Disordered eating behavior, health and motives to exercise in young men: cross-sectional population-based MOPO study.

BACKGROUND: Being overweight is an increasing problem among young people, among whom disordered eating behavior is linked with weight problems as well as unhealthy weight control. The aim of the present study was to investigate whether health factors and motives to exercise differ in young men by the type of disordered eating behavior. METHODS: The population-based, cross-sectional MOPO study consisted of 2,096 young Finnish men (mean age 17.9, SD 0.7) attending compulsory call-ups for military service in the Oulu area in 2010, 2011, and 2013. They responded to a questionnaire that included two subscales of the Eating Disorder Inventory-3 indicating drive for thinness and bulimic behavior and questions on health, physical activity, and motives to exercise. The association between disordered eating behavior and related factors was analyzed by binary logistic regression. RESULTS: Altogether, 6.9 % (n = 145) of the men had symptoms of disordered eating, i.e., 5.4 % had a drive for thinness (n = 114) and 3.7 % had bulimic behavior (n = 77). Drive for thinness was associated with a perception of being overweight (OR 3.7; 95 % CI 2.2-6.1), poor self-rated health (2.3; 1.2-4.4), more leisure sitting time (1.1; 1.0-1.2), and body-related exercise motives (body acceptance: 3.0; 1.7-5.2; weight loss: 2.5; 1.4-4.4). Bulimic behavior was positively associated with poor self-rated health (2.6; 1.1-5.8) and several motives to exercise, i.e., due to another person's suggestion (2.8; 1.6-4.8), competitive sports (2.1; 1.2-3.7), body acceptance (2.1; 1.1-3.9), and weight loss (1.9; 1.1-3.3), but inversely associated with health/fitness-related exercise motives (health promotion: 0.3; 0.1-0.5; muscular strength or physical performance: 0.5; 0.2-0.9). CONCLUSIONS: In young men, disordered eating behavior was associated with being overweight, having poor self-rated health, and having a greater amount of leisure sitting time as well as non-health-related motives to exercise. In order to recognize those at risk for disordered eating behavior, evaluating these factors could be beneficial.

Persuasive user experiences of a health Behavior Change Support System: A 12-month study for prevention of metabolic syndrome.

BACKGROUND: Obesity has become a severe health problem in the world. Even a moderate 5% weight loss can significantly reduce the prevalence of metabolic syndrome, which can be vital for preventing comorbidities caused by the obesity. Health Behavior Change Support Systems (hBCSS) emphasize an autogenous approach, where an individual uses the system to influence one's own attitude or behavior to achieve his or her own goal. Regardless of promising results, such health interventions technology has often been considered merely as a tool for delivering content that has no effect or value of its own. More research on actual system features is required. OBJECTIVES: The objective of this study is to describe how users perceive persuasive software features designed and implemented into a support system. METHODS: The research medium in this study is a web-based information system designed as a lifestyle intervention for participants who are at risk of developing a metabolic syndrome or who are already suffering from it. The system was designed closely following the principles of the Persuasive Systems Design (PSD) model and the Behavior Change Support Systems (BCSS) framework. A total of 43 system users were interviewed for this study during and after a 52 week intervention period. In addition, the system's login data and subjects' Body Mass Index (BMI) measures were used to interpret the results. RESULTS: This study explains in detail how the users perceived using the system and its persuasive features. Self-monitoring, reminders, and tunneling were perceived as especially beneficial persuasive features. The need for social support appeared to grow along the duration of the intervention. Unobtrusiveness was found to be very important in all stages of the intervention rather than only at the beginning. CONCLUSIONS: Persuasive software features have power to affect individuals' health behaviors. Through their systematicity the PSD model and the BCSS framework provide effective support for the design and development of technological health interventions. Designers of such systems may choose, for instance, to implement more self-monitoring tools to help individuals to adjust their personal goals with the system's offerings better.

Effects of Group Counseling Transmitted Through Videoconferencing on Changes in Eating Behaviors.

OBJECTIVE: To compare the effects of constructivism-based dietary group counseling transmitted through videoconferencing (VC) and face-to-face (FF) counseling on changes in eating behaviors. METHODS: Altogether, 74 participants with high risk of type 2 diabetes were divided into FF and VC groups based on their place of residence in northern Finland. Constructivism-based dietary group counseling, a nonrandomized intervention, was performed (evaluations at 0, 6, and 21 months). The Three-Factor Eating Questionnaire-18 was used to evaluate cognitive restraint eating (CR), emotional eating (EE), and uncontrolled eating (UE). Data were analyzed using ANOVA and ANCOVA (significance level of 0.05). RESULTS: Cognitive restraint eating increased and UE decreased between baseline and 6 months in both groups, but between baseline and 21 months only in the FF group (P = .005 and P = .021, respectively). Emotional eating decreased only in the VC group (P = .016). There were no differences between groups at 6 or 21 months. CONCLUSIONS AND IMPLICATIONS: Constructivism-based counseling delivered through videoconferencing was effective at improving eating behaviors.

Lifestyle intervention has a beneficial effect on eating behavior and long-term weight loss in obese adults.

OBJECTIVE: To investigate the change in eating behavior and the factors related with the change among successful dieters (maintained a weight loss of ≥5% of original weight). METHODS: Obese adult subjects (21 male, 55 female) were randomized into three-year lifestyle intervention (n=59) and control groups (n=17). Eating behavior (cognitive restraint of eating, uncontrolled eating and emotional eating) was evaluated by the TFEQ-18 and motivation to lose weight and tolerance to problems by a separate questionnaire. Weight, height and body mass index were measured. RESULTS: Weight decreased more in the intervention group than in the control group (5.0% vs 0.6%, p=0.027). Cognitive restraint increased twice as much in the intervention group compared to the control group (16.0 vs. 7.0, p=0.044). The increment in cognitive restraint was positively associated with weight loss and high baseline motivation and tolerance to problems. Cognitive restraint increased in both successful (n=27) and unsuccessful dieters (n=32), but only the successful dieters were able to decrease uncontrolled eating in the long term. CONCLUSIONS: Our results showed that intensive lifestyle counseling improved cognitive restraint which was associated with enhanced weight loss among obese adults. Successful dieters also showed a long-term improvement of uncontrolled eating. Eating behavior should be evaluated and followed before and during lifestyle interventions in order to support the change, e.g. by finding methods to control eating at risk situations and strengthening motivation and tolerance to problems.

Quitting a weight loss program is associated with anhedonia: preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland.

OBJECTIVES: To examine whether a diagnosis for major depression, chronic depression or specific symptoms of depression is associated with the risk of quitting a weight loss program. STUDY DESIGN: The study involved 82 overweight adults participating in the Lifestyle Intervention Treatment Evaluation (LITE) follow-up study at Oulu University Hospital in northern Finland. METHODS: Psychiatric diagnostic assessments were based on the Structured Clinical Interview for DSMIV disorders (SCID-I) conducted by a clinical psychiatrist. Anhedonia (lack of pleasure) was assessed as one of the core symptoms of major depression and chronic depression (dysthymia). Anhedonia was defined to be present if the participants reported having suffered a major loss of interest during the previous month. RESULTS: Twenty participants (24.4%) quit during the 6-month intervention period. Anhedonia put individuals at risk of quitting the weight loss program (bivariate analysis OR 3.1, 95% CI 0.8-11.6, p=0.091, multivariate analysis OR 6.5, 95% CI 1.1-38.2, p=0.038). However, a diagnosis for major depression or chronic depression did not predict quitting. CONCLUSIONS: Individual assessments of obesity and overweight should also include an assessment for subthreshold depression, mainly anhedonia.

Using pictures as vignettes to assess stages of change in weight management.

AIMS: To evaluate the association between descriptions of the stage of change in weight management (using pictures as vignettes) and the changes in the restriction of amount of food and body weight. The goal is to develop counselling methods for helping people to change their lifestyles. METHODS: A total of 74 people at high risk of type 2 diabetes participated in six months of group counselling. The data were collected through questionnaires and video-recordings at the beginning and the end of the counselling process, and were analyzed using both deductive content analysis and statistical analysis. RESULTS: Most of the participants were at the contemplation stage at the beginning of the study, and nearly half were at the action stage at six months. There were associations between progression in the lifestyle change process, the restriction of food amount, and weight changes. Judging from this, the descriptions of the change process of weight management using pictures were well made, because the change process progressed in parallel with the changes in weight and restriction of the amount of food eaten. CONCLUSIONS: Assessing the stages of change in weight management by using pictures as vignettes is easy to carry out, and feasible. The descriptions of the stages of change were parallel with the changes in restriction of food and changes in weight.

Effect of weight loss intervention on the association between eating behaviour measured by TFEQ-18 and dietary intake in adults.

Associations between eating behaviour (cognitive restraint, emotional eating and uncontrolled eating) and dietary intake (energy, energy nutrients and fibre) were assessed in overweight or obese adults (body mass index >27 kg/m(2), n=49) before and after weight loss intervention in a randomized follow-up study lasting 18 months. Counselling was either intensive or short-term. Eating behaviour was assessed using the three-factor eating questionnaire-18 and dietary intake with 5-day food records at 0 and 18 months. The only difference in dietary intake between the groups was higher protein intake (% of energy, E%) in the short-term group at 18 months (18.7 ± 3.1 E% vs. 17.1 ± 1.7 E%). Cognitive restraint was associated with lower energy intake at 0 and 18 months (r=-0.34, r=-0.36, respectively) and higher intakes of carbohydrates (r=0.39), sucrose (r=0.33) and fibre (r=0.44) and a lower intake of fat (r=-0.43) at 18 months. Those with the highest cognitive restraint at 18 months had the lowest energy and fat intake, the highest carbohydrate and fibre intake and the greatest weight loss. The results suggest that enhancing cognitive restraint could be a target for improving weight loss counselling, although further evaluation of the causal relationship would be needed in order to find the best practices for enhancing cognitive restraint.

Feasibility of videoconferencing in lifestyle group counselling.

OBJECTIVES: The rapid increase in the prevalence of type 2 diabetes (T2D) has created an urgent need to develop new practices to prevent and treat it. One possibility is to provide specialists services to remote areas through videoconferencing (VC). Therefore, the aim was to study the feasibility of short-term group counselling by a clinical nutritionist (4 sessions at 1.5-hour each at 2-week intervals from baseline, and the session 5 at 6 months) performed by videoconferencing (VC). STUDY DESIGN: We recruited 74 subjects at high risk of T2D, and compiled 5 VC groups (each group included 5-9 subjects, total n=33) and 6 face-to-face groups (FF, total n=44). The subjects were also asked to participate in a follow-up visit 15 months after the last counselling session. METHODS: Data were collected by a questionnaire (satisfaction with group counselling via videoconferencing), by theme interviews (experiences on group counselling) and by metabolic measures (laboratory tests). RESULTS: Only one of the 74 subjects dropped out during the first 6 months. The proportion of subjects who had received social support from group peers was higher in the videoconferencing group than in the face-to-face groups (p=0.001). The experiences of group counselling transmitted by videoconferencing were positive. Waist circumference decreased significantly at 0 to 6 months of counselling (p<0.01), and was significantly lower at 21 months than at baseline in FF groups (p=0.015). However, no significant differences were observed in most of the measurements between VC and face-to-face groups. CONCLUSIONS: Short-term group counselling by a clinical nutritionist through videoconferencing is a feasible way and a practical model to provide specialists services to remote areas, and thus can be used as an option to diminish inequality related to restricted health care services in sparsely inhabited areas.

Eating behavior in obese and overweight persons with and without anhedonia.

The aim of this study was to evaluate differences in body mass index and eating behavior in obese and overweight persons with and without anhedonia during a weight loss intervention study. Psychiatric diagnostics were based on the Structured Clinical Interview for DSM-IV disorders. Eating behavior was assessed by the Three Factor Eating Questionnaire (TFEQ-18) and binge eating by the Binge Eating Scale (BES). Out of 82 participants, 20 (24.4%) reported experiencing anhedonia at least once during the study period. Those suffering from anhedonia scored significantly higher values in BES at baseline and at follow-up. They also reported more uncontrolled and emotional eating at the first follow-up. Overall, persons suffering from anhedonia achieved a poorer outcome in weight loss compared to those without anhedonia. Anhedonia was associated with uncontrolled eating, emotional eating, and binge eating, all of which may have contributed to the poorer outcomes achieved in weight loss.

The effect of eating behavior on weight loss and maintenance during a lifestyle intervention.

OBJECTIVE: To investigate the effects of intensive counseling on eating behavior and weight loss and maintenance and their associations. METHODS: A randomized weight loss counseling intervention with follow-up of 18 months, conducted between 2002-2004 at Oulu University Hospital, Finland included obese adults (n=82, body mass index >27 kg/m(2)). Subjects were randomized into 1) intensive counseling and 2) short-term counseling. Forty-nine subjects who completed the study were included. Eating behavior was repeatedly assessed by the Three Factor Eating Questionnaire-18 and Binge Eating Scale. RESULTS: Eating behavior improved in both groups. Effect of counseling was -5.0+/-5.7 kg compared with -2.4+/-2.5 kg in the control group (p<0.05 between the groups) during the first 6 months. At 18 months the weight loss results were -2.6+/-6 kg and -0.7+/-3.5 kg, respectively (NS). Success in weight loss maintenance is associated with improved eating behavior (p<0.05). By contrast, failure in weight loss is associated with high scores of uncontrolled eating and binge eating symptoms at the baseline (p<0.05). CONCLUSIONS: Both intensive and short-term interventions improved eating behavior and weight loss but there was no difference between the two modes of intervention. The association between the improvement of eating behaviour and the success of weight loss suggests a causal relationship which however should be confirmed in a prospective study focusing specifically on this aspect.