Stepped-care in obesity treatment: matching treatment intensity to participant performance.

This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI≥27 kg/m(2); mean BMI of 37.3, SD=6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M=8.6%) lost a significantly greater percentage of weight than individuals who received SH+IC (M=4.7%; p<.05) and individuals in SH+IC lost a significantly greater percentage of weight than individuals who received SH+WLG+IC (M=1.6%; p<.05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.

The self-protective nature of implicit identity and its relationship to weight bias and short-term weight loss.

BACKGROUND/AIMS: Research suggests that making overly positive self-evaluations is the norm rather than the exception. However, unlike other stigmatized groups, overweight individuals do not exhibit a positive in-group social identity and instead exhibit significant explicit, implicit, and internalized weight bias. Therefore, it is not known whether overweight/obese individuals will evidence self-enhancement on general traits (good, attractive), or on traits inconsistent with fat stereotypes (disciplined, active, healthy eater), on an assessment of implicit attitudes. Similarly, it is not known whether these ratings will be associated with preexisting levels of weight bias, gender, or short-term weight loss. METHODS: At baseline, 53 overweight/obese adults (BMI > 27 kg/m(2), mean BMI = 37.3 kg/m(2), SD = 6.6 kg/m(2), 89% Caucasian, and 77% female) participating in a weight loss intervention completed measures of explicit and internalized weight bias as well as implicit weight bias and identity (self-other comparisons). RESULTS: Although participants evidenced significant anti-fat attitudes, they implicitly identified themselves as significantly thinner, better, more attractive, active, disciplined, and more likely to eat healthy than 'other' people. Compared to men, women were less likely to view themselves as thin and attractive relative to others. Greater implicit anti-fat bias and implicitly seeing the self as thin relative to others was associated with less short-term weight loss. CONCLUSION: Despite evidence for explicit, implicit, and internalized weight bias, participants generally evidenced a positive implicit self-identity, including areas consistent with negative fat stereotypes.

Assessing anti-fat bias in preschoolers: a comparison of a computer generated line-drawn figure array and photographic figure array.

This study examined differences in preschoolers' ratings of anti-fat bias and identification of current body size depending on the realism of the figure array used: computer generated line-drawn or photographic. Children reported strong anti-fat bias with both arrays. However, less extreme bias was elicited with the photographic figure array. In addition, children were inaccurate reporters of their current body size when both figure arrays were used. However, children were consistent in their selection of figures that were thinner than their actual body size. Children's consistent selection of thinner figures as representative of their current body size may be an additional indicator of anti-fat bias. Overall, these results suggest that some of the anti-fat bias observed in preschoolers is attributable to less realistic figure arrays. Therefore, photographic figure arrays are proposed as a better measurement tool in the assessment of anti-fat bias in preschoolers.

Emerald dragon bites vs veggie beans: Fun food names increase children's consumption of novel healthy foods.

Caregivers often struggle with food neophobia on the part of young children. This study examined whether labeling novel healthy foods with fun names would increase children's willingness to try those foods and encourage them to eat more of those foods in a child care setting. Thirty-nine toddler and preschool age children (mean age = 3.9 years) were served each of three foods twice, once labeled with a fun name and once with a healthy name. Percentage of the food consumed by each child was recorded. Overall, children ate a greater percentage of the target foods when they were labeled with fun names. Also, a larger percentage of the children tasted the foods when they were labeled with fun names. This simple strategy could be effective for increasing consumption of healthy foods among young children.

Successful weight loss with self-help: a stepped-care approach.

In a stepped-care approach to treatment, patients are transitioned to more intensive treatments when less intensive treatments fail to meet treatment goals. Self-help programs are recommended as an initial, low intensity treatment phase in stepped-care models. This investigation examined the effectiveness of a self-help, stepped-care weight loss program. Fifty-eight overweight/obese adults (BMI ≥27 kg/m(2)) participated in a weight loss program. Participants were predominately Caucasian (93.1%) and female (89.7%) with a mean BMI of 36.6 (SD=7.1). Of those completing the program, 57% of participants (N=21) who remained in self-help maintained an 8% weight loss at follow-up. Participants who were stepped-up self-monitored fewer days and reported higher daily caloric intake than self-help participants. Once stepped-up, weight loss outcomes were equivalent between individuals who remained in self-help compared to those who were stepped-up. Individuals who were stepped-up benefited from early intensive intervention when unsuccessful at losing weight with self-help.