Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments.

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants' change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants' changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

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

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

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

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

Behavioral and Psychosocial Mediators of the Effects of Increased Self-Regulation on Short- and Long-Term Weight Loss in Women Within Community-Based Obesity Treatments.

The aim of this study was to evaluate behavioral mediators of relationships between increased self-regulation of eating and weight loss so that findings on psychosocial correlates of treatment-associated weight change could be extended. Participants were women enrolled in 6-month community-based obesity treatments using primarily self-regulatory (SR-treatment, n = 52) or education-focused (Didactic training, n = 54) methods. Changes from baseline in self-regulation of eating, self-efficacy for controlled eating, emotional eating propensity, exercise, and the diet were first calculated. There were significant overall improvements in each psychosocial and behavioral measure, and weight. Except for emotional eating change from baseline-Month 12, improvements were each significantly greater in the SR-treatment group. Mediation of the relationships of change in self-regulation with 6-, 12-, and 24-month weight changes, by changes in self-efficacy and emotional eating, were significant, R2s = .19-.26, ps < .001. Only changes in emotional eating over 6 and 12 months were significant mediators. Mediations of the same self-regulation-weight change relationships by changes in exercise and the diet were also significant, R2s = .19-.28, ps < .001, and only changes in exercise over 12 and 24 months were significant mediators. Although group membership did not moderate effects on weight, substitution of sweets for the (composite) diet demonstrated it to be a significant mediator over 6 and 12 months. In women with obesity, self-regulation improvement was associated with short- and longer-term weight loss through changes in emotional eating, exercise, and sweets consumption. Thus, behavioral treatments will benefit from targeting those variables.

Self-regulatory and self-efficacy mechanisms of weight loss in women within a community-based behavioral obesity treatment.

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy-primary targets of that intervention-with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12 months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested.

Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children.

6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.

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

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

Effects of cardiovascular exercise on eating behaviours: Accounting for effects on stress, depression-, and anger-related emotional eating in women with obesity.

Obesity remains a medical issue of great concern. Behavioural methods attempting to induce weight loss have largely failed because of a minimal understanding of stress- and depression-associated psychosocial correlates. This study extended research into the effects of exercise on weight loss through psychological pathways to improve treatments. Women with obesity (N = 108), participating in an original theory-driven cognitive-behavioural treatment within community-based health promotion centres, were evaluated over 24 months. Their mean scores on anxiety, depression, and anger at baseline were significantly higher than normative data from a general sample of United States women. Three serial mediation models were specified assessing mediation of the significant exercise→dietary change relationship. These yielded two significant paths: changes in exercise→anxiety→anxiety-associated emotional eating→self-efficacy→diet, and changes in exercise→depression→depression-associated emotional eating→self-efficacy→diet; and one non-significant path: changes in exercise→anger→anger-associated emotional eating→self-efficacy→diet. In a subsequent moderated moderation model, change in eating-related self-regulation moderated the relationship between changes in anxiety and anxiety-associated emotional eating, where exercise-associated self-regulation moderated effects from eating-related self-regulation. Dietary improvement was significantly related to weight loss over 6 (ß = -0.40), 12 (ß = -0.42), and 24 (ß = -0.33) months. Findings indicated an increased treatment focus on the completion of moderate amounts of exercise for weight loss and, following that, attention to improvements in anxiety, depression, anxiety- and depression-associated emotional eating, self-efficacy for controlled eating, and the transfer of exercise-related self-regulation to eating-related self-regulation. Given the scope of the obesity problem, extensions of this research within field settings are warranted to accelerate application opportunities.

The Role of Change in Self-efficacy in Maintaining Exercise-Associated Improvements in Mood Beyond the Initial 6 Months of Expected Weight Loss in Women with Obesity.

BACKGROUND: Although mechanisms are unclear, there is a robust association between exercise and mood improvements. However, beyond ~ 6 months of expected weight loss, weight-management behaviors such as exercise wane as weight gradually regains in most adults. The amount of exercise required to maintain mood improvement is unknown, as is the possible role of theory-based psychosocial changes associated with treatment such as in self-efficacy. METHODS: Women who volunteered for a community-based cognitive-behavioral obesity treatment emphasizing exercise and building self-efficacy via self-regulating through lifestyle challenges/barriers, and were of the 86% who reduced their negative mood during its initial 6 months, were allocated into groups who either maintained their negative mood reduction (Sustain group, n = 43) or reverted toward initial levels of negative mood (Revert group, n = 73) during months 6-24. A binary stepwise logistic regression analysis assessed whether exercise amount and/or change in self-efficacy significantly classified Sustain vs. Revert group membership. RESULTS: Change in exercise amount was not significantly associated with group membership. However, after additional entry of change in exercise self-efficacy, a significant association was found - successfully classifying 70% and 42% of the Revert and Sustain group participants, respectively. When self-efficacy change was entered as the sole independent variable, group membership was classified with 62% accuracy, overall (96% in the Revert group). CONCLUSIONS: Consistent with behavioral explanations of the exercise-mood change relationship, it was interpreted that self-efficacy, rather than exercise amount, was an important correlate of mood change beyond month 6. Suggestions for bolstering self-efficacy later in behavioral obesity treatments were provided.

Early Effects of Body Satisfaction on Emotional Eating: Tailored Treatment Impacts via Psychosocial Mediators in Women with Obesity.

It was proposed that emotional eating is a critical factor to address early in a behavioral obesity treatment for women to improve their long-term weight-loss, which has been problematic. Poor body image/body satisfaction is a likely predictor of emotional eating. Possible social cognitive theory-based mediators of the body satisfaction-emotional eating relationship having treatment implications include disturbed mood and self-efficacy for controlled eating. Women with obesity volunteered for a community-based weight loss program. After confirming salience of disturbed mood and self-efficacy for controlling one's eating as mediators of the body satisfaction-emotional eating relationship at baseline, a 3-month protocol emphasizing exercise and targeting those mediators through a focus on self-regulation was developed and administered to the treatment group (n = 86). The control group (n = 51) received matched time in typical, educationally based weight-loss processes. Improvements in body satisfaction, emotional eating, disturbed mood, and self-efficacy for controlled eating from baseline-month 3 were each significantly greater in the treatment group. Further analysis of the treatment group found that changes in disturbed mood and self-efficacy completely mediated the body satisfaction change-emotional eating change relationship and neither age nor race (White/Black) were significant moderators. Improvement in emotional eating from baseline-month 3 significantly predicted lost weight over both 3 months and with changes incorporating a 6-month follow up. Findings confirmed the importance of addressing the relationship between body satisfaction and emotional eating over the critical initial months of a behavioral obesity treatment for women through targeting improvements in mood and controlled eating-related self-efficacy.

Effects of women's age on their emotional eating changes within a self-regulation-focused obesity treatment.

Results of behavioral obesity treatments have generally been unsuccessful. Reduction of participants' emotional eating (EE) might be essential. Women with obesity within age-groups of emerging adult, young adult, and middle-aged adult - participating in a community-based obesity treatment centered around self-regulatory skills to control eating - were evaluated over 6 months. There were significant reductions in participants' EE and eating-related self-regulation. Participants' change in self-regulation significantly predicted their changes in depression-related, anxiety-related, and total EE. Participants' age group did not significantly affect either their degree of improvement or self-regulation-EE change relationships. Emphasizing self-regulatory skills development for the control of EE, regardless of age-group in women, was suggested by the study authors.

Short- and Long-Term Weight Loss Among Women Is Unrelated to Completed Exercise Within an Obesity Intervention Focused on Self-Regulation.

INTRODUCTION: The aim of this study was to evaluate 1) if completed exercise amounts were associated with short- and long-term weight loss within a cognitive behavioral intervention and 2) if changes in theory-based psychosocial factors significantly explained weight change. METHODS: A total of 110 women with obesity participated in a yearlong treatment focused on self-regulation and were grouped based on their amount of completed exercise and assessed on changes in weight, self-regulation, and self-efficacy. RESULTS: There were significant overall improvements in all study measures from baseline-month 6 and baseline-month 12. Overall weight loss means (-5.8 and -5.3 kg, respectively) did not significantly differ across groups averaging the equivalent of < 2.5; 2.6-4.5; 4.6-7.0; and > 7.0 moderate-intensity exercise sessions per week. Similarly, psychosocial improvements did not significantly differ by exercise amount grouping. Increase in exercise self-regulation significantly predicted eating self-regulation gains over both 6 and 12 months. Over the same time periods, the significant prediction of weight loss by eating self-regulation increase was mediated by change in eating self-efficacy. CONCLUSION: Results suggest attainment of government-recommended amounts of exercise are not associated with significantly greater weight loss than lower amounts of exercise within an intervention focused on self-regulation. Associations of exercise with psychosocial correlates of weight loss should be a treatment consideration.

Effects of Women's Body Satisfaction, Emotional Eating, and Race on Short-, Mid-, and Long-term Weight Loss.

OBJECTIVE: To improve understanding of psychosocial factors, their changes, and racial differences with implications for behavioral obesity treatments. METHODS: Women with obesity of White (n = 64) and Black (n = 33) racial groups participated in cognitive-behavioral community-based obesity treatment and were assessed on body satisfaction, emotional eating, and weight changes over 3, 6, 12, and 24 months via mixed-model repeated-measures analysis of variance and stepwise multiple regression analyses. RESULTS: Baseline body satisfaction scores were significantly higher (P < 0.001) in Black participants. White participants had significantly higher (P = 0.04) emotional eating scores. Significant overall improvements (P < 0.001) in body satisfaction, emotional eating, and weight were found, with weight reduction significantly greater (P = 0.05) among the White women. Weight reductions were significantly predicted by changes in body satisfaction and emotional eating (R2 = 0.12-0.20, P < 0.01). When racial group was entered into the analyses, the explained variance in weight change over 6 and 12 months significantly increased (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Findings suggest addressing body satisfaction, emotional eating, and racial differences by adjusting obesity treatment targets could improve outcomes. Research-to-practice needs include a control group and further identification/elucidation of other psychosocial and economic factors that might affect outcomes.

Theory to treatment to theory: Evolving a community-based obesity intervention.

Within weight-loss treatments, a better understanding of psychosocial correlates of exercise and controlled eating is required to improve lagging outcomes. Within this two-phase study, women with obesity participating in community-based treatments with educational (Phase 1 n = 57, Phase 2 n = 44) and behavioral (Phase 1 n = 80, Phase 2 n = 53) formats were contrasted on psychosocial variables over 3 and 6 months and their interrelations based on the mood-behavior-model and coaction theory. Phase 1 findings informed curricular extensions in Phase 2. In Phase 1, there were significant overall improvements in total mood disturbance, self-regulation of exercise, self-regulation of eating, and weight, which were more pronounced in the behavioral vs. educational format group (-3.5 % vs. -1.4 % weight loss, respectively). Mediation analyses indicated that change in self-regulation of exercise mediated the prediction of change in self-regulation of eating by mood change. Phase 2 findings were similar; however, effect sizes were greater (-6.2 % vs. -2.9 % weight loss, respectively). Within both phases, increased self-regulation of eating significantly predicted weight reduction. Paths from changes in mood→self-regulation of exercise→self-regulation of eating suggested future program attention focus on treatment-associated mood change reinforcing self-regulation, and self-regulation generalizing from an exercise to eating context. Methods of progressing treatment curricula via theory-testing were suggested.

Emotional Eating: Psychosocial Bases, Accordingly Directed Treatment Design, and Longitudinal Effects in Women with Obesity.

Emotional eating (eating triggered by adverse mood) might be an important psychosocial variable to address to improve overwhelmingly deficient obesity treatment outcomes in women. However, emotional eating has rarely been focused upon in a systematic, evidence-based manner. Within Part 1 of this field-based study completed within community health-promotion centers the United States, a treatment protocol was developed targeting negative mood, body satisfaction, and self-efficacy to resist negative emotion-related eating (SE-NegEm), which were the significant psychosocial predictors of emotional eating found at baseline in the women participants with obesity. A comparison condition consisted of matched treatment time, but focused upon typical processes of providing education in healthy eating and exercise. Cluster sampling allocated participants to either the treatment group (n = 100) or comparison group (n = 86). In Part 2, overall improvements in mood, body satisfaction, SE-NegEm, and emotional eating were found to be significant, and significantly more pronounced in the treatment group. In parallel multiple mediation analyses incorporating aggregated data, changes from baseline-Month 3 and baseline-Month 6 in negative mood, body satisfaction, and SE-NegEm significantly mediated relationships between group and changes in emotional eating from baseline-Month 6 and baseline-Month 12, respectively. Changes in body satisfaction and SE-NegEm were significant independent mediators for 6-month change, with negative mood change additionally significant for 12-month change. Reduced emotional eating significantly predicted lost weight, which was greater in the treatment group (- 5.8% vs. - 0.9%). The present process of tailoring and testing treatment content based on earlier-identified predictors of emotional eating was supported.

Coaction of Exercise and Eating Improvements Within a Behavioral Obesity Treatment: Directionality and Psychological Mechanisms.

Purpose: Because coaction (a favorable change in one behavior increasing the probability of a similarly favorable change in another behavior) associated with health behaviors has been identified, directionalities of such relationships within weight-loss behaviors (e.g., exercise, healthy eating) and their theory-based psychological mechanisms requires more investigation. Method: Women with obesity and either disturbed mood (n = 61) or normal mood (n = 58) participated in a cogntive-behavioral weight-management treatment within a community setting. Analyses of both group differences, and mediation models using aggregate data of behavioral and psychological variables, were conducted. Results: Improvements in measures of self-regulation, self-efficacy, mood, exercise, and fruit/vegetable intake were significant overall; with fruit/vegetable increase greater in the disturbed mood group. The prediction of increase in fruits/vegetables from baseline-Month 6 by increase in exercise from bascline-Month 3 (ß = .24) was stronger than effects of change in fruit/vegetabe intake on exercise (ß = .16). Overall mediation models were significant where changes in self-regulation and self-efficacy were entered as serial mediators of predictions of fruit/vegetable change by change in exercise (R2= .35 and .32), and vice versa (R2= .24 and .23). Paths demonstrating effects through self-regulation change and self-efficacy change were significant in the prediction of eating and exercise changes, respectively. Conclusion: Contributions to advancements in behavioral theory and treatment curricula targeting self-regulation and self-efficacy to improve exercse-eating change relationships were suggested.  .

Effects of Increased Physical Activity/Exercise on Long-Term Losses in Weight and Waist Circumference: Serial Mediation from Changes in Exercise-Related to Eating-Related Self-Regulation.

BACKGROUND: Behavioral obesity treatments have generally been unsuccessful at facilitating long-term weight reductions. Increased physical activity/exercise is a strong predictor of maintained weight loss. It has been proposed this is more linked to increases in exercise-related self-regulation carrying-over to eating-related self-regulation than through direct energy expenditures. METHODS: Women with obesity participated in 10-month community-based behavioral treatments that had theory-based foci on either self-regulation skills building (n = 59) or knowledge of weight loss methods (n = 54). Physical activity/exercise, exercise-related self-regulation, and eating-related self-regulation were assessed at baseline and months 3, 6, and 12 in the prediction of weight and waist circumference changes over 24 months. RESULTS: Significant overall improvements on all measures were found, which were significantly greater in the self-regulation-focused group than the knowledge-focused group. Mean reductions in waist circumference/weight were - 4.64 cm/ - 5.17 kg (- 5.5% of baseline weight) and - 0.66 cm/ - 1.19 kg (- 1.2% of baseline weight), respectively. Aggregated data indicated that early increase in physical activity/exercise significantly predicted 24-month reductions in both weight and waist circumference. Serial mediation analyses indicated that a sequential path from exercise-related self-regulation (baseline-month 3) → eating-related self-regulation (baseline-month 6) → eating-related self-regulation (baseline-month 12) fully mediated the physical activity/exercise-weight/waist circumference change relationships. Energy expenditures from physical activity/exercise accounted for 21% of lost weight. CONCLUSIONS: Findings of this field research supported benefits of progressively building self-regulation skills, first for physical activity/exercise then controlled eating, through accordingly focused behavioral treatments. Opportunities for tailoring large-scale community-based interventions grounded in theory were enhanced.

Contrasts of Initial and Gain Scores in Obesity Treatment-Targeted Psychosocial Variables by Women Participants' Weight Change Patterns Over 2 Years.

The typical pattern of weight change associated with behavioral obesity treatments has been some loss in weight through approximately 6 months, followed by near complete regain. However, patterns vary widely across individuals. The objectives are to determine whether recent prediction model-based indications of relations among changes in psychosocial correlates of the weight loss behaviors of physical activity and controlled eating vary by patterns of weight change. Women with obesity enrolled in a community-based behavioral obesity treatment who failed to lose at least 5% of their baseline weight (Minimal Effect group, n = 44), lost 5% or greater and then regained most during months 6 to 24 (Loss/Regain group, n = 42), or lost 5% or greater and then maintained/continued loss (Loss/Loss group n = 42) were evaluated. Improvements in physical activity- and eating-related self-regulation and self-efficacy, mood, and emotional eating over 6 months were significant overall and generally most favorable in the Loss/Loss group and least favorable in the Minimal Effect group. Expected model-based relationships between 6-month changes in the aforementioned psychosocial variables were significant and generally not significantly affected by weight change group. However, group substantially affected the prediction of self-regulation of eating at month 24-a key correlate of long-term weight loss. Findings suggested community-based obesity treatment targets and emphases.

Behavioral Weight Loss and Maintenance: A 25-Year Research Program Informing Innovative Programming.

Introduction Behavioral interventions targeting sustained weight loss have largely failed for decades, with little chance of improvement using prevailing methods. Objective To address treatment limitations, a focused 25-year research program was reviewed through the lens of social cognitive theory, probative investigations, and original predictive models. Innovative, but evidence-based, treatment suggestions were sought. Results Task 1 of the research program addressed adherence to exercise, a well-established requirement for maintained weight loss. A culminating model addressing this treatment aspect suggested that interrelations among changes in self-regulatory skills usage, self-efficacy, and mood should guide exercise-support programming. Task 2 attached an eating-behavior change component and probed for malleable psychosocial variables predictive of success over the weight-loss phase (initial 6 months after treatment initiation). After thorough evaluation of selected theory- and research-driven psychosocial variables, changes in self-regulation, self-efficacy, and mood were again deemed to be the most salient predictors driving eating change. In Task 3, treatment foci related to changes in the 3 psychosocial variables were supported into the weight-loss maintenance phase (beyond 6 months), and the carry-over of changes in self-regulation and self-efficacy from exercise- to eating-related contexts was identified and leveraged. Task 4 suggested value in additionally addressing emotional eating as a distinct factor. Conclusion Suggestions informing principles and extensions of a treatment approach previously demonstrating atypically high degrees of success with maintaining weight loss in field- and community-based settings are provided. Those methods emanate from the reviewed research program, which shaped novel procedures to leverage exercise-induced psychosocial changes for their carry-over benefits for controlling eating.

Cognitive Behavior-Based Programming to Increase Physical Activity and Control Overweight/Obesity in Youth: An 18-Year Research Program Informing Novel Curricula.

IntroductionBecause only 42% of elementary school-aged children and 8% of adolescents complete the recommended amount of physical activity, programs beyond physical education are required to address this inadequacy and the associated rise in overweight/obesity. ObjectiveOur 18-year research program, conducted through the lens of accepted behavioral theory, field-based investigations, and predictive models intended to shape programs to address physical inactivity and high body mass index in youths, was reviewed. ResultsIn research-to-practice task 1, studies evaluated a cognitive-behavioral elementary afterschool treatment developed from principles of social cognitive theory. It provided exercise/physical activity through an individualized goal-setting perspective and training in self-regulatory skills such as restructuring unproductive self-talk. In task 2, the research program focused on favorable associations between treatment-induced improvements in physical self-concept, the overall self, physical appearance, exercise-related self-efficacy, and mood; it also focused on increased physical activity and reductions in excess weight. Program adaptations for preschool and middle school were also found productive. As the treatment model was extended in research-to-practice task 3, a refined focus on self-regulation, self-efficacy, and mood yielded findings of enhanced effects. In task 4, protocol adaptations intended for youths with severe obesity, additional diabetes risks, and candidacies for bariatric surgery were reported. Finally, the reviewed research evaluated treatment adjuncts that incorporate technology. ConclusionOur program of field research yielded progress on physical inactivity and high body mass index in youths via psychosocial pathways. Findings suggested medical professionals more strongly attend to physical inactivity and weight issues in their young patients while seeking evidence-based methods to induce ongoing behavioral progress.