Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating.

CONTEXT: For decades, behavioral weight-loss treatments have been unsuccessful beyond the short term. Development and testing of innovative, theoretically based methods that depart from current failed practices is a priority for behavioral medicine. OBJECTIVE: To evaluate a new, theory-based protocol in which exercise support methods are employed to facilitate improvements in psychosocial predictors of controlled eating and sustained weight loss. METHODS: Women with obesity were randomized into either a comparison treatment that incorporated a print manual plus telephone follow-ups (n = 55) or an experimental treatment of The Coach Approach exercise-support protocol followed after 2 months by group nutrition sessions focused on generalizing self-regulatory skills from an exercise support to a controlled eating context (n = 55). Repeated-measures analysis of variance contrasted group changes in weight, physical activity, fruit and vegetable intake, mood, and exercise- and eating-related self-regulation and self-efficacy over 24 months. Regression analyses determined salient interrelations of change scores over both the weight-loss phase (baseline-month 6) and weight-loss maintenance phase (month 6-month 24). RESULTS: Improvements in all psychological measures, physical activity, and fruit and vegetable intake were significantly greater in the experimental group where a mean weight loss of 5.7 kg (6.1% of initial body weight) occurred at month 6, and was largely maintained at a loss of 5.1 kg (5.4%) through the full 24 months of the study. After establishing temporal intervals for changes in self-regulation, self-efficacy, and mood that best predicted improvements in physical activity and eating, a consolidated multiple mediation model suggested that change in self-regulation best predicted weight loss, whereas change in self-efficacy best predicted maintenance of lost weight. CONCLUSIONS: Because for most participants loss of weight remained greater than that required for health benefits, and costs for treatment administration were comparatively low, the experimental protocol was considered successful. After sufficient replication, physician referral and applications within health promotion and wellness settings should be considered.

Treatment-associated changes in body composition, health behaviors, and mood as predictors of change in body satisfaction in obese women: effects of age and race/ethnicity.

A lack of satisfaction with one's body is common among women with obesity, often prompting unhealthy "dieting." Beyond typically slow improvements in weight and body composition, behavioral factors might also affect change in body satisfaction. Age and race/ethnicity (African American vs. White) might moderate such change. Obese women (N = 246; M(age) = 43 years; M BMI = 39 kg/m(2)) initiating a 6-month cognitive-behaviorally based physical activity and nutrition treatment were assessed on possible predictors of body satisfaction change. At baseline, African American and younger women had significantly higher body satisfaction. The treatment was associated with significant within-group improvements in mood, health behaviors (physical activity and fruit/vegetable intake), and body composition (waist circumference). A multiple regression analysis indicated that mood, health behavior, and body composition changes explained a significant 27% of the variance in body satisfaction change. Of these predictors, changes in mood (ß = -.36, p < .001) and health behaviors (ß = .18, p = .01) made significant, unique contributions to the variance in change in body satisfaction that was accounted for, while only the measure of actual physiological change (body composition) did not. Neither age nor race/ethnicity was a significant moderator when each was entered separately into the multiple regression equation. Practical implications for leveraging manageable changes in behavioral factors for improving body satisfaction were discussed.

Effects of a cognitive-behaviorally based physical activity treatment for 4- and 5-year-old children attending US preschools.

BACKGROUND: Inadequate volumes of physical activity may be associated with the increases in inappropriately high weight in children of 5 years of age and younger. Preschools have typically lacked sufficient time in daily physical activity. PURPOSE: A preschool-administered physical activity treatment based on social cognitive and self-efficacy theory (Start For Life) was tested for its association with increased physical activity and reduced body mass index (BMI). METHODS: Data from accelerometer and BMI assessments over a 9-month preschool year (18 treatment and 8 control classes of 17 to 20 children each; mean age = 4.4 years) were used to contrast the behaviorally based treatment of 30 min per day with a usual care condition of the same duration. The sample was primarily African-American. Preschool teachers administered all processes. RESULTS: The Start For Life treatment was associated with a significantly greater percentage of the preschool day in moderate-to-vigorous and vigorous physical activity (approximately 30 min per week more), with sedentary time unaffected. The treatment was also associated with a significant reduction in BMI, with effect sizes greatest in overweight and obese children. CONCLUSIONS: Although results were positive in contrast to usual care and other related interventions, the specific sample requires that the Start For Life treatment undergo sufficient replication to increase confidence in generalizability of the findings to others. Although reduction in sedentary time may require a different strategy, the practical application of the present treatment suggests possibilities for addressing overweight through increasing moderate-to-vigorous physical activity in preschool settings.

Reducing high BMI in African American preschoolers: effects of a behavior-based physical activity intervention on caloric expenditure.

OBJECTIVES: Overweight and obesity in young children are increasing concerns for medical professionals. Lack of sufficient physical activity may be the primary cause; therefore, the development and testing of a theory-based intervention for preschoolers is a priority. METHODS: A 30-minutes/day preschool-based intervention (Start For Life), with a foundation in social cognitive theory that emphasizes the use of self-regulation skills and feelings of mastery (self-efficacy), was administered for 9 months to 4- and 5-year-old African American children. RESULTS: Findings indicated a significant increase in accelerometer-measured moderate-to-vigorous and vigorous physical activity during the 7-hour school day. Reductions in body mass index (BMI; kg/m) were significant, with greater effects found in participants with an initially higher BMI. Further analyses indicated that the kilocalories expended through physical activity explained approximately 87% of the weight lost. Participants' sex did not affect the identified changes in BMI. CONCLUSIONS: A brief theory-based physical activity intervention (Start For Life) was associated with increased moderate-to-vigorous and vigorous physical activity and reduced overweight/obesity in 4- to 5-year-old preschoolers. Because of its practical format, opportunities for widespread dissemination may be possible.

Mediation of social cognitive theory variables in the relationship of exercise and improved eating in sedentary adults with severe obesity.

Results from behavioral treatments for obesity have been disappointing due to an inability to sustain healthy eating. The concurrent use of theory, research, and practical application has the potential of reducing overeating through innovative treatments. When overweight individuals begin an exercise program their eating tends to improve, however, the basis of this relationship is not determined. If the psychosocial mediators of the relationship between exercise and improved eating are better understood, supported exercise may be a key component for improving the efficacy of behavioral weight management treatments. In Phase 1 of this research, psychosocial variables derived from social cognitive theory were tested as possible mediators of the relationship of exercise participation with increased fruit and vegetable intake in severely obese adults initiating a 26-week treatment of supported exercise and standard nutrition education (n = 161). Change in self-regulation for healthy eating and self-regulation at treatment end was a strong mediator; with the addition of mood and self-efficacy for healthy eating being additional mediators that notably increased effect ratios. In Phase 2, participants in a cognitive-behavioral nutrition treatment tailored to improve the identified mediators (n = 163) were contrasted with the original group. The cognitive-behavioral nutrition treatment was associated with significantly greater increases than standard nutrition education in self-regulation, p = 0.023, CIs [4.69, 6.48], and [3.19, 5.02], respectively; self-efficacy, p = 0.013, CIs [19.72, 29.41], and [11.70, 20.71], respectively; and a marginally significant decrease in negative mood, p = 0.062, CIs [-14.26, -9.36], and [-10.90, -6.45], respectively. Findings served to inform treatment designs concerning the use of supported exercise and cognitive-behavioral means to derive better outcomes related to nutrition and weight loss in individuals with severe obesity.

Effects of the Start For Life treatment on physical activity in primarily African American preschool children of ages 3-5 years.

In U.S. children of ages 2-5 years, combined overweight and obesity has increased to 21%, with African American children of this age range highest at 26%. Lack of physical activity is highly predictive of overweight and obesity in children. Preschools may be a useful point for intervention. An innovative preschool physical activity treatment (Start For Life) was developed based on principles of social cognitive and self-efficacy theory. It incorporated 30 minutes daily of highly structured physical activity with behavioral and self-regulatory skills training (e.g. goal setting, self-monitoring, productive self-talk) interspersed. Data obtained from accelerometry was used to contrast physical activity outputs during the preschool day in the Start For Life condition (n = 202) with a usual-care control condition (n = 136). After controlling for age and sex of the primarily African American participants (M age = 4.7 years), changes over eight weeks in moderate-to-vigorous and vigorous physical activity were significant, and significantly more favorable in the Start For Life group; F(1, 344) = 4.98, p = .026 and F(1, 344) = 3.60, p = .058, respectively. Start For Life was associated with a weekly increase in moderate-to-vigorous physical activity of approximately 40 minutes. After sufficient replications that better account for different sample types, parental effects and physical activity outside of the school day, and long-term effects, widespread dissemination may be considered.

From morbid obesity to a healthy weight using cognitive-behavioral methods: a woman's three-year process with one and one-half years of weight maintenance.

BACKGROUND: Obesity is a national health problem regularly confronting medical professionals. Although reduced-energy (kilocalorie [kcal]) eating and increased exercise will reliably reduce weight, these behaviors have been highly resistant to sustained change. OBJECTIVE: To control eating using theory-based cognitive-behavioral methods that leverage the positive psychosocial effects of newly initiated exercise as an alternate to typical approaches of education about appropriate nutrition. METHOD: A woman, age 48 years, with morbid obesity initiated exercise through a 6-month exercise support protocol based on social cognitive and self-efficacy theory (The Coach Approach). This program was followed by periodic individual meetings with a wellness professional intended to transfer behavioral skills learned to adapt to regular exercise, to then control eating. There was consistent recording of exercises completed, foods consumed, various psychosocial and lifestyle factors, and weight. RESULTS: Over the 4.4 years reported, weight decreased from 117.6 kg to 59.0 kg, and body mass index (BMI) decreased from 43.1 kg/m(2) to 21.6 kg/m(2). Mean energy intake initially decreased to 1792 kcal/day and further dropped to 1453 kcal/day by the end of the weight-loss phase. Consistent with theory, use of self-regulatory skills, self-efficacy, and overall mood significantly predicted both increased exercise and decreased energy intake. Morbid obesity was reduced to a healthy weight within 3.1 years, and weight was maintained in the healthy range through the present (1.3 years later). CONCLUSION: This case supports theory-based propositions that exercise-induced changes in self-regulation, self-efficacy, and mood transfer to and reinforce improvements in corresponding psychosocial factors related to controlled eating.

Exercise program-induced mood improvement and improved eating in severely obese adults.

BACKGROUND: Using a practical setting, this study aimed to test exercise and nutrition interventions' effects on negative mood, self-regulation, and self-efficacy to control eating; and to assess the ability of mood change to predict changes in eating behavior, while accounting for changes in self-regulation and self-efficacy. METHODS: Severely obese adults participated in a cognitive-behavioral exercise support treatment paired with either nutrition education (n = 140) or cognitive-behavioral methods applied to improved eating (n = 146). They were assessed on measures of overall negative mood, self-regulatory skill usage, self-efficacy to control eating when negative moods are present, and fruit and vegetable consumption at baseline and Week 26. RESULTS: Significant improvements in each psychosocial variable and fruit and vegetable intake were found. Improved mood significantly predicted fruit and vegetable consumption change, R2 = 0.12, P < 0.001. Entry of changes in self-regulation and self-efficacy into the multiple regression equation significantly strengthened the variance explained, R2 = 0.18, P < 0.001. DISCUSSION: Findings suggest that exercise-induced improvements in mood improve eating behaviors, with increases in self-regulation and self-efficacy adding to this effect.