Applying self-determination theory to internalized weight stigma and mental health correlates among young and middle adult women: A structural equation model.

Limited research has explored the relationship between self-determination theory constructs (basic psychological needs, autonomous/controlled regulation) and internalized weight stigma (IWS). This cross-sectional, online study surveyed 480 U.S. women aged 18-40 between 2021 and 2022. We hypothesized that need frustration and controlled weight regulation would relate to higher IWS, which would be associated with dysfunctional eating, distress, and lower life satisfaction. Conversely, we predicted that need satisfaction, autonomous regulation, and body satisfaction would be associated with reduced IWS, dysfunctional eating and distress, and higher life satisfaction. Structural equation modeling demonstrated an acceptable model fit (CMIN/DF = 2.95, CFI = 0.90, RMSEA = 0.06, SRMR = 0.07), accounting for 74% of IWS variance. Findings indicate the relevance of self-determination theory in understanding IWS, supporting a dual-process model whereby adverse and adaptive outcomes follow distinct pathways. Longitudinal studies are warranted to validate psychological needs and regulatory styles as mechanisms for IWS development and to assess generalizability across diverse populations.

Comparing measurement of internalized weight stigma and body dissatisfaction.

Respective conceptualizations of internalized weight stigma and body dissatisfaction are distinct; however, strong relationships between measures of these two constructs prompts consideration about if these are truly unique constructs or whether current measurement tools are not adequately capturing their uniqueness. In this cross-sectional study, 480 U.S. women (78.8% white; MBMI = 25.9) ages 18-40 years, recruited from Amazon's MechanicalTurk and a mid-sized university, completed an online survey with the Modified Weight Bias Internalization Scale (WBIS-M), a modified Body Parts Satisfaction Scale (BPSS), and other validated measures of body image, eating behavior, and mental health. Exploratory factor analysis of the WBIS-M and the BPSS supported a two-factor solution, although two items from the WBIS-M loaded with BPSS items. After removing these items, the 9-item version of the WBIS-M demonstrated stronger relationships with dysfunctional eating and mental health symptoms than did the BPSS (ꞵ range = 0.32-0.62 vs. 0.01-0.18, respectively). Findings from this study provide evidence to support the validity of WBIS-M and BPSS measuring unique constructs, suggesting that internalized weight stigma can be differentiated from body dissatisfaction. This study also highlights the need for further research that examines current measurement tools for internalized weight stigma and body dissatisfaction.

Changes in basic psychological needs, passion, and well-being of first-semester graduate students.

OBJECTIVE: Examine changes in graduate student health and well-being in the first semester. PARTICIPANTS: Full-time, first-semester graduate students (N = 74) from a midsized midwestern university. METHOD: Graduate students were surveyed prior to starting their master's program and 10 weeks later. Passion for academics, basic psychological needs, physical and mental health symptoms, positive and negative affects, and quality of life were assessed. RESULTS: Need satisfaction, harmonious passion, and indicators of well-being decreased across the first semester, whereas need frustration and indicators of ill-being increased over the first semester. Obsessive passion, harmonious passion, need satisfaction, and need frustration were associated with students' well-being at the end of the semester, with need frustration being the most robust predictor. CONCLUSIONS: Although most graduate students reported good general health and moderately low mental health symptoms, findings suggest that a need supportive environment may contribute to better health and well-being.

Effects of physical activity interventions for caregivers of adults: A meta-analysis.

OBJECTIVES: Caregivers of adults afflicted with a variety of chronic physical and mental health conditions are at risk for poorer well-being and reduced health related to chronic stress. Physical activity (PA) interventions may alleviate aspects of this burden, as well as provide benefits to physical health. However, notable limitations exist in the previous reviews that have attempted to synthesize the evidence for the benefits of PA interventions. METHOD: A meta-analysis was conducted investigating and quantifying the impact of PA interventions on different domains of mental and physical health for caregivers of adults, including only randomized and nonrandomized control trials. RESULTS: A comprehensive search yielded 25 studies. PA interventions led to small-to-medium effects (Hedges' g = .37, 95% confidence interval [.18, .56]) on mental health, with the most notable impact on quality of life (Hedges' g = .74, 95% CI [48, 1.01]). PA interventions led to trivial effects on physical health (Hedges' g = .15, 95% CI [.01, .31]), with small but significant effects found for mobility outcomes (Hedges' g = .28, 95% CI [.10, .47]). Yoga interventions yielded large effects (g = .85, 95% CI [.52, 1.17], p < .001) compared to other forms of PA (g = .24, 95% CI [.40, .43], p = .018), primarily within the domain of mental health. CONCLUSIONS: PA interventions appear to be effective for improving caregiver health, particularly in relation to psychological health. Further high-quality research using standardized measures for outcome comparison is needed to determine the type, formats, and length of PA interventions that best serve different caregiving populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Change in Perceived Stress and Health Behaviors of Emerging Adults in the Midst of the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented disruptions, restrictions, and concerns about physical and mental health. Emerging adulthood, including the first year of college, is associated with declines in healthy eating and physical activity, as well as possible heightened distress. The impact of COVID-19 may exacerbate these concerns. PURPOSE: The purpose of this study was to examine changes in health behaviors and perceived stress in emerging adults over the first year of college and to determine whether prepandemic health behaviors were protective for mental health and stress during the initial changes after the COVID-19 pandemic. METHODS: First-year college students (N = 234, 58.6% female) completed three surveys during their first year of school, the third being after the onset of COVID-19 and during a stay-at-home order. At Time 3, we also assessed symptoms of anxiety and depression. RESULTS: Using linear mixed modeling, sedentary time increased and physical activity decreased over time, but 20%-35% of students reported improvements in these behaviors. Dietary changes appeared mixed, with some improvements noted early during COVID-19. Perceived stress increased over time. Multiple regression indicated that of the health behaviors examined for protective effects on mental health and stress during the pandemic, only diet quality emerged as a significant predictor. CONCLUSIONS: Although notable declines in some health habits were observed over time, including following COVID-19 disruptions, some students reported improved health behaviors. Efforts should be directed at identifying and intervening with students most at risk for poor functioning.

Using self-determination theory to understand eating behaviors and weight change in emerging adults.

INTRODUCTION: College may be a time when emerging adults establish eating patterns that influence future weight trajectories. Self-determination theory (SDT) suggests that satisfaction of basic psychological needs (autonomy, competence, relatedness) supports autonomous regulation of behavior, which is associated with healthier behaviors. When needs are frustrated, individuals feel as though their behaviors are controlled by others, which is associated with unhealthy behaviors. This study used SDT to examine a model for associated body satisfaction, eating/weight control behaviors, and weight change. METHODS: Using a cross-sectional design, undergraduates (N = 875; 57% women; AgeM = 20 ± 1.4 yrs.; BMIM = 24.3 ± 4.4) completed measures of need satisfaction and frustration, behavioral regulation of healthy weight, body satisfaction, eating/weight control behaviors, and weight change in their first semester of college. RESULTS: Structural equation modeling showed that need satisfaction was positively associated with greater autonomous regulation, which was positively associated with greater body satisfaction and fruit/vegetable intake. Conversely, greater need frustration was associated with greater controlled regulation, which was associated with lower body satisfaction. Participants who had greater body satisfaction engaged in fewer unhealthy weight control behaviors. Engaging in more unhealthy behaviors was associated with greater weight gain during the first semester of college, whereas fruit and vegetable intake was not associated with weight change. The associations were stronger for women than men, particularly for the relationships between body satisfaction and unhealthy weight control behaviors and increased weight gain. CONCLUSIONS: The model was generally supported, suggesting that psychological need satisfaction and autonomous motivation in college students may facilitate greater body satisfaction and healthier eating behaviors. Future longitudinal research is needed to clarify the factors that influence health behaviors and weight gain in college students.

Go!: results from a quasi-experimental obesity prevention trial with hospital employees.

BACKGROUND: Worksite obesity prevention interventions using an ecological approach may hold promise for reducing typical weight gain. The purpose of this study was to examine the effectiveness of Go!, an innovative 12-month multi-component worksite obesity prevention intervention. METHODS: A quasi-experimental non-equivalent control group design was utilized; 407 eligible hospital employees (intervention arm) and 93 eligible clinic employees (comparison arm) participated. The intervention involved pedometer distribution, labeling of all foods in the worksite cafeteria and vending machines (with calories, step equivalent, and a traffic light based on energy density signaling recommended portion), persuasive messaging throughout the hospital, and the integration of influential employees to reinforce healthy social norms. Changes in weight, BMI, waist circumference, physical activity, and dietary behavior after 6 months and 1 year were primary outcomes. Secondary outcomes included knowledge, perceptions of employer commitment to employee health, availability of information about diet, exercise, and weight loss, perceptions of coworker support and frequency of health discussions with coworkers. A process evaluation was conducted as part of the study. RESULTS: Repeated measures ANCOVA indicated that neither group showed significant increases in weight, BMI, or waist circumference over 12 months. The intervention group showed a modest increase in physical activity in the form of walking, but decreases in fruit and vegetable servings and fiber intake. They also reported significant increases in knowledge, information, perceptions of employer commitment, and health discussions with peers. Employees expressed positive attitudes towards all components of the Go! CONCLUSIONS: This low-intensity intervention was well-received by employees but had little effect on their weight over the course of 12 months. Such results are consistent with other worksite obesity prevention studies using ecological approaches. Implementing low-impact physical activity (e.g., walking, stair use) may be more readily incorporated into the worksite setting than more challenging behaviors of altering dietary habits and increasing more vigorous forms of physical activity. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (NCT01585480) on April 24, 2012.

Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study.

Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n=232) were randomized to a 6-month program of: 1) PCST+BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other 3 conditions (Ps<0.05). PCST+BWM also did significantly better than at least one of the other conditions (ie, PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.

Psychosocial and environmental determinants of eating behaviors, physical activity, and weight change among college students: a qualitative analysis.

OBJECTIVE: The goal of this study was to identify factors that college students perceived as contributing to healthy and unhealthy eating patterns, physical activity (PA) levels, and weight change. PARTICIPANTS: Forty-nine 18- to 22-year-old students at a midwestern university participated. METHODS: Six focus groups (3 with each gender) were conducted, and data were analyzed using qualitative software to code and categorize themes and then reduce these to clusters according to commonly practiced methods of qualitative analysis. RESULTS: Eating and PA behaviors appear to be determined by a complex interplay between motivations and self-regulatory skills as well as the unique social and physical environment comprising college life. Moreover, there appear to be gender differences in how these determinants impact behavior. CONCLUSIONS: Future research should examine these interactions in the college context in order to further our understanding of potential interventions or environmental modifications that support healthy eating and PA.

Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability.

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Arthritis self-efficacy and self-efficacy for resisting eating: relationships to pain, disability, and eating behavior in overweight and obese individuals with osteoarthritic knee pain.

This study examined arthritis self-efficacy and self-efficacy for resisting eating as predictors of pain, disability, and eating behaviors in overweight or obese patients with osteoarthritis (OA) of the knee. Patients (N=174) with a body mass index between 25 and 42 completed measures of arthritis-related self-efficacy, weight-related self-efficacy, pain, physical disability, psychological disability, overeating, and demographic and medical information. Hierarchical linear regression analyses were conducted to examine whether arthritis self-efficacy (efficacy for pain control, physical function, and other symptoms) and self-efficacy for resisting eating accounted for significant variance in pain, disability, and eating behaviors after controlling for demographic and medical characteristics. Analyses also tested whether the contributions of self-efficacy were domain specific. Results showed that self-efficacy for pain accounted for 14% (p=.01) of the variance in pain, compared to only 3% accounted for by self-efficacy for physical function and other symptoms. Self-efficacy for physical function accounted for 10% (p=.001) of the variance in physical disability, while self-efficacy for pain and other symptoms accounted for 3%. Self-efficacy for other (emotional) symptoms and resisting eating accounted for 21% (p<.05) of the variance in psychological disability, while self-efficacy for pain control and physical function were not significant predictors. Self-efficacy for resisting eating accounted for 28% (p=.001) of the variance in eating behaviors. Findings indicate that self-efficacy is important in understanding pain and behavioral adjustment in overweight or obese OA patients. Moreover, the contributions of self-efficacy were domain specific. Interventions targeting both arthritis self-efficacy and self-efficacy for resisting eating may be helpful in this population.

Obesity and litigation predict workers' compensation costs associated with interbody cage lumbar fusion.

BACKGROUND CONTEXT: Results of lumbar fusion surgery have been mixed and procedures are costly. Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis and clinical outcomes; however, little attention has been given to ICLF costs or potential predictors of these expenses. PURPOSE: To depict medical and compensation costs associated with ICLF in a Utah cohort of patients receiving workers' compensation as well as to investigate predictors of costs. STUDY DESIGN/SETTING: A retrospective-cohort research design was used involving completion of presurgical and postsurgical medical record reviews and accrual of medical and compensation costs. Presurgical variables included in a regression model were presurgical spinal pathophysiology rating, obesity, and litigation status. PATIENT SAMPLE: Forty-three consecutive patients who were compensated by the Workers' Compensation Fund of Utah and underwent ICLF. OUTCOME MEASURES: Total accrued compensation and medical costs. METHODS: A retrospective review of presurgical variables and total accrued compensation and medical costs was conducted. RESULTS: Multiple regression analysis indicated that nonpathophysiological factors predicted compensation costs (lawyer involvement [beta=0.40]; obesity [beta=0.34]). Specifically, compensation for those with versus without lawyers was $41,657 versus $24,837, and for those who were obese versus nonobese was $46,152 versus $28,168. Arthrodesis was correlated with medical costs (r=-0.47, p=.002), with incurred costs for patients achieving solid fusion versus pseudarthrosis equaling $38,881 versus $71,655, respectively. CONCLUSIONS: Considerable costs were associated with ICLF, particularly for those who were obese, involved in litigation, or failed to achieve solid fusion. With regard to compensation costs, the findings support the importance of assessing nonpathophysiological factors in spinal fusion patients.