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Abstract

Objective Examine psychological and behavioral predictors of 3-year weight loss maintenance in women.Methods Participants were 154 women in a 1-year randomized controlled trial on weight management with a 2-year follow-up. Signal detection analyses identified behavioral and psychological variables that best predicted 5% and 10% weight loss at 3 years.ResultsWomen with better body image were more likely to have lost ≥5% weight at 3 years (P < 0.001). Exercise intrinsic motivation had a partial compensatory effect, in that women with poor body image but higher motivation were more likely to maintain weight loss than women with poor body image and lower motivation (P < 0.001). Women with high exercise autonomous motivation were three times more likely to have lost ≥10% weight than were those with lower autonomous motivation (P < 0.001). Among women with lower autonomous motivation, perceiving fewer exercise barriers was somewhat compensatory: these women were more likely to maintain weight loss than women with lower autonomy but more perceived barriers (P < 0.01).Conclusions In overweight women, improving body image and increasing autonomous and intrinsic motivation for exercise likely promotes clinically significant long-term weight loss maintenance. Decreasing perceived exercise barriers is another promising intervention target.

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... Self-determination theory has been applied in the prediction of healthy behaviours and in interventions, showing that autonomous motivation is more effective than controlled motivation in both cases (15)(16)(17) . Specifically, selfdetermination theory has been used to understand the mechanisms operating in the success of a weight change process, which often involves habit change. ...
... Becoming autonomous is essential for achieving weight control, which involves understanding the reasons for initiating the behaviour and, thus, preventing abandonment, as well as redirecting the objective in overweight treatments towards process-focused treatment rather than outcome-focused treatment (15,16) . Deci and Ryan (13) suggested that inflexible thoughts and externally controlled behaviour could lead to maladaptive behaviours, such as unhealthy weight control behaviour. ...
... In previous studies, no differences in healthy diet motivation were found based on age group (15)(16)(17)(18)(19) or gender in the type of healthy eating motivation (autonomous and controlled motivation) (22) . ...
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Objective In order to understand the psychological antecedents or personal factors that lead to weight control behaviours that can help to develop more effective prevention strategies. Design The present correlational study has a non-experimental, quantitative, cross-sectional design. A model was tested considering types of motivation (autonomous motivation, controlled motivation, and amotivation) as mediators in the relationship between the Grit personality and healthy and unhealthy weight control behaviours, with self-control as a moderator in the aforementioned indirect effects. Setting Monterrey (Nuevo León, México) Participants A representative sample of 1219 adults (men = 599; women = 620) aged 18 to 65 years ( M = 29.37, SD = 11.83). Results Findings supported the mediator role of the types of motivation. Specifically, Grit showed a positive indirect effect on healthy weight control behaviours through autonomous motivation. Conversely, Grit showed a negative indirect effect on unhealthy weight control behaviours through autonomous motivation. Furthermore, findings supported the moderator role of self-control in the relationship between amotivation and healthy and unhealthy weight control behaviours. Conclusions This study provides evidence for the key role of Grit in the adoption of healthy or unhealthy control behaviours, as well as the role of autonomous motivation in the development of healthy behaviours.
... One study demonstrated that children who reported a motivation for weight loss relating to social/familial factors lost more weight than children who were motivated by personal factors (12). In adults, certain motivations, such as intrinsic motivation for exercise, have been associated with increased maintenance of long-term weight loss (13). With the increasing focus on the prevention and treatment of obesity (14), there is a need to ensure that messages and encouragement for healthy living and weight loss are safe as well as effective (15,16). ...
... Older children (aged[12][13][14][15] had significantly greater odds compared to younger children of more frequently attempting to lose weight by cutting back on eating (OR 1.35 [1.1-1.68]), exercising (OR 1.25 [1.01-1.55]), ...
... Older children (aged[12][13][14][15] had significantly greater odds than younger children of being motivated to lose weight more frequently to look better (OR 2.32 [1.84-2.92]), because of a health professional (OR 2.37 [1.39-4.02]), to be healthier (OR 1.41 [1.13-1.75]), ...
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Objectives: To examine the association between weight loss behaviors and motivations for weight loss in children and adolescents and the association of weight status with these behaviors and motivations in a nationally representative sample. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) was examined, focusing on children in the United States aged 8-15 years, in repeated cross-sections from 2005 to 2011. Results: Half of participants (N = 6,117) reported attempting to lose weight, and children with obesity attempted to lose weight more frequently (76%) than children who were a healthy weight (15%). Children reported attempting to lose weight by both healthy and unhealthy means: "exercising" (92%), "eating less sweets or fatty foods" (84%), "skipping meals" (35%), and "starving" (18%). The motivation to be better at sports was more likely to be associated with attempting weight loss through healthy behaviors, whereas children motivated by teasing were more likely to engage in unhealthy behaviors. Motivations for losing weight differed by weight status. Conclusions: Many children and adolescents attempt to lose weight, using either or both healthy and unhealthy behaviors, and behaviors differed based on motivations for weight loss. Future research should examine how physicians, parents, and teachers can inspire healthy behavior changes.
... For instance, Gorin et al. showed that autonomy support from one's partner predicted better weight loss outcomes at 6 and 18 months among overweight and obese individuals participating in a behaviourally based lifestyle intervention, while more directive forms of support hampered progress (Gorin, Powers, Koestner, Wing, & Raynor, 2014). More recently, in the context of a 1-year SDT-based randomized controlled trial with a 2-year follow-up period, a large set of behavioural and psychological variables at the end of intervention as predictors of 3-year weight loss maintenance in overweight and obese women was examined (Santos, Mata, Silva, Sardinha, & Teixeira, 2015). Seeking for a hierarchy of predictors, this study showed that, from the 28 potential predictors included (within general and exercise motivation, psychological wellbeing and quality of life, eating behaviours and eating habits, and physical activity), exercise autonomous motivation emerged as the best predictor of at least 10% weight loss maintenance at 3 years. ...
... For its role in energizing the direction and persistence of human behaviour, motivation is clearly among the best candidates for predicting weight loss maintenance. As these and other studies show (see (Ng, et al., 2012) for a metaanalysis of SDT empirical studies and (Teixeira et al., 2015) for a systematic review of intervention studies), not all types of motivation predict longterm and positive behavioural outcomes. Therefore, targeting the motivational quality underlying weight-related behaviours, rather than imposing and prescribing behavioural changes, seems to be more promising for helping individuals achieve weight loss maintenance. ...
... Psychological factors Depression (-) 23,38,39,41,49,54,64) (ㆍ) 67) , Stress (-) 21,22,25,26,39,54,77) (ㆍ) 38) , Social support (+) 19,25,30,31,70,81,87) , Self-regulation (+) 31,44,65,87) , Motivation (+) 19,29,31) , Positive body image (+) 29,67) , Self-esteem (+) 39,43) (ㆍ) 67) , Self-efficacy (+) 30,62) , Successful goals and plans (+) 19,87) , Flexible restraint (+) 63,88) , Dichotomous thinking (-) 65,66) , Emotion regulation difficulties (-) 84,86) (ㆍ) 85) , Internalized weight bias (-) 72,73) , Anxiety (-) 53,56) , Self-blame (-) 44) , Experience of abandonment (-) 43) Treatment process factors Self-weighing (+) 9,23,28,38,51,62,68) , Initial weight loss (+) 15,20,57) , Attendance (+) 38,39,51) (-) 40) Unchangeable predictors Genetic factors PAI-1 (+) 59) , FVII (+) 59) , RBP4 (-) 16) , SHBG (-) 16) , PRG4 (+) 17) , PRAP1 (+) 17) , SNPs-; NEGRI rs2815752, BDNF rs6265, PRARG rs1801282, TMEM18 rs6548238, KTCD15 rs29941 (-) 60) , Family history of obesity (-) 9) Physiological factors GLP-1 (ㆍ) 50) , PYY (ㆍ) 50) , Insulin (+) 13,56) (-) 18) (ㆍ) 48) , Leptin (-) 11) (ㆍ) 48) , Ghrelin (ㆍ) 48,50) , Testosterone (-) 16) , TNF α (-) 11) ACE (+) 12,14) , Acylcarnitine (+) 33) , LPL (+) 24) , HOMA-IR (+) ...
... Psychological factors Depression (-) 23,38,39,41,49,54,64) (ㆍ) 67) , Stress (-) 21,22,25,26,39,54,77) (ㆍ) 38) , Social support (+) 19,25,30,31,70,81,87) , Self-regulation (+) 31,44,65,87) , Motivation (+) 19,29,31) , Positive body image (+) 29,67) , Self-esteem (+) 39,43) (ㆍ) 67) , Self-efficacy (+) 30,62) , Successful goals and plans (+) 19,87) , Flexible restraint (+) 63,88) , Dichotomous thinking (-) 65,66) , Emotion regulation difficulties (-) 84,86) (ㆍ) 85) , Internalized weight bias (-) 72,73) , Anxiety (-) 53,56) , Self-blame (-) 44) , Experience of abandonment (-) 43) Treatment process factors Self-weighing (+) 9,23,28,38,51,62,68) , Initial weight loss (+) 15,20,57) , Attendance (+) 38,39,51) (-) 40) Unchangeable predictors Genetic factors PAI-1 (+) 59) , FVII (+) 59) , RBP4 (-) 16) , SHBG (-) 16) , PRG4 (+) 17) , PRAP1 (+) 17) , SNPs-; NEGRI rs2815752, BDNF rs6265, PRARG rs1801282, TMEM18 rs6548238, KTCD15 rs29941 (-) 60) , Family history of obesity (-) 9) Physiological factors GLP-1 (ㆍ) 50) , PYY (ㆍ) 50) , Insulin (+) 13,56) (-) 18) (ㆍ) 48) , Leptin (-) 11) (ㆍ) 48) , Ghrelin (ㆍ) 48,50) , Testosterone (-) 16) , TNF α (-) 11) ACE (+) 12,14) , Acylcarnitine (+) 33) , LPL (+) 24) , HOMA-IR (+) ...
... Literature findings suggest that motivational factors are key psychosocial variables that influence long-term success in weight loss (Teixeira et al., 2004(Teixeira et al., , 2012. For example, intrinsic reasons or motivation, such as an individual's interest in exercise, predicts long-term weight maintenance and the adoption of healthy behaviors (Santos et al., 2015;Silva et al., 2011). Reasons cited as extrinsic, such as appearance (Teixeira et al., 2012), are associated with binge eating and linked to negative weight loss outcomes (Vartanian et al., 2012). ...
... In this study, we did not include measures of women's' satisfaction with their appearance throughout, but future investigations should do so to more fully explore the mechanisms by which initial appearance for weight loss affects actual weight loss. One explanatory mechanism may be that participants motivated for selfappearance reasons are less autonomously motivated to exercise, which has been demonstrated to be a very important factor in long-term weight maintenance (Santos et al., 2015;Silva et al., 2011). The effect of baseline motivation to lose weight for self-appearance reasons on weight loss at 3 months through 30 months. ...
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This study investigated whether women’s initial reasons (health, appearance to others, or appearance to self) for wanting to lose weight influenced their weight change over a 30-month web-based intervention. Multilevel modeling with 1416 observations revealed that only appearance in relation to one’s self was a significant (negative) predictor. Women highly motivated to lose weight to improve their appearance in relation to themselves gained weight at 30 months, whereas those not motivated for this reason achieved clinically significant weight loss. Results suggest examining participants’ initial reasons for weight loss as an important component of intervention failure or success.
... The pivotal studies and the most recent published reports are presented in Table 1. 4,13,15,16,[19][20][21][22][23][24][25][26][27][28][29] The NWCR, described in the "Data on long-term weight loss maintenance" section, is the most important and longest study assessing the characteristics of individuals who successfully lost and maintained their weight loss, as well as the strategies they use to maintain their weight loss. 30 In a large NWCR analysis, the members reported an average weight loss of 33 kg, which was maintained for more than 5 years. ...
... 49 Physical activity has modest impact during the weight loss period, but becomes essential to weight maintenance. 26 Unfortunately, the level of daily energy expenditure necessary to prevent weight regain is high compared with the modern-day lifestyle, 50 and subjects with metabolic disorders do not perceive physical activity as a relevant component of healthy behavior. 51 Although total daily energy expenditure is a strong predictor of weight maintenance in obese individuals, 52 adherence to a prescribed exercise intensity and/or dose is quite low, also considering the perceived fatigue in accomplishing the desired intensity goals. ...
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The long-term weight management of obesity remains a very dif cult task, associ- ated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low- calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, con dence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction. Trials based on the most recent protocols of lifestyle modi cation, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modi cation- based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment.
... These data might suggest that for people who did not manage to sustain weight reduction it was easier to change diet than to increase physical activity. According to Santos et al, while physical activity had a modest impact during the weight loss period, it was essential to weight loss maintenance [17]. In the NWCR, keeping stable weight over a long term period was associated with a high level of physical activity of approximately 1 hour per day [9]. ...
... Aziz found, confirming earlier research, that lifestyle-focused diabetes prevention programs that include a 'high' degree of contact and long duration are more likely to achieve effective outcomes, especially in terms of weight loss [12][13][14]. In the meta-analysis by Montessi et al several strategies to promote sustained weight loss have been evaluated: group sessions delivered twice a month for 1 year after the weight loss phase and keeping patients in active treatment to help maintain weight loss [17]. There is also evidence that long-term self-help group pressure and support might help some people maintain weight [18]. ...
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Lifestyle interventions in type 2 diabetes (DM2) prevention implementation studies can be effective and lasting. Long-term weight loss maintenance enhances the intervention effect through a significant decrease in diabetes incidence over time. Our objective was to identify factors predicting long-term successful weight reduction maintenance achieved during a DM2 prevention program in patients with high DM2 risk in primary health care. Study participants (n = 263), middle-aged, slightly obese with baseline increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC)>14), but no diabetes were invited to receive 11 lifestyle counselling sessions, guided physical activity sessions and motivational support during 10-months. The study participants had three clinical examinations during the study (baseline, one and three years). Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of weight reduction maintenance two years after the discontinuation of the intervention. Out of 105 patients who completed all three examinations (baseline age 56.6 (standard deviation (SD) = 10.7), body mass index 31.1 kg/m² (SD = 4.9), FINDRISC 18.6 (SD = 3.1)), 73 patients (70%) showed weight loss during the intervention (mean weight loss 4.2 kg, SD = 5.1). The total weight loss achieved in the maintainers (27 of 73 study participants) two years after the intervention had finished was 6.54 kg (4.47 kg+2.0 kg). The non-maintainers, on the other hand, returned to their initial weight at the start of the intervention (+0.21 kg). In multivariable analysis baseline history of increased glucose (odds ratio (OR) = 3.7; 95% confidence interval (CI) 1.0–13.6) and reduction of total fat in diet during follow-up (OR = 4.3; 95% CI 1.5–12.2) were independent predictors of successful weight loss. Further studies exploring predictors of weight loss maintenance in diabetes prevention are needed to help health care providers to redesign interventions and improve long-term outcomes of real life interventions.
... These results suggest that especially in women initially trying to lose and maintain weight, finding a source of intrinsic motivation may be critical in the longer term. These findings are consistent with results from a weight management intervention showing that, in overweight and obese women who underwent to a 1-year SDT-based intervention, not all types of motivation predicted physical activity and weight loss maintenance; intrinsic and autonomous motivation were the only predictors of long-term outcomes [33, 34]. Strengths of the study include the longitudinal prospective design; the large sample of women living in socioeconomically disadvantaged neighborhoods, a high risk population group for overweight and other health problems, difficult to reach in research studies and interventions ; and the wide variety of potential sociodemographic and physical and social environment confounders in physical activity behavior. ...
... Different studies suggest that critical variables that dieters use to evaluate the benefit of their weight-loss behavior are body dissatisfaction, 12 the level of attributed self-efficacy 13,14the individual's belief that one has the ability to engage successfully in a specific behavior-and the level of self-worth in terms of weight and shape. 15 For example, a recent study assessing the psychological and behavioral predictors of 3 year weight-loss maintenance in women 16 clearly showed that improving body image and increasing autonomous and intrinsic motivation for exercise also significantly improves long-term weight-loss maintenance: women with a better body image after the 1 year intervention were most likely to achieve at least 3% or 5% weight loss. ...
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It is well known that obesity has a multifactorial etiology, including biological, environmental, and psychological causes. For this reason, obesity treatment requires a more integrated approach than the standard behavioral treatment based on dietary and physical activity only. To test the long-term efficacy of an enhanced cognitive-behavioral therapy (CBT) of obesity, including a virtual reality (VR) module aimed at both unlocking the negative memory of the body and to modify its behavioral and emotional correlates, 163 female morbidly obese inpatients (body mass index >40) were randomly assigned to three conditions: a standard behavioral inpatient program (SBP), SBP plus standard CBT, and SBP plus VR-enhanced CBT. Patients' weight, eating behavior, and body dissatisfaction were measured at the start and upon completion of the inpatient program. Weight was assessed also at 1 year follow-up. All measures improved significantly at discharge from the inpatient program, and no significant difference was found among the conditions. However, odds ratios showed that patients in the VR condition had a greater probability of maintaining or improving weight loss at 1 year follow-up than SBP patients had (48% vs. 11%, p = 0.004) and, to a lesser extent, than CBT patients had (48% vs. 29%, p = 0.08). Indeed, only the VR-enhanced CBT was effective in further improving weight loss at 1 year follow-up. On the contrary, participants who received only the inpatient program regained back, on average, most of the weight they had lost. Findings support the hypothesis that a VR module addressing the locked negative memory of the body may enhance the long-term efficacy of standard CBT.
... These results suggest that especially in women initially trying to lose and maintain weight, finding a source of intrinsic motivation may be critical in the longer term. These findings are consistent with results from a weight management intervention showing that, in overweight and obese women who underwent to a 1-year SDT-based intervention, not all types of motivation predicted physical activity and weight loss maintenance; intrinsic and autonomous motivation were the only predictors of long-term outcomes [33,34]. ...
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Introduction: The aim of this study was to examine cross-sectional and longitudinal associations between motivation and barriers for physical activity, and physical activity behavior in women living in socioeconomic disadvantage. This study also examined whether weight control intentions moderate those associations. Methods: Data from 1664 women aged 18-46 years was collected at baseline and three-year follow-up as part of the Resilience for Eating and Activity Despite Inequality study. In mail-based surveys, women reported sociodemographic and neighborhood environmental characteristics, intrinsic motivation, goals and perceived family barriers to be active, weight control intentions and leisure-time physical activity (assessed through the IPAQ-L). Linear regression models assessed the association of intrinsic motivation, goals and barriers with physical activity at baseline and follow-up, adjusting for environmental characteristics and also physical activity at baseline (for longitudinal analyses), and the moderating effects of weight control intentions were examined. Results: Intrinsic motivation and, to a lesser extent, appearance and relaxation goals for being physically active were consistently associated with leisure-time physical activity at baseline and follow-up. Perceived family barriers, health, fitness, weight and stress relief goals were associated with leisure-time physical activity only at baseline. Moderated regression analyses revealed that weight control intentions significantly moderated the association between weight goals and leisure-time physical activity at baseline (β = 0.538, 99% CI = 0.057, 0.990) and between intrinsic motivation and leisure-time physical activity at follow-up (β = 0.666, 99% CI = 0.188, 1.145). For women actively trying to control their weight, intrinsic motivation was significantly associated with leisure-time physical activity at follow-up (β = 0.184, 99% CI = 0.097, 0.313). Conclusions: Results suggest that, especially in women trying to control their weight, intrinsic motivation plays an important role in sustaining physical activity participation over time. Also, weight goals for being physically active seem to play a role regarding short-term physical activity participation in this particular population. Addressing these motivational features may be important when promoting physical activity participation in women living in socioeconomically disadvantaged neighborhoods.
... Another issue of public health concern from the study is the poor attitudes, and lack of resources and motivation for physical activity, which could negatively influence intentions to lose or maintain optimal weight in this community. Evidence from a recent study indicated that women with high exercise motivation were three times more likely to lose more than 10 % body weight than those who were not properly motivated [47]. It is therefore essential to implement community-based physical exercise interventions that have strong motivation for moderate and less vigorous outdoor and indoor exercises. ...
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Background: The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity. Method: This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35–70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m2). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach. Results: Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is ‘normal’ and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants’ readiness to lose weight. Conclusion: Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.
... Another issue of public health concern from the study is the poor attitudes, and lack of resources and motivation for physical activity, which could negatively influence intentions to lose or maintain optimal weight in this community. Evidence from a recent study indicated that women with high exercise motivation were three times more likely to lose more than 10 % body weight than those who were not properly motivated [47]. It is therefore essential to implement community-based physical exercise interventions that have strong motivation for moderate and less vigorous outdoor and indoor exercises. ...
... Physical activity has been clearly shown to have a significant impact on weight loss maintenance [59]. Several studies have evaluated methods to increase motivation and adherence to routine physical activity. ...
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More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity.
... Another issue of public health concern from the study is the poor attitudes, and lack of resources and motivation for physical activity, which could negatively influence intentions to lose or maintain optimal weight in this community. Evidence from a recent study indicated that women with high exercise motivation were three times more likely to lose more than 10 % body weight than those who were not properly motivated [47]. It is therefore essential to implement community-based physical exercise interventions that have strong motivation for moderate and less vigorous outdoor and indoor exercises. ...
Conference Paper
Full-text available
Background: The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based intervention for the prevention of obesity. Method: This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35-70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index. Participants were asked to discuss perceived obesity threat and risk of CVD, body image perceptions and the willingness to lose excess body weight. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach. Findings: Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, the severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and CVD. Obese participants, particularly men, expressed willingness to lose weight, compared to the overweight ones. The belief that overweight is ‘normal’ and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants’ readiness to lose weight. Conclusion: Low perception of the threat of obesity to health, particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve motivation for physical activity and maintenance of optimal body weight are needed.
... Self-weighing+ dietary restaint+ physical activity+ Nikolić (2015) 29) Initial weight loss after restrictive bariatric procedures may predict mid-term weight maintenance: Results from a 12-month pilot trial. Initial weight loss+ Santos (2015) 30) Predicting long-term weight loss maintenance in previously overweight women: A signal detection approach. body image+ exercise autonomous motivation+ Ross (2016) 31) Successful weight loss maintenance associated with morning chronotype and better sleep quality. ...
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Objectives: Dropout and weight regain are common problems in most obesity treatments. The purpose of this study was to review previously published study results of the predictive factors associated with dropout during weight loss treatment and weight loss maintenance after successful weight loss. Methods: Authors searched for the articles related to dropout and weight loss maintenance, published from 2007 to 2016 found on Pubmed, Scopus, RISS, and KISS. A total of 19 articles were finally selected. From the study results, unchangeable and changeable predictors were extracted, and these predictors were examined according to dropout and weight loss maintenance categories. Results: The unchangeable predictors of dropout were younger age, lower education level and female, whereas the changeable predictors of dropout were lower initial weight loss, symptoms of depression and body dissatisfaction. The strongest factor for predicting the dropout was initial weight loss. The unchangeable predictors of weight loss maintenance were old age, male and family history of obesity, whereas the changeable predictors of weight loss maintenance were regular exercise, dietary restraint, self-weighing and low depressive symptoms. Initial weight loss, depressive symptoms, body image, dietary restraint, physical activity, weight loss expectation and social support were considered to be dominant factors for weight loss treatments. Conclusions: Our review results suggest that unchangeable and changeable predictors of dropout and weight loss maintenance should be carefully examined during treatments of obesity.
... Another issue of public health concern from the study is the poor attitudes, and lack of resources and motivation for physical activity, which could negatively influence intentions to lose or maintain optimal weight in this community. Evidence from a recent study indicated that women with high exercise motivation were three times more likely to lose more than 10 % body weight than those who were not properly motivated [47]. It is therefore essential to implement community-based physical exercise interventions that have strong motivation for moderate and less vigorous outdoor and indoor exercises. ...
Conference Paper
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Background: The high rates of obesity and its associated health complications in populations undergoing rapid urbanisation and nutrition transition requires setting-specific behaviour change interventions. This study explored the effect of body image and perceived threat of obesity (PTO) on the willingness to lose weight (WTL) and weight change/year among adults in resource-poor communities. Methods: This is a longitudinal survey and a qualitative inquiry with black African adults aged 35-78 years in the PURE (Prospective Urban and Rural Epidemiology) Study, Cape Town. A sub-sample of 963 original study participants from the rural (n=406) and urban (n=557) communities were randomly selected and interviewed at year four follow-up. Weight and height measurements were taken at baseline and at follow-up. Data on body size and body weight perceptions, PTO, and the WTL were collected at follow-up using a validated structured questionnaire. Narrative and pictorial constructs were used to describe body image dissatisfaction Feel Ideal Size Difference (FID) and body weight dissatisfaction Feel Actual Weight Difference (FAD) indexes. PTO and WTL constructs were each based on three different Likert-scale measures. The study hypothesized that readiness to lose weight is dependent on perceived obesity risk which would in turn impact on weight change. Structural equation modelling (SEM) was performed with SPSS version 24 and AMOS software to verify the hypothesis. Standard SEM model fit and model modifications were adhered to during the analysis. In addition, 13 focus group discussions were conducted with purposively selected separate groups of obese and non-obese men and women in the PURE study communities to further establish the SEM findings. Participants were asked to weight their perceptions of obesity threat, body image, and the willingness to lose excess body weight. Qualitative data was analysed using a thematic analysis approach, and both qualitative and SEM results were triangulated. Results: Of the predominantly (82%) overweight/obese adults, 341 (35%) were willing to lose weight, and 237 (25%) had positive annual weight change. Based on SEM, body size dissatisfaction (FID), weight dissatisfaction, and current body mass index (BMI) had significant positive effects on WTL, with FID contributing comparatively highest variability of 20% (at p=0.001) of WTL. Participants’ perception of threat and their age did not predict WTL. Although BMI had a strong correlation with weight change, WTL unexpectedly, had no significant effect on annual weight change. Qualitative findings, however, indicated that participants who had experienced chronic disease conditions indicated strongly that obesity can lead to chronic diseases such as stroke, hypertension, heart disease and diabetes. Overweight women were generally unwilling to lose weight. The belief that overweight size is ‘normal’ and not a disease, subjective norms, attitude towards vulnerability, and physical inactivity can be the mediating factors between willingness to lose weight and actual weight change. Conclusion: In a predominantly black overweight population with low perception of the threat of obesity, body size dissatisfaction index predicted the willingness to lose weight. Prevention of obesity should therefore include community-based health promotion interventions that target appropriate body image and obesity risk evaluation in adults.
... Another issue of public health concern from the study is the poor attitudes, and lack of resources and motivation for physical activity, which could negatively influence intentions to lose or maintain optimal weight in this community. Evidence from a recent study indicated that women with high exercise motivation were three times more likely to lose more than 10 % body weight than those who were not properly motivated [47]. It is therefore essential to implement community-based physical exercise interventions that have strong motivation for moderate and less vigorous outdoor and indoor exercises. ...
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Background: High prevalence of obesity increases the risk of cardiovascular disease in the South Africa population, particularly among the Blacks. Information on the determinants of obesity among men and women in the rural and urban communities are critical for developing prevention strategy for obesity. Methods: A cross-sectional analysis of data collected between June 2009 and May 2010 from individuals participating in a global Prospective Urban and Rural Epidemiology (PURE) study in Cape Town. Face-to-face interviews were conducted using validated questionnaires to obtain information on risk factors for cardiovascular diseases including lifestyle and psychological factors. Anthropometric measurements were taken using PURE study protocols. The study sample included 1220 participants aged 35-70 years. Overweight (BMI=25.0-29.9), obesity, BMI≥30.0), and abdominal obesity (waist circumference >88cm for women, >94cm for men) were defined. Logistic regression analysis was undertaken to determine the association of risk factors with obesity. Results: Up to 48.4% and 22.8% of the study sample were obese and overweight respectively; and 70.8% had abdominal obesity. Significantly higher proportions of women in the rural community were obese (31.7%) compared to those in urban (25.7%). Unemployment, reported food unavailability, tobacco/alcohol use, and primary-secondary education were significantly associated with obesity. Physical activity, stress or depression did not predict obesity. Discussion: About 32% of black South African adults living in the rural community and 27% in urban township are obese. Obesity was associated with food insecurity, unemployment and tobacco and/or alcohol use. Community-based economic empowerment and nutrition-focused intervention targeting behaviour modification can prevent obesity.
... These results are similar to the general population, which generally ranks appearance and health in the top reasons for wanting to lose weight [34,35]. Additionally, while it was encouraging to hear that physicians were discussing weight loss with patients, success in weight loss and maintenance is often linked with a high sense of autonomy and intrinsic motivation [36,37]. When weight loss is prescribed by a physician, autonomy and self-determination may be diminished and perceived as controlling, leading to a lack of enjoyment of the new eating and activity behaviors. ...
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Background Most knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes. Methods Patients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis. Results Twenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m²). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight. Conclusions This study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.
... Most of the studies conducted in Qatar and other countries in the Arabian Gulf region focus on eating habits or poor dietary choices and their associations with overweight and obesity. Additionally, studies have shown that DE is relatively common among young females who attend post-secondary education in Arab countries ranging from 16.2% to 42.7% (Santos, Mata, Silva, Sardinha, & Teixeira, 2015). Little is known about the relationship between DE and PWLD in young Arab women engaging in weight loss practices. ...
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Little is known about the impact of eating behaviors on weight management efforts among college students in non-Western settings. This study aimed to explore the relationship between eating behaviors, weight loss outcomes, and perceived weight loss difficulties (PWLD) among young Arab women trying to lose weight. A crosssectional probability sample was used to recruit female university students aged 18 years and older in the state of Qatar. Participants (N = 937) completed an online survey measuring their attitudes and behaviors towards healthy eating, body image, and weight loss. More than two third (67.2%) reported facing difficulties when trying to lose weight and around one-third (31.2%) screened positive for disordered eating. Chi-squared and logistic regression analyses showed a strong and independent association between unsuccessful weight loss including lack of weight loss or maintenance after weight loss attempts, and PWLD (OR 8.6, p = .002). In addition, eating meals a few hours before sleeping (OR 1.98; p = .02) and having disordered eating (OR 2.28; p = .02) were positively associated with PWLD. BMI, weight loss goal and skipping breakfast were not associated with PWLD after adjustment for all covariates. Future studies are needed to develop better tools to comprehensively assess PWLD and validate against short- and long-term measured weight loss outcomes
... Body image and obesity have a complex relationship. Body image is suggested to play a role in the origin of obesity, it can be a motivational catalyst for appearance-enhancing behavior and it affects regulating body weight over time after weight loss [14,[39][40][41][42][43]. Body image generally improves after bariatric surgery [44][45][46]; however, it fails to reach population norms [13,34,35], and body image also affects the desire for post-bariatric body contouring surgery [47]. ...
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Background Not every eligible person opts for bariatric surgery. Body image concerns might be a reason to choose surgery. This case-control study evaluated differences in body image between a pre-bariatric surgery population and a weight-matched control group from the general population. We hypothesized that the pre-bariatric group would show less satisfaction with appearance, defined as a discrepancy between evaluating one’s appearance as less attractive while attaching more importance to appearance.Methods Data from 125 pre-bariatric patients were compared with 125 body weight-matched controls from the general population. The Multidimensional Body-Self Relations Questionnaire-Appearance Scales was used to assess appearance evaluation (AE), appearance orientation (AO), and their discrepancy score. Both groups were compared with norms from the non-body weight-matched general population.ResultsThe pre-bariatric group had lower AE scores (mean 2.23 ± 0.65 vs. mean 2.54 ± 1.06) and higher AO scores (mean 3.33 ± 0.69 vs. mean 3.04 ± 0.90) than the control group. The discrepancy between AE and AO was larger in the pre-bariatric group (p < 0.001). Compared with the general population, both groups showed lower AE scores (d = − 1.43 and d = − 1.12, p < 0.001) and lower AO scores (d = − 0.23 and d = − 0.58, p < 0.001).Conclusions People with morbid obesity have on average less body image satisfaction. The results indicate that part of the motivation of people that choose bariatric surgery may be due to relatively low global appearance evaluation combined with considering appearance more important. Knowledge about motivations can be used to communicate realistic expectations regarding treatment outcome.
... Unfortunately, this study had a very short follow-up. In an earlier study based on SDT, Santos et al. (2015) examined predictors of 3-year weight loss maintenance in 154 Portuguese women who participated in an intensive (12-month) RCT. ...
Chapter
Over the last decade, research applying SDT in the health domain has been prolific, arguably more so than in any other applied domain. We review the evidence, both empirical and meta-analytic, on the application of SDT to promote health outcomes and behaviors. These behaviors range from simple and infrequent ones (e.g., receiving vaccinations) to complex behaviors repeated or abstained from over long-periods of time (e.g., consuming healthy foods, engaging in physical activity, abstaining from smoking and excessive alcohol use). We also review a recent classification system of motivation and behavior change techniques (MBCTs), discuss the use of rewards to incentivize health behaviors, and the significance of interventions shifting from in-person, face-to-face delivery to digital delivery formats. Finally, we present numerous suggestions for future theoretical and applied research, spanning conceptual, empirical, and methodological issues
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Background: Traditional methods for predicting weight loss success use regression approaches, which make the assumption that the relationships between the independent and dependent (or logit of the dependent) variable are linear. The aim of the present study was to investigate the relationship between common demographic and early weight loss variables to predict weight loss success at 12 months without making this assumption. Methods: Data mining methods (decision trees, generalised additive models and multivariate adaptive regression splines), in addition to logistic regression, were employed to predict: (i) weight loss success (defined as ≥5%) at the end of a 12-month dietary intervention using demographic variables [body mass index (BMI), sex and age]; percentage weight loss at 1 month; and (iii) the difference between actual and predicted weight loss using an energy balance model. The methods were compared by assessing model parsimony and the area under the curve (AUC). Results: The decision tree provided the most clinically useful model and had a good accuracy (AUC 0.720 95% confidence interval = 0.600-0.840). Percentage weight loss at 1 month (≥0.75%) was the strongest predictor for successful weight loss. Within those individuals losing ≥0.75%, individuals with a BMI (≥27 kg m(-2) ) were more likely to be successful than those with a BMI between 25 and 27 kg m(-2) . Conclusions: Data mining methods can provide a more accurate way of assessing relationships when conventional assumptions are not met. In the present study, a decision tree provided the most parsimonious model. Given that early weight loss cannot be predicted before randomisation, incorporating this information into a post randomisation trial design may give better weight loss results.
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Background Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity. We have therefore systematically synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity. Methods With the use of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement, prospective studies were identified from searches in PubMed and PsycINFO from 2006 to 2016. We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication. Included articles were scored on their methodological quality, and a best‐evidence synthesis was applied to summarize the results. Results Our search resulted in 8,222 articles of which 67 articles were selected. In total, 124 determinants were identified of which 5 were demographic, 59 were behavioural, 51 were psychological/cognitive and 9 were social and physical environmental determinants. We found consistent evidence that demographic determinants were not predictive of weight loss maintenance. Behavioural and cognitive determinants that promote a reduction in energy intake, an increase in energy expenditure and monitoring of this balance are predictive determinants. Conclusion This review identifies key determinants in weight loss maintenance. However, more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance.
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Background Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss. Objective The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss. Methods One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m ² , age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires. Results Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID. Conclusion Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID. Clinical trial registration [ https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052 ], identifier [UMIN000006803] and [ https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850 ], identifier [UMIN000049041].
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Objective: Successful weight management relies on at least two health behaviors, eating and exercise. However, little is known about their interaction on a motivational and behavioral level. Based on the Hierarchical Model of Motivation the authors examined whether exercise-specific motivation can transfer to eating regulation during a lifestyle weight control program. The authors further investigated whether general, treatment-related, and exercise motivation underlie the relation between increased exercise and improved eating regulation. Design: Overweight/obese women participated in a 1-year randomized controlled trial (N = 239). The intervention focused on promoting physical activity and internal motivation for exercise and weight loss, following Self-Determination Theory. The control group received general health education. Main Outcome Measures: General and exercise specific self-determination, eating self-regulation variables, and physical activity behavior. Results: General self-determination and more autonomous exercise motivation predicted eating self-regulation over 12 months. Additionally, general and exercise self-determination fully mediated the relation between physical activity and eating self-regulation. Conclusion: Increased general self-determination and exercise motivation seem to facilitate improvements in eating self-regulation during weight control in women. These motivational mechanisms also underlie the relationship between improvements in exercise behavior and eating regulation.
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Behavior change interventions are effective to the extent that they affect appropriately-measured outcomes, especially in experimental controlled trials. The primary goal of this study was to analyze the impact of a 1-year weight management intervention based on self-determination theory (SDT) on theory-based psychosocial mediators, physical activity/exercise, and body weight and composition. Participants were 239 women (37.6 +/- 7.1 years; 31.5 +/- 4.1 kg/m(2)) who received either an intervention focused on promoting autonomous forms of exercise regulation and intrinsic motivation, or a general health education program (controls). At 12 months, the intervention group showed increased weight loss (-7.29%,) and higher levels of physical activity/exercise (+138 +/- 26 min/day of moderate plus vigorous exercise; +2,049 +/- 571 steps/day), compared to controls (P < 0.001). Main intervention targets such as more autonomous self-regulation (for treatment and for exercise) and a more autonomous perceived treatment climate revealed large effect sizes (between 0.80 and .96), favoring intervention (P < 0.001). Results suggest that interventions grounded in SDT can be successfully implemented in the context of weight management, enhancing the internalization of more autonomous forms of behavioral regulation, and facilitating exercise adherence, while producing clinically-significant weight reduction, when compared to a control condition. Findings are fully consistent with previous studies conducted within this theoretical framework in other areas of health behavior change.
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Developed, based on S. Harter's (1985) methodology, a physical self-perception (SP) profile that applied self-esteem theory to the study of SP in the physical domain. Open-ended questionnaire responses of 1,191 male and female undergraduates were used. Four subdomain subscales (SUBs) were constructed along with a physical self-worth subscale as the basis of the profile. The sensitivity, reliability, and stability of the SUBs were supported for both genders across 3 samples. The discriminant validity of the SUBS was indicated, supporting the concept of multidimensionality within the physical domain. Also, results consistent with a 3-tier hierarchical structure among SP elements were provided, and initial predictive validity of the SUBs was demonstrated through their association with degree and type of involvement in physical activity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Motivation is a critical factor in supporting sustained exercise, which in turn is associated with important health outcomes. Accordingly, research on exercise motivation from the perspective of self-determination theory (SDT) has grown considerably in recent years. Previous reviews have been mostly narrative and theoretical. Aiming at a more comprehensive review of empirical data, this article examines the empirical literature on the relations between key SDT-based constructs and exercise and physical activity behavioral outcomes. This systematic review includes 66 empirical studies published up to June 2011, including experimental, cross-sectional, and prospective studies that have measured exercise causality orientations, autonomy/need support and need satisfaction, exercise motives (or goal contents), and exercise self-regulations and motivation. We also studied SDT-based interventions aimed at increasing exercise behavior. In all studies, actual or self-reported exercise/physical activity, including attendance, was analyzed as the dependent variable. Findings are summarized based on quantitative analysis of the evidence. The results show consistent support for a positive relation between more autonomous forms of motivation and exercise, with a trend towards identified regulation predicting initial/short-term adoption more strongly than intrinsic motivation, and intrinsic motivation being more predictive of long-term exercise adherence. The literature is also consistent in that competence satisfaction and more intrinsic motives positively predict exercise participation across a range of samples and settings. Mixed evidence was found concerning the role of other types of motives (e.g., health/fitness and body-related), and also the specific nature and consequences of introjected regulation. The majority of studies have employed descriptive (i.e., non-experimental) designs but similar results are found across cross-sectional, prospective, and experimental designs. Overall, the literature provides good evidence for the value of SDT in understanding exercise behavior, demonstrating the importance of autonomous (identified and intrinsic) regulations in fostering physical activity. Nevertheless, there remain some inconsistencies and mixed evidence with regard to the relations between specific SDT constructs and exercise. Particular limitations concerning the different associations explored in the literature are discussed in the context of refining the application of SDT to exercise and physical activity promotion, and integrating these with avenues for future research.
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This article explores the topics of motivation and self-regulation in the context of weight management and related behaviors. We focus on the role of a qualitative approach to address motivation--not only considering the level but also type of motivation--in weight control and related behaviors. We critically discuss the operationalization of motivation in current weight control programs, present a complementary approach to understanding motivation based on self-determination theory, and review empirical findings from weight control studies that have used self-determination theory measures and assessed their association with weight outcomes. Weight loss studies which used Motivational Interviewing (MI) are also reviewed, considering MI's focus on enhancing internal motivation. We hypothesize that current weight control interventions may have been less successful with weight maintenance in part due to their relative disregard of qualitative dimensions of motivation, such as level of perceived autonomy, often resulting in a motivational disconnect between weight loss and weight-related behaviors. We suggest that if individuals fully endorse weight loss-related behavioral goals and feel not just competent but also autonomous about reaching them, as suggested by self-determination theory, their efforts are more likely to result in long-lasting behavior change.
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Within Western society, many people have difficulties adequately regulating their eating behaviors and weight. Although the literature on eating regulation is vast, little attention has been given to motivational dynamics involved in eating regulation. Grounded in Self-Determination Theory (SDT), the present contribution aims to provide a motivational perspective on eating regulation. The role of satisfaction and thwarting of the basic psychological needs for autonomy, competence, and relatedness is introduced as a mechanism to (a) explain the etiology of body image concerns and disordered eating and (b) understand the optimal regulation of ongoing eating behavior for healthy weight maintenance. An overview of empirical studies on these two research lines is provided. In a final section, the potential relevance and value of SDT in relation to prevailing theoretical models in the domain of eating regulation is discussed. Although research on SDT in the domain of eating regulation is still in its early stages and more research is clearly needed, this review suggests that the SDT represents a promising framework to more thoroughly study and understand the motivational processes involved in eating regulation and associated problems.
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This study examined the association of autonomy-related variables, including exercise motivation, with psychological well-being and quality of life, during obesity treatment. Middle-aged overweight/obese women (n = 239) participated in a 1-year behavioral program and completed questionnaires measuring need support, general self-determination, and exercise and treatment motivation. General and obesity-specific health-related quality of life (HRQOL), self-esteem, depression, and anxiety were also assessed. Results showed positive correlations of self-determination and perceived need support with HRQOL and self-esteem, and negative associations with depression and anxiety (P < .001). Treatment autonomous motivation correlated positively with physical (P = .004) and weight-related HRQOL (P < .001), and negatively with depression (P = .025) and anxiety (P = .001). Exercise autonomous motivation was positively correlated with physical HRQOL (P < .001), mental HRQOL (P = .003), weight-related HRQOL (P < .001), and self-esteem (P = .003), and negatively with anxiety (P = .016). Findings confirm that self-determination theory's predictions apply to this population and setting, showing that self-determination, perceived need support, and autonomous self-regulation positively predict HRQOL and psychological well-being.
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Maintaining weight loss is a major challenge in obesity treatment. Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors. Therefore, a novel weight loss maintenance program that specifically targets motivational factors was evaluated. Overweight women (N=338; 19% African American) with urinary incontinence were randomized to lifestyle obesity treatment or control and followed for 18 months. All participants in lifestyle (N=226) received the same initial 6-month group behavioral obesity treatment and were then randomized to (1) a novel motivation-focused maintenance program (N=113) or (2) a standard skill-based maintenance approach (N=113). Weight assessed at baseline, 6 and 18 months. Both treatment groups (motivation-focused and skill-based) achieved comparable 18-month weight losses (-5.48% for motivation-focused vs -5.55% in skill-based, P=0.98), and both groups lost significantly more than controls (-1.51%; P=0.0012 in motivation-focused and P=0.0021 in skill-based). A motivation-focused maintenance program offers an alternative, effective approach to weight maintenance expanding available evidence-based interventions beyond traditional skill-based programs.
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Successful weight management relies on at least two health behaviors, eating and exercise. However, little is known about their interaction on a motivational and behavioral level. Based on the Hierarchical Model of Motivation the authors examined whether exercise-specific motivation can transfer to eating regulation during a lifestyle weight control program. The authors further investigated whether general, treatment-related, and exercise motivation underlie the relation between increased exercise and improved eating regulation. Overweight/obese women participated in a 1-year randomized controlled trial (N = 239). The intervention focused on promoting physical activity and internal motivation for exercise and weight loss, following Self-Determination Theory. The control group received general health education. General and exercise specific self-determination, eating self-regulation variables, and physical activity behavior. General self-determination and more autonomous exercise motivation predicted eating self-regulation over 12 months. Additionally, general and exercise self-determination fully mediated the relation between physical activity and eating self-regulation. Increased general self-determination and exercise motivation seem to facilitate improvements in eating self-regulation during weight control in women. These motivational mechanisms also underlie the relationship between improvements in exercise behavior and eating regulation.
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Assessment of habitual physical activity in epidemiologic and health education studies has been difficult. A seven-day physical activity recall interview was developed and administered in a community health survey, a randomized clinical trial, and two worksite health promotion programs during 1979-1982. These studies were conducted in several populations in California, Texas, Pennsylvania, and New Jersey. Energy expenditure estimates from the physical activity recall conformed to expected age- and sex-specific values in the cross-sectional community survey. Estimates of energy expenditure were also congruent with other questions on physical activity and job classification. In a randomized, one-year exercise trial, the physical activity recall detected increases in energy expenditure in the treated group and was positively associated with miles run during training (p less than 0.05). Changes in energy expenditure were associated with changes in maximal oxygen uptake (VO2max (r = 0.33, p less than 0.05) and body fatness (r = -0.50, p less than 0.01) at six months, and in high density lipoprotein-cholesterol (r = 0.31, p less than 0.05) and triglyceride (r = -0.41, p less than 0.01) at one year. The physical activity recall detected significant (p less than 0.01) increases in energy expenditure in treatment groups in two worksite health promotion projects. These data suggest that the physical activity recall provides useful estimates of habitual physical activity for research in epidemiologic and health education studies.
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This paper describes the study aimed at validating the Portuguese version of the MOS SF-36 instrument of assessment. It starts by presenting the results of the implementation of this instrument in a sample of 930 pregnant women and the results of scaling tests, including the values of internal consistency and reliability. However, since a reliable instrument is not necessarily a valid one, the results of several validity tests are also presented. Finally, this paper ends by recommending the use of the Portuguese version of the SF-36 instrument of assessment.
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Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
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There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
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This study investigated changes in psychosocial variables related to exercise, eating, and body image during a weight reduction program and evaluated their association with weight loss in middle-aged overweight and obese women up to 1 yr after intervention. The 136 participants (age, 48.1 +/- 4.4 yr; weight, 30.6 +/- 5.6 kg x m(-2)) who completed the 4-month lifestyle weight reduction program (86% retention), losing -6.2 +/- 4.6% (P < 0.001) of their initial weight, were followed up for 12 additional months. Of these, 82% completed 16-month assessments (weight change, -5.5 +/- 7.7%, P < 0.001). Psychosocial variables were assessed by validated instruments in standardized conditions at baseline and after the intervention (4 months). Compared with 4-month assessments, body weight did not change at 16 months (P > 0.09). Changes in eating restraint, disinhibition, and hunger; exercise, self-efficacy, and intrinsic motivation; body shape concerns; and physical self-worth were associated with weight change at 4 months (P < 0.001, except hunger, P < 0.05). Baseline-adjusted 4-month scores in all psychosocial variables also predicted weight change from baseline to 16 months (P < 0.01), except hunger (P > 0.05). After controlling for 4-month weight change and other covariates, increases in exercise intrinsic motivation remained predictive of weight loss at 16 months (P < 0.05). Multiple linear regression showed that eating variables were significant and independent correlates of short-term weight change, whereas changes in exercise variables were stronger predictors of longer term weight outcomes. Results highlight the importance of cognitive processes during weight control and support the notion that initial focus on diet is associated with short-term weight loss, while change in exercise-related motivational factors, with a special emphasis on intrinsic sources of motivation (e.g., interest and enjoyment in exercise), play a more important role in longer term weight management.
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To examine women's weight control practices and their effectiveness in preventing weight gain. Retrospective cohort study of weight control practices and 2-year weight change among mid-age women participating in the Australian Longitudinal Study on Women's Health (ALSWH). 11,589 Australian women (aged 47-52 years). The prevalence and types of self-reported weight control practices used were assessed by a nine-item instrument. Two-year weight change was self-reported and adjusted for baseline body mass index (BMI) and other potential confounders. Seventy-four per cent of the cohort (N=8556) reported actively trying to control their weight. Dietary modification was used more frequently than exercise. Two-thirds of the weight-controlling women used a combination of practices, the two most common being 'decreased food quantity, cut down on fats/sugars and exercise' (32%, baseline BMI 25.87(0.10)), and 'decreased food quantity and cut down on fats/sugars without exercise' (15.6%, baseline BMI 27.04(0.14)). Potentially health-damaging practices (smoking, laxatives, fasting) were relatively uncommon, at 7.9%. Only one combination of practices (decreased food quantity, cut down on fats/sugars, use of a commercial weight loss programme and exercise) prevented mean weight gain (-0.03 kg), whereas the mean (s.d.) weight of the cohort increased (+1.19(4.78)) over the 2-year period. The majority of mid-age women attempting weight control used practices consistent with public health messages. Despite their efforts, the group was mostly unsuccessful in preventing weight gain. Public health authorities and health practitioners may need to make more quantitative recommendations and emphasize the importance of balancing physical activity with dietary intake to achieve successful weight control for women at this life stage.
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Research on the motivational model proposed by Self-Determination Theory (SDT) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors, and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation. Although obesity is notoriously difficult to reverse and its recidivism is high, adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term. The purposes of this study are twofold: i) to describe a 3-year randomized controlled trial (RCT) aimed at testing a novel obesity treatment program based on SDT, and ii) to present the rationale behind SDT's utility in facilitating and explaining health behavior change, especially physical activity/exercise, during obesity treatment. Study design, recruitment, inclusion criteria, measurements, and a detailed description of the intervention (general format, goals for the participants, intervention curriculum, and main SDT strategies) are presented. The intervention consists of a 1-year group behavioral program for overweight and moderately obese women, aged 25 to 50 (and pre-menopausal), recruited from the community at large through media advertisement. Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team (30 2 h sessions in total), and go through a program covering most topics considered critical for successful weight control. These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines. Comparison group receive a general health education curriculum. After the program, all subjects are follow-up for a period of 2 years. Results from this RCT will contribute to a better understanding of how motivational characteristics, particularly those related to physical activity/exercise behavioral self-regulation, influence treatment success, while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity. Clinical Trials Gov. Identifier NCT00513084.
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There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that ≈20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity (≈1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2–5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
Article
There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
Article
This diary study examined the proposal that satisfaction of two psychological needs, competence and autonomy, leads to daily well-being. Between-subjects analyses indicated that participants higher in trait competence and trait autonomy tended to have "better" days on average. Independently, within-subject analyses showed that good days were those in which participants felt more competent and autonomous in their daily activities, relative to their own baselines. Other predictors of daily well-being included gender, whether the day fell on a weekend, and the amount of negative affect and physical symptomatology felt the day before. Although past diary studies have tended to focus on threats to daily well-being, the authors suggest that psychological need concepts offer promise for understanding its positive sources.
Article
Objective Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior.Method Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales.ResultsRigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program.DiscussionRigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 53–64, 1999.
Article
Objectives. The aim of this study was to further develop and refine the Exercise Motivations Inventory (EMI), a measure of individuals' reasons for exercising. Design. Confirmatory factor analytic procedures using LISREL were employed to test the hypothesized 14-factor structure of the revised instrument (the EMI-2) and the invariance of the factor structure across gender. Methods. Four hundred and twenty-five civil servants completed the revised instrument. Analyses were conducted in three phases. Phase 1 involved detailed examination of the fit of the 14-factors separately in order to detect and eliminate poor indicators. In Phase 2 each factor was paired with every other factor in order to detect and eliminate ambiguous items. In Phase 3 factors were grouped with conceptually related factors into five submodels and the fit and factorial invariance across gender of these submodels was tested. Results. Item elimination at Phases 1 and 2 led to the development of a set of internally consistent factors with strong indicators and good discriminant validity. Phase 3 gave further evidence for the convergent and discriminant validity of the items and factors and strong support for the invariance of the factor structure across gender. Conclusions. The EMI-2 is a factorially valid means of assessing a broad range of exercise participation motives in adult males and females, applicable to both exercisers and non-exercisers.
Article
Objective To evaluate the properties of a Portuguese version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire and to compare quality of life scores between samples of Portuguese and American women.Research Methods and ProceduresIWQOL-Lite scores were obtained from 138 Portuguese participants who were enrolled in a 2-year lifestyle weight management programme (‘Portuguese clinical sample’) and 250 Portuguese volunteers from the community (‘Portuguese community sample’). Subjects were matched on gender (all female), BMI, age and treatment-seeking status to American individuals from the IWQOL normative database who completed the IWQOL-Lite in English. In addition, Portuguese community subjects completed the SF-36 and their scores were compared to American individuals' scores from the normative database. The psychometric properties of the Portuguese version of the IWQOL-Lite were determined, and Portuguese and American samples were compared on quality of life.ResultsThe Portuguese and English versions of the IWQOL-Lite appeared psychometrically very comparable. The Portuguese IWQOL-Lite demonstrated excellent psychometric properties (internal consistency, correlations with BMI, factor structure, correlation with SF-36, discriminant validity). Comparison of Portuguese and American subjects suggested that increasing BMI may have a more adverse effect on quality of life in Portuguese individuals as compared to Americans.DiscussionThe results suggest that the Portuguese translation of the IWQOL-Lite is a reliable and valid measure of obesity-specific quality of life. Obesity may have a greater impact on quality of life in Portuguese women compared to American women. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.
Book
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
Article
Social support could be a powerful weight-loss treatment moderator or mediator but is rarely assessed. We assessed the psychometric properties, initial levels, and predictive validity of a measure of perceived social support and sabotage from friends and family for healthy eating and physical activity (eight subscales). Overweight/obese women randomized to one of two 6-month, group-based behavioral weight-loss programs (N = 267; mean BMI 32.1 ± 3.5; 66.3% White) completed subscales at baseline, and weight loss was assessed at 6 months. Internal consistency, discriminant validity, and content validity were excellent for support subscales and adequate for sabotage subscales; qualitative responses revealed novel deliberate instances not reflected in current sabotage items. Most women (>75%) "never" or "rarely" experienced support from friends or family. Using nonparametric classification methods, we identified two subscales-support from friends for healthy eating and support from family for physical activity-that predicted three clinically meaningful subgroups who ranged in likelihood of losing ≥5% of initial weight at 6 months. Women who "never" experienced family support were least likely to lose weight (45.7% lost weight) whereas women who experienced both frequent friend and family support were more likely to lose weight (71.6% lost weight). Paradoxically, women who "never" experienced friend support were most likely to lose weight (80.0% lost weight), perhaps because the group-based programs provided support lacking from friendships. Psychometrics for support subscales were excellent; initial support was rare; and the differential roles of friend vs. family support could inform future targeted weight-loss interventions to subgroups at risk.
Article
This study evaluated exercise-related predictors of successful long-term weight control in women by analyzing the extent to which sustained exercise participation and self-determination theory (SDT)-based exercise motivation variables mediated the impact of a behavioral weight control intervention on 3-yr weight change. Longitudinal randomized controlled trial consisting of a 1-yr SDT-based intervention and a 2-yr follow-up with 221 female participants (means ± SD: age = 37.6 ± 7 yr, body mass index = 31.6 ± 4.1 kg·m(-2)). The tested model incorporated experimentally manipulated perceived need support, motivational regulations, and 2-yr exercise adherence as mediators of the intervention's impact on 3-yr weight change. Paths were tested using partial least squares analysis. Where there were significant intervening paths, tests of mediation were conducted. Treatment had significant effects on 1- and 2-yr autonomous regulations, 2-yr physical activity, and 3-yr weight change, fully mediated by the tested paths (effect ratio = 0.10-0.61). Moderate and vigorous exercise at 2 yr had a significant effect (P < 0.001) on weight loss success at 3 yr and partially mediated the effect of treatment on weight change. The 2-yr autonomous regulation effects on follow-up weight change were only partially mediated by physical activity (effect ratio = 0.42). This application of SDT to physical activity and weight management showed that not all types of motivation predict long-term behavioral outcomes and that sustained moderate and vigorous exercise mediated long-term weight change. It provides strong evidence for a link between experimentally increased autonomous motivation and exercise and long-term weight loss maintenance. Results highlight the importance of interventions targeting the internalization of exercise behavioral regulation and making exercise and physical activity positive and meaningful experiences rather than simply focusing on immediate behavior change in overweight/obese women.
Article
The purpose of the study was to develop selfefficacy scales specifically for health-related eating and exercise behaviors. Study I consisted of interviews with 40 individuals to identify behavioral and situational components of dietary and exercise change. In Study II items derived from their responses were administered to 171 subjects. Principal-components factor analysis yielded two meaningful exercise self-efficacy factors and five dietary self-efficacy factors. The test-retest reliabilities and internal consistencies of the factors were examined. Self-efficacy factors were significantly associated with reported diet and exercise behaviors, providing evidence of criterion-related validity. These self-efficacy scales for eating and exercise behaviors show preliminary evidence of being reliable and valid, and they warrant further study.
Article
Long-term behavioral self-regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a randomized controlled 12-month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 4.1kg/m 2) were randomly assigned to a control or a 1-year group intervention designed to promote autonomous self-regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention-to-treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32-0.79, P <0.01 vs. controls). Weight change was 7.3 5.9% (12-month) and 5.5 5.0% (24-month) in the intervention group and 1.7 5.0% and 2.2 7.5% in controls. Change in most psychosocial variables was associated with 12-month weight change, but only flexible cognitive restraint (P <0.01), disinhibition (P <0.05), exercise self-efficacy (P 0.001), exercise intrinsic motivation (P <0.01), and body dissatisfaction (P 0.05) predicted 24-month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12-month weight loss (R 2 = 0.31, P< 0.001; effect ratio: 0.37), but only flexible restraint and exercise self-efficacy mediated 24-month weight loss (R 2 = 0.17, P< 0.001; effect ratio: 0.89). This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long-term success, interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy.
Article
The present study was designed to assess selected psychometric properties of the Intrinsic Motivation Inventory (IMI) (Ryan, 1982), a multidimensional measure of subjects' experience with regard to experimental tasks. Subjects (N = 116) competed in a basketball free-throw shooting game, following which they completed the IMI. The LISREL VI computer program was employed to conduct a confirmatory factor analysis to assess the tenability of a five factor hierarchical model representing four first-order factors or dimensions and a second-order general factor representing intrinsic motivation. Indices of model acceptability tentatively suggest that the sport data adequately fit the hypothesized five factor hierarchical model. Alternative models were tested but did not result in significant improvements in the goodness-of-fit indices, suggesting the proposed model to be the most accurate of the models tested. Coefficient alphas for the four dimensions and the overall scale indicated adequate reliability. The results are discussed with regard to the importance of accurate assessment of psychological constructs and the use of linear structural equations in confirming the factor structures of measures.
Article
We conducted two studies to examine the reliability and validity of self-report scales for assessing outcome-expectancy values and perceived barriers for participating in regular physical activity. In study one with college students (N = 243), independent and reliable psychometric factors were identified as outcome-expectancy values (psychologic, body image, and health) and perceived barriers (time, effort, and obstacles). alpha internal consistency coefficients ranged from .47 to .78, and test-retest stability correlations were .66 to .89. In prospective analyses, subscales significantly predicted supervised running (R2 = .27) and free-living physical activity estimated by seven-day recall at two-, five-, and nine-week intervals (R2 ranged from .13 to .24). In study two with employees at CONOCO World Headquarters (N = 968), similar independent scales were derived for outcome-expectancy values (psychologic, body image/health, competition, fun, and social) and perceived barriers (time, effort, obstacles, and limiting health). alpha internal consistencies ranged from .66 to .85. In cross-sectional analyses the scales combined with sociodemographic factors were significantly correlated with membership (R2 = .18) and participation (R2 = .17) in the on-site health and fitness program. In each instance outcome-expectancy values and perceived barriers explained variance in physical activity not accounted for by sociodemographics (R2 values increased .12). Membership in health and fitness programs outside the work site was also predicted (R2 = .07) by the scales. The scales provide a reliable and valid measurement technology that can be implemented with college or work site populations. Existing social psychology theories of behavior that include outcome-expectancy values or perceived barriers can now be examined as explanations for the adoption and maintenance of a physical activity program.
Article
Theories of internalization typically suggest that self-perceptions of the "causes" of (i.e. reasons for) behavior are differentiated along a continuum of autonomy that contains identifiable gradations. A model of perceived locus of causality (PLOC) is developed, using children's self-reported reasons for acting. In Project 1, external, introjected, identified, and intrinsic types of reasons for achievement-related behaviors are shown to conform to a simplex-like (ordered correlation) structure in four samples. These reason categories are then related to existing measures of PLOC and to motivation. A second project examines 3 reason categories (external, introject, and identification) within the domain of prosocial behavior. Relations with measures of empathy, moral judgement and positive interpersonal relatedness are presented. Finally, the proposed model and conceptualization of PLOC are discussed with regard to intrapersonal versus interpersonal perception, internalization, cause-reason distinctions, and the significance of perceived autonomy in human behavior.
Article
The purpose of this study was to develop measures of perceived social support specific to health-related eating and exercise behaviors. In Study I, specific supportive and nonsupportive behaviors were identified through interviews with 40 individuals making health-behavior changes. In Study II, items derived from the interviews were administered to 171 subjects. Support from family and friends was assessed separately for both diet and exercise habits. Meaningful factors were identified for each of the four scales, and some factors were similar for family and friend scales. Both test-retest and internal consistency reliabilities were acceptable, and six factors can be used as subscales. Social support scales were correlated with respective self-reported dietary and exercise habits, providing evidence of concurrent criterion-related validity. A measure of general social support was not related to the specific social support scales or to reported health habits. These scales are among the first measures of social support behaviors specific to dietary- and exercise-habit change.
Article
This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.
Article
Ten commonly used physical activity questionnaires were evaluated for reliability and validity in 78 men and women aged 20-59, with varying physical activity habits. One month reliability was found to be high for all questionnaires except those pertaining only to the last week or month. Longer term test-retest reliability tended to be lower. Validity was studied in relation to treadmill exercise performance, vital capacity, body fatness, the average of 14 4-wk physical activity histories and the average of 14 2-d accelerometer readings. No questionnaire measure was correlated with the accelerometer reading, and correlations with vital capacity were generally low. Only the Minnesota Leisure Time Physical Activity Questionnaire household chores measure was correlated with habitual performance of household chores. Most questionnaires, even very simple ones, were related to performance of heavy intensity physical activity and treadmill performance; these same questionnaires tended to be related to percent body fat. Fewer questionnaires related to performance of light or moderate activity. Occupational activity was unrelated to any of the validation measures. It is concluded that there are multiple, nonoverlapping dimensions of physical activity, reflected in multiple nonoverlapping validation realms. More important than the length or attention to detail of a questionnaire seems to be the logic of its questions. Important areas of physical activity that should be addressed in future questionnaires include sleep, light, moderate and heavy intensity leisure activities, household chores, and occupational activity. Recent versus habitual activity should also be considered.
Article
The Body Shape Questionnaire (BSQ) is a useful measure of weight and shape concern. The purpose of this study is to contribute new psychometric information on the BSQ in order to assist clinicians and researchers who intend to use this measure. This paper reports average scores on American samples of clinical subjects referred for body image problems, obese persons seeking weight reduction, and nonclinical samples of college students and adults. The BSQ demonstrated good test-retest reliability, concurrent validity with other measures of body image, and criterion validity for clinical status.
Article
Two subscales for the Eating Inventory (Three-Factor Eating Questionnaire) are developed and validated: Rigid and Flexible control of eating behavior. Study I is an analysis of questionnaire data and a 7-day food diary of 54,517 participants in a computer-assisted weight reduction program. Study II is a study of 85 subjects used to develop a final item pool. Study III is a questionnaire survey of a random sample (N = 1,838) from the West German population aged 14 years and above used to validate the developed subscales. Rigid control is associated with higher scores of Disinhibition, with higher body mass index (BMI), and more frequent and more severe binge eating episodes. Flexible control is associated with lower Disinhibition, lower BMI, less frequent and less severe binge eating episodes, lower self-reported energy intake, and a higher probability of successful weight reduction during the 1-year weight reduction program. Rigid and flexible control represent distinct aspects of restraint having different relations to disturbed eating patterns and successful weight control.
Article
Identifying subgroups of high-risk individuals can lead to the development of tailored interventions for those subgroups. This study compared two multivariate statistical methods (logistic regression and signal detection) and evaluated their ability to identify subgroups at risk. The methods identified similar risk predictors and had similar predictive accuracy in exploratory and validation samples. However, the 2 methods did not classify individuals into the same subgroups. Within subgroups, logistic regression identified individuals that were homogeneous in outcome but heterogeneous in risk predictors. In contrast, signal detection identified individuals that were homogeneous in both outcome and risk predictors. Because of the ability to identify homogeneous subgroups, signal detection may be more useful than logistic regression for designing distinct tailored interventions for subgroups of high-risk individuals.
Article
Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments. To date, however, research efforts have resulted in weak predictive models with limited practical usefulness. The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area. Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management. In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses. Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment. Importantly, for a considerable number of psychosocial constructs (e.g. eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn. Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described.
Article
To evaluate the relation between intake and adipose tissue composition of fatty acids and acute myocardial infarction in Portuguese men. Case-control study. Diet was assessed using a semiquantitative food frequency questionnaire. In 49 case and 49 control subjects, adipose tissue composition was assessed by gas-liquid chromatography. Population-based; subjects were 297 consecutively admitted cases of first acute myocardial infarction in a tertiary care hospital who were aged>or=40 years. Three hundred ten community controls were selected by random-digit dialing. Odds ratio (OR). Logistic regression, adjusting for age, education, family history of acute myocardial infarction, smoking, physical activity, body mass index, and energy intake. Total fat intake (OR 0.45, fourth quartile, P=0.02), lauric acid (OR 0.44, fourth quartile, P=0.02), palmitic acid (OR 0.58, fourth quartile, P=0.03), and oleic acid (OR 0.42, fourth quartile, P=0.03) were inversely associated with acute myocardial infarction. No significant effects were found for the remaining fatty acids. In the adipose tissue composition data, the adjusted risk estimates of acute myocardial infarction for the highest vs the lowest tertile were 0.16, 0.14, and 0.04 for lauric, oleic, and trans-fatty acids, respectively. A significant direct association was found for palmitic and linoleic acids (adjusted ORs for the highest tertile were 9.02 and 3.63, respectively). Low intake of total fat and lauric acid from dairy products was associated with acute myocardial infarction. The association of polyunsaturated fatty acids with risk of acute myocardial infarction was nonsignificant after adjustment for energy intake and confounders. Recommendations on fatty acid intake should aim for both an upper and lower limit.
Article
To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk- benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained (= 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients.
The development of scales to measure social support for diet and exercise behaviors
  • Jf Sallis
  • Rm Grossman
  • Rb Pinski
  • Tl Patterson
  • Pr Nader
Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med 1987;16: 825-836.
Manual for the Beck Depression Inventory. Psychological Corporation
  • A T Beck
  • R A Steer
Beck AT, Steer RA. Manual for the Beck Depression Inventory. Psychological Corporation: New York; 1987.
The development of scales to measure social support for diet and exercise behaviors
  • Sallis