Use of an Orientation Session May Help Decrease Attrition in a Pediatric Weight Management Program for Low-Income Minority Adolescents

This study examined predictors of attrition from a pediatric weight-control program in a low-income minority community and the potential usefulness of an orientation session to increase length of treatment. Participants were 342 children and adolescents (M age=13.0 years old; 54% female; 89% African American; M BMI=44.2, M BMI z-score=6.0) and their caregivers who attended FitMatters, a multidisciplinary cognitive-behavioral program focused on long-term participation. Those who attended an orientation session stayed in treatment significantly longer, but attrition was not affected by demographic factors, weight status, or psychological functioning. These results indicate that an orientation session that clearly delineates the structure of a program and expected attitudinal and behavioral requirements for the families may help align expectations, as well as more effectively identify families who are ready to make concerted efforts to change the family lifestyle in support of their obese children's efforts.     

Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss

Physical activity may affect weight loss largely through psychological pathways associated with eating changes, especially in obese individuals whose caloric expenditure through exercise is typically small. Direct testing of this is, however, lacking. Previously sedentary adults (N?=?114; 77% female; M _age?=?43.3 years), with a minimum body mass index (BMI) of 35?kg/m² (M _BMI?=?42.0?kg/m²), participated in a 24-week treatment of cognitive-behavioural exercise support and nutrition information. A path model based on tenets of social cognitive and self-efficacy theory was constructed. It was expected that improvements in self-efficacy, physical self-concept, body satisfaction and mood associated with the exercise treatment would predict changes in self-regulation and increased physical activity. It was also hypothesised that improvements in self-efficacy and self-regulation for appropriate eating would transfer from these relationships and predict weight loss. After three theoretically viable paths were added based on modification indices, structural equation modelling indicated a good fit with the data, χ ²(16)?=?20.53, p?=?0.20; RMSEA?=?0.05; SRMR?=?0.06; CFI?=?0.97; TLI?=?0.95. Associations of psychological effects linked to exercise programme participation with predictors of appropriate eating and weight loss were found, and may inform theory, research and treatments.     

Challenging body weight: evidence from a community-based intervention on weight,behaviour and motivation

The objective of this study was to examine the effectiveness of a 12 week weight loss intervention within a commercial fitness centre on body weight, moderate to vigorous physical activity (MVPA), dietary intake, and behavioural regulations for exercise and healthy eating. Using a quasi-experimental design, the intervention group received weekly coaching sessions and bi-weekly seminars designed to increase MVPA and improve dietary intake. Outcome variables were assessed at three time points over a six month period. Results showed a significant interaction for body weight (p = .04) and dietary changes (p < .05) following the weight loss challenge but were not maintained across the six month period. Changes in behavioural regulations favoured the intervention condition. Results imply that a 12 week weight loss challenge within a commercial fitness centre may be effective at prompting short-term weight loss and support the internalization of behavioural regulations specific to healthy eating and exercise.     

Two-year follow-up of an interdisciplinary cognitive-behavioral intervention program for obese adults

Intervention programs for treating adiposity which focus on dietary change and physical exercise often do not lead to the desired long-term reduction in weight. This article reports on the effectiveness of M.O.B.I.L.I.S., a standardized theory-driven intervention program. Participants are taught cognitive-behavioral strategies of goal setting, action planning, barrier management, and self-monitoring. Persons with obesity (N=316) responded to a public advertisement to participate in the intervention program (IG) or comparison group (CG; quasi-experimental design). Assessments were conducted at four time points, with the last assessment being conducted two years after baseline. At the 24-month follow-up, the IG showed weight loss of 5.57%, whereas the CG lost 1.12% of their weight (t1-t4, p < .01). The results yielded significant interaction terms (group x time), indicating that the intervention had a substantial effect on food choice and level of physical exercise (p < .01). The IG showed significantly enhanced self-efficacy, stronger goal intentions, and more detailed implementation intentions than the CG at follow-ups. The intervention program has the potential to evoke enduring changes in the cognitions we hypothesized to be responsible for inducing obese adults to begin and continue regular exercise and healthy eating behavior, resulting in substantial weight loss.     

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.     

The Effect of Effort and Weight Controllability on Perceptions of Obese Individuals

We examined the impact of offset controllability (capability of losing weight) and offset effort (efforts to lose weight) on judgments of an obese target. Participants (n = 216) read about an obese person whose body weight was controllable/uncontrollable, and who did/did not put in effort to eat healthily and exercise. Effort played a more important role than controllability in evaluations of the target. Targets who put in effort to be healthy were ascribed fewer obesity stereotypes, evoked less disgust, and were considered to have a more acceptable lifestyle. These findings extend attribution theory and have implications for strategies to reduce weight bias.     

Overweight and obese men’s experiences in a sport-based weight loss intervention for men

In Western countries, such as Australia and the UK, a significantly greater proportion of men (relative to women) are overweight and obese, yet relatively few weight loss interventions have been developed that sufficiently target men. This lack of male-focused programming may be in part because ‘traditional’ weight loss programs are unappealing for what is considered a ‘hard-to-reach’ population. One program that appears to have such appeal for men is the MAN v FAT Football (MVFF) program, based out of the United Kingdom, which is designed for men with a body mass index of (or greater than) 27.5. MVFF encourages men’s participation in a community-based weight loss program that incentivizes weight loss through participation in a football league, and since 2016 MVFF has supported the weight loss efforts of several thousand men. Using MVFF as an exemplar, our aim was to derive insight into how men experience a male-only competitive, sport-based weight loss program. We recruited twenty-seven players (Mage = 41.13, SD = 9.93), and ten coaches (Mage = 31.8, SD = 11.55) from program locations throughout the United Kingdom. Using semi-structured interviews and thematic analysis, we identified several appraisal aspects of the program that players and coaches considered important, including the appeal of sport, competition on a level playing field, being part of a team, camaraderie, accountability, men sharing issues with other men, gender-sensitized environment, likeminded and similar men, and perceptions that traditional weight loss programs are tailored towards women. Player experiences (i.e., competence and enjoyment) and functional supports in the program (e.g., player handbook, weight loss coach) were reported to drive outcomes of effective weight loss and program retention. Interventions aiming to target men may be more successful working with rather than against formulations of identity such as masculinities, and this can be achieved by tailoring program content (e.g., messaging), settings (e.g., among men sharing similar characteristics such as body-type or goals), and mode of delivery (e.g., through organized sports, and leveraging competition to drive healthy behaviours).     

An evaluation of the Garren-Edwards diet and behavior modification program

This study evaluated the efficacy of the Garren-Edwards Behavior Modification Program, which uses the Garren-Edwards Gastric Bubble as an adjunct to treatment. Group therapy sessions were conducted with 23 morbidly obese subjects for 6 months on a biweekly basis. Each therapy session used a five-stage problem-solving sequence designed to facilitate adaptive behavioral alternatives. In evaluating weight change, a multivariate analysis of variance was conducted along with two preplanned orthogonal comparisons. Patients lost significant amounts of weight between initial to 3-month (p<.0001) and 3- to 6-month intervals (p<0001). A similar treatment effect was noted in an additional sample of 24 morbidly obese subjects following 3 months of treatment (p<0005). The findings support the value of longer goal-oriented programs in promoting continued weight loss. Implications for treatment process and therapist interventions prompted by this new format are discussed.     

“Weak,Sad, and Lazy Fatties”: Adolescents’ Explicit and Implicit Weight Bias Following Exposure to Weight Loss Reality TV Shows

Weight loss reality TV shows, which portray obese individuals and their struggle to lose weight, are highly popular. However, the shows often contain negative and stereotypical portrayals of obese individuals that can contribute to the formation of weight bias among viewers. In particular, adolescents might be highly susceptible to such portrayals, since physical appearance and body image play an important role during adolescence. In our experimental study, we investigated the priming effects of exposure to weight loss reality TV shows on implicit and explicit attitudes toward obese individuals among 353 adolescents. We exposed a treatment group (n = 173) to video clips of a weight loss reality TV show and a control group (n = 180) to video clips of an information-based TV magazine. Results indicated that for individuals who expressed a fear of being obese, exposure to the weight loss reality TV show reinforced negative explicit attitudes toward obese individuals by activating a perception of weight controllability. Exposure to the weight loss reality TV show also enhanced negative implicit attitudes toward obese individuals among all adolescents, irrespective of their fear of being obese. Altogether, our findings underscore the role of media in perpetuating weight bias.     

Bi-Directional Relationship Between Self-Regulation and Improved Eating: Temporal Associations With Exercise,Reduced Fatigue,and Weight Loss

ABSTRACT. Severely obese men and women (body mass index ≥ 35 ≤ 55 kg/m²; M_age = 44.8 years, SD = 9.3) were randomly assigned to a 6-month physical activity support treatment paired with either nutrition education (n = 83) or cognitive-behavioral nutrition (n = 82) methods for weight loss. Both groups had significant improvements in physical activity, fatigue, self-regulation for eating, and fruit and vegetable intake. Compared to those in the nutrition education group, participants in the behavioral group demonstrated greater overall increases in fruit and vegetable intake and physical activity. These group differences were associated with changes that occurred after Month 3. Increased physical activity predicted reduced fatigue, β = ?.19, p =.01. A reciprocal relationship between the mediators of that relationship, which were changes in self-regulation and fruit and vegetable intake, was identified. There was significantly greater weight loss over six months in the behavioral nutrition group when contrasted with the nutrition education group. Self-regulation for eating and fruit and vegetable intake were significant predictors of weight loss over both three and six months. Findings enabled a better understanding of psychosocial effects on temporal aspects of weight loss and may lead to more effective behavioral treatments for weight loss.     

Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.

This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.     

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.     

A qualitative analysis of the role of emotions in different patterns of long-term weight loss

Objective: To explore participant perspectives of the impact emotions have on weight loss.

Design: A qualitative design gathered data through semi-structured interviews with participants in a weight management programme. The interview addresses the following research questions: (1) how do individuals working to lose weight perceive the impact emotions have on their long-term success, and (2) what strategies do more or less successful participants use to regulate their emotions? Researchers conducted and transcribed the interviews then completed content analysis to create and organise themes.

Results: Two broad themes emerged through the interviews with 21 participants: emotional impact and emotional regulation. Further subthemes captured emotions blocking action toward goals, strategies for regulating emotions (e.g. exercise, food) and the need for new strategies to regulate emotions. Themes were also split in to three groups based on weight outcomes: regainer, moderate success (3–6% loss) and large success (>7% loss). More successful participants, compared to regainers, shared being aware of the impact of their emotions and made efforts to develop healthy regulation strategies.

Conclusions: Emotional awareness and regulation play an important role in participant’s weight management experience. Taking time to build emotional awareness and strategies to manage emotions is important to participants in weight management.     

The Effects of Weight Loss Attempts, Exercise Initiation, and Dietary Practices on Health Related Quality of Life

This study (N = 98) randomly placed participants in either a higher protein or American Heart Association diet group with each group initiating an aerobic exercise program. Body composition (BC) was measured using four different methodologies (DEXA, BIA, skinfold, BMI) along with height and weight, while Health-Related Quality of Life (HRQOL) changes were measured using the Medical Outcomes Short Form 36 (SF-36). There were no significant time/diet interactions in HRQOL scores, body fat measures, and weight with the exception of Role-Physical scores (p = .006) with posttest scores higher in participants in Diet 1. Role-Physical scores changed significantly in participants in Diet 1 (p = .0001) and Diet 2 (p = .026) with higher posttest scores in each group. Social functioning had a significant main effect for time in both groups with pretest scores in both diet groups lower than their respective posttest scores (p = .015). HRQOL pretest scores were not significantly different between groups at baseline (p = .56). ANOVA revealed no significant differences in average calories between groups (p = .88). Analysis revealed no differences in exercise in minutes (p = .66) nor statistically significant changes in BC or weight (p = .65). Conclusions: Improvements in HRQOL were demonstrated in two subscales related to physiological and psychological functioning. These novel findings add to literature suggesting that HRQOL, at least concerning social functioning, work and other daily activities (Role-Physical) may improve by initiating an exercise and dietary program even when weight loss or BC improvements have been unsuccessful.     

Social Cognitive Theory as a Framework to Explain Intentions to Practice Healthy Eating Behaviors1

Our focus in this study was the observed gap between informed awareness and the intention to act. We used elements of social cognitive theory to develop a theoretical model of six psychosocial factors hypothesized to influence the intention to adopt healthy eating behaviors. Survey data from 490 white-collar employees were analyzed using a Linear Structural Relations (LISREL) program and a stacked model. The overall fit of the model to one half of the data was excellent, x² (6, 237) = 3.79, p= 0.71, and the model was successfully replicated with the second half of the data x² (28, 249) = 28.68, p= 0.43. Our model suggests that self-efficacy expectations (a) partially depend on the perceived likelihood of an outcome; (b) act as a conduit for the effects of media, disincentives, and outcome expectancy; and (c) have powerful direct influences on intentions. As expected, outcome expectancy adds little to the prediction of intentions.     

Excel: An intensive and structured program of advising and academic support to assist minority freshmen to succeed at a large state university

It is a consistent observation that minority students graduate at much lower rates than majority students at our large state colleges and universities. The Excel program was designed to assist ethnic minority students adjust to the demands of university life and succeed both academically and personally. The program has three major components: a two semester two credit core seminar, weekly instructional support groups, and peer led tutorial/discussion groups. The results of the first two years of the program were evaluated in a number of studies comparing the performance of the Excel students to other minority and majority freshmen at the university. In all comparisons the Excel students were found to have performed significantly better than other minority groups and equal to or better than majority students. The results are discussed in terms of the variables that appear to affect minority student success at large universities.     

Clustered Patterns of Behavioral and Health-Related Variables Among Young Lesbian Women

Lesbian women are at increased risk for a variety of mental and physical health problems compared to heterosexual women. In order to inform treatment and prevention, the purpose of this study was to examine behavioral and health-related patterns among lesbian women and elucidate how these patterns are associated with general discrimination, sexual minority stress, affect, and social support. A sample of self-identified lesbian women (N = 436) completed an online survey from August 2014–March 2015. A latent profile analysis was conducted using measures of body mass index, hazardous alcohol use, binge eating, eating disorder risk, and exercise as indicators. A 5-class solution best fit the data and included two healthy groups: (a) low health risk, moderate exercise (54%), (b) low health risk + high exercise (22%); and three unhealthy risk groups: (c) obese + binge eating (14%); (d) disordered eating + hazardous alcohol use (5%); (e) disordered eating + high exercise (5%). The three unhealthy classes generally reported more general discrimination, sexual minority stress, social anxiety, negative affect, and lower social support compared to the healthy classes. These findings show that behavioral and health-related variables cluster together in several distinct patterns among lesbian women. In addition, general discrimination and sexual minority stress and associated psychosocial functioning may be related to these maladaptive behavioral and health-related patterns and may be important to consider in behavioral interventions.     

Self‐Presentational Cognitions for Exercise in Female Adolescents

The study's main purpose was to clarify the role of a range of self‐presentational cognitions in the relationship between social physique anxiety and exercise behavior. Female participants (N= 331; M age = 14.5 years) reported their exercise frequency and completed measures of self‐presentation. Exercise frequency was positively predicted by self‐presentational efficacy expectations (SPEE) and self‐presentational outcome value (SPOV). Moreover, SPEE moderated the relationship between social physique anxiety (SPA) and exercise frequency. SPA was negatively related to exercise frequency when SPEE was high, but positively related to exercise frequency when SPEE was low. Therefore, interventions designed to increase exercise frequency among adolescent girls should include strategies that both reduce SPA and enhance SPEE and SPOV.     

Influence of Accelerometer Placement and/or Heart Rate on Energy Expenditure Prediction during Uphill Exercise

Studies using a triaxial accelerometer and heart rate (HR) simultaneously for estimating energy expenditure (EE) during uphill exercise are rare. Exploring the optimal location for placing the accelerometer for predicting EE during uphill exercise is essential. Sixteen healthy male participants (M ± SEM; age 25.00 ± 0.61 years; body weight 74.13 ± 2.51 kg; body height 1.74 ± 0.01 m; body mass index 24.30 ± 0.63 kg/m²) exercised on a treadmill under 12 conditions (4 speeds and 3 gradients) on 3 days. Triaxial accelerometers, an HR recorder, and a metabolic measurement system were simultaneously used. Accelerometer outputs from various anatomical locations (upper arm, chest, lower back, waist, thigh, and instep) showed significant positive correlations with EE (0.819, 0.846, 0.816, 0.820, 0.672, and 0.669, respectively; p < .05). The linear regression equation for changes in HR showed the highest coefficient of determination (r²) of .837 with 87.9% reliability. When the HR signal was included, the r² value (> .842) and reliability (87.9%) between the accelerometer outputs and EE improved. Accelerometer outputs from the waist position alone provide highly accurate EE values. Using both accelerometer outputs and HR for EE estimation during uphill exercise is feasible and improves the accuracy of EE prediction.