International Journal of Behavioral Medicine

, Volume 17, Issue 3, pp 168–175 | Cite as

Psychological Factors Discriminating Between Successful and Unsuccessful Weight Loss in a Behavioral Exercise and Nutrition Education Treatment

  • James J. AnnesiEmail author
  • Ann C. Whitaker



Psychological and behavioral characteristics that predict success or failure with weight-loss treatments are poorly understood.


The purpose of this study was to assess whether social cognitive theory-based factors discriminate between women who are successful and unsuccessful at weight loss.


Obese women (BMI = 30 to 45 kg/m2) who participated in a treatment of behavioral exercise support counseling and nutrition education were divided into quartiles based on percentage of body weight lost over 6 months. Factors based on social cognitive theory, both at baseline and change over 6 months, and exercise attendance were used to discriminate between the successful (highest quartile, Mchange in body weight = −9.3%; n = 40) and unsuccessful (lowest quartile, Mchange in body weight = 1.9%; n = 37) groups.


Stepwise discriminant analyses indicated that body satisfaction and tension (anxiety) scores at baseline, and changes over 6 months in self-regulatory efficacy and body satisfaction, made significant contributions to predicting group membership (64% and 69% of cases were correctly classified, respectively). Attendance percentage of exercise sessions was significantly greater for the successful weight-loss group, and when added as a predictor, changes in self-regulatory efficacy and attendance made a significant contribution to predicting group membership (81% of cases were correctly classified).


Further research may enable psychological determinants to better guide weight loss theory and treatments.


Exercise Weight loss Social cognitive Behavioral Self-efficacy Physical activity 


  1. 1.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Obesity among U.S. children, adolescents, and adults, 1999–2002. J Am Med Assoc. 2004;291:2847–50.CrossRefGoogle Scholar
  2. 2.
    World Health Organization (2008) Obesity and overweight. Retrieved September 26, 2008, from
  3. 3.
    Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for controlling weight. J Am Med Assoc. 1999;282:1353–8.CrossRefGoogle Scholar
  4. 4.
    Byrne SM, Cooper Z, Fairburn CG. Psychological predictors of weight regain in obesity. Behavior Research and Therapy. 2004;42:1341–56.CrossRefGoogle Scholar
  5. 5.
    Mann T, Tomiyama J, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62:220–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Kruger J, Blanck HM, Gillespie C. Dietary and physical activity behaviors among adults successful at weight loss maintenance. International Journal of Behavioral Nutrition and Physical Activity. 2006;3:17. Scholar
  7. 7.
    Elfhag K, Rossner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and regain. Obes Rev. 2005;6:67–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Tiexiera PJ, Going SB, Houtkooper LB, Cussler EC, Martin CJ, Metcalfe LL, et al. Weight loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction. J Behav Med. 2002;25:499–523.CrossRefGoogle Scholar
  9. 9.
    Tiexiera PJ, Palmeira AL, Branco TL, Martins SS, Minderico CS, Brata JT, et al. Who will lose weight? A reexamination of predictors of weight loss in women. International Journal of Behavioral Nutrition and Physical Activity. 2004;1:12. doi: 10.1186/1479-5868-1-12. Scholar
  10. 10.
    Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise, or diet plus exercise intervention. Int J Obes. 1997;21:941–7.CrossRefGoogle Scholar
  11. 11.
    Pronk NP, Wing RR. Physical activity and long-term maintenance of weight loss. Obes Res. 1994;2:587–99.PubMedGoogle Scholar
  12. 12.
    Brownell KD. Exercise and obesity treatment: psychological aspects. Int J Obes Relat Metab Disord. 1995;10(Suppl):122–5.Google Scholar
  13. 13.
    Annesi JJ. Effects of a cognitive behavioral treatment package on exercise attendance and drop out in fitness centers. European Journal of Sport Science. 2003;3(2):1–16.CrossRefGoogle Scholar
  14. 14.
    Buckworth J, Dishman RK. Exercise psychology. Champaign, IL: Human Kinetics; 2002.Google Scholar
  15. 15.
    Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise. 2008;40:181–8.Google Scholar
  16. 16.
    Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; 1986.Google Scholar
  17. 17.
    Bandura A. Self-efficacy: the exercise of control. New York, NY: Freeman; 1997.Google Scholar
  18. 18.
    Baker CW, Brownell KD. Physical activity and maintenance of weight loss: physiological and psychological mechanisms. In: Bouchard C, editor. Physical activity and obesity. Champaign, IL: Human Kinetics; 2000. p. 311–28.Google Scholar
  19. 19.
    Annesi JJ. Relations of changes in exercise self-efficacy, physical self-concept, and body satisfaction with weight changes in obese White and African American women initiating a physical activity program. Ethn Dis. 2007;17:19–22.PubMedGoogle Scholar
  20. 20.
    Annesi JJ, Whitaker AC. Weight loss and psychologic gain in obese women - participants in a supported exercise intervention. Permanente Journal. 2008;12(3):36–45.Google Scholar
  21. 21.
    McAuley E, Peña MM, Jerome GJ. Self-efficacy as a determinant and an outcome of exercise. In: Roberts G, editor. Advances in motivation in sport and exercise. Champaign, IL: Human Kinetics; 2001. p. 235–61.Google Scholar
  22. 22.
    Annesi JJ. Effects of minimal exercise and cognitive behavior modification on adherence, emotion change, self-image, and physical change in obese women. Percept Mot Skills. 2000;91:322–36.CrossRefPubMedGoogle Scholar
  23. 23.
    Landers DM, Arent SM. Physical activity and mental health. In: Singer RN, Hausenblas HA, Janelle CM, editors. Handbook of sport psychology. 2nd ed. New York: Wiley; 2001. p. 740–65.Google Scholar
  24. 24.
    Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol. 2008;30:392–410.PubMedGoogle Scholar
  25. 25.
    Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med. 1998;15:266–97.CrossRefPubMedGoogle Scholar
  26. 26.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63:60–6.PubMedGoogle Scholar
  28. 28.
    McAuley E, Mihalko SL. Measuring exercise-related self-efficacy. In: Duda JL, editor. Advances in sport and exercise psychology measurement. Morgantown, WV: Fitness Information Technology; 1998. p. 371–90.Google Scholar
  29. 29.
    Fitts WH, Warren WL. Tennessee Self-Concept Scale manual. 2nd ed. Los Angeles, CA: Western Psychological Services; 1996.Google Scholar
  30. 30.
    Popkess-Vawter S, Banks N. Body image measurement in overweight females. Clin Nurs Res. 1992;1:402–17.CrossRefPubMedGoogle Scholar
  31. 31.
    Cash TF. The Multidimensional Body-Self Relations Questionnaire users’ manual. Norfolk, VA: Old Dominion University; 1994.Google Scholar
  32. 32.
    McNair DM, Lorr M, Droppleman LF. Manual for the Profile of Mood States. San Diego, CA: Education and Industrial Testing Service; 1992.Google Scholar
  33. 33.
    Jackson AS, Pollock ML. Practical assessment of body composition. Phys Sportsmed. 1985;13:76–90.Google Scholar
  34. 34.
    Kaiser Permanente Health Education Services. Cultivating Health weight management resource guide. Portland, OR: Author; 2002.Google Scholar
  35. 35.
    Annesi JJ, Unruh JL. Effects of THE COACH APPROACH® intervention on drop out rates among adults initiating exercise programs at nine YMCAs over three years. Percept Mot Skills. 2007;104:459–66.CrossRefPubMedGoogle Scholar
  36. 36.
    Borg G. Borg’s perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998.Google Scholar
  37. 37.
    Gadbury GL, Coffey CS, Allison DB. Modern statistical methods for handling missing repeated measurements in obesity trial data: beyond LOCF. Obes Rev. 2003;4:175–84.CrossRefPubMedGoogle Scholar
  38. 38.
    Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, et al. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19(Suppl):5–16.CrossRefPubMedGoogle Scholar
  39. 39.
    Toobert DJ, Stryker LA, Glaskow RE, Barrera M, Angell K. Effects of the Mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Annals Behav Med. 2005;29:128–37.CrossRefGoogle Scholar
  40. 40.
    Warziski MT, Sereika SM, Styn MA, Music E, Burke LE. Changes in self-efficacy and dietary adherence: the impact on weight loss in the PREFER study. J Behav Med. 2008;31:81–92.CrossRefPubMedGoogle Scholar
  41. 41.
    Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial weight loss program. Obes Res. 2004;12:1011–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.CrossRefGoogle Scholar
  43. 43.
    Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8:3–15.CrossRefPubMedGoogle Scholar
  44. 44.
    Jaccard J. Interaction effects in factorial analysis of variance: Sage University paper series on quantitative applications in the social sciences, series no. 07-118. Thousand Oaks, CA: Sage; 1998.Google Scholar
  45. 45.
    Holm D. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;6:65–70.Google Scholar
  46. 46.
    Kromery JD, Dickson WB. The use of an overall F test to control Type I error rates in factoral analysis of variance: limitations and better strategies. JAppl Behav Anal. 1995;31:51–64.Google Scholar
  47. 47.
    Jakicic JM, Wing RR, Winters-Hart C. Relationship of physical activity to eating behaviors and weight-loss treatment. Medicine & Science in Sports & Exercise. 2002;34:1653–9.CrossRefGoogle Scholar
  48. 48.
    O’Brien K, Venn BJ, Perry T, Green TJ, Aitken W, Bradshaw A, et al. Reasons for wanting to lose weight: different strokes for different folks. Eat Behav. 2007;8:132–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Glasgow RE. What types of evidence are most needed to advance behavioral medicine? Annals Behav Med. 2008;35:19–25.Google Scholar
  50. 50.
    Wilfley DE, Brownell KD. Physical activity and diet in weight loss. In: Dishman RK, editor. Advances in exercise adherence. Champaign, IL: Human Kinetics; 1994. p. 361–93.Google Scholar

Copyright information

© International Society of Behavioral Medicine 2009

Authors and Affiliations

  1. 1.YMCA of Metropolitan AtlantaAtlantaUSA
  2. 2.Kaiser PermanenteAtlantaUSA

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