Long‐term Self‐monitoring of Weight: A Case Study

The aim of this study was to examine the self‐monitoring of weight on a daily basis over a long period of time in order to understand the process of weight regain. An obese female client measured her weight every morning over a period of 10 years. The subject made a total of 2081 weight measurements. Thus, her weight was measured on 67% of all possible days. After the initial weight loss a pattern of gradual weight gain was observed. The subject gained weight during August and September, and at the end of December, in particular. Furthermore, her weight increased slightly at the weekends. This case study highlights the advantage of self‐monitoring of weight on a daily basis. Individual patterns of weight change possibly associated with season and weekly variation may be crucial when obese subjects try to maintain their weight after weight loss. However, it may take several months or even years to detect the weekly and yearly rhythms or other patterns in the data. Thus, self‐control of weight is problematic, since patterns in the weight regain process are difficult to detect. This may be one reason why self‐control of weight is so difficult.     

Behavioral techniques in the treatment of obesity: A comparative analysis

The relative efficacy of the major techniques typically used in behavioral treatment programs for weight reduction was investigated using obese adult volunteers. Study 1 compared the effects of self-monitoring, self-control procedures, monetary rewards, aversive imagery and relaxation training. These procedures resulted in significantly greater weight reduction than either a no treatment group or subjects who graphed and recorded daily weight. Self-monitoring of daily caloric intake was as effective as the other methods, both singly and combined, over a 4 week treatment period. Study 2 compared the long-term effects of self-monitoring vs the full complement of behavioral techniques used in Study 1. The full behavior management program was significantly more effective, both during the treatment period and at 3 and 12 week follow-ups, although self-monitoring again produced substantial weight loss.     

Attributes of successful approaches to weight loss and control

Most weight loss treatments result in only temporary losses, followed by slow regain. This paper examines those factors that are correlated with the most favorable results in terms of loss and maintenance of loss. Weight loss is positively related to self-monitoring, goal setting, social support, and length of treatment. Maintenance of weight loss is correlated with regular physical activity, self-monitoring, and continued contact with therapists. Regain is associated with inconsistent and restrictive dieting, life stress, negative coping style, and emotional or binge eating patterns. The implications drawn from these findings are (a) normalize eating patterns, (b) emphasize exercise, (c) ensure social support, (d) set realistic goal weights, (e) focus on health rather than appearance, (f) focus on self-esteem, and (g) target binge eating.     

How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently.

This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention group's treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.     

I want to keep on exercising but I don’t: The negative impact of momentary lacks of self-control on exercise adherence

ObjectivesWe investigated the impact of state and trait self-control strength on exercise execution. We hypothesized that state self-control strength is reduced on days that are perceived as stressful and that reductions in self-control strength result in a lower likelihood to work out. Additionally, trait self-control strength may affect the execution of workout plans.DesignUniversity students, who stated that they have not been exercising regularly for at least one month, filled in a trait self-control inventory, a personality questionnaire, and were instructed to perform a daily workout over a one-week period. Perceived stress levels, state self-control strength, and workout completion were assessed on a daily basis.ResultsResults revealed that people were less likely to exercise on days they perceived as stressful. State self-control mediated the relation between stress and exercise completion. Trait self-control and other personality variables did not affect workout completion.ConclusionsResults indicate that daily stress is associated with self-control depletion and a lower likelihood to work out.     

Behavior therapy for obesity: Booster sessions and long-term maintenance of weight loss

Following 8 weekly sessions of group behavioral self-control treatment, 75 obese women were assigned to one of five different maintenance conditions: (a) structured behavioral booster sessions held every two weeks; (b) structured behavioral booster sessions held every month; (c) unstructured nonspecific booster sessions held every two weeks; (d) unstructured nonspecific booster sessions held every month; and (e) a control group that received no booster sessions. Follow-ups were conducted at 3, 6, 9 and 12 month intervals. The study was completed in two replications. Results failed to show a significant effect of either booster session content or frequency. All groups continued to lose weight during the first three months of follow-up. Thereafter subjects in Replication 1 showed significant increases in weight over the next 9 months, whereas subjects in Replication 2 maintained their treatment-produced weight loss. The data do not support the view that booster sessions facilitate maintenance.     

A Healthy Lifestyle Program for the Treatment of Obesity in Minority Men

Historically, minority males have had limited success in programs designed to reduce weight. Twenty-five obese minority males participated in a healthy lifestyle program designed to treat essential hypertension, hyperlipidemia, type II diabetes, obesity, and hypothyroidism. Coined the LE ³ AN Lifestyle Program (emphasizing healthy lifestyles, realistic exercise, reasonable expectations and emotions, attitudes, and nutrition), the program offered a treatment model that involved reasonable low-intensity short exercise regimens, instruction, and extensive practice in making healthy food choices, behavior modification, and self-monitoring techniques coupled with guidance on realistic weight loss and exercise expectations. The participants were able to lose 13 Ib during the inpatient plus day treatment phases of the program and continued to maintain a 19-lb weight loss at 12 months. A program overview, case examples, and suggestions to improve outcome efficacy with difficult to manage obese, minority, male patients are provided.     

Intermittent low-calorie regimen and booster sessions in the treatment of obesity

The present study investigated two new weight-control strategies: an intermittent low-calorie regimen and intermittent scheduling of booster sessions. A new approach to predicting patient weight loss, based on a pretreatment assessment with a highly-structured eating regimen, was also studied. Forty-eight obese patients were randomly assigned to either a Standard Behavioral weight-control condition or to an Intermittent Low-calorie Regimen (< 750 cal for 2 days/week) condition and to one of two maintenance schedules: a Spaced schedule in which the six booster sessions were held at monthly intervals, or a Massed schedule, in which four of the six meetings were held during the third month. Neither the intermittent low-calorie regimen nor the intermittent scheduling of booster sessions significantly affected weight loss. However, weight loss at 1 year was related to compliance to self-monitoring and to self-reported change in eating habits and exercise. In addition, weight loss at 1 year was related to weight loss during the initial pretreatment assessment period.     

A Screening Tool to Assess and Manage Behavioral Risk in the Postoperative Bariatric Surgery Patient: The WATCH

Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.     

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.     

Obese-normal differences in the self-monitoring of expressive behavior

Several recent studies have found that while the behavior of normal weight individuals is primarily determined by internal cues, the behavior of the obese is chiefly controlled by external or environmental cues. The present study sought to generalize this finding to the self-monitoring of expressive behavior. Specifically, it was predicted that obese persons would tend to be high in the self-monitoring of their expressive behavior while individuals of normal weight would tend to monitor their expressive behavior to a lesser extent. This hypothesis was strongly supported. The findings are discussed both in terms of further extending the Schachterian model and in terms of the obese as a deviant population.     

THEORETICAL,PRACTICAL, AND SOCIAL ISSUES IN BEHAVIORAL TREATMENTS OF OBESITY

Although showing superior maintenance, behavioral treatments of obesity typically produce small weight losses at a decelerating rate. Rather than reflecting poor compliance with treatment, these findings are consistent with known compensatory metabolic changes that operate to slow weight loss and promote regain. Other problems associated with dieting include failure of caloric regulation, hyper-responsivity to food palatability, and hunger, which is greatest under conditions of moderate restriction and unpredictability of access to food. The inevitability of treatment failure in many instances must be faced and efforts made to prevent further worsening of the obese patient's self-esteem. Prognosis and treatment planning may be aided by consideration of the historical difficulties of weight loss, the degree of hunger experienced on diets, which may reflect important physiological differences among individuals, and the use of food to optimize arousal level. Full involvement of the patient in setting goals and planning treatment is recommended.     

Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Goal-setting and spouse involvement in the treatment of obesity

Two types of goal-setting (daily vs weekly) and two levels of spouse involvement (couples vs individual treatment) were evaluated in a 19-week behavioral weight-control program. Forty-seven married Ss with spouses willing to participate were randomly assigned to one of four treatments: Couples/Weekly Goals, Couples/Daily Goals, Individual/Weekly Goals, Individual/Daily Goals. At posttreatment, Ss had lost an average of 171b and reduced their percent over ideal weight from 49 to 36%. Losses were maintained at the 6-month clinic follow-up. Weight losses for the two goal-setting conditions and the two spouse treatments did not differ. Improvements were observed in resting pulse, blood pressure and step-test time, and these were maintained at the 6-month follow-up. Adherence to caloric self-monitoring, self-reported exercise adherence and marital satisfaction were significantly correlated with weight loss. Decreases in depression and improvements in body-image satisfaction were also observed. Mail and telephone follow-up at 12 and 30 months posttreatment indicated satisfactory maintenance for the majority of Ss. Factors associated with maintenance and relapse during long-term follow up are discussed.     

GENDER DIFFERENCES IN INTERNAL BELIEFS ABOUT WEIGHT AND NEGATIVE ATTITUDES TOWARDS SELF AND OTHERS

Previous research has found that people with an internal weight locus of control (beliefs in self-control over weight) are more likely to join and stay in weight-loss programs and have higher self-esteem than those who have an external locus of control (e.g., belief that weight is due to luck, genes). There has been no research on how weight locus of control affects the self-esteem of people who are not average weight or not satisfied with their weight. The present study predicted that for people who are overweight, weight locus of control would be negatively related to self-esteem. The results confirmed this interaction between weight locus of control and weight on self-esteem for women, but not for men. The second prediction was that internal weight locus of control would have negative social consequences in terms of greater negative stereotyping of obese people, and this was also confirmed for women. Because weight loss is rarely permanent, it would seem important to change people's attitudes about the lack of control that they (and others) have over body weight.     

A randomized controlled trial on the long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice

OBJECTIVES: To examine the long-term effects of a new behavioral weight control program (Kenkou-tatsujin, KT program). The program consisted of twice-interactive letter communications including computer-tailored personal advice on treatment needs and behavioral modification. DESIGN: A randomized controlled trial comparing Group KM: KT program with 6-month weight and targeted behavior's self-monitoring, Group K: KT program only, Group BM: an untailored self-help booklet with 7-month self-monitoring of weight and walking, and Group B: the self-help booklet only. PARTICIPANTS: Two hundreds and five overweight Japanese females were recruited via a local newspaper. MEASUREMENTS: Weight loss (body weight, BMI, reduction quotient, etc.) and behavioral changes (daily eating, exercise and sleeping habits). FINDINGS: A significant weight loss was observed in all groups. At 1 month, Groups KM and K were superior, but at 7 months, the mean weight loss was significantly more in Group KM than the other 3 groups. At 7 months, 8 dietary habits and 4 physical activities were improved in all subjects. Habitual improvement was related to the weight loss in Groups KM and K at 1 month.     

Weight maintenance: Self-regulatory factors underpinning success and failure

Objectives: To investigate the differences in the contributing factors involved in weight maintenance success and failure.

Design: Semi-structured interviews were conducted with both successful and unsuccessful weight maintainers. Eighteen participants were recruited (16 women), nine of who had lost 10% of their body weight and maintained this weight for a minimum of 12?months (Maintainers), and nine individuals who met the above criteria for weight loss but had subsequently regained their weight (Regainers). A thematic analysis was employed to compare the differences between the two groups.

Results and conclusions: Two main themes highlighted the differences between the two groups, these were: goal regulation and self-control. Within these overarching themes, successful weight maintenance was related to the following subthemes: long-term, realistic goal setting, consistent use of routines and self-monitoring, avoiding deprivation and effective coping skills. Unsuccessful maintenance was related to short-term unrealistic goal setting, inconsistent routines and self-monitoring, experiencing deprivation and poor coping skills. These factors are explained in terms of the interrelationships that they have on one another and their subsequent impact on weight maintenance success or failure.     

Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial

Background: In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.

Methods: Fifty-two overweight/obese adults (Age: M?=?47?years, SD?=?13.5; female?=?67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6?weeks, while the other half remained in their groups regardless of weight loss.

Results: There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC?=?4.9% vs. BWLP?=?7.8%; p?=?.10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p?<?.01).

Conclusion: There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.