study participants reported improvements in binge eating severity, emotional eating, and depression from pre- to posttreatment, and all participants provided positive qualitative feedback regarding the intervention.     

Integrating research into practice: The Forward-Focused Model of adolescent sexual behavior treatment

Knowledge of adolescents with sexual behavior problems has continued to grow over the past two decades, further differentiating the needs of this group from adult sex offenders. However, treatment programs based upon the current literature have yet to be fully articulated. In an attempt to address this gap between knowledge and practice, a comprehensive treatment program for adolescents with sexual behavior problems was developed: the Forward-Focused Model. The Forward-Focused Model is rooted in cognitive–behavioral theory, incorporates motivational approaches, and is developmentally-sensitive to address the unique needs of adolescents. This empirically-based model is introduced in this article.     

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.     

Rorschach personality predictors of weight loss with behavior modification in obesity treatment

Weight loss outcome for 49 obese patients after 6 months treatment in a behavior modification program was related to Rorschach personality characteristics according to the Comprehensive System (Exner, 2003), also including the Rorschach Oral Dependency Scale (Bornstein, 1996; Masling & Rabie, 1967). Less weight loss was predicted by signs of perceptual and cognitive distortions indicated by the Schizophrenia Index. More weight loss was predicted by Food Contents, suggesting a food preoccupation and possibly a benign dependency orientation. Patients with a focus on food and dependent needs could benefit above all from the treatment program implying learning how to handle food and eating in a supportive setting, as evidenced by more weight loss. Distortions in perception and cognition could constitute more profound difficulties in weight reduction important to recognize in obesity treatment.     

Children with SED and Their Families in an Urban Public Mental Health System: Characteristics, Needs, and Expectations

We present information with implications for the design of comprehensive systems of care for children with severe emotional disturbance and their families. Combining quantitative data derived from children and caregivers on multiple standardized assessments and qualitative data based on the caregivers' personal comments, we provide a detailed account of child clinical status, service needs, involvement in normative childhood activities, aspects of family coping and functioning, and expectations of mental health services. Research participants were from a random sampling of children, 9 to 11 years of age, receiving an above average number of services from a large urban public mental health system. Results from this comprehensive needs assessment demonstrate the serious nature of the children's disabilities, illuminate the corresponding challenges for families, and provide direction for enhancing the system of care. The caregivers rated recreation and after school programs as their first priority. Since traditional mental health services are fairly well articulated and evolved, we concentrate on using information about child functioning and family context to inform the development of recreation and after school programs that can accommodate children with extremely challenging behaviors.     

Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up

It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects.     

Big-Five personality factors, obesity and 2-year weight gain in Australian adults

The objective of this paper was to examine whether the Big-Five Personality factors were associated with obesity and 2-year weight gain in Australian adults. The sample included 5265 Australian adults aged 25-65 years. Binary logistic regression models indicated that Extraversion, Agreeableness and Neuroticism were cross-sectionally associated with obesity, with Conscientiousness inversely associated with obesity. The longitudinal analyses indicated that Extraversion predicted 2-year weight gain. The relationships between personality and obesity/weight gain were not moderated by age or sex. These results have potentially important implications for developing more effective treatment and prevention strategies for obesity.     

Correctional treatment for co-occurring disorders: results of a national survey

The significant expansion of correctional populations in the last decade, coupled with the gradual erosion of community treatment infrastructure and health insurance, have brought greater attention to the needs of offenders who have co-occurring mental health and substance use disorders. Individuals with co-occurring disorders frequently cycle through acute care facilities in the community and increasingly are placed in jails or prisons. Approximately 16% of inmates in correctional facilities have major mental health disorders (Bureau of Justice Statistics, 1999), and a large majority of these inmates have co-occurring substance use disorders. Few studies have examined the effectiveness of correctional treatment for co-occurring disorders, and there is little information available regarding clinical and programmatic approaches used with this population. The current study provides findings from a comprehensive national survey of co-occurring disorder treatment programs in correctional settings. A total of 20 co-occurring disorder treatment programs from 13 state correctional systems were identified and surveyed. Many of the programs featured modified therapeutic communities, but there was significant diversity in the duration of treatment and type of services provided. Several unique structural and clinical modifications to treatment have been developed in these settings. Implementation of co-occurring disorder treatment programs has led to enhanced collaboration with prison health services and community supervision and treatment agencies, and greater use of interdisciplinary staff to provide outreach and case management services. Research is now being conducted to examine outcomes in several of these correctional treatment programs.     

Marriage and Family Therapy Students’ Views on Including Weight Bias Training into Their Clinical Programs

Discussions about diversity rarely focus on overweight, obesity, and bias about body size (i.e., weight bias). These discussions allow students to develop self-awareness about how their biases can affect their clinical work, as well as the challenges and subsequent bias clients may face in their everyday lives and from clinical providers. One consequence of the rising prevalence of overweight and obesity in the United States is the increase in the level of weight bias and discrimination towards individuals who are overweight, which has been documented among mental and healthcare professionals. Thus, it is imperative that training programs integrate weight bias as a part of diversity training. The authors will review weight bias in mental and healthcare professions, and describe several trainings focused on self-awareness about weight bias. The purpose of this study was to pilot and evaluate a training program for marriage and family therapy (MFT) students about developing self-awareness around weight bias and working with clients who are overweight. Following the program, focus groups were conducted to explore participants’ experiences, learning, and feedback on the content and delivery method. Focus Group methodology was used to guide the analysis process. Four themes emerged: training program feedback, challenges for the MFT field, self-of-therapist, and etiology of weight loss/gain. Implications for MFT training programs are discussed.