Psychosocial Predictors of Maintained Weight Loss in Women: Informing Behavioral Obesity Treatment Foci.

BACKGROUND: Behavioral obesity treatments are typically unable to facilitate meaningful weight loss beyond the short term. Implications of malleable psychosocial factors are unclear, which limits behavioral intervention contents. The current aim was to inform obesity treatments to improve their foci on psychosocial factors leading to resilient behavioral changes and maintained weight loss. METHOD: Based on pre-planned analyses, women participating in a community-based obesity treatment emphasizing self-regulation and exercise, and who lost at least 3% of their initial weight (N = 89), were measured on eating-related self-efficacy, negative mood, emotional eating, body satisfaction, and self-regulating eating at baseline, Month 3, and Month 6; and on weight change over 12 months. RESULTS: From baseline to Month 6, there was a significant overall improvement in each psychosocial variable. In separate multiple regression equations, scores at (1) Month 6, (2) change from baseline to Month 6, and (3) change from Month 3 to Month 6 were entered as predictors of maintained weight loss from Month 6 to Month 12. Using a backward elimination process, only negative mood was retained in the final Month 6 model, and significantly predicted maintained weight loss (R2adjusted = .03, p = .050). Changes in self-efficacy, mood, emotional eating, and self-regulation were retained in the final baseline to Month 6 model, and significantly predicted weight loss maintained over 12 months (R2adjusted = .30, p < .001). CONCLUSION: Findings add to research on obesity treatment development by suggesting an enhanced focus on facilitating changes in self-efficacy, mood, emotional eating, and self-regulation may enhance maintenance of lost weight (or increase weight loss).

Obesity treatment-associated transfer of exercise-related self-regulation to eating-related self-regulation changes in women.

Obesity in the United States has risen to 42 percent of its adult population and is similarly problematic in many other countries. Although the U.S. government has provided education on healthy eating and the need to exercise regularly, behavioral obesity treatments have largely failed to sustain reductions in weight. Self-regulation, and the incorporation of exercise for its psychological impacts on eating, has sometimes been targeted. While there has been sporadic investigation into the carry-over of exercise-related self-regulation to eating-related self-regulation, the present aim is to further inquiry in that area to inform future treatment content for improved effects. Women enrolled in community-based obesity treatments with either a self-regulation (n = 106) or education (n = 54) focus were assessed on changes in exercise- and eating-related self-regulation, negative mood, completed exercise, and weight. Improvements were significantly greater in the self-regulation-focused group. After controlling for initial change in eating-related self-regulation, change in that measure from Month 3 to 6 was significantly predicted by change in exercise-related self-regulation during the initial 3 treatment months. This suggested a carry-over effect. A stronger predictive relationship was associated with the self-regulation-focused treatment. In further analyses, paths from changes in exercise→negative mood→self-regulation of both exercise and eating were significant. Increase in eating-related self-regulation was significantly associated with weight loss over 6, 12, and 24 months. The self-regulation-focused group had stronger relationships, again. Findings suggested utility in targeting exercise-related self-regulation to impact later change in eating-related self-regulation, and the use of exercise-associated mood improvement to bolster participants' self-regulation capabilities.

Impacts of early psychological changes on correlates of weight-loss maintenance: Seeking increased precision for sustained behavioural obesity treatment effects.

ISSUE ADDRESSED: Obesity is an increasing worldwide health issue. In affluent English-speaking countries, obesity ranges from ~28% (Australia) to ~42% (United States) of the adult population. Enabling weight loss beyond an initial 6 months is an unresolved challenge. METHODS: Women with obesity participated in community-based obesity treatments incorporating either cognitive-behavioural methods emphasizing self-regulatory skills development (n = 106) or typical information/education processes (n = 47). Psychosocial, behavioural, and weight changes were measured. RESULTS: Significant overall improvements in exercise-related self-regulation and self-efficacy, mood, physical activity/exercise (PA/exercise), diet, and weight were found from baseline-month 6 (weight-loss phase) and baseline-month 12, but not from months 6-12 (weight-loss maintenance phase). Significantly greater improvements were found in the cognitive-behavioural group. Within the weight-loss phase, changes in both PA/exercise and diet significantly contributed to the explained variance in weight loss, whereas within the weight-loss maintenance phase, only change in PA/exercise was a significant predictor. There was no significant relationship of weight loss across phases. Months 6-12 change in PA/exercise significantly mediated relationships of changes in self-regulation→weight, mood→weight, and self-efficacy→weight. Earlier scores and score changes in mood and self-efficacy significantly impacted the subsequent parallel relationships. CONCLUSIONS: Cognitive-behavioural methods affect psychosocial changes leading to initial changes in diet, PA/exercise, and weight. Those changes then impact subsequent changes in PA/exercise-a primary malleable correlate of maintained weight loss. SO WHAT?: This research extended previous findings to better-inform behavioural obesity-treatment foci to address the pervasive public health problem of attaining and sustaining weight loss. Findings related to PA/exercise will help impact health-promotion outcomes.

Carry-Over of Exercise-Related Self-Regulation to Eating-Related Self-Regulation in Women Participating in Behavioral Obesity Treatments.

Purpose: Because obesity has not responded well to instructing affected adults in healthier eating behaviors and increased physical activity/exercise, enhanced research on psychosocial determinants of those behavioral changes is needed. Intervention foci on self-regulation have been suggested, but targeted research is required. Method: Women with obesity participated in community-based treatments that were either self-regulation-focused (self-regulation emphasis group; n = 52) or typical instruction-based (education [treatment-as-usual] group; n = 54). Results: There were overall significant increases in exercise-related self-regulation, physical activity/exercise, exercise-related self-efficacy, and eating-related self-regulation that were each significantly more pronounced in the self-regulation emphasis group. Increase in exercise-related self-regulation over 3 months predicted eating-related self-regulation over 6 months; however, sequential entry of changes in physical activity and exercise-related self-efficacy significantly mediated that relationship. However, only the path from changes in exercise-related self-regulation to exercise self-efficacy to eating-related self-regulation was significant. In a revised model where change in exercise self-efficacy was the sole mediator, treatment group did not significantly moderate the exercise self-regulation to eating self-regulation change relationship, but full mediation of that relationship occurred. Conclusion: Findings indicated salience for perceived ability/self-efficacy for physical activity, over actual physical activity progress, and its role in the transfer of self-regulatory skills from an exercise to eating context. Increased eating self-regulation significantly predicted weight loss over 6, 12, and 24 months. In the self-regulation emphasis group that translated to meaningful weight loss/weight-loss maintenance of greater than 5% of initial weight. Findings contributed to an increased understanding of psychosocial-change processes within obesity treatment research.

Temporal Aspects of Psychosocial Mediators of the Exercise-Weight Loss Maintenance Relationship Within Scalable Behavior-Change Treatments.

STUDY BACKGROUND: Limited knowledge of psychological correlates of weight loss is associated with continuing failures of behavioral obesity treatments beyond the short term. PURPOSE: This study aimed to inform health professionals' obesity interventions via an increased knowledge of mediators of the exercise-weight loss maintenance relationship. METHODS: Women participated in 6-month obesity treatments within community settings emphasizing moderate exercise and self-regulation skills development via primarily in-person (n = 54) or primarily written (n = 54) means. Changes in mood, self-regulating eating, and weight over 6, 12, and 24 months were assessed. A moderated mediation model was tested using the PROCESS macro instruction. RESULTS: Improvements in mood, self-regulating eating, and weight were significantly greater in the in-person group. The relationship between a dichotomous measure of completing at least 3 sessions of exercise per week (or not) and change in weight over 6 months was no longer significant when the mediators of changes in negative mood and self-regulation of eating were sequentially entered. Paths of exercise→negative mood reduction→eating self-regulation increase→weight loss over 6, 12 and 24 months were significant. Exercise self-regulation at Month 3 significantly moderated the mood change→eating self-regulation change relationship. CONCLUSIONS: Based on the identified paths, scalable obesity-treatment content and emphases were informed. This could help guide health professionals' actions concerning the management of obesity.