Journal of Behavioral Medicine

, Volume 36, Issue 6, pp 601–610 | Cite as

Correlates of health-related quality of life, psychological well-being, and eating self-regulation after successful weight loss maintenance

  • Paulo N. Vieira
  • Marlene N. Silva
  • Jutta Mata
  • Sílvia R. Coutinho
  • Teresa C. Santos
  • Luís B. Sardinha
  • Pedro J. Teixeira


The purpose of this study was to evaluate health-related quality of life and other psychosocial characteristics, including eating self-regulation and body image, in a group of successful long-term weight loss maintainers. Women enrolled in the Portuguese Weight Control Registry (n = 107) were matched and compared to women at the end of a behavior weight loss treatment program (n = 107), and also with women in the community who were not trying to lose weight (n = 107). Successful maintainers displayed higher quality of life and a more positive profile in selected eating and exercise markers of self-regulation compared to similarly-weighed women not attempting weight loss, but not when compared to the ‘weight loss treatment’ group. However, results also suggest that concerns with body shape and size may persist after weight loss and that some aspects of well-being and eating self-regulation can be more successfully targeted in specific weight loss programs.


Quality of life Well-being Eating self-regulation Weight loss maintenance Obesity Overweight women 



This study was funded by grants by the Portuguese Science and Technology Foundation (FCT-POCI/DES/57705/2004 and SFRH/BD/31408/2006 to Paulo Vieira) and the Calouste Gulbenkian Foundation (grant number 65565/2004). The investigators are also grateful to the Oeiras City Council, Nestlé Portugal, and IBESA for their additional financial support.


  1. Andrade, A. M., Coutinho, S. R., Silva, M. N., Mata, J., Vieira, P. N., Minderico, C. S., et al. (2010). The effect of physical activity on weight loss is mediated by eating self-regulation. Patient Education and Counseling, 79, 320–326. doi: 10.1016/j.pec.2010.01.006 PubMedCrossRefGoogle Scholar
  2. Azevedo, A., & Faria, L. (2004). Self-esteem in the scholl’ secondary level: Validation of the Rosenberg Self-Esteem Scale [A auto-estima no ensino secundário: Validação da Rosenberg Self-Esteem Scale] Avaliação Psicológica, Formas e Contextos. Braga (pp. 415–421). Portugal: Universidade do Minho.Google Scholar
  3. Bryant, E. J., King, N. A., & Blundell, J. E. (2008). Disinhibition: Its effects on appetite and weight regulation. Obesity Reviews, 9, 409–419. doi: 10.1111/j.1467-789X.2007.00426.x PubMedCrossRefGoogle Scholar
  4. Byrne, S., Cooper, Z., & Fairburn, C. (2003). Weight maintenance and relapse in obesity: A qualitative study. International Journal of Obesity and Related Metabolic Disorders, 27, 955–962.PubMedCrossRefGoogle Scholar
  5. Carraça, E. V., Markland, D., Silva, M. N., Coutinho, S. R., Vieira, P. N., Minderico, C. S., et al. (2010). Dysfunctional body investment versus body dissatisfaction: Relations with well-being and controlled motivations for obesity treatment. Motivation and Emotion, 34, 1.CrossRefGoogle Scholar
  6. Carraça, E. V., Silva, M. N., Markland, D., Vieira, P. N., Minderico, C. S., Sardinha, L. B., et al. (2011). Body image change and improved eating self-regulation in a weight management intervention in women. International Journal of Behavioral Nutrition and Physical Activity, 8, 75. doi: 10.1186/1479-5868-8-75 PubMedCrossRefGoogle Scholar
  7. Cash, T. F., Melnyk, S. E., & Hrabosky, J. I. (2004). The assessment of body image investment: An extensive revision of the appearance schemas inventory. International Journal of Eating Disorders, 35, 305–316. doi: 10.1002/eat.10264 PubMedCrossRefGoogle Scholar
  8. Cash, T. F., & Pruzinsky, T. (Eds.). (2002). Body image: A handbook of theory, research, and clinical practice. New York: Guilford Press.Google Scholar
  9. Conway, J. M., Seale, J. L., Jacobs, D. R., Jr., Irwin, M. L., & Ainsworth, B. E. (2002). Comparison of energy expenditure estimates from doubly labeled water, a physical activity questionnaire, and physical activity records. American Journal of Clinical Nutrition, 75, 519–525.PubMedGoogle Scholar
  10. Cooper, Z., Fairburn, C. G., & Hawker, D. M. (2003). Cognitive-behavioral treatment of obesity: A clinician’s guide. New York: Guilford.Google Scholar
  11. Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of a body shape questionnaire. International Journal of Eating Disorders, 6, 485–494.CrossRefGoogle Scholar
  12. Dallman, M. F., Pecoraro, N., Akana, S. F., La Fleur, S. E., Gomez, F., Houshyar, H., et al. (2003). Chronic stress and obesity: A new view of “comfort food”. Proceedings of the National Academy of Sciences USA, 100, 11696–11701.CrossRefGoogle Scholar
  13. Deci, E., & Ryan, R. (2008). Facilitating optimal motivation and psychological well-being across life’s domains. Canadian Psychology, 49, 14–23.CrossRefGoogle Scholar
  14. Dohm, F. A., Beattie, J. A., Aibel, C., & Striegel-Moore, R. H. (2001). Factors differentiating women and men who successfully maintain weight loss from women and men who do not. Journal of Clinical Psychology, 57, 105–117. doi: 10.1002/1097-4679(200101)57 PubMedCrossRefGoogle Scholar
  15. Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., & Smith, B. K. (2009). American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine and Science in Sports and Exercise, 41(2), 459–471. doi: 10.1249/MSS.0b013e3181949333 PubMedCrossRefGoogle Scholar
  16. Edmunds, J., Ntoumanis, N., & Duda, J. (2009). Helping your clients and patients take ownership over their exercise: Fostering exercise adoption, adherence, and associated well-being. ACSM’s Health and Fitness Journal, 13, 20–25.Google Scholar
  17. Ekkekakis, P., & Lind, E. (2006). Exercise does not feel the same when you are overweight: The impact of self-selected and imposed intensity on affect and exertion. International Journal of Obesity (London), 30, 652–660. doi: 10.1038/sj.ijo.0803052 CrossRefGoogle Scholar
  18. Elfhag, K., & Rossner, S. (2005). Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews, 6, 67–85.PubMedCrossRefGoogle Scholar
  19. Engel, S. G., Kolotkin, R. L., Teixeira, P. J., Sardinha, L. B., Vieira, P. N., Palmeira, A. L., et al. (2005). Psychometric and cross-national evaluation of a Portuguese version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. European Eating Disorders Review, 13, 133–143.CrossRefGoogle Scholar
  20. Ferreira, P. L. (2000). The development of the Portuguese version of the MOS SF-36. Part II—Validation testing [Portuguese]. Acta Médica Portuguesa, 13, 119–127.PubMedGoogle Scholar
  21. Fitzgibbon, M. L., Stolley, M. R., & Kirschenbaum, D. S. (1993). Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychology, 12, 342–345.PubMedCrossRefGoogle Scholar
  22. Ford, E. S., Moriarty, D. G., Zack, M. M., Mokdad, A. H., & Chapman, D. P. (2001). Self-reported body mass index and health-related quality of life: Findings from the Behavioral Risk Factor Surveillance System. Obesity Research, 9, 21–31.PubMedCrossRefGoogle Scholar
  23. Foster, G. D., Wadden, T. A., Swain, R. M., Stunkard, A. J., Platte, P., & Vogt, R. A. (1998). The eating inventory in obese women: Clinical correlates and relationship to weight loss. International Journal of Obesity and Related Metabolic Disorders, 22, 778–785.PubMedCrossRefGoogle Scholar
  24. Hagger, M., & Chatzisarantis, N. (2007). Intrinsic motivation and self-determination in exercise and sport. Champaign, IL: Human Kinetics.Google Scholar
  25. Jeffery, R. W., Drewnowski, A., Epstein, L. H., Stunkard, A. J., Wilson, G. T., Wing, R. R., et al. (2000). Long-term maintenance of weight loss: Current status. Health Psychology, 19, 5–16.PubMedCrossRefGoogle Scholar
  26. Joseph, R. J., Alonso-Alonso, M., Bond, D. S., Pascual-Leone, A., & Blackburn, G. L. (2011). The neurocognitive connection between physical activity and eating behaviour. Obesity Reviews, 12, 800–812. doi: 10.1111/j.1467-789X.2011.00893.x PubMedCrossRefGoogle Scholar
  27. Karlsson, J., Sjostrom, L., & Sullivan, M. (1998). Swedish obese subjects (SOS)–an intervention study of obesity. Two- year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. International Journal of Obesity and Related Metabolic Disorders, 22(2), 113–126.PubMedCrossRefGoogle Scholar
  28. Kayman, S., Bruvold, W., & Stern, J. S. (1990). Maintenance and relapse after weight loss in women: Behavioral aspects. American Journal of Clinical Nutrition, 52, 800–807.PubMedGoogle Scholar
  29. Keys, A., Brozek, J., Henschel, A., Mickelson, O., & Taylor, H. L. (Eds.). (1950). The biology of human starvation (Vol. 2). Minneapolis: University of Minnesota Press.Google Scholar
  30. Klem, M. L., Wing, R. R., McGuire, M. T., Seagle, H. M., & Hill, J. O. (1997). A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66, 239–246.PubMedGoogle Scholar
  31. Klem, M. L., Wing, R. R., McGuire, M. T., Seagle, H. M., & Hill, J. O. (1998). Psychological symptoms in individuals successful at long-term maintenance of weight loss. Health Psychology, 17, 336–345.PubMedCrossRefGoogle Scholar
  32. Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001). Development of a brief measure to assess quality of life in obesity. Obesity Research, 9, 102–111.PubMedCrossRefGoogle Scholar
  33. Kottke, T. E., Wu, L. A., & Hoffman, R. S. (2003). Economic and psychological implications of the obesity epidemic. Mayo Clinical Proceedings, 78, 92–94.CrossRefGoogle Scholar
  34. Leenders, N. Y., Sherman, W. M., Nagaraja, H. N., & Kien, C. L. (2001). Evaluation of methods to assess physical activity in free-living conditions. Medicine and Science in Sports and Exercise, 33, 1233–1240.PubMedCrossRefGoogle Scholar
  35. Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology, 25, 282–291. doi: 10.1037/0278-6133.25.3.282 PubMedCrossRefGoogle Scholar
  36. Lohman, T. G., Roche, A. F., & Martorell, R. (1991). Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Book.Google Scholar
  37. Martin, C. K., Church, T. S., Thompson, A. M., Earnest, C. P., & Blair, S. N. (2009). Exercise dose and quality of life: A randomized controlled trial. Archives of Internal Medicine, 169, 269–278. doi: 10.1001/archinternmed.2008.545 PubMedCrossRefGoogle Scholar
  38. Mata, J., Silva, M. N., Vieira, P. N., Carraça, E. V., Andrade, A. M., Coutinho, S. R., et al. (2009). Motivational “spill-over” during weight control: Increased self-determination and exercise intrinsic motivation predict eating self-regulation. Health Psychology, 28, 709–716. doi: 10.1037/a0016764 PubMedCrossRefGoogle Scholar
  39. McAuley, E., Duncan, T., & Tammen, V. V. (1989). Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: A confirmatory factor analysis. Research Quarterly for Exercise & Sport, 60, 48–58.CrossRefGoogle Scholar
  40. McGuire, M. T., Wing, R. R., Klem, M. L., Lang, W., & Hill, J. O. (1999). What predicts weight regain in a group of successful weight losers? Journal of Consulting and Clinical Psychology, 67, 177–185.PubMedCrossRefGoogle Scholar
  41. Niemeier, H. M., Phelan, S., Fava, J. L., & Wing, R. R. (2007). Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity (Silver Spring), 15, 2485–2494. doi: 10.1038/oby.2007.295 CrossRefGoogle Scholar
  42. Ogden, J. (2000). The correlates of long-term weight loss: A group comparison study of obesity. International Journal of Obesity and Related Metabolic Disorder, 24, 1018–1025.CrossRefGoogle Scholar
  43. Palmeira, A. L., Branco, T. L., Martins, S. C., Minderico, C. S., Silva, M. N., Vieira, P. N., et al. (2010). Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance. Body Image, 7, 187–193. doi: 10.1016/j.bodyim.2010.03.002 PubMedCrossRefGoogle Scholar
  44. Phelan, S., Liu, T., Gorin, A., Lowe, M., Hogan, J., Fava, J., et al. (2009). What distinguishes weight-loss maintainers from the treatment-seeking obese? Analysis of environmental, behavioral, and psychosocial variables in diverse populations. Annals of Behavioral Medicine, 38, 94–104. doi: 10.1007/s12160-009-9135-2 PubMedCrossRefGoogle Scholar
  45. Riesco, E., Rossel, N., Rusques, C., Mirepoix, M., Drapeau, V., Sanguignol, F., et al. (2009). Impact of weight reduction on eating behaviors and quality of life: Influence of the obesity degree. Obesity Facts, 2, 87–95. doi: 10.1159/000210692 PubMedCrossRefGoogle Scholar
  46. Rippe, J. M., Price, J. M., Hess, S. A., Kline, G., DeMers, K. A., Damitz, S., et al. (1998). Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. Obesity Research, 6, 208–218.PubMedCrossRefGoogle Scholar
  47. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.Google Scholar
  48. Sallis, J. F., Haskell, W. L., Wood, P. D., Fortmann, S. P., Rogers, T., Blair, S. N., et al. (1985). Physical activity assessment methodology in the Five-City Project. American Journal of Epidemiology, 121, 91–106.PubMedGoogle Scholar
  49. Sarwer, D. B., Wadden, T. A., & Foster, G. D. (1998). Assessment of body image dissatisfaction in obese women: Specificity, severity, and clinical significance. Journal of Consulting and Clinical Psychology, 66, 651–654.PubMedCrossRefGoogle Scholar
  50. Silva, M. N., Markland, D., Carraça, E. V., Vieira, P. N., Coutinho, S. R., Minderico, C. S., et al. (2011). Exercise autonomous motivation predicts 3-yr weight loss in women. Medicine and Science in Sports and Exercise, 43, 728–737. doi: 10.1249/MSS.0b013e3181f3818f PubMedCrossRefGoogle Scholar
  51. Silva, M. N., Markland, D., Minderico, C. S., Vieira, P. N., Castro, M. M., Coutinho, S. R., et al. (2008). A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: Rationale and intervention description. BMC Public Health, 8, 234. doi: 10.1186/1471-2458-8-234 PubMedCrossRefGoogle Scholar
  52. Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985–993. doi: S0022399902004889 PubMedCrossRefGoogle Scholar
  53. Stunkard, A., & Messick, S. (1985). The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research, 29, 71–83.PubMedCrossRefGoogle Scholar
  54. Stunkard, A. J., & Rush, J. (1974). Dieting and depression reexamined. A critical review of reports of untoward responses during weight reduction for obesity. Annals of Internal Medicine, 81, 526–533.PubMedCrossRefGoogle Scholar
  55. Teixeira, P. J., Going, S. B., Houtkooper, L. B., Cussler, E. C., Metcalfe, L. L., Blew, R. M., et al. (2006). Exercise motivation, eating, and body image variables as predictors of weight control. Medicine and Science in Sports and Exercise, 38, 179–188.PubMedCrossRefGoogle Scholar
  56. Teixeira, P. J., Going, S. B., Sardinha, L. B., & Lohman, T. G. (2005). A review of psychosocial pre-treatment predictors of weight control. Obesity Reviews, 6, 43–65.PubMedCrossRefGoogle Scholar
  57. Teixeira, P. J., Silva, M. N., Coutinho, S. R., Palmeira, A. L., Mata, J., Vieira, P. N., et al. (2010). Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring), 18, 725–735.CrossRefGoogle Scholar
  58. Vieira, P. N., Mata, J., Silva, M. N., Coutinho, S. R., Santos, T. C., Minderico, C. S., et al. (2011). Predictors of psychological well-being during behavioral obesity treatment in women. Journal of Obesity, 2011, 936153. doi: 10.1155/2011/936153 PubMedCrossRefGoogle Scholar
  59. Vieira, P. N., Silva, M. N., Mata, J., Coutinho, S. R., Santos, T. C., Sardinha, L. B., et al. (in submission). Successful weight loss maintenance in Portugal: The National Weight Control Registry [Sucesso na manutenção do peso perdido em Portugal: O Registo Nacional de Controlo do Peso].Google Scholar
  60. Ware, J. E., Jr., & Kosinski, M. (2001). SF-36 Physical and mental health summary scales: A manual for users of version 1 (2nd ed.). Lincoln, RI: Qualitymetric.Google Scholar
  61. Ware, J., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston, MA: New England Medical Center, The Health Institute.Google Scholar
  62. Washburn, R. A., Jacobsen, D. J., Sonko, B. J., Hill, J. O., & Donnelly, J. E. (2003). The validity of the Stanford Seven-Day Physical Activity Recall in young adults. Medicine and Science in Sports and Exercise, 35, 1374–1380.PubMedCrossRefGoogle Scholar
  63. Weiss, S. R., & Ebert, M. H. (1983). Psychological and behavioral characteristics of normal-weight bulimics and normal-weight controls. Psychosomatic Medicine, 45, 293–303.PubMedGoogle Scholar
  64. Westenhoefer, J. (1991). Dietary restraint and disinhibition: Is restraint a homogeneous construct? Appetite, 16, 45–55.PubMedCrossRefGoogle Scholar
  65. Westenhoefer, J., Stunkard, A. J., & Pudel, V. (1999). Validation of the flexible and rigid control dimensions of dietary restraint. International Journal of Eating Disorders, 26, 53–64. doi: 10.1002/(SICI)1098 PubMedCrossRefGoogle Scholar
  66. Williamson, D. A., Davis, C. J., Bennett, S. M., Goreczny, A. J., & Gleaves, D. H. (1989). Development of a simple procedure for assessing body image disturbances. Behavioral Assessment, 15, 57–68.CrossRefGoogle Scholar
  67. Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. American Journal of Clinical Nutrition, 82, 222S–225S. doi: 82/1/222S PubMedGoogle Scholar
  68. Wyatt, S. B., Winters, K. P., & Dubbert, P. M. (2006). Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. American Journal of the Medical Sciences, 331, 166–174.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Paulo N. Vieira
    • 1
  • Marlene N. Silva
    • 1
  • Jutta Mata
    • 1
  • Sílvia R. Coutinho
    • 1
  • Teresa C. Santos
    • 1
  • Luís B. Sardinha
    • 1
  • Pedro J. Teixeira
    • 1
  1. 1.Interdisciplinary Center for the Study of Human Performance, Faculty of Human KineticsTechnical University of LisbonCruz-QuebradaPortugal

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