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.

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.

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.