Theory-based psychosocial factors that discriminate between weight-loss success and failure over 6 months in women with morbid obesity receiving behavioral treatments

Original Article

Abstract

Purpose

To improve success rates of behavioral weight-loss treatments, a better understanding of psychosocial factors that discriminate between weight-loss success and failure is required. The inclusion of cognitive–behavioral methods and manageable amounts of exercise might induce greater improvements than traditional methods of education in healthy eating practices.

Methods

Women with morbid obesity [body mass index (BMI) ≥40 kg/m2] were recruited for a treatment of supported exercise paired with either a cognitive–behavioral or an educational approach to eating change over 6 months. They were classified as either successful with (i.e., at least 5 % loss; n = 40) or failed at (no loss, or weight gain; n = 43) weight loss. Discriminate function analysis incorporated theory-based models of 1 (self-efficacy), 5 (self-efficacy, self-regulation, mood, physical self-concept, body satisfaction), and 3 (self-efficacy, self-regulation, mood) psychosocial predictors at both month 6, and change from baseline–month 6.

Results

All three models significantly discriminated weight-loss success/failure (66, 88, and 87 % for success; and 81, 87, and 88 % for failure, respectively). Self-regulation had the strongest correlations within the multi-predictor models (0.90–0.96), and all variables entered were above the standard of 0.30 set for relevance. Participants in the cognitive–behavioral nutrition group demonstrated significantly greater improvements in all psychosocial variables and success with weight loss. Completing at least two sessions of exercise per week predicted success/failure with weight loss better than overall volume of exercise.

Conclusions

New and relevant findings regarding treatment-induced psychosocial changes might be useful in the architecture of more successful behavioral weight-loss interventions.

Keywords

Obesity Weight loss Psychological factors Behavioral theory 

Notes

Acknowledgment

We acknowledge Ms. Kristin McEwen for her role in data collection within this study.

Conflict of interest

For this study the authors declare no conflict of interest.

References

  1. 1.
    Mann T, Tomiyama J, Westling E, Lew AM, Samuels B, Chatman J (2007) Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol 62:220–233. doi: 10.1037/0003-066X.62.3.220 CrossRefPubMedGoogle Scholar
  2. 2.
    Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR et al (2000) Long-term maintenance of weight loss: current status. Health Psychol 19(suppl):5–16. doi: 10.1037/0278-6133.19.Suppl1.5 CrossRefPubMedGoogle Scholar
  3. 3.
    Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79. doi: 10.1001/jama.289.1.76 CrossRefPubMedGoogle Scholar
  4. 4.
    Andreyeva T, Sturm R, Ringle JS (2004) Moderate and severe obesity have large differences in health care costs. Obes Res 12:1936–1943. doi: 10.1038/oby.2004.243 CrossRefPubMedGoogle Scholar
  5. 5.
    Santry HP, Gillen DL, Lauderdale DS (2005) Trends in bariatric surgical procedures. JAMA 15:1909–1917. doi: 10.1001/jama.294.15.1909 CrossRefGoogle Scholar
  6. 6.
    Wing RR (1999) Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 31(suppl 11):S547–S552. doi: 10.1097/00005768-199911001-00010 CrossRefPubMedGoogle Scholar
  7. 7.
    Fogelholm M, Kukkonen-Harjula K (2000) Does physical activity prevent weight gain—a systematic review. Obes Rev 1:95–111. doi: 10.1046/j.1467-789x.2000.00016.x CrossRefPubMedGoogle Scholar
  8. 8.
    Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM et al (2008) Comparison of strategies for sustaining weight loss. JAMA 299:1139–1148. doi: 10.1001/jama.299.10.1139 CrossRefPubMedGoogle Scholar
  9. 9.
    Baker CW, Brownell KD (2000) Physical activity and maintenance of weight loss: physiological and psychological mechanisms. In: Bouchard C (ed) Physical activity and obesity. Human Kinetics, Champaign, pp 311–328Google Scholar
  10. 10.
    American College of Sports Medicine (2009) Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 41:459–471. doi: 10.1249/MSS.0b013e3181949333 Google Scholar
  11. 11.
    Buckworth J, Dishman RK (2002) Exercise psychology. Human Kinetics, ChampaignGoogle Scholar
  12. 12.
    Strong SM, Williamson DA, Netemeyer RG, Geer JH (2000) Eating disorder symptoms and concerns about body differ as a function of gender and sexual orientation. J Soc Clin Psychol 19:240–255. doi: 10.1521/jscp.2000.19.2.240 CrossRefGoogle Scholar
  13. 13.
    Annesi JJ, Unruh JL, Marti CN, Gorjala S, Tennant G (2011) Effects of The Coach Approach intervention on adherence to exercise in obese women: assessing mediation of social cognitive theory factors. Res Q Exerc Sport 82:99–108. doi: 10.1080/02701367.2011.10599726 CrossRefPubMedGoogle Scholar
  14. 14.
    Rothman AJ (2004) Is there nothing more practical than a good theory: why innovations and advances in health behavior change will arise if interventions are used to test theory. Int J Behav Nutr Phys Act 1:11. doi: 10.1186/1479-5868-1-11 CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Huisman S, Maes S, De Gucht VJ, Chatrou M, Haak HR (2010) Low goal ownership predicts drop-out from a weight intervention study in overweight patients with type 2 diabetes. Int J Behav Med 17:176–181. doi: 10.1007/s12529-009-9071-3 CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Andrade AM, Coutinho SR, Silva MN, Mata J, Viera PN, Minderico CS et al (2010) The effect of physical activity on weight loss is mediated by eating self-regulation. Patient Educ Couns 79:320–326. doi: 10.1016/j.pec.2010.01.006 CrossRefPubMedGoogle Scholar
  17. 17.
    de Bruin M, Sheeran P, Kok G, Hiemstra A, Prins JM, Hospers HJ et al (2012) Self-regulatory processes mediate the intention-behavior relation for adherence and exercise behaviors. Health Psychol 31:695–703. doi: 10.1037/a0027425 CrossRefPubMedGoogle Scholar
  18. 18.
    Annesi JJ (2011) Self-regulatory skills usage strengthens the relations of self-efficacy for improved eating, exercise, and weight in the severely obese: toward an explanatory model. Behav Med 37:71–76. doi: 10.1080/08964289.2011.579643 CrossRefPubMedGoogle Scholar
  19. 19.
    Anderson ES, Winett RA, Wojcik JR, Williams DM (2010) Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: social support, self-efficacy, outcome expectations, and self-regulation in the guide-to-health trial. J Health Psychol 15:21–32. doi: 10.1177/1359105309342297 CrossRefPubMedGoogle Scholar
  20. 20.
    Anderson ES, Winett RA, Wojcik JR, Williams DM (2007) Self-regulation, self-efficacy outcome expectations, and social support: social cognitive theory and nutrition behavior. Ann Behav Med 34:304–312CrossRefPubMedGoogle Scholar
  21. 21.
    Teixeira PJ, Silva MN, Coutinho SR, Palmiera AL, Mata J, Viera PN et al (2009) Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity 18:725–735. doi: 10.1038/oby.2009.281 CrossRefPubMedGoogle Scholar
  22. 22.
    Warzinski MT, Sereika SM, Styn MA, Music E, Burke LE (2008) Changes in self-efficacy and dietary adherence: the impact on weight change in the PREFER study. J Behav Med 31:81–92. doi: 10.1007/s10865-007-9135-2 CrossRefGoogle Scholar
  23. 23.
    Linde JA, Rothman AJ, Baldwin AS, Jeffrey RW (2006) The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychol 25:282–291. doi: 10.1037/0278-6133.25.3.282 CrossRefPubMedGoogle Scholar
  24. 24.
    Annesi JJ, Tennant GA (2013) Exercise program-induced mood improvement and improved eating in severely obese adults. Int Q Community Health Edu 33:391–402. doi: 10.2190/IQ.33.4.f CrossRefGoogle Scholar
  25. 25.
    Palmiera AL, Markland DA, Silva MN, Branco TL, Martins SC, Minderico CS, et al. (2009) Reciprocal effects among changes in weight, body image, and other behavioral factors during behavioral obesity treatment: a mediation analysis. Int J Behav Nutr Phys Act 6:9. doi: 10.1186/1479-5868-6-9. http://www.ijbnpa.org/content/6/1/9
  26. 26.
    Mata J, Silva MN, Vieira PN, Carraça EV, Andrade AM, Coutinho SR (2009) Motivational “spill-over” during weight control: increased self-determination and exercise intrinsic motivation predict eating self-regulation. Health Psychol 28:709–716. doi: 10.1037/a0016764 CrossRefPubMedGoogle Scholar
  27. 27.
    Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL (2006) A self-regulation program for maintenance of weight loss. N Engl J Med 355:1563–1571. doi: 10.1056/NEJMoa061883 CrossRefPubMedGoogle Scholar
  28. 28.
    Diabetes Prevention Program Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25:2165–2171CrossRefGoogle Scholar
  29. 29.
    Diabetes Prevention Program Research Group (2009) 10-year follow-up of diabetes and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374:1677–1686. doi: 10.1016/S0140-6736(09)61457-4 CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E et al (2010) Testing a new cognitive behavioural treatment for obesity: a randomized controlled trial with three-year follow-up. Behav Res Ther 48:706–713. doi: 10.1016/j.brat.2010.03.008 CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice Hall, Englewood CliffsGoogle Scholar
  32. 32.
    Bandura A (1997) Self-efficacy: the exercise of control. Freeman, GordonsvilleGoogle Scholar
  33. 33.
    Annesi JJ (2012) Supported exercise improves controlled eating and weight through its effects on psychosocial factors: extending a systematic research program toward treatment development. Perm J 16(1):7–18CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Annesi JJ, Marti CN (2011) Path analysis of cognitive–behavioral exercise treatment-induced changes in psychological factors leading to weight loss. Psychol Health 26:1081–1098. doi: 10.1080/08870446.2010.534167 CrossRefPubMedGoogle Scholar
  35. 35.
    Willett WC, Dietz WH, Colditz GA (1999) Guidelines for healthy weight. N Engl J Med 341:427–434. doi: 10.1056/NEJM199908053410607 CrossRefPubMedGoogle Scholar
  36. 36.
    Flechtner-Mors M, Ditschuneit HH, Johnson TD, Suchard MA, Adler G (2000) Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res 8:399–402. doi: 10.1038/oby.2000.48 CrossRefPubMedGoogle Scholar
  37. 37.
    Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO (2005) Exercise treatment for depression: efficacy and dose response. Am J Prev Med 28:1–8CrossRefPubMedGoogle Scholar
  38. 38.
    Annesi JJ, Tennant GA (2014) Generalization of theory-based predictions for improved nutrition and weight loss to adults with morbid obesity: implications of initiating exercise. Int J Clin Health Psychol 14:1–8CrossRefGoogle Scholar
  39. 39.
    Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001. doi: 10.1249/01.MSS.0000038974.76900.92 CrossRefPubMedGoogle Scholar
  40. 40.
    Saelens BE, Gehrman CA, Sallis JF, Calfas KJ, Sarkin JA, Caparosa S (2000) Use of self-management strategies in a 2-year cognitive–behavioral intervention to promote physical activity. Behav Ther 31:365–379. doi: 10.1016/S0005-7894(00)80020-9 CrossRefGoogle Scholar
  41. 41.
    Baumeister RF, Vohs KD, Tice DM (2007) The strength model of self-control. Curr Dir Psychol Sci 16:351–355. doi: 10.1111/j.1467-8721.2007.00534.x CrossRefGoogle Scholar
  42. 42.
    Marcus BH, Selby VC, Niaura RS, Rossi JS (1992) Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport 63:60–66. doi: 10.1080/02701367.1992.10607557 CrossRefPubMedGoogle Scholar
  43. 43.
    Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS (1991) Self-efficacy in weight management. J Consult Clin Psychol 59:739–744. doi: 10.1037/0022-006X.59.5.739 CrossRefPubMedGoogle Scholar
  44. 44.
    McNair DM, Heuchert JWP (2005) Profile of Mood States technical update. Multi-Health Systems, North TonawandaGoogle Scholar
  45. 45.
    Fitts WH, Warren WL (1996) Tennessee Self-Concept Scale manual, 2nd edn. Western Psychological Services, Los AngelesGoogle Scholar
  46. 46.
    Popkess-Vawter S, Banks N (1992) Body image measurement in overweight females. Clin Nurs Res 1:402–417. doi: 10.1177/105477389200100408 CrossRefPubMedGoogle Scholar
  47. 47.
    Cash TF (1994) The Multidimensional Body-Self Relations Questionnaire users’ manual. Old Dominion University, NorfolkGoogle Scholar
  48. 48.
    Godin G (2011) The Godin–Shephard Leisure-Time Physical Activity Questionnaire. Health Fit J Can 4(1):18–22Google Scholar
  49. 49.
    Jetté M, Sidney K, Blümchen G (1990) Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 18:555–565. doi: 10.1002/clc.4960130809 CrossRefGoogle Scholar
  50. 50.
    Godin G, Shephard RJ (1985) A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10:141–146PubMedGoogle Scholar
  51. 51.
    Jacobs DR, Ainsworth BE, Hartman TJ, Leon AS (1993) A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sport Exerc 25:81–91CrossRefGoogle Scholar
  52. 52.
    Miller DJ, Freedson PS, Kline GM (1994) Comparison of activity levels using Caltrac accelerometer and five questionnaires. Med Sci Sport Exerc 26:376–382Google Scholar
  53. 53.
    Kaiser Permanente Health Education Services (2008) Cultivating health weight management kit, 8th edn. Kaiser Permanente Northwest, PortlandGoogle Scholar
  54. 54.
    Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177. doi: 10.1037/1082-989X.7.2.147 CrossRefPubMedGoogle Scholar
  55. 55.
    Glymour MM, Weuve J, Berkman LF, Kawachi I, Robins JM (2005) When is baseline adjustment useful in analyses of change? An example with education and cognitive change. Am J Epidemiol 162:267–278. doi: 10.1093/aje/kwi187 CrossRefPubMedGoogle Scholar
  56. 56.
    Grimm LG, Yarnold PR (eds) (1995) Reading and understanding multivariate statistics. American Psychological Association, Washington DCGoogle Scholar
  57. 57.
    Hsieh FY, Bloch DA, Larsen MD (1998) A simple methods of sample size calculation for linear and logistic regression. Stat Med 17:1623–1634CrossRefPubMedGoogle Scholar
  58. 58.
    Tabachnick BG, Fidell LS (1996) Using multivariate statistics. Harper Collins, New YorkGoogle Scholar
  59. 59.
    Diekhoff GM (1992) Statistics for the social and behavioral sciences: univariate, bivariate, multivariate. Brown, DubuqueGoogle Scholar
  60. 60.
    Kruger J, Blanck HM, Gillespie C (2006) Dietary and physical activity behaviors among adults successful at weight loss maintenance. Int J Behav Nutr Phys Act 3:17. doi: 10.1186/1479-5868-3-17 CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Tiexiera PJ, Going SB, Houtkooper LB, Cussler EC, Martin CJ, Metcalfe LL et al (2002) Weight loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction. J Behav Med 25:499–523. doi: 10.1023/A:1020687832448 CrossRefGoogle Scholar
  62. 62.
    Annesi JJ, Whitaker AC (2010) Psychological factors discriminating between successful and unsuccessful weight loss in a behavioral exercise and nutrition education treatment. Int J Behav Med 17:168–175. doi: 10.1007/s12529-009-9056-2 CrossRefPubMedGoogle Scholar
  63. 63.
    Bandura A (2005) The primacy of self-regulation in health promotion. Appl Psychol Int Rev 54:245–254CrossRefGoogle Scholar
  64. 64.
    Morgan WP (1997) Methodological considerations. In: Morgan WP (ed) Physical activity and mental health. Taylor & Francis, Washington DCGoogle Scholar
  65. 65.
    Nunally JC, Bernstein IH (1994) Psychometric theory, 2nd edn. McGraw-Hill, New YorkGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.YMCA of Metro AtlantaAtlantaUSA
  2. 2.Kennesaw State UniversityKennesawUSA

Personalised recommendations