Participation as a leader in immersion weight loss treatment: a 1-year follow-up study.

Non-overweight individuals may follow aggressive weight management approaches alongside overweight/obese friends or family members; thus, research has begun to evaluate subsequent effects among non-overweight populations. A prior study evaluated the short-term effects of an immersion weight loss programme on healthy young adult staff leaders. Results indicated that participation seemed to benefit, not harm, the young adults. The current investigation examined 1-year eating disorder and weight trajectories in this sample. The total sample (N = 244) consisted of staff leaders (44.3%) and demographically similar comparison participants who completed eating disorder and weight assessments across four time points: baseline, end of summer, 6-week follow-up and 1-year follow-up. Forty-seven per cent of the original sample responded to all time points (staff leaders n = 60; comparison n = 55). Over the course of 1 year, risk trajectories did not differ between groups. Staff leaders did not report significant changes in body mass index, suggesting that they maintained healthy weight over the course of 1 year. Participation as an immersion weight loss programme leader appeared to be protective against weight gain, without increasing eating disorder risk, for healthy young adults. This provides further support for using weight management interventions across a wide range of individuals.

Participation as a leader in immersion weight loss treatment may benefit, not harm, young adult staff members.

Despite the success of weight-management programmes, some researchers caution that participation in an aggressive approach to weight management could promote the development of eating pathology. The current study evaluated the risks and benefits for young adults of serving as staff members in an immersion treatment of adolescent obesity over the course of a summer. Participants included weight loss staff members (n = 108) along with a comparison group of young adults with similar demographic characteristics (n = 136). Participants completed assessments of eating disorder and obesity risk at three time points: the beginning of the summer, the end of the summer and a 6-week follow-up. Weight loss leadership participants who were initially overweight lost weight over the course of the summer, but those at healthy weights maintained their weight. Comparison participants also maintained their weight during the summer. Weight loss staff members also increased dietary restraint over the summer, and increases in dietary restraint appeared to facilitate appropriate weight reduction. Participation as a leader in an immersion weight loss programme seemed to benefit, not harm, young adults; this suggests potential advantages for using weight controlling interventions in a wide range of individuals, including as an obesity prevention strategy.

Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention.

Obese children have attended weight loss camps and residential programmes for more than 40 years. This paper provides the first systematic review of the effects of those programmes. Twenty-two studies met inclusion criteria (targeted and assessed change in weight status, minimal stay of 10 days and nights). Similar components across programmes included controlled diet, activities, nutrition education, and therapy and/or education regarding behaviour change. Participants lost substantial amounts of weight in all 22 studies, as measured by reductions in per cent-overweight during intervention. Eleven programmes included long-term follow-up evaluations. Compared with results highlighted in a recent meta-analysis of out-patient treatments, these immersion programmes produced an average of 191% greater reductions in per cent-overweight at post-treatment and 130% greater reduction at follow-up. Furthermore, mean attrition rates were much lower when compared with standard out-patient treatment. Inclusion of a cognitive-behavioural therapy (CBT) component seemed especially promising; follow-up evaluations showed decreased per cent-overweight at follow-up by an average of 30% for CBT immersion programmes vs. 9% for programmes without CBT. Explanations for the potentially greater impact of immersion relative to out-patient treatments are presented, including possibly differential effects on self-efficacy for both children and their parents.

Weight loss and changes in generic and weight-specific quality of life in obese adolescents.

PURPOSE: To investigate how weight loss correlates with changes in generic and weight-specific quality of life (QoL). METHODS: Youth generic (YQOL-S) and weight-specific instruments (YQOL-W) from 133 youth age 11-19 were analyzed at the beginning and end of 4-week immersion camp sessions known to produce weight loss. Paired samples t tests were used to test mean difference between baseline and final Body Mass Index (BMI) and YQOL-S and YQOL-W scores. YQOL-S and YQOL-W scores were transformed to values between 0 and 100, with higher values indicating better QOL. Cohen's d effect sizes were calculated to assess magnitude of effects. Percent weight loss (as % of baseline weight), change in BMI (baseline kg/m²-follow-up kg/m²), and change in % overweight ((BMI-50th% BMI for age and sex)/50th% BMI for age and sex × 100) were calculated. Multiple regressions were used to model final YQOL scores in the 11-14 and 15-19 age groups as functions of each measure of weight change, sex, age, and baseline YQOL score. RESULTS: Youth experienced significant reductions in BMI (Mean change = 3.7, SD = 1.4, t = 34.1, P < 0.001) and in the other measures of weight change. YQOL-S and YQOL-W scores improved significantly (P < 0.001), and effect sizes were 0.61 and 0.66, respectively. CONCLUSION: Changes in generic and weight-specific quality of life scores are associated with weight loss. The weight-specific measure is slightly more sensitive to weight changes; however, when controlling for modifiers, the YQOL-W remained significantly associated with weight loss, while the generic QoL measure did not.

Helping young weight controllers develop healthy obsessions: preliminary test of the Healthy Obsession Model.

The Healthy Obsession Model posits that successful weight controllers must develop a preoccupation with the planning and execution of target behaviours, including eating on programme, consistent activity and self-monitoring. When barriers emerge, committed weight controllers are expected to feel distressed (e.g. anxious or frustrated), which should motivate them to reinstate these behaviours. This study investigated the effects on moods of sudden withdrawal of self-monitoring among obese adolescents within an immersion treatment programme. Fifty-five (55% female) adolescents participated in a weight loss camp and received four weekly cognitive-behaviour therapy sessions focused on maximizing commitment to programme behaviours. During the fourth week, campers and staff completed daily mood ratings using the Positive and Negative Affect Schedule. After 3 d of ratings, campers' self-monitoring journals were removed without warning for 1 d. As expected, journal removal resulted in decreased positive affect for the campers, according to staff ratings. Also in accord with hypotheses, campers who demonstrated heightened commitment to the programme based on higher levels of activity and more writing in their journals reacted more negatively to the withdrawal of the opportunity to self-monitor. Mood ratings by campers did not show the effects hypothesized by the Healthy Obsession Model. These results provide preliminary support for the Healthy Obsession Model by showing some of the anticipated negative reactions to the removal of access to self-monitoring, especially among those who demonstrated strong commitments to the process.

Do as I do? Prospects for parental participation 1.5 years after immersion treatment for adolescent obesity.

This study compared successful with unsuccessful participants and their mothers 1.5 years following completion of an immersion programme for the treatment of adolescent obesity. Teenagers (M age = 14.5; 69.5% female) participated in a 4- to 8-week therapeutic camp; those who continued losing weight 1.5 years post-camp were identified as 'Losers'; those who regained weight were considered 'Gainers'. Twenty-six Loser campers, 23 Gainer campers and all mothers were interviewed about their current weights and lifestyle habits. Losers' and Gainers' mothers both reported losing weight significantly. Relative to Gainer mothers, however, Loser mothers reported 26% fewer high-fat foods in the house and greater likelihood of self-monitoring. Loser campers, relative to Gainer campers, reported self-monitoring more consistently; using trainers more frequently; and consuming fewer calories and less fat. Gainer campers also reported a tendency to use family therapy more than Loser families. The Loser campers reported following the dictates of the programme more than the Gainer campers, as expected. One striking and unique finding, however, was that Gainer mothers seemed to follow the programme for themselves as much as Loser mothers. Apparently for some participants in immersion treatment (like the Loser campers in this study), parents who participate fully may promote sustained success; for other adolescent weight controllers (like the present Gainer campers), having 'Do as I do' mothers clearly does not guarantee sustained changes in lifestyle for the teenagers. A hypothesis based on these results is that additional cognitive-behaviour therapy subsequent to immersion may be useful for this latter group.

How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently.

This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention group's treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.

Weight control during the holidays: highly consistent self-monitoring as a potentially useful coping mechanism.

The study examined the extent to which trait self-monitoring (the systematic observation and recording of target behaviors) was related to weight control during the high-risk holiday season. The participants (32 women, 6 men) averaged 223.1 lbs (101.41 kg), 57.2% overweight, 50.2 weeks of participation, and 21.3 lbs (9.68 kg) lost at the beginning of the study. Consistency of self-monitoring and weight changes were assessed for 3 holiday versus 7 nonholiday weeks. Analyses of variance (Consistency of Self-Monitoring Groups x Holiday/Nonholiday Weeks) revealed that participants gained 500% more weight per week during holiday compared with nonholiday weeks. Only participants in the most consistent self-monitoring quartile averaged any weight loss over the 10 weeks of the study and during the holiday weeks.

Further support for consistent self-monitoring as a vital component of successful weight control.

OBJECTIVE: This study attempted to replicate that of Baker and Kirschenbaum by providing a descriptive analysis of the relationship between self-monitoring and weight control. PROCEDURES: Fifty-nine women and men in long-term cognitive-behavioral treatment for obesity participated over an 8-week period. Percentages of participants who self-monitored consistently and the relationship between the variability in self-monitoring and weight change were examined. RESULTS: As in the previous study, a substantial minority of the participants in this research (26.3%) self-monitored all foods eaten on less than half of the days evaluated. The assertion of Baker and Kirschenbaum that self-monitoring is most appropriately viewed as both a state and a trait was supported by finding that the most consistent self-monitors lost more weight than the least consistent self-monitors; however, regardless of overall self-monitoring consistency, participants lost much more weight during their two most consistent weeks compared with their two least consistent weeks. Again, as in the previous study, only the more consistent quartile of self-monitors lost a substantial amount during the course of this study. DISCUSSION: The results of both studies taken together suggests that a reasonable target for consistency for self-monitoring within the context of a professional cognitive-behavioral treatment program may be self-monitoring all foods eaten on at least 75% of the days. If participants generally self-monitor on less than half of the days during participation in such programs, they may be very unlikely to succeed at weight loss both during the program and afterward.

Affect and self-regulation in binge eaters: effects of activating family images.

OBJECTIVE: This study examined the impact of activating internalized family images on affective states and behavioral self-regulation. METHOD: Sixty-four female binge eaters and normal controls were randomly assigned to family- or neutral-state inductions. RESULTS: The family induction had a differentially negative impact on binge eaters. When their family images were activated, binge eaters felt more negatively about the experiment, more hostile, experienced greater sensations of hunger, and were more preoccupied with their family images than their counterparts in the other groups. Behaviorally, they also required a relatively greater amount of time to complete a visual-motor task, with a degree of accuracy comparable to that of other subjects. DISCUSSION: The present findings suggest that for women with eating disorders, the activation of internalized images of their family relationships may produce distress and perhaps problems in behavioral self-regulation as well.

Factors associated with weight control in older adults.

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.

Meta-monitoring: Case illustrations of a potential "Slump-Buster" for self-regulatory problems.

Meta-monitoring has been defined as a secondary feedback system in which people monitor their rates of progress in attaining their primary self-regulatory goals. The purpose of this study was to explore the effects of adding an explicit version of meta-monitoring to a long-term cognitive-behavioral treatment program for obesity. It was expected that meta-monitoring in this therapeutic context might increase positive affect and, thereby, improve self-regulated cognitive and behavioral changes. Four obese women who were in treatment for 1 to 2 years prior to the study served as subjects. They meta-monitored by rating their self-monitoring, affect, and eating and thinking patterns for each of 34 weeks. Weight changes and measures of self-monitoring, affect, and eating/thinking patterns suggested some initially positive effects (during the first 2 weeks, especially). While the duration of the impact of meta-monitoring in this clinical trial seemed modest, the approach may have promise as a means of reenergizing self-regulatory efforts during lapses or slumps. Experiments on various methods of operationalizing meta-monitoring, examining its effects on different problems, and testing its hypothesized mechanisms seem warranted.

Obese people who seek treatment have different characteristics than those who do not seek treatment.

A group of obese people who had not sought treatment, an obese group who had sought treatment in a professional, hospital-based program, and normal-weight controls (N = 547) were compared in regard to level of psychopathology, binge eating, and negative emotional eating. Because the groups differed significantly on several demographic variables, 3 demographically matched groups were created and compared (n = 177, 59 per group). In the matched subgroups, obese people who had sought treatment reported greater psychopathology and more binge eating than did those who had not sought treatment or did normal-weight controls. Both obese groups (including those who had not sought treatment) endorsed more symptoms of distress, negative emotional eating, overeating, difficulty resisting temptation, and less exercise than did normal-weight controls.

Evaluation of an intensive weight control program using a priori criteria to determine outcome.

This study evaluated the effectiveness of a comprehensive obesity treatment program which incorporated open-ended treatment duration, pre-treatment assessments, protein-sparing modified fasts (PSMFs), and the use of six a priori outcome categories to analyse outcomes. Subjects were the first 291 obese individuals (mean weight = 235 lb, 66% overweight) to participate in the program's intake procedures. Data obtained after 55 weeks of treatment (on average) showed that the program seemed quite effective for 65% of those who participated for at least 12 weeks (mean = 62 and 30 lb lost in the two successful groups). Analyses supported the continued use of pre-treatment assessments, extended treatment times, and a priori categorizations of outcomes. In addition, correlational analyses showed that binge eating, high levels of psychological distress, and low income levels were associated with poorer outcomes.

Disinhibited eating by resourceful restrained eaters.

Restrained eaters who reported consistent use of a variety of self-control skills were expected to avoid disinhibited eating in a high-risk situation better than were restrained eaters, who reportedly used fewer self-control skills. Eighty women were selected as subjects on the basis of their scores on the Revised Restraint Scale and the Self-Control Schedule. A 2 x 2 design was used: Restraint (high, low) x Self-Control (high, low). Subjects participated in the usual "preload + taste-test" restraint paradigm. Restrained eaters who reported high self-control skills disinhibited their eating significantly more (not less, as expected) than all other groups.

Distressed binge eaters as a distinct subgroup among obese individuals.

This study was conducted to examine the degree to which binge eating and psychological distress among obese adults are associated with a variety of behavioral patterns and competencies that could substantially affect weight control. Subjects were 167 obese people who sought help in a long-term cognitive behavioral treatment program. Subjects were divided into three groups depending on their level of psychological distress and severity of binge eating. Subjects were also assessed on coping style, subjective distress, weight history, and exercising and eating patterns. Results demonstrated substantial differences between those reporting relatively few problems with binge eating or psychological distress as opposed to those with noteworthy problems in both. The presence of either severe binge eating or psychological distress was associated with problems in regulating food-related behavior and, more generally, to problematic coping styles. These findings support the importance of in-depth assessment when treating obesity, more intensive treatment for some subgroupings, and long-term studies that incorporate comprehensive pretreatment process measure of eating style and psychological distress.

Heterogeneity of clinical presentation among obese individuals seeking treatment.

This study provides a test for the assumption of psychological homogeneity among 60 individuals who sought treatment for obesity and were referred for cognitive-behavioral group treatment. Subjects were divided along the dimension of severity of psychopathology and were assessed on subjective distress, binge eating, coping ability, and a variety of historical and demographic dimensions. Twenty-three percent of the sample scored in a range indicative of significant personality disturbance on the Borderline Syndrome Index. This distressed group did not differ from the less distressed cohort in weight, but reported more extensive symptoms of psychopathology, more chaotic eating patterns, more binge eating, and evidenced less effective coping skills. These findings provide support for the importance of a thorough assessment prior to initiating treatment for obesity.

Self-regulation of sport performance.

All serious sport participants must engage in goal-directed behaviors in the relative absence of immediate external constraints (i.e., self-regulation). Psychologists have developed theoretical models of self-regulation and produced principles of self-regulation that are summarized by the models. These concepts apply directly to sport performance. The purpose of this paper is to review the most relevant concepts in self-regulation and show how they impact on sport psychology. Several studies are reviewed which have used self-regulatory concepts to help both elite and ordinary athletes improve their performance. For example, the research indicates that when performance is difficult (e.g., at low and moderate skill levels), performance can be improved by keeping track of successes while performing or while viewing videotapes of one's own performance. Keeping track of instances of inadequate performance may prove detrimental except if the tasks being monitored are extremely easy or routine. How to apply this principle and others to sport performance is discussed.

Promoting self-directed hemodialysis: measurement and cognitive-behavioral intervention.

Approximately 98% of hemodialysis patients who are treated in hemodialysis units currently use staff-directed treatment. This may well be the most expensive and most dependent mode of hemodialysis treatment. If an effective strategy were developed to enhance degree of self-directed care, millions of public health dollars might be saved while patients reap potentially substantial psychological benefits. The present research took two steps in the direction of promoting increased self-directed treatment of hemodialysis. First, a reliable and easily used behavioral observation system was developed to define and measure degree of self-directed treatment of hemodialysis. Second, a five-step cognitive-behavioral strategy to improve degree of self-directed treatment was developed and tested preliminarily. The strategy includes an initial rationale, decisional counseling, behavioral contracting, self-monitoring, and staff support/problem solving. Four nurses used this approach with 4 elderly patients (mean age = 70.5 years). A multiple-baseline-across-subjects design revealed substantial and relatively rapid improvements in degree of self-directedness associated with the intervention for the 3 patients who remained healthy throughout the study. The discussion focuses on the implications of the results for future research.