Self-efficacy improves weight loss in overweight/obese postmenopausal women during a 6-month weight loss intervention.

The objective was to examine the relationship between self-efficacy and subsequent weight loss during a 6-month weight loss intervention in 90 white early postmenopausal healthy women. We hypothesized that participants with higher self-efficacy scores, either at baseline or follow-up, would lose more weight than those with lower scores. Each participant received a balanced meal plan with reduced energy intake. Nutritional and behavioral sessions were provided every 2 weeks during the first 3 months. Weight and height were measured at baseline, every 2 weeks in the first 3 months, and at month 6. Three-day dietary and physical activity records and Weight Efficacy Lifestyle Questionnaire were completed at the same intervals. At month 6, participants lost 3.6 ± 4.1 kg or 4.4% (mean ± SD) and decreased in weight from 82.2 ± 11.1 kg to 77.6 ± 11.4 kg (P < .001). When participants were divided into groups based on weight loss success (<5% or ≥5% of initial weight), logistic regression (controlling for age, energy intake, physical activity, attendance at group sessions, and previous weight loss attempts) demonstrated that higher self-efficacy for the Availability of Food subscale of Weight Efficacy Lifestyle Questionnaire (95% confidence interval, 1.03-1.17) and total self-efficacy (95% confidence interval, 1.00-1.04) were associated with a greater likelihood of losing 5% or more of initial weight. Overall, participants who had higher total self-efficacy and self-efficacy to resist eating when food was available were able to lose more weight. Therefore, cognitive-behavioral efforts promoting self-efficacy may be useful for bolstering individual's confidence to resist eating under various conditions and thereby improve weight loss outcomes.

The freshman weight gain phenomenon revisited.

Earlier studies associated the first year of college with a dramatic increase in body weight, termed the "freshman 15". However, recent studies showed that weight gain might be smaller. The purpose of this review was to evaluate the extent of observed weight/body composition changes, including factors associated with them, among students entering university. Searches were conducted for studies examining weight/body composition changes during freshman semesters. Most studies were not comprehensive in assessing numerous potential causative factors for weight gain. Methods for assessing diet, physical activity, and behavioral factors varied among studies. Weight changes were often not quantified by measures of body composition (lean/fat) to ascertain that changes were limited just to gains in fat mass. Overall, weight changes ranged from 0.7-3.1 kg, but among individuals who gained weight, the range was narrower, 3.1-3.4 kg. There may be specific groups of students with a greater predisposition for weight gain and future research should focus on identifying those groups.

Evaluation of a school-based teen obesity prevention minimal intervention.

OBJECTIVE: A school-based nutrition education minimal intervention (MI) was evaluated. DESIGN: The design was experimental, with random assignment at the school level. SETTING: Seven schools were randomly assigned as experimental, and 7 as delayed-treatment. PARTICIPANTS: The experimental group included 551 teens, and the delayed treatment group included 329 teens. INTERVENTION: The minimal intervention was Present and Prevent, a commercially available PowerPoint program presented in two 30-minute time slots over 1 week. MAIN OUTCOME MEASURES: The dependent variables were nutrition knowledge, attitudes, peer and family influences, behavioral intentions, and program satisfaction. The independent variable was group assignment. ANALYSES: A matched-pairs and 2-sample t test were used respectively to assess within-group and between-group changes. RESULTS: Significant experimental posttest improvements occurred in the following: knowledge (P < .001); intention to maintain a healthy body weight because of importance to friends (P < .001); and intention to eat fewer fried foods, eat fewer sweets, look more at food labels, and limit TV watching (all P < .001). Program satisfaction measures were significantly associated with each of the healthy weight maintenance behavioral intentions. CONCLUSIONS AND IMPLICATIONS: The MI teen obesity prevention program made an impact on nutrition knowledge and positive behavioral intentions in only 2 classroom sessions and was well received by participants.

Body mass index and percentage body fat as health indicators for young adults.

OBJECTIVES: To investigate the validity of an axiom that body mass index (BMI) and percentage body fat (%BF), above an ideal, are health risk factors. METHODS: Participants were 2615 volunteers who participated in a health-screening program conducted in college residence halls over a consecutive 8-year period. RESULTS: Nearly half of all participants were misclassified when BMI and/or %BF were used to define better versus poorer health whether analyzing all variables together, by individual factor, or by type of variable. CONCLUSIONS: Results of this study indicate that BMI and %BF are poor indicators of health status among young adults.

Loss-framed minimal intervention increases mammography use.

INTRODUCTION: Although mammography is the most effective early detection breast cancer screening technology available, it is underutilized. This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use. Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action. METHODS: Participants were medically un- and underinsured women 50-64 years old who called one of two urban clinics randomly selected based on demographic statistical equivalency. The women who participated telephoned to inquire about a mammogram during the 6-month study period. The group randomly designated as the experimental group received a loss-framed message conveyed by trained staff telephonically. Members of the comparison group received the "usual" communication, also conveyed telephonically. In the experimental group, 31 of 112 (27%) women who inquired received mammograms, whereas 157 of the 992 (16%) comparison group women who inquired received mammograms. RESULTS: The odds of a mammogram, adjusted for race and breast cancer symptoms, significantly increased for the experimental (odds ratio [OR] = 1.914, chi2 = 7.48, p = .0063, 95% confidence interval [CI] 1.20-3.05) versus comparison group. CONCLUSIONS: A loss-framed, in-reach, minimal intervention approach holds promise as a mammography promotion strategy.

Nutrition education intervention for college female athletes.

OBJECTIVE: To evaluate the efficacy of a nutrition education intervention for college female athletes to improve nutrition knowledge, build self-efficacy with respect to making healthful dietary choices, and improve dietary intake. DESIGN: A pretest-posttest control group design was implemented. PARTICIPANTS: A women's soccer team (n =15) and a women's swim team (n = 15) were randomly assigned to experimental and control groups, respectively. INTERVENTION: The intervention focused on nutrition knowledge, self-efficacy in making healthful dietary choices, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES: Dependent variables were nutrition knowledge, self-efficacy, and dietary practices. Independent variables were group assignment. ANALYSES: The Mann-Whitney U test was used to analyze the results between groups, and the Fisher exact probability test was used to detect differences between groups in the number of positive dietary changes. RESULTS: Treatment participants significantly improved nutrition knowledge, self-efficacy (P <.05), and the overall number of positive dietary changes (P <.03). CONCLUSIONS: This study reduces the paucity of nutrition education intervention research among athletes and demonstrates the ability to increase not only nutrition knowledge, which is typically reported, but also self-efficacy and improvement in overall positive dietary changes during an 8-week intervention.

Nutrition education worksite intervention for university staff: application of the health belief model.

OBJECTIVE: To evaluate the efficacy of an 8-week worksite nutrition education intervention for university staff using the Health Belief Model (HBM) to promote healthful dietary behaviors that reduce risks for cardiovascular disease and cancer. DESIGN: 2 3 2 repeated measures baseline/posttest ex post facto research design. PARTICIPANTS: Staff employees were randomly assigned to treatment (n = 28) and control groups (n = 25). INTERVENTION: The intervention focused on specific health beliefs, nutrition knowledge, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES: Dependent variables were specific health beliefs, nutrition knowledge, and dietary behaviors. Independent variables were demographic characteristics and group assignment. ANALYSES: Tests of parametric assumptions, power analyses, analysis of variance, and Kuder-Richardson and Pearson product-moment coefficients were computed and specificity of treatment effects was assessed. RESULTS: Perceived benefits of healthy nutrition practices and nutrition knowledge related to cardiovascular disease and cancer significantly improved among the treatment participants, P <.001. Treatment group participants also significantly reduced total calories, fat, saturated fat, and cholesterol intake (each P <.001). CONCLUSIONS: The intervention appears to be related to treatment effects and significantly increased nutrition knowledge and decreased energy, fat, saturated fat, and cholesterol intake to levels consistent with national recommendations.

Physiologic Screening Test for Eating Disorders/Disordered Eating Among Female Collegiate Athletes.

OBJECTIVE: To develop and evaluate a physiologic screening test specifically designed for collegiate female athletes engaged in athletic competition or highly athletic performances in order to detect eating disorders/disordered eating. No such physiologically based test currently exists. METHODS: Subjects included 148 (84.5%) of 175 volunteer, National Collegiate Athletic Association Division I (n = 92), club (n = 15), and dance team (n = 41) athletes 18 to 25 years old who attended a large, Midwestern university. Participants completed 4 tests: 2 normed for the general population (Eating Disorders Inventory-2 and Bulimia Test-Revised); a new physiologic test, developed and pilot tested by the investigators, called the Physiologic Screening Test; and the Eating Disorder Exam 12.0D, a structured, validated, diagnostic interview used for criterion validity. RESULTS: The 18-item Physiologic Screening Test produced the highest sensitivity (87%) and specificity (78%) and was superior to the Eating Disorders Inventory-2 (sensitivity = 62%, specificity = 74%) and Bulimia Test-Revised (sensitivity = 27%, specificity = 99%). A substantial number (n = 51, 35%) of athletes were classified as eating disordered/disordered eating. CONCLUSIONS: The Physiologic Screening Test should be considered for screening athletes for eating disorders/disordered eating. The Physiologic Screening Test seems to be a viable alternative to existing tests because it is specifically designed for female athletes, it is brief (4 measurements and 14 items), and validity is enhanced and response bias is lessened because the purpose is less obvious, especially when included as part of a mandatory preparticipation examination.

Levels of cigarette and alcohol use related to eating-disorder attitudes.

OBJECTIVE: To examine levels of cigarette and alcohol use relative to body dissatisfaction and drive for thinness in 206 black and white college women. METHOD: Anonymous, paper-and-pencil, self-report questionnaires were administered. RESULTS: Frequency of both cigarette and alcohol use were significantly and linearly related to body dissatisfaction and drive for thinness. Regression analyses indicated that negative-affect reduction motivations for use of these substances were more strongly related to eating-disorder attitudes than were levels of use. CONCLUSIONS: Cigarette and alcohol use, independent of race and other demographic variables, increased along a continuum with eating-disorder attitudes.

Evaluation of a "loss-framed" minimal intervention to increase mammography utilization among medically un- and under-insured women.

This study was conducted because mammography is under-utilized, even though it is the most effective early detection screening device for breast cancer. A loss-framed telephonic message based on prospect theory was evaluated for the effects on mammography utilization among medically un- and under-insured women living in demographically similar rural counties in Florida. The sample consisted mostly of White women (approximately 89%) 50-64 years old. Experimental group participants received the loss-framed message telephonically and those in the comparison group received the "usual telephone procedure." Logistic regression analyses revealed that women who received the loss-framed message were six times more likely to obtain a mammogram (OR = 6.6, P < 0.0001). The impact of the loss-framed message persisted even after adjustment for initial versus re-screen mammogram effects. This in-reach, loss-framed, minimal intervention seems to have viability and may serve as an alternative or adjunct program for encouraging women to receive mammograms.