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.     

Clustering of diet,physical activity and smoking and a general willingness to change

Addressing multiple health behaviours are important in preventing disease and mortality. The present study investigated the clustering of health behaviours, cognitive determinants and stages of change in 2827 adults for the lifestyle factors of physical activity, fruit, vegetable and fat consumption and smoking. The results showed that only 3% of the total population met recommended guidelines for all of the five behaviours. Behaviours were found to be weakly associated. Behaviour-specific cognitions and stages of change for the behaviours clustered more strongly, however. With respect to diet and physical activity, respondents in the preparation stage for one behaviour were likely also to be preparing to change another behaviour. Possible mechanisms for the apparent general willingness to change multiple behaviours are discussed, as well as potential implications for health promotion practice.     

Lifestyle Risk Factors for Breast Cancer in BRCA1/2-Mutation Carriers Around Childbearing Age

BRCA1/2-mutation carriers are at high risk of breast cancer (BC) and ovarian cancer. Physical inactivity, overweight (body mass index ≥25, BMI), smoking, and alcohol consumption are jointly responsible for about 1 in 4 postmenopausal BC cases in the general population. Limited evidence suggests physical activity also increases BC risk in BRCA1/2-mutation carriers. Women who have children often reduce physical activity and have weight gain, which increases BC risk. We assessed aforementioned lifestyle factors in a cohort of 268 BRCA1/2-mutation carriers around childbearing age (born between 1968 and 1983, median age 33 years, range 21–44). Furthermore, we evaluated the effect of having children on physical inactivity and overweight. Carriers were asked about lifestyle 4–6 weeks after genetic diagnosis at the Familial Cancer Clinic Nijmegen. Physical inactivity was defined as sports activity fewer than once a week. Carriers were categorized according to the age of their youngest child (no children, age 0–3 years and ≥4 years). In total, 48% of carriers were physically inactive, 41% were overweight, 27% smoked, and 70% consumed alcohol (3% ≥8 beverages/week). Physical inactivity was 4–5 times more likely in carriers with children. Overweight was not associated with having children. Carriers with children are a subgroup that may specifically benefit from lifestyle support to reduce BC risk.     

Body mass index and environmental supports for physical activity among active and inactive residents of a U. S. southeastern county.

OBJECTIVE: This study examined the associations between body mass index (BMI) and environmental supports for physical activity in active and inactive adults based on national recommendations for physical activity and walking. Residents of a southeastern community (N = 1,111; ages 18-75 years) were contacted using a random-digit-dial method and were asked about neighborhood and community social and environmental supports for physical activity. MAIN OUTCOME MEASURE: Physical activity was measured using the 2001 Behavioral Risk Factor Surveillance System (BRFSS) physical activity module. RESULTS: There was a positive association between higher physical activity and walking levels and lower BMI levels. Trusting neighborhoods, having recreational facilities present, and using trails were each associated with twice the odds of being overweight versus obese among those not meeting the national physical activity recommendations. Using trails was also associated with 2.7 times the odds of being overweight as opposed to obese among participants who were not regular walkers. CONCLUSION: Improving environmental supports for access and use of trails and recreational facilities may be important for future environmental interventions aimed at reducing obesity among inactive individuals.     

Mediating relationship between body mass index and the direct measures of the Theory of Planned Behaviour on physical activity intention

This research examines (a) the interrelationships between body mass index (BMI), the direct measures of the Theory of Planned Behaviour (TPB) and physical activity intention and (b) the potential mediation effects of the direct measures of the TPB in the relationship between BMI and physical activity intention in a sample of Australian adults. A total sample of 1,062 respondents participated in a computer-assisted telephone-interview (CATI) survey comprised of a standardised introduction; questions regarding TPB and physical activity; and standard demographic questions. BMI for each participant was calculated from self-reported height and weight. Separate regression analyses were performed to examine the mediating effects of each of the direct measures of the TPB on the predictive relationship between the BMI and physical activity intention, as proposed by Baron and Kenny (Journal of Personality and Social Psychology, 51(6), 1173 - 1182, 1986). Findings indicated that the direct measure of attitude and perceived behavioural control mediated the relationship between BMI and physical activity intention. However, the direct measure of subjective norm failed to act as a mediating mechanism. To date there has been no research that has examined the mechanism by which body mass may affect physical activity behaviour. Given the current focus for health promotion specialists on promoting physical activity as a strategy for reducing overweight and obesity, a theoretical understanding of weight-related barriers to physical activity may aid in the development of future interventions and community physical activity programs, particularly those targeting overweight and obese populations.     

Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke

Abstract

Objective: To assess levels of self-efficacy for health-related behaviour change and its correlates in patients with TIA or ischemic stroke.

Methods: In this prospective cohort study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behaviour change and fear, social support and depressive symptoms. Relations between fear, social support, depressive symptoms, cognitive impairment, vascular risk factors and history and demographic characteristics and low-self-efficacy were studied with univariable and multivariable logistic regression.

Results: Median total self-efficacy score at baseline was 4 (IQR 4–5). Older age (OR 1.05, 95% CI 1.01–1.09), depressive symptoms (OR 1.09, 95% CI 1.03–1.16), presence of vascular history (OR 2.42, 95% CI 0.97–6.03), higher BMI (OR 1.15, 95% CI 1.01–1.30), fear (OR 1.06, 95% CI 1.01–1.12) and low physical activity (OR 1.49, 95% CI 1.01–2.21) were significantly associated with low self-efficacy.

Conclusion: Patients with recent TIA or ischemic stroke report high self-efficacy scores for health-related behaviour change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity and fear were correlates of low self-efficacy levels.

Practice implications: These correlates should be taken into account in the development of interventions to support patients in health behaviour change after TIA or ischemic stroke.     

The effect of autonomous and controlled motives on eating dysregulation: Implications for individuals classified as underweight,overweight or obese

IntroductionControlled and autonomous motivational factors from self-determination theory have previously been highlighted as key factors in eating regulation. The present study examined controlled motives as an overarching motivational factor in eating dysregulation and examined its effects on dieting behaviour for those who are underweight, overweight or obese.ObjectiveTo examine whether the influence of controlled motives on dieting behaviour would be moderated by body mass index (BMI). Specifically, it was hypothesised that controlled motives would be associated with high levels of dieting behaviour in underweight individuals and low levels of dieting behaviour in individuals classified as overweight or obese.MethodOne hundred and thirty-seven participants completed the measures of height, weight, and motivation and intentions towards watching their diet and subsequently completed a measure of dieting behaviour two weeks later.ResultsModerated regression and simple slopes analyses provided support for the hypothesised effects at underweight, overweight, and obese range BMIs.ConclusionThe effect of controlled motives on dieting behaviour is dependent upon BMI and therefore varies across underweight, overweight, and obese individuals. The implications of controlled motives and external pressures to watch one's diet are discussed.     

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.     

Post-traumatic stress disorder and health risk behaviour among persons 15 years and older in South Africa

The aim of this study was to investigate the association between post-traumatic stress disorder (PTSD) and health risk behaviours among persons 15 years and older in South Africa. We analysed data from the South African National Health and Nutrition Examination Survey (SANHANES-1, 2012) (N = 15 201; mean age = 36.9 years, SD = 16.5; 2.1% with PSTD, 4.0% with partial PTSD). The survey included questions from validated measures of the following health risk behaviours: problem drinking, current tobacco use, physical activity, sedentary behaviour, vegetable consumption, and fast food and frequent soft drinks consumption. In adjusted logistic regression analysis, only self-reporting with PTSD was associated with problem drinking. The data did not yield significant association between PTSD status and any of the other health risk behaviours (tobacco use, low physical activity, and fast food consumption).     

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values>0.05). Participants with larger increases in objective activity reported weaker perceived control (β=-0.342; p=0.001) and more negative instrumental attitudes (β=-0.230; p=0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.     

Body image change in obese and overweight women enrolled in a weight-loss intervention: the importance of perceived versus actual physical changes

Using the exercise and self-esteem model as a guiding framework, this study examined variables related to body image change among 88 overweight and obese women (M(age)=28.4±7.8; M(BMI)=31.6±3.5) participating in a 16-week diet and exercise weight-loss intervention. Measures of body image and potential mechanisms of body image change (actual and perceived physical changes, self-efficacy) were administered at baseline, Weeks 8 and 16. Body image improved significantly over the study time-points (ps<.001). Perceived physical changes accounted for most explained variance (12-37%) in body image change (total R(2)(adj)=.21-.50). Improved perceptions of body fat were a particularly important predictor in each model (ps≤.04). Results support the notion that to improve body image, perceived changes to the body are more important than actual changes. Such information is integral to developing theories to explain body image change and interventions to maximize it.     

Emotional, external, restrained eating and overweight in Dutch adolescents

The purpose of this study was to determine how emotional, external and restrained eating behavior and other health-related lifestyle factors were associated with being overweight in adolescents. Moreover, demographic and ethnic differences in eating behavior have been examined. The respondents were 10,087 Dutch adolescents aged 11-16 years (M= 13.0, SD= 0.8). Self-reported eating behavior was measured with the DEBQ. Health-related lifestyle was determined by physical activity, breakfasting, fruit consumption and snacking. High restrained, and low external eating were positively associated with being overweight, whereas no significant association between emotional eating and being overweight was found for girls, and a negative association for boys. Adolescents who ate breakfast on a daily basis were less likely to be overweight than those who ate breakfast irregularly or never. Being overweight was positively associated with fruit consumption for girls and negatively with physical activity for boys.     

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values > 0.05). Participants with larger increases in objective activity reported weaker perceived control (β?=??0.342; p?=?0.001) and more negative instrumental attitudes (β?=??0.230; p?=?0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.     

Internet-delivered physical activity intervention for college students with mental health disorders: a randomized pilot trial

The prevalence of mental health disorders among college students is rising and the increasing rates of anxiety and depression have important societal implications. Physical activity has been proposed as an adjuvant to traditional treatment approaches (i.e. psychotherapy or pharmacotherapy), and the internet is a potentially useful means of delivering physical activity information to the college-aged population. This randomized pilot trial examined the effects of an internet-based physical activity intervention on physical activity, self-efficacy, depression, and anxiety in college students (n?=?47) receiving mental health counseling. Physical activity, depression, anxiety, exercise self-efficacy, and barriers self-efficacy were assessed at baseline and post-intervention. There was a significant time effect for physical activity, with both groups increasing their physical activity levels across the 10-week intervention but with a larger increase in the intervention condition (d?=?0.68) than the control condition (d?=?0.05). Exercise and barriers self-efficacy declined across the intervention, but more so in the control than intervention condition. Effects on depression and anxiety were nonsignificant. Finally, correlation analyses showed increases in physical activity were associated with increases in exercise self-efficacy (r?=?0.62) and barriers self-efficacy (r?=?0.63) and decreases in depression (r?=?-0.44) in the intervention condition, but not in the control condition. These results suggest that an internet-delivered physical activity intervention may be a promising approach to promoting physical activity among college students undergoing mental health counseling.     

Accuracy of self-reported weight and role of gender,body mass index,weight satisfaction,weighing behavior,and physical activity among rural college students

This study measured accuracy of self-reported body mass index (BMI), particularly weight, in a college population. The main purpose was to examine the role of gender, BMI, body weight satisfaction, weighing frequency and physical activity level in accuracy (weight difference, percent weight difference, and absolute weight difference). Students (N = 405; 56% female) completed a questionnaire and 325 agreed to have their height and/or weight measured. Gender, BMI and activity level were significantly associated with weight difference and percent weight difference while BMI, activity level and weighing frequency were associated with absolute weight difference. However, interactions between BMI and physical activity were found. Our findings indicate that women and heavier individuals underestimate weight.     

A comparison of health behaviours in lonely and non-lonely populations

Loneliness can be defined as perceived social isolation and appears to be a relatively common experience in adults. It carries a significant health risk and has been associated with heart disease, depression and poor recovery after coronary heart surgery. The mechanisms that link loneliness and morbidity are unclear but one of the mechanisms may be through poor health beliefs and behaviours. The aims of this cross-sectional survey of 1289 adults were to investigate differences in health behaviours (smoking, overweight, BMI, sedentary, attitudes towards physical activity) in lonely and non-lonely groups. Lonely individuals were more likely to be smokers and more likely to be overweight - obese. The lonely group had higher body mass index scores controlling for age, annual income, gender, employment and marital status. Logistic regression revealed no differences in sedentary lifestyles. Lonely individuals were significantly less likely to believe it was desirable for them to lose weight by walking for recreation, leisure or transportation. The findings provide support for an association between health behaviours, loneliness and excess morbidity reported in previous studies.     

Weighed Down by Stigma: How Weight‐Based Social Identity Threat Contributes to Weight Gain and Poor Health

Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article, we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight‐based social identity threat increases physiological stress, undermines self‐regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.     

Resisting Moralisation in Health Promotion

Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the (perceived) need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the moralisation of people’s lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline (alongside the related term moralism) and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’s health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions (including informational and educational campaigns) to promote health.