Self-efficacy and self-motivation as predictors of weight loss

Physical Activity Determinants in Adults

The determinants of physical activity in adults were explored in this study. Explanatory variables included perceived benefits of and perceived barriers to physical activity, and perceived self efficacy for physical activity. Inactive participants were asked to identify barriers to activity, and active participants cited cues prompting them to adopt a physically active lifestyle. Data were collected from 137 adults obtained from work sites, an evening college program, and church groups. Overall, participants were physically active. Self efficacy was the only variable to predict physical activity. Race (i.e., being White) and body mass index (i.e., being overweight) explained perceived barriers to activity. The primary reason for inactivity was lack of time, and the most frequently cited cues to activity were dissatisfaction with one's weight or appearance. Few nursing studies have attempted to increase participants' levels of self efficacy. However, the occupational health nurse is in a unique position to increase workers' perceived self efficacy for activity and, in turn, their activity levels.

Understandings of Health

The purpose of the study was to discover what the concept of health means to the participants and to determine how an organization can assist its members in developing and maintaining their notion of health. The participants for this study were drawn from the employees at a post secondary educational institution. Tape recorded interviews were transcribed by the researcher, and the transcripts were analyzed for common topics and predominant themes.

Imbedded in the data were four themes that provided an over arching conceptual framework from which to view health and health promoting activities: well being as a broad definition of health; the concept of balance as a prime contributor to health; the notion of self efficacy in determining one's health, and the value of caring as a significant determinant of health.

Findings of the study have significance for individual health, organizations and health, health promoters, and further research.

Two-year outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement: A protocol for a randomized clinical trial

Background

As the prevalence of hip pathology in the younger athletic population rises, the medical community continues to investigate effective intervention options. Femoracetabular impingement is the morphologically abnormal articulation of the femoral head against the acetabulum, and often implicated in pre-arthritic hip conditions of musculoskeletal nature. Arthroscopic surgical decompression and non-surgical rehabilitation programs focused on strengthening and stability are common interventions. However, they have never been directly compared in clinical trials.

The primary purpose of this study will be to assess the difference in outcomes between these 2 commonly utilized interventions for femoracetabular impingement.

Methods

The study will be a single site, non-inferiority, randomized controlled trial comparing two different treatment approaches (surgical and nonsurgical) for FAI. The enrollment goal is for a total of 80 subjects with a diagnosis of Femoracetabular impingement that are surgical candidates and have failed 6 weeks of conservative treatment. This will be a convenience sample of consecutive patients that are Tricare beneficiaries and seeking care at Madigan Army Medical Center. Patients that meet the criteria will be screened, provide written consent before enrollment, and then randomized into one of two arms (Group I = hip arthroscopy, Group II = physical therapy). Group I will undergo hip arthroscopy with or without labral repair. Group II will follow an impairment based physical therapy program consisting of 2 sessions per week for 6 weeks. The primary outcome will be the Hip Outcome Score and secondary measures will include the International Hip Outcome Tool and the Global Rating of Change. Measures will be taken at baseline, 6 months, 1 and 2 years. Hip-related healthcare utilization between both groups will also be assessed at the end of 2 years.

Discussion

The current evidence to support both surgical and conservative interventions for femoroacetabular impingement is based on low-level research. To date, none of these interventions have been directly compared in a randomized clinical trial. Clinical trials are needed to help establish the value of these interventions in the management of femoracetabular impingement and to help define appropriate clinical pathways.

Trial registration

NCT01993615 30 October 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-0914-1) contains supplementary material, which is available to authorized users.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

False and true pre-treatment predictors of weight loss in obese patients starting a program for lifestyle change

PURPOSE

Weight loss treatment effectiveness and cost-effectiveness may be improved by the identification of patients who are more prone to participate and gain benefit from specific interventions. Aim of the present study is to identify easily available additional predictors of weight loss among data usually present in the medical records of obese/overweight patients attending an outpatient clinic for a non-pharmacological lifestyle change program.

RESULTS

268 patients, 74 men and 195 women (age 43.2 ± 11.9 years, BMI 38.9 ± 6.8 kg/m(2)) were enrolled. Among these patients, only 35.6 % men and 22.7 % women completed the 6-month protocol. Among participants, 50.7 % lost at least 5 % initial body weight after 6 months (SUCCESSES), while 49.3 % failed (FAILURES). Baseline nutritional parameters (total Kcal, lipid, carbohydrate, protein and alcohol intake) were not significantly different in successes when compared to failures, while a significant difference between groups was observed for baseline diastolic blood pressure (DBP); free fat mass (FFM); muscle mass (MM); total body water (TBW); HDL cholesterol; ALT; AST; γGT. After dividing into quartiles the not-normally distributed variables, successes had AST values above median (3rd and 4th quartiles; χ (2) = 0.003). At multivariate analysis (linear regression), the OR was 3.34 (1.42-7.85; p = 0.006).

CONCLUSIONS

In our patients, baseline liver enzyme levels (AST in particular), but not baseline quantitative and qualitative dietary intake, were significantly different in successes versus failures and could therefore represent a predictor of success. In conclusion, AST could represent a usually available biomarker that could be used as a predictor of outcome (weight loss) in obese patients starting a lifestyle change program.

The association between self-efficacy and hypertension self-care activities among African American adults

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08-1.39), not smoking (PR = 1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.

Motivational readiness for treatment in weight control programs: the TREatment MOtivation and REadiness (TRE-MORE) test

BACKGROUND AND AIMS

The degree of motivation before starting the treatment represents a pre-treatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment MOtivation and REadiness test) (TRE-MORE) for overweight patients.

METHODS AND RESULTS

TRE-MORE was evaluated in a consecutive series of 129 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity. Subjects have been evaluated by means of a clinical interview, and different self-reported questionnaires, assessing the eating specific and general psychopathology, and quality of life. TRE-MORE total and subscales scores showed good test-retest reliability and internal consistency. We identified 10 items grouped in 3 areas (obstacles and desire to overcome, taking care of themselves, and sharing the problems, current lifestyle). TREMORE scores were significantly correlated with eating specific psychopathology and quality of life measures. Univariate and Receiver Operating Characteristic curve analysis showed that TRE-MORE total and subscales scores represent a good model for predicting a weight loss >5% of the initial weight after 6 months of treatment.

CONCLUSION

TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime the treatment motivation and readiness with good predictive capacity for weight loss.

Prevalence and predictors of weight-loss maintenance in a biracial cohort: results from the coronary artery risk development in young adults study

BACKGROUND

Few population-based studies have examined the behavioral and psychosocial predictors of long-term weight-loss maintenance.

PURPOSE

The goal of this study was to determine the prevalence and predictors of weight-loss maintenance in a biracial cohort of younger adults.

METHODS

This study examined a population-based sample of overweight/obese African-American and white men and women who had ≥ 5% weight loss between 1995 and 2000. Subsequent changes in weight, physical activity, and behavioral and psychosocial factors were examined between 2000 and 2005. Analyses were conducted in 2008-2009.

RESULTS

Among the 1869 overweight/obese individuals without major disease in 1995, a total of 536 (29%) lost ≥ 5% between 1995 and 2000. Among those who lost weight, 34% (n=180) maintained at least 75% of their weight loss between 2000 and 2005, whereas 66% subsequently regained. Higher odds of successful weight-loss maintenance were related to African-American race (OR=1.7, p=0.03); smoking (OR=3.4, p=0.0001); history of diabetes (OR=2.2, p=0.04); increases in moderate physical activity between 2000 and 2005 (OR=1.4, p=0.005); increases in emotional support over the same period (OR=1.6, p=0.01); and less sugar-sweetened soft drink consumption in 2005 (OR=0.8, p=0.006).

CONCLUSIONS

One third of overweight men and women who lost weight were able to maintain 75% or more of their weight loss over 5 years. Interventions to promote weight-loss maintenance may benefit from targeting increased physical activity and emotional support and decreased sugar-sweetened soft drink consumption.

Motivational readiness for treatment in weight control programs: the TREatment MOtivation and REadiness (TRE-MORE) test

BACKGROUND AND AIMS

The degree of motivation before starting the treatment represents a pre-treatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment MOtivation and REadiness test) (TRE-MORE) for overweight patients.

METHODS AND RESULTS

TRE-MORE was evaluated in a consecutive series of 129 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity. Subjects have been evaluated by means of a clinical interview, and different self-reported questionnaires, assessing the eating specific and general psychopathology, and quality of life. TRE-MORE total and subscales scores showed good test-retest reliability and internal consistency. We identified 10 items grouped in 3 areas (obstacles and desire to overcome, taking care of themselves, and sharing the problems, current lifestyle). TREMORE scores were significantly correlated with eating specific psychopathology and quality of life measures. Univariate and Receiver Operating Characteristic curve analysis showed that TRE-MORE total and subscales scores represent a good model for predicting a weight loss >5% of the initial weight after 6 months of treatment.

CONCLUSION

TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime the treatment motivation and readiness with good predictive capacity for weight loss.

Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?

Background

Physicians are encouraged to counsel obese patients to lose weight, but studies measuring the quality of physicians' counseling are rare. We sought to describe the quality of physicians' obesity counseling and to determine associations between the quality of counseling and obese patients' motivation and intentions to lose weight, key predictors of behavior change.

Methods

We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation.

Results

137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6) of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55), intending to eat better (OR 1.23, CI 1.06-1.44), and intending to exercise regularly (OR 1.14, CI 1.00-1.31). Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47) and exercise (OR 26.07, CI 3.70-83.93).

Conclusions

Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales) was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity counseling leads to improved behavioral and weight outcomes.

Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out

OBJECTIVE

To identify pre-treatment factors related to weight loss in obesity treatment.

METHODS

Weight-related and psychological factors were tested in relation to three different weight loss phases: spontaneous weight loss after screening visit (Pre-treatment), weight loss after a preparatory 5-week series of lectures (Step I) and after group treatment lasting two semesters (Step II) in 247 obesity patients.

RESULTS

The strongest factor for predicting weight loss in the Step II treatment was initial Step I weight loss. At least 1kg weight loss in Step I predicted 13% of the variation in Step II weight loss. Spontaneous pre-treatment weight loss after screening and a history of more weight losses were also related to more Step II weight loss. Psychological encumbrances such as eating disorders and mental distress were not related to weight loss, neither were self-reported motivation nor weight locus of control. The overall attrition rate was 63% and associated with lower education, being an immigrant, lack of occupation, fewer previous weight losses and higher body dissatisfaction.

CONCLUSION

Initial weight loss is the most certain factor for predicting treatment outcome.

PRACTICE IMPLICATION

A treatment design including an introductory phase with a minimum weight loss criterion for continuing treatment is suggested.

Outcome of Group Therapy for Body-Image Emotionality and Weight-Control Self-Efficacy

Long-term maintenance of weight loss is generally poor after clinical interventions, whether behavioural, cognitive-behavioural, dietary, pharmacological or surgical. This may be because self-assertion regarding body shape and self-efficacy in weight control are insufficiently encouraged in clients. Semi-structured group therapy sessions with written handouts were therefore designed to strengthen personal effectiveness and self-esteem. The therapy sessions also provided information about successful dieting behaviour, and encouragement of less switching between dieting strategies, less emotional eating, and more resistance to inappropriate social pressures. The clients were 24 women with a median (range) Body Mass Index of 28.9 (24.6–48.5) kg/m2, referred by their General Practitioners or self-referred. They participated in eight weekly therapeutic sessions in four groups and were followed up six months after the final session. There were large improvements during therapy in reported self-esteem, emotional overeating, personal effectiveness and self-efficacy, habit variation, and attitudes to body-size, improvements which were maintained at follow-up. In addition, there was a significant loss of body weight during therapy, with further loss observed at follow-up. Thus it is practicable to achieve marked reductions in professed problems with body image and eating control, changes that are theoretically necessary to empower clients to choose appropriate weight targets and to make progress towards them.

Motivation, readiness to change, and weight loss following adjustable gastric band surgery

High levels of readiness to change (RTC) are considered critical to the long-term success of weight management programs including bariatric surgery. However, there are no data to support this assertion. We hypothesize that RTC level will not influence weight outcomes following surgery. In 227 consecutive patients undergoing adjustable gastric banding surgery, we recorded reasons for seeking surgery, and RTC measured with the University of Rhode Island Change Assessment. Scores were blinded until study completion. The primary outcome measure was percentage of excess BMI loss at 2 years (%EBMIL-2); others included compliance and surgical complications. Of 227 subjects, 204 (90%) had weight measurement at 2 years. There was no significant correlation between RTC score and %EBMIL-2 (r = 0.047, P = 0.5). Using the median split for RTC score the lowest 102 subjects mean %EBMIL-2 was 52.9 +/- 26.9% and the highest 52.2 +/- 28.3%, P = 0.869. There was no weight loss difference between highest and lowest quartiles, or a nonlinear relationship between weight loss and RTC score. There was no significant relationship between RCT score and compliance, or likelihood of complications. Those motivated by appearance were more likely to be younger women who lost more weight at 2 years. Poor attendance at follow-up visits was associated with less weight loss, especially in men. Measures of RTC did not predict weight loss, compliance, or surgical complications. Caution is advised when using assessments of RTC to predict outcomes of bariatric surgery.

The relationship between self-monitoring, outcome expectancies, difficulties with eating and exercise, and physical activity and weight loss treatment outcomes

BACKGROUND/PURPOSE

During a behavioral weight loss program (BWLP), weight loss and exercise can vary considerably from week to week. Weekly fluctuations in outcome expectancies and perceived difficulties with eating and exercise may be associated with weekly variability in weight loss and exercise. Also, inconsistent self-monitoring of exercise may be associated with poor weight loss and physical activity treatment outcomes.

METHODS

Forty obese, sedentary participants completed a 6-month BWLP. Body weight, outcome expectancies, and difficulties with eating and exercise were assessed weekly. Weekly self-monitoring of exercise was computed from physical activity diaries. Physical activity, VO2max, and caloric intake were assessed pre- and posttreatment.

RESULTS

Within-subjects analyses indicated that participants exercised less during weeks that participants reported greater difficulties with exercise, relative to weeks participants reported fewer difficulties. Participants lost significantly more weight during weeks that participants reported more positive outcome expectancies and greater difficulties with exercise, compared to weeks participants reported less positive outcome expectancies and fewer difficulties with exercise. Consistent self-monitoring of exercise was associated with fewer difficulties with exercise and greater exercise and weight loss.

CONCLUSIONS

Interventions that are targeted to increase self-monitoring and to improve transient difficulties with exercise and diminished outcome expectancies may improve BWLP treatment outcomes.

Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents

AIM

To investigate the role of physical activity and eating behaviour in weight control 1.5 y after a weight-reduction programme in severely obese children.

METHODS

Forty-seven children (13.4 +/- 2.1 y) were measured 1.5 y after the completion of a 10-mo residential treatment programme. Stature and body mass were measured; physical activity, fat and fibre intake, and self-efficacy in relation to physical activity and healthy eating behaviour were assessed using validated structured interviews. The total sample was divided into four subgroups according to unhealthy versus healthy physical activity and eating behaviour at follow-up.

RESULTS

One-and-a-half years after treatment, subjects had regained 34 +/- 19% overweight, but were on average still 20 +/- 19% less overweight than before treatment (p < 0.001). The four subgroups did not differ in level of overweight at the beginning or end of treatment. At follow-up, there was a significant difference in overweight between the four subgroups (p < 0.05). The least healthy group (unhealthy physical activity and unhealthy eating behaviour) had a significantly higher level of overweight 1.5 y after treatment (183 +/- 36%) in comparison with the other groups (unhealthy physical activity and healthy eating: 150 +/- 21%; healthy physical activity and unhealthy eating: 156 +/- 14%; healthy physical activity and healthy eating: 138 +/- 16%) (p < 0.05), whilst the healthiest group showed the lowest level of overweight after treatment when compared to the other groups (p < 0.05).

CONCLUSION

Results suggest that both physical activity and nutritional habits play an important role in weight maintenance after initial weight loss in obese children and that one healthy behaviour can not compensate for another unhealthy behaviour.

Self-efficacy and adherence to cognitive-behavioral treatment of insomnia

This study describes a self-efficacy (SE) scale and examines its usefulness in predicting adherence to cognitive-behavioral therapy (CBT) of insomnia. The SE scale, which included three subscales (global, task-related, and self-regulation), was administered to 39 patients receiving CBT for primary insomnia. Participants'daily sleep diaries were used to estimate their adherence to treatment. The results showed that the SE scale has adequate psychometric properties. Treatment adherence increased from Week 2 to Week 7 and decreased during the week following the last therapy session. In general, the global self-efficacy measure was more strongly associated with adherence during the first week of treatment, whereas the task-related efficacy was more strongly associated with adherence behaviors from Weeks 4 to 8. These findings suggest that self-efficacy perceptions are useful in predicting adherence to CBT of insomnia.

Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.

A review of psychosocial pre-treatment predictors of weight control

Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments. To date, however, research efforts have resulted in weak predictive models with limited practical usefulness. The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area. Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management. In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses. Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment. Importantly, for a considerable number of psychosocial constructs (e.g. eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn. Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described.

Use of the weight efficacy lifestyle questionnaire with African American women: validation and extension of previous findings

While the Weight Efficacy Lifestyle Questionnaire (WEL) shows promise as a measure of self-efficacy for eating control, there is a lack of research examining the psychometric properties of this measure with ethnic minorities. The current study examined the WEL with a sample of 144 overweight and obese African American females. Analyses indicated similar self-efficacy levels compared to predominantly Caucasian samples. Supporting the validity of the WEL, participants undergoing obesity treatment demonstrated modest improvement in WEL scores, while standard care participants showed no changes in self-efficacy over time. Factor analysis indicated a four-factor structure rather than the five factors previously found. The four-factor structure accounted for 61.85% of the variance. Results indicate the WEL may be a valid measure of self-efficacy for overweight and obese African American women, although researchers should be mindful of the variation in scale properties when using the WEL with this population.

Who will lose weight? A reexamination of predictors of weight loss in women

BACKGROUND: The purpose of this study was to analyze pretreatment predictors of short-term weight loss in Portuguese overweight and obese women involved in a weight management program. Behavioral and psychosocial predictors were selected a priori from previous results reported in American women who participated in a similar program. METHODS: Subjects were 140 healthy overweight/obese women (age, 38.3 +/- 5.9 y; BMI, 30.3 +/- 3.7 kg/m2) who participated in a 4-month lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity. At baseline, all women completed a comprehensive behavioral and psychosocial battery, in standardized conditions. RESULTS: Of all starting participants, 3.5% (5 subjects) did not finish the program. By treatment's end, more than half of all women had met the recomended weight loss goals, despite a large variability in individual results (range for weight loss = 19 kg). In bivariate and multivariate correlation/regression analysis fewer previous diets and weight outcome evaluations, and to a lesser extent self-motivation and body image were significant and independent predictors of weight reduction, before and after adjustment for baseline weight. A negative and slightly curvilinear relationship best described the association between outcome evaluations and weight change, revealing that persons with very accepting evaluations (that would accept or be happy with minimal weight change) lost the least amount of weight while positive but moderate evaluations of outcomes (i.e., neither low nor extremely demanding) were more predictive of success. Among those subjects who reported having initiated more than 3-4 diets in the year before the study, very few were found to be in the most successful group after treatment. Quality of life, self-esteem, and exercise variables did not predict outcomes. CONCLUSIONS: Several variables were confirmed as predictors of success in short-term weight loss and can be used in future hypothesis-testing studies and as a part of more evolved prediction models. Previous dieting, and pretreatment self-motivation and body image are associated with subsequent weight loss, in agreement with earlier findings in previous samples. Weight outcome evaluations appear to display a more complex relationship with treatment results and culture-specific factors may be useful in explaining this pattern of association.

An attempt to identify predictors of treatment outcome in two comprehensive weight loss programs

The present study attempted to predict weight loss in, and completion of, low-calorie diet (LCD, n=167) and very low-calorie diet (VLCD, n=96) weight loss programs. Program completion and weight loss were examined in association with three groups of variables: demographic (e.g., age), medical/physical (e.g., body mass index [BMI]), and motivational/behavioral (e.g., exercise, ratings for motivation and commitment for the program). In the LCD group, age was positively associated with program completion, and commitment to the program was negatively associated with both program completion and weight loss. In the VLCD group, no variables predicted program completion, and only male gender predicted weight loss. Our results offer little to contradict previous findings that preexisting participant characteristics are of limited utility in predicting weight loss treatment outcome. In the LCD group, the negative associations of commitment with program completion and weight loss were surprising. If replicated, they might suggest the need to clarify patients' expectations about the level of commitment required for successful treatment.

Qualitative study of spirituality in a weight loss program: contribution to self-efficacy and locus of control

OBJECTIVE

The purpose of this qualitative study was to examine how spirituality affects intrapersonal characteristics associated with a weight loss program.

DESIGN

A series of 5 focus group interviews was conducted with women who were past participants of the Weigh Down Workshop, a spiritually based weight loss program.

SETTING

Three churches in the Minneapolis/St. Paul, Minnesota, metropolitan area.

PARTICIPANTS

Focus group participants (N = 32) were white, fairly well educated, with moderate income levels. Their mean age was 50 years.

PHENOMENA OF INTEREST

Behavior changes, factors affecting self-efficacy for performing the behaviors, and locus of control.

ANALYSIS

Sessions were audiotaped and transcribed. Transcribed text was coded and analyzed using qualitative data analysis procedures.

RESULTS

Major changes in self-reported eating behaviors included eating only when experiencing true physiological hunger and stopping when sensing a feeling of fullness. Self-efficacy for these behaviors was reported to be enhanced by observing weight loss for themselves or others. Support from other group members, the simplicity of the program, and spiritual benefits through prayer and scripture reading were also reported to enhance confidence. Women indicated that they relied on an internal locus of control based on a sense of self-discipline.

CONCLUSIONS AND IMPLICATIONS

Traditional means to enhance self-efficacy were important for all women; however, for some women, spirituality was also an important aspect of adhering to program principles.

The early identification of poor treatment outcome in a women's weight loss program

Research examining factors associated with program attrition or failure to lose weight during active treatment has yielded mixed findings. The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of attrition and failure to lose weight during treatment. This investigation examined whether baseline characteristics, early weight loss, attendance, weight-related quality of life, confidence and difficulties with eating and exercise, and diet-related thoughts and feelings during the final week of treatment were associated with percentage change in body weight. Forty-four, obese, sedentary, postmenopausal women were recruited to participate in a 24-session weight loss intervention. Poor treatment outcome (i.e., percentage change in body weight) was significantly associated with several baseline characteristics including higher body mass index (BMI), greater fat and lower carbohydrate consumption, poor body image, and greater expectations for program success. Poor treatment outcome was also significantly associated with poor program attendance, unsatisfactory early weight loss, unsatisfactory improvements in weight-related quality of life, and lower self-control and self-confidence. By the end of active treatment, women with poor treatment outcome evidenced significantly higher levels of guilt and feelings of failure. The need for early identification and intervention with participants at risk for treatment failure is discussed.

Weight loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction

Accurate prediction of weight loss success and failure has eluded researchers for many years. Thus, we administered a comprehensive psychometric battery before a 4-month lifestyle behavioral weight reduction program and analyzed weight changes during that period to identify baseline characteristics of successful and unsuccessful participants, among 112 overweight and obese middle-aged women (age, 47.8 +/- 4.4 years; BMI, 31.4 +/- 3.9 kg/m2). Mean weight and percentage fat losses among the 89 completers were -5.4 kg and -3.4%, respectively (p < .001). A higher number of recent dieting attempts and recent weight loss, more stringent weight outcome evaluations, a higher perceived negative impact of weight on quality of life, lower self-motivation, higher body size dissatisfaction, and lower self-esteem were associated with less weight loss and significantly distinguished responders from nonresponders among all participants. These findings are discussed as to their usefulness (i) to screen individuals before treatment, (ii) to provide a better match between interventions to participants, and (iii) to build a weight loss readiness questionnaire.

Self-efficacy in relation to eating behaviour among obese and non-obese women

OBJECTIVE

To assess the effect of a 3 month behaviour modification weight management programme on self-efficacy and anthropometric variables among obese women seeking treatment at an obesity management clinic and to compare self-efficacy among these obese women to non-obese women.

DESIGN

Cross sectional.

SUBJECTS

A total of 161 non-obese (BMI 22.6+/-2.9 kg/m(2)) and 138 obese (BMI 37.7+/-5.8 kg/m(2)) women of similar age.

MEASUREMENTS

Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle (WEL) questionnaire. Demographic information was obtained by interview and questionnaire in the obese and by questionnaire in the non-obese. Anthropometric measurements were obtained by direct measure in the obese and BMI was calculated from self-reported weight and height in the non-obese.

RESULTS

At entry to the programme obese women scored significantly less (P<0.0001) than non-obese women on the WEL (99.4+/-34.1 vs 139.0+/-24.9). Women who completed the programme (n=65) demonstrated a decrease in waist circumference of 3.9+/-5.3 cm, a 10.0+/-11.5% loss of excess weight and a significant improvement in total WEL score from 106.0+/-30.3 to 126.5+/-28.4.

CONCLUSION

Improvements in some dimensions of self-efficacy among obese women were of sufficient magnitude to attain scores similar to women of a normal weight. The WEL questionnaire may provide an additional measure of success as well as provide positive feedback and encouragement to the client.

Psychological symptoms are greater among weight cycling women with severe binge eating behavior

OBJECTIVE

To identify psychological characteristics and eating behaviors associated with weight cycling and binge eating behaviors in overweight women (body mass index > 27.3).

DESIGN

Questionnaires measuring self-esteem, self-efficacy, coping strategies, psychological symptoms, depression, binge eating, restrained eating, disinhibition, and hunger were administered to female weight cyclers who were overweight. Psychological characteristics were compared between subjects grouped by binge eating disorder classification and by binge eating severity.

SUBJECTS

A convenience sample of 62 female weight cyclers who were overweight was recruited from the Chicago, Ill, area. Questionnaires were administered individually or in small groups in subjects' homes or other private settings.

STATISTICAL ANALYSES

Student's t tests or Mann-Whitney U tests were used to assess differences in psychological characteristics.

RESULTS

Thirty-six weight cyclers (58%) met the criteria for binge eating disorder and 26 (42%) did not. Weight cyclers with binge eating disorder reported greater severity of binge eating (P < .0005) and disinhibition (P < .0005) and poorer eating self-efficacy (P < .0005) than weight cyclers without binge eating disorder. Weight cyclers with severe binge eating behaviors reported greater psychological distress (P < .0005) and depression (P < .005) and lower self-esteem (P = .0001) and used less healthful coping strategies (P = .0027) than weight cyclers with no binge eating to moderate binge eating problems. Weight cyclers with severe binge eating behavior also reported more hunger (P < .0005) and used less cognitive restraint (P = .0024) than those with no binge eating to moderate binge eating problems.

APPLICATIONS

Operational definitions of weight cycling and binge eating are needed to facilitate research on effective weight-loss treatments. Persons seeking to lose weight (especially weight cyclers) should be assessed for binge eating severity, problematic eating behaviors, and psychological symptoms.

Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease

BACKGROUND

Medication nonadherence in the treatment of chronic diseases compromises the effectiveness of therapy. Little information is available about the extent of medication adherence or determinants of medication adherence in HIV disease, an issue of increasing importance in this new therapeutic era of combination antiretroviral therapy.

METHODS

We studied 244 HIV-infected Medicaid-insured patients attending an HIV hospital-based clinic regarding the extent of and predictors of adherence to antiretroviral therapy and Pneumocystis carinii pneumonia (PCP) prophylaxis. Patients were asked to report medications being taken, patterns of use, and knowledge and attitudes about HIV therapies. Medical record report of type, dose, and frequency of medication was compared with self-report using the kappa statistic. Urine sulfamethoxazole assay was obtained from patients prescribed sulfamethoxazole-trimethoprim.

RESULTS

Among patients prescribed antiretroviral therapy, 60% reported > or = 80% adherence in the previous 7 days; 49% reported > or = 80% adherence with PCP prophylaxis in the previous seven days. Seventy-nine percent of patients who reported taking daily sulfamethoxazole-trimethoprim had detectable urinary sulfamethoxazole. In multivariate analysis, > or = 80% adherence to antiretroviral therapy was associated with taking medication < or = twice a day (odds ratio [OR]=1.44; 95% confidence interval [CI], 1.01, 1.96), being likely to take medication when not at home, (OR=1.41; 95% CI, 1.04, 2.00) and patients' belief in their ability to adhere to therapy (OR=1.57; 95% CI, 1.13, 2.17). For PCP prophylaxis, > or = 80% adherence was associated with presence of family (OR=2.39; 95% CI, 1.01, 5.63) and patients' belief in their ability to adhere to therapy (OR=2.87; 95% CI, 1.44-1.78). Sociodemographic characteristics and belief in the efficacy of medications were not associated with adherence.

CONCLUSIONS

A relatively low level of adherence to antiretroviral therapy and PCP prophylactic regimens was found. Although our results are principally from patients receiving antiretroviral monotherapy, these findings may have important implications for patients receiving highly active antiretroviral therapy (HAART). Decreasing the complexity of antiretroviral regimens, and working with patients to modify identified barriers to adherence may improve effectiveness of medications and prolong survival.

Weight control self-efficacy types and transitions affect weight-loss outcomes in obese women

Matching obesity treatments to heterogeneous clients is a recent evolution in the development of more effective weight-control programs, yet most interventions emphasize the external features of treatments rather than the internal belief structures of individuals. The purpose of this study was to determine whether Q methodology would identify distinct types of weight-control self-efficacy beliefs in obese women that would be linked to outcomes of a weight-loss program. Fifty-four women (45 +/- 9 yrs, Mean +/- SD) 136 +/- 10% over ideal body weight participated in a 9-month nutritional/behavioral weight loss program. Two major self-efficacy categories emerged through factor analysis of Q sorts: assureds and disbelievers. The assureds (n = 28) had the strongest self-efficacy beliefs and at baseline reported significantly (p < .01) greater self-esteem and less depression than the disbelievers (n = 26). By posttreatment, the assureds had lost significantly more weight (10 +/- 6 vs. 7 +/- 7 kg). Regrouping the data for analysis by posttreatment self-efficacy types demonstrated transitions in the self-efficacy beliefs of the women during treatment. Those who were disbelievers at baseline but became assureds posttreatment (n = 7) lost twice as much weight as the women who started and finished as disbelievers (n = 19) (10 +/- 7 kg vs. 5 +/- 5 kg). The posttreatment assureds (n = 32) lost significantly more weight than the disbelievers (n = 22) (10 +/- 6 vs. 6 +/- 5 kg), and reported better self esteem, mood, and eating patterns. Thus, assessment of intrinsic belief systems, particularly weight-control self-efficacy, may provide new directions for designing interventions that target distinctly different needs of obese women to affect greater weight loss and more positive affective states.

Dietary helplessness and disinhibition in weight cyclers and maintainers

OBJECTIVE

The primary purpose of this study was to compare obese versus nonobese adults and weight cyclers versus maintainers on measures of dietary helplessness, nutrition concern, dietary restraint, and disinhibition.

METHOD

Dietary helplessness, nutrition concern, dietary restraint, and disinhibition were assessed in 385 healthy obese and nonobese men and women in the RENO Diet-Heart Study, a 5-year prospective investigation of cardiovascular risk factors, weight cycling, and lifestyle.

RESULTS

The results indicated that dietary helplessness and disinhibition were significantly greater in obese individuals, subjects with a history of weight cycling, and weight fluctuators (prospectively measured). Women were found to score significantly higher than men on measures of dietary helplessness, disinhibition, and cognitive restraint.

DISCUSSION

The role of nutrition attitudes is discussed in relation to dietary self-regulation, weight fluctuation, and management of body weight.

The application of motivational theory to cardiovascular risk reduction

The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained cardiovascular risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict cardiovascular risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of cardiovascular health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and practice in the study of individual motivation in health behavior change are discussed.

Factors associated with participation or nonparticipation in a workplace wellness center

The aim of this project was to compare characteristics and factors that distinguished those individuals (n = 101) who participated in a worksite wellness program from those who did not (n = 100). This project was unique in that the majority of subjects were bluecollar workers. Factor analysis of a 35-item questionnaire resulted in six factors: perceived benefits of health promotion behaviors, perceived physical barriers of health promotion, perceived self-efficacy for health promotion behaviors, perceived psychological barriers, situational components relating to convenience of the wellness facility, and the need for social support. Discriminant analysis revealed that self-efficacy was the most useful factor in distinguishing between the two groups. Participants identified more benefits and fewer barriers to health promotion activities. Nonparticipants were older, less educated, and tended to view their age, their perceived lack of fitness, and perceived poorer health status as deterrents to regular physical activity. Nonparticipants also identified shift work, working overtime, responsibilities at home, and distance from work as important barriers to health promotion activities. Self-efficacy factors appear to warrant further investigation in future attempts to explain health promotion behaviors in this high risk group.

Beliefs about resistance self-efficacy and drug prevalence: do they really affect drug use?

Testing the same structural equation model for eighth-grade users and nonusers, this study examines social influence and cognitive precursors of adolescent drug use among 1138 West Coast students. For the eighth-grade nonusers of alcohol, cigarettes, and marijuana (n = 518), low resistance self-efficacy and prodrug social influences directly predicted generic expectations of using drugs and actual use nine months later. For the users (n = 620), both variables directly affected expectations and indirectly affected actual use. While the latent variable measure of drug use prevalence did not predict either outcome, specific estimates of peer alcohol use directly affected later drinking. Estimates of several other drug-specific relations were required to fit the model, indicating that both general and drug-specific effects are needed to explain adolescent drug use.