Ya gotta have friends: social support and self-efficacy predict success following immersion treatment.

OBJECTIVE: This study examined the impact of perceived social support and self-efficacy on predicting success in weight management following immersion treatment of adolescent obesity. METHODS: 198 overweight and obese adolescents (M% overweight = 81.4%; M BMI = 36.0) participated in Wellspring's cognitive-behavioral therapeutic camps for 3-10 weeks during the summer of 2011. The campers and one of their caretakers completed a series of questionnaires at the halfway point during immersion. One year following camp, campers and their parents provided follow-up heights and weights. RESULTS: Multiple regression intent to treat analyses indicated that campers who perceived their friends as supportive, reported confidence in their ability to succeed, and believed that their families functioned well achieved relatively more substantial reductions in percent overweight 1 year after immersion. Perceptions of support anticipated from parents failed to predict success. Campers who more fully engaged in the process of change at camp also achieved somewhat greater success in the long run. CONCLUSIONS: These results suggest that participants in cognitive-behavioral immersion treatment may improve outcomes by nurturing support from their friends, increasing self-efficacy, and having their families consider family therapy if warranted.

Five recent expert recommendations on the treatment of childhood and adolescent obesity: toward an emerging consensus--a stepped care approach.

BACKGROUND: Various organizations published five sets of expert recommendations recently: 2007 Healthcare Organizations' Four Stage Model; 2006 Canadian Clinical Practice Guidelines; 2008 The Endocrine Society Recommendations; 2009 Seven Step Model; and 2010 US Preventive Task Force Recommendations. METHODS: We compared the recommendations' approaches and conclusions pertaining to four treatments (self-help groups, outpatient cognitive-behavior therapy [CBT], immersion CBT, and surgery). RESULTS: All of the expert committees supported using intensive dietary, physical activity, and cognitive-behavioral counseling; two of the five groups discouraged reliance on educational interventions alone, and two of the groups explicitly promoted a stepped-care approach. CONCLUSIONS: Greatest benefits may accrue by encouraging healthcare providers and parents to view medical management and education as foundations to change, but to pursue increasingly intensive viable options until overweight and obese children make clinically significant progress toward improved health and happiness.

Highly successful weight control by formerly obese adolescents: a qualitative test of the healthy obsession model.

BACKGROUND: The Healthy Obsession Model (HOM) suggests that successful weight controllers must develop a preoccupation with the planning and execution of target behaviors to reach and maintain healthy weights (e.g., controlled eating, consistent selfmonitoring). This model further posits that committed weight controllers will feel substantial anxiety or frustration when lapses occur, which, in turn, will motivate them to reinstate target behaviors. METHODS: The present study tested the HOM by examining the perceptions and attitudes of four very successful and four relatively unsuccessful adolescent weight controllers 1 year after completing immersion treatment. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions and describe more negative reactions to potential and actual lapses. In-depth interviews were conducted using a version of the Scanlan Collaborative Interview Method. RESULTS AND CONCLUSIONS: Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers seem to nurture strong healthy obsessions, including clear definitions of healthy obsessions, heightened commitment based on the emotional impact of excess weight, and negative reactions to lapses. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model (e.g., Emotional and Experiential Consequences; Social Support of Parents, Friends, and Peers; Institutional Influences; and Valuable Opportunities).