Self-Efficacy as a Predictor of Weight Change in African-American Women

From Restriction to Intuition: Evaluating Intuitive Eating in a Sample of the General Population

Intuitive eating (IE) is a non-dieting approach that promotes listening to internal cues of hunger and satiety, rather than adhering to external dietary restrictions aimed at weight loss. However, the role of IE in dieting behaviors related to weight-loss approaches is still unclear. To address this issue, the aim of this study was to compare IE levels between dieting and non-dieting individuals, exploring the relationship between IE and dieting-related psychological and physical factors. A sample of 2059 females was recruited via social media and self-reported questionnaires were administered to measure IE, eating psychopathology, self-efficacy, and quality of life. Individuals with a history of dieting exhibited lower IE levels, a higher BMI, and a greater eating psychopathology, as well as a reduced self-efficacy and quality of life, compared to non-dieters. IE showed a protective effect against dieting behaviors, with higher IE levels being associated with a lower likelihood of dieting. Additionally, higher BMI and eating psychopathology were predictors of dieting. Promoting IE could represent a relevant clinical target strategy to address disordered eating and enhance overall well-being, underscoring the need for interventions that foster a healthier relationship with food and bodily internal sensations.

Factors associated with weight gain after breast cancer: Results from a community-based survey of Australian women

PURPOSE

Weight gain after breast cancer is common. The aim of this study was to determine factors associated with weight gain after breast cancer in Australian women.

METHODS

A cross-sectional online survey was conducted between November 2017 and January 2018. Women living in Australia who self-identified as having breast cancer or ductal carcinoma in-situ were eligible. We created stepwise linear and logistic regression models to evaluate predictors for absolute and clinically significant (≥5%) weight gain respectively.

RESULTS

Data from 276 women were analysed. Most were Caucasian and 92% had been diagnosed with Stage 0-III breast cancer. Absolute weight gain was associated with hot flushes, being in the menopausal transition at diagnosis, being less physically active than at diagnosis, lower eating self-efficacy when watching television or using a computer, and higher self-efficacy when anxious or nervous (F-ratio = 3.26, R²-adjusted = 0.16, p < .001). Clinically significant weight gain was associated with tamoxifen use (OR 2.7), being less physically active than at diagnosis (OR 3.1), and lower eating self-efficacy when watching television or using a computer (OR 0.82) (Chi-square 64.94, df = 16, p < .001). Weight gain was not associated with chemotherapy, radiotherapy, aromatase inhibitor use, number of lymph nodes removed, or body mass index at diagnosis.

CONCLUSIONS

Interventions to prevent weight gain after breast cancer, particularly aiming to maintain physical activity, should be targeted at women receiving tamoxifen. The role of eating self-efficacy, especially attentive eating, in managing weight after breast cancer should be explored.

The General Self-Efficacy Scale in a population planned for bariatric surgery in Sweden: a psychometric evaluation study

OBJECTIVES

This study psychometrically evaluated General Self-Efficacy (GSE) Scale in patients planned for bariatric surgery in Sweden.

DESIGN

A cross-sectional psychometric study. The psychometric evaluation was guided by the COnsensus-based Standards for the selection of health status Measurement Instruments checklist for health-related reported-patient outcomes.

SETTING

Three bariatric centres in Sweden.

PARTICIPANTS

Adult patients≥18 years old scheduled for primary bariatric surgery (with sleeve gastrectomy or Roux-en-Y gastric bypass).

PRIMARY AND SECONDARY MEASURES

Psychometric properties of the GSE.

RESULTS

In total, 704 patients were included in the analysis. Mean values for GSE items were 2.9-3.4 and the mean GSE sum score was 31.4 (SD 4.7). There were no floor or ceiling effects. Cronbach's alpha was 0.89. Men reported a higher mean GSE than did women, that is, 31.2 (SD 4.8) for women versus 32.1 (SD 4.3) for men, p=0.03. Correlation coefficients were weak or negligible: GSE and mental component summary score of 36-Item Short Form Health Survey (SF-36)/RAND 36, r=0.18 (p<0.00); GSE and physical component summary score of SF-36/RAND 36, r=0.07 (p=0.138); GSE and obesity-related problem scale r=-0.15 (p=0.001) and GSE and level of education, r=0.04 (p=0.35). Confirmatory factor analysis indicated a one-factor construct with a satisfactory goodness of fit, that is, Comparative Fit Index=0.927, root mean square error of approximation=0.092 and standardised root mean square residual=0.045. The factor GSE explained almost half or over half of the variance of each item (0.45-0.75, p-values<0.001).

CONCLUSIONS

The GSE scale is a valid and reliable scale that can be used to assess general self-efficacy in patients undergoing bariatric surgery.

Psychometric Testing: Self-Efficacy for Calorie Control and Exercise

Enhancing self-efficacy for calorie control and exercise is a crucial strategy for successful weight management. This study developed and psychometrically tested a 13-item quick checklist for assessing self-efficacy for calorie control and exercise (QCSE-CCE). A convenience sample of 425 adults between 18 and 69 years old completed the QCSE-CCE online. The principle axis factor analysis and a parallel analysis demonstrated a three-factor structure that accounts for 72.8% of the total variance. The confirmatory factor analysis indicated a good model fit (χ²/df = 2.168, GFI = .913, AGFI = .873, RMR = .049, RMSEA = .073, CFI = .959). The predictive validity was adequate (.38 < r < .39, p < .000), with Cronbach's alphas ranging from .87 to .91. The test-retest demonstrated good stability (r = .69; p < .001). The QCSE-CCE is a valid and reliable instrument for assessing self-efficacy for calorie control and exercise for weight management purposes.

Aging and Neural Vulnerabilities in Overeating: A Conceptual Overview and Model to Guide Treatment

Given the vulnerability of older adults to chronic disease and physical disability, coupled with the threat that obesity poses to healthy aging, there is an urgent need to understand the causes of positive energy balance and the struggle that many older adults face with intentional weight loss. This paper focuses on neural vulnerabilities related to overeating in older adults, and moderating variables that can have either favorable or unfavorable effect these vulnerabilities. Research from our laboratory on older adults with obesity suggests that they are prone to similar neural vulnerabilities for overeating that have been observed in younger and middle-aged populations. In addition, following brief postabsorptive states, functional brain networks both in the resting state and in response to active imagery of desired food are associated with 6-month weight loss. Data reviewed suggest that the sensorimotor network is a central hub in the process of valuation and underscores the central role played by habits in overeating. Finally, we demonstrate how research on the neural vulnerabilities for overeating offers a useful framework for guiding clinical decision-making in weight management.

French validation of the Weight Efficacy Life-Style questionnaire (WEL): Links with mood, self-esteem and stress among the general population and a clinical sample of individuals with overweight and obesity

Eating self-efficacy refers to a person’s belief in their ability to regulate eating. Although the Weight Efficacy Life-Style questionnaire (WEL) is one of the most widely used eating self-efficacy tools, its French validation is lacking. The objective of this research was to validate a French version of the WEL in a general and a clinical sample, and to explore the links between eating self-efficacy and psychosocial variables. In study 1, the general population sample included 432 adults (93% of women, mean age = 43.18 ± 11.93 years). In study 2, the clinical sample included 2010 adults with overweight and obesity (87% of women, mean age = 44.44 ± 11.25 years). Exploratory and confirmatory factor analyses were performed. Two distinct versions of the WEL were retained: a 12-item questionnaire intended for use in the general population, named WEL-Fr-G, and an 11-item questionnaire for clinical samples, named WEL-Fr-C. The two French versions of the WEL presented strong reliability and sensibility. In addition, study 2 provided support for the measurement invariance of the WEL-Fr-C across sex and Body Mass Index. The two versions are therefore psychometrically sound instruments for assessing eating self-efficacy in the general population (WEL-Fr-G) and clinical samples (WEL-Fr-C).

Effects of caloric restriction on human physiological, psychological, and behavioral outcomes: highlights from CALERIE phase 2

Caloric restriction (CR) is a strategy that attenuates aging in multiple nonhuman species. The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trials are part of a research program aiming to test the effects of CR on aging and longevity biomarkers in humans. Building on CALERIE phase 1, CALERIE phase 2 (CALERIE 2) was the largest study to date to assess sustained CR in healthy humans without obesity. In a 24-month randomized controlled trial comprising 218 participants at baseline, CALERIE 2 showed that moderate CR, 11.9% on average, induced improvements in aging-related biomarkers without adversely affecting psychological or behavioral outcomes. The objectives of this report are to summarize and review the highlights of CALERIE 2 and report previously unpublished results on eating disorder symptoms and cognitive function. This article specifically summarizes the physiological, psychological, aging, behavioral, and safety results of the trial. Also provided are research directions beyond CALERIE 2 that highlight important opportunities to investigate the role of CR in aging, longevity, and health span in humans.

Functional Brain Networks: Unique Patterns with Hedonic Appetite and Confidence to Resist Eating in Older Adults with Obesity

OBJECTIVE

The purpose of this study was to determine whether baseline measures of hedonic hunger-the Power of Food Scale-and self-control for food consumption-the Weight Efficacy Lifestyle Questionnaire-were associated with network topology within two sets of brain regions (regions of interest [ROIs] 1 and 2) in a group of older adults with obesity. These previously identified brain regions were shown in a different cohort of older adults to be critical for discriminating weight loss success and failure.

METHODS

Baseline functional magnetic resonance imaging data (resting state and food cue task) were collected in a novel cohort of 67 older adults with obesity (65-85 years, BMI = 35-42 kg/m² ) participating in an 18-month randomized clinical trial on weight regain.

RESULTS

The Power of Food Scale was most related to ROI 1, which includes the visual cortex and sensorimotor processing areas during only the food cue state. During both the food cue and resting conditions, the Weight Efficacy Lifestyle Questionnaire was associated with ROI 2, which includes areas of the attention network and limbic circuitry.

CONCLUSIONS

Our findings show critical, distinct links between brain network topology with self-reported measures that capture hedonic hunger and the confidence that older adults have in resisting the consumption of food because of both intrapersonal and social/environmental cues.

Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial

OBJECTIVE

Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA).

METHODS

Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months' post-intervention.

RESULTS

There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months' follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups.

CONCLUSION

Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing.

CLINICAL TRIAL

This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.

Impact of an Internet-Based Lifestyle Intervention on Behavioral and Psychosocial Factors During Postpartum Weight Loss

OBJECTIVE

This cluster randomized trial tested whether an effective internet-based weight-loss intervention for low-income, postpartum women resulted in greater improvements in targeted social cognitive theory (SCT) constructs and psychosocial outcomes.

METHODS

Fit Moms/Mamás Activas was a 12-month cluster randomized controlled trial of 370 postpartum women at 12 Special Supplemental Nutrition Program for Women, Infants, Children (WIC) clinics that were randomly assigned to intervention or standard WIC. SCT constructs (weight-control behaviors, cognitive restraint, disinhibition, self-efficacy, social support, body image) and psychosocial outcomes (depressive symptoms and stress) were measured at study entry and after 6 and 12 months.

RESULTS

The intervention versus standard WIC resulted in greater 12-month increases in weight-control behaviors (3.28 points [95% CI: 1.06-5.50]), self-monitoring of weight and eating (2.28 points [1.17-3.40]), and cognitive restraint (1.93 points [0.78-3.08]) (all P ≤ 0.004). The intervention effect was only modestly (η_p ²  = 0.02) mediated by improvements in these factors. No significant group by time effect was observed for disinhibition, self-efficacy, social support, body image, depressive symptoms, or stress.

CONCLUSIONS

Among low-income postpartum women, an effective internet-based weight-loss program resulted in improved weight-control behaviors and cognitive restraint but did not affect other SCT targets and psychosocial outcomes.

Change in self-efficacy, eating behaviors and food cravings during two years of calorie restriction in humans without obesity

Calorie restriction (CR) enhances longevity in humans who are normal weight, overweight and obese. While dietary regimens can change self-efficacy, eating behaviors, and food cravings in individuals with obesity, the responses of these measures to prolonged CR in individuals who are exclusively not obese is unknown. The aim of this analysis was to test the effects of a two-year CR intervention on self-efficacy and eating attitudes and behaviors in humans without obesity by analyzing data from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 (CALERIE 2) study. Participants (n = 218, BMI range = 21.3-29.0 kg/m2) were randomized to a 25% CR group or an ad libitum (AL) group. Eating attitudes and behaviors and self-efficacy were assessed using validated questionnaires at baseline, month 12, and month 24. Dietary restraint and self-efficacy increased in the CR compared to the AL group (ES ≥ 0.32). Increased self-efficacy was negatively related to weight change (ρ < -0.24). In the CR group, males showed a reduction in cravings for carbohydrates and fats at month 24, whereas females did not. The CR group showed elevations in state hunger, which were transient, and disinhibited eating (ES ≥ 0.37). In individuals without obesity, dietary restraint and self-efficacy could be important in promoting long-term CR for individuals looking to use CR as a tool to improve longevity.

Adaptation of the Spanish version of the Self-Efficacy Consumption of Fruit and Vegetables Scale

The objective of this study was to analyse the psychometric properties of the Spanish version of the Self-Efficacy Consumption of Fruit and Vegetables Scale among the Spanish population. The sample was made up of 506 subjects who were selected through a convenience sample. The original version was translated from English to Spanish and later was translated back into English, by different translators. Upon translating, not only did the translators keep in mind the grammatical and linguistic aspects of the text, but also the cultural aspects. In order to validate the content of the Scales, the adapted and agreed-upon version of the scale was evaluated by a panel of experts, in order to obtain the final version. Data collection took place between March and September 2017.The internal consistency was tested using Chronbach’s alpha. For the analysis of the structural validity, a factor analysis was carried out on the Self-Efficacy Consumption of Fruit and Vegetables Scale-Spanish version. Kaiser-Meyer Olkin and Bartlett’s test of sphericity (0.90) confirmed that the analysis was suitable. A two-factor structure was confirmed, as in the original scale. The value of Chronbach’s α for the total questionnaire was 0.877, which shows a good internal consistency. In the analysis of the reliability test-retest, a correlation value of 0.79 (p<0.05) was found, demonstrating its temporal stability. The Self-Efficacy Consumption of Fruit and Vegetables questionnaire is a reliable tool to measure self-efficacy in the consumption of fruits and vegetables in the Spanish context.

A Step toward Understanding Diet Quality in Urban African-American Breast Cancer Survivors: A Cross-sectional Analysis of Baseline Data from the Moving Forward Study

PURPOSE

Little is known about the dietary behaviors of African-American breast cancer survivors (AABCS). We sought to describe dietary intake and quality in AABCS and examine associations with demographic, social, lifestyle, and body composition factors to potentially inform the development of effective dietary interventions.

METHODS

Baseline data from a prospective weight loss trial of 210 AABCS were assessed. A food frequency questionnaire was used to evaluate dietary intake and diet quality via the Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010). Linear regression analysis was conducted to determine the most influential variables on diet quality.

RESULTS

Mean HEI- and AHEI-2010 total scores were 65.11 and 56.83 indicating that diet quality needs improvement. Women were the least adherent to recommendations for intake of whole grains, dairy, sodium, empty calories, sugary beverages, red/processed meats, and trans-fat. Increased self-efficacy for healthy eating behaviors, more years of education (AHEI only), negative smoking status, smaller waist circumference, and increased physical activity (HEI only) were significantly associated with higher diet quality scores.

CONCLUSION

Our findings suggest the diet quality of AABCS needs improvement. Intervention programs may achieve higher diet quality in AABCS by focusing on increasing self-efficacy for healthy eating behaviors.

The feasibility of a binge eating intervention in Black women with obesity

INTRODUCTION

U.S. Black women have the highest rates of obesity and report frequent binge eating behaviors. To our knowledge, no intervention research has aimed to treat binge eating specifically among Black women. The purpose of this study was to investigate the feasibility and preliminary effect of Appetite Awareness Treatment (AAT), an 8-week cognitive-behavioral binge eating intervention, among Black women with obesity, and who report binge eating.

METHODS

Participants (N = 31), had a mean (±SD) age of 48.8 ± 12.8 years, a body mass index of 33.7 ± 3.9 kg/m², and reported at least one binge eating episode monthly over the last three months. Using a randomized controlled trial design, Black women were randomized to AAT or a wait-list control group (WAIT) group. We examined recruitment, attendance, retention, and adherence. Linear mixed models explored preliminary differences between the AAT and WAIT on the primary outcome variables of binge eating and eating self-efficacy measured at baseline and 8-weeks.

RESULTS

Approximately one-third of screened participants were eligible and did enroll. Participants completed 55% of homework assignments, and attended 59% of intervention sessions. Retention to AAT was 87.5%. Compared to participants in the WAIT group, AAT participants had greater decreases in binge eating scores and greater improvements in eating self-efficacy scores at the end of Week 8.

CONCLUSION

Results suggest that AAT is feasible among Black women with binge eating behaviors, with evidence of preliminary efficacy, providing a rationale for a trial of AAT in a larger sample of Black women.

Promoting healthy home environments and lifestyles in families with preschool children: HomeStyles, a randomized controlled trial

The purpose of the HomeStyles randomized controlled trial was to determine the effect of participation in the HomeStyles intervention vs an attention control condition on the weight-related aspects of the home environment and lifestyle behavioral practices of families with preschool children. Parents of preschool children (n=489) were systematically randomized to experimental or attention control group after completing the baseline survey. Baseline and post surveys comprehensively assessed study outcomes using a socio-ecological approach incorporating valid, reliable intrapersonal (e.g., diet, activity), interpersonal (e.g., family meal frequency), and environmental measures (e.g., home media environment), and self-reported parent and child measured heights and weights. For all outcome measures, paired t-tests compared within group differences over time and ANCOVA, controlling for baseline scores and prognostic variables (e.g., parent sex), determined differences in post survey scores between groups. The final analytical sample (N=172; age 32.34±5.71SD; 58% White; 93% female) completed baseline and post surveys. The experimental group families had improved family meal and diet-related behaviors, and self-efficacy for food-related childhood obesity-protective practices. Household food supplies changed little, except for less availability of salty/fatty snacks. Within group effects indicated the control group also experienced some improvements, however these were few in number. ANCOVA revealed the experimental group parents had greater physical activity, reduced screentime, improved family mealtime behaviors, and increased self-efficacy for childhood obesity-protective behaviors and cognitions compared to the control group at post survey, though effect sizes were small. The HomeStyles program for families with preschool children promoted improvements in an array of obesity-preventive behaviors.

Weight resilience and fruit and vegetable intake among African-American women in an obesogenic environment

OBJECTIVE

To investigate relationships between weight resilience (maintaining a normal weight in a food desert environment) and fruit and vegetable (F&V) intake, attitudes and barriers.

DESIGN

Cross-sectional, in-person surveys collected May-December 2011, including self-reported data on F&V-related psychosocial factors, attitudes and barriers. Two 24 h dietary recalls were completed; weight and height were measured. Multivariable regression models estimated prevalence ratios (95 % CI).

SETTING

Two low-income, predominantly African-American food deserts in Pittsburgh, Pennsylvania, USA.

SUBJECTS

Women aged 18-49 years (n 279) who were the primary food shopper in a household randomly selected for a parent study.

RESULTS

Fifteen per cent were weight resilient, 30 % were overweight and 55 % were obese. Overall, 25 % reported eating ≥5 F&V servings/d. After adjustment for age, education, parity, employment, living alone, physical activity, per capita income and mean daily energy intake, women eating ≥5 F&V servings/d were 94 % more likely to be weight resilient compared with those eating <5 servings/d (1·94; 1·10, 3·43). Across BMI groups, self-efficacy regarding F&V consumption was high and few F&V barriers were reported. The most frequently reported barrier was concern about the cost of F&V (36 %). Of the attitudinal F&V-related factors, only concern about wasting food when serving F&V was associated with weight resilience in adjusted models (0·29; 0·09, 0·94). In a model predicting consuming ≥5 F&V servings/d, driving one's own car to the store was the only attitudinal F&V-related factor associated with consumption (1·50; 1·00, 2·24).

CONCLUSIONS

In this population, weight resilience may be encouraged by improving access to affordable and convenient F&V options and providing education on ways to make them palatable to the entire household, rather than by shifting women's F&V perceptions, which are already positive.

Psychometrics of the "Self-Efficacy Consumption of Fruit and Vegetables Scale" in African American women

PURPOSE

Assess the psychometric properties of the Self-Efficacy Consumption of Fruit and Vegetable Scale (F/V scale) in African American women.

SETTING

Midwestern Health Maintenance Organization.

SUBJECTS

221 African American women age 40-65 with BMI≥30 MEASURES: F/V scale was compared to eating efficacy/availability subscale reported on the WEL and mean micronutrient intake (vitamins A, C, K, folate, potassium, and beta-carotene reported on 3-day food records.

RESULTS

F/V scale construct validity and internal consistency were assessed and compared to: 1) the original scale validation in Chinese women, 2) WEL scale, and 3) to micronutrient intake from 3-day food records. Total scale scores differed between African American women (μ=1.87+/-0.87) and Chinese (μ=0.41). In a Chinese population, F/V scale factored into two subscales; the F/V factored into one subscale in African American women. Construct validity was supported with correlation between the F/V scale and the eating efficacy WEL subscale (r²=-0.336, p=0.000). There was not a significant correlation between dietary consumption of micronutrients representative of fruit and vegetable intake and the F/V scale.

CONCLUSION

The F/V scale developed for Chinese populations can be reliably used with African American women.

Perceived Self-Efficacy and Financial Incentives: Factors Affecting Health Behaviors and Weight Loss in a Workplace Weight Loss Intervention

OBJECTIVE

To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up.

METHODS

Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables.

RESULTS

Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P < 0.05). Incentives significantly moderated the effects of self-efficacy (P = 0.00) on weight loss.

CONCLUSIONS

Self-efficacy and FI may affect weight loss and play a role in weight-loss interventions.

Longitudinal analysis of virtual community perceptions of cohesion: The role of cooperation, communication, and competition

Online, virtual group interactions may help adherence to health promotion programs. The purpose of this study was to explore longitudinal relationships among dimensions of group cohesion and group-interaction variables to inform and improve group-based strategies within programs aimed at promoting physical activity in virtual communities. In all, 56 online virtual users completed a group dynamics-based physical activity promotion intervention and assessments of group cohesion and group interaction at baseline and 4 weeks. Friendly competition and cooperation were consistently strong predictors of cohesion. Facilitating a sense of friendly competition and cooperation may increase engagement in physical activity programs by bolstering group cohesion.

The Impact of Racial and Socioeconomic Disparities on Binge Eating and Self-Efficacy among Adults in a Behavioral Weight Loss Trial

The prevalence of obesity is a significant problem among racial and ethnic minorities and those of low socioeconomic status (SES). Psychosocial barriers, such as binge eating and low self-efficacy, are known to hinder the adoption of a more healthful diet. There is limited research identifying racial and SES differences in binge eating and self-efficacy. Further investigations of these constructs may allow researchers to improve the effectiveness of weight management interventions and increase social worker involvement. In this article, the authors examine the socioeconomic and racial differences in binge eating and eating self-efficacy in a sample of individuals seeking weight loss treatment (N = 151). They explore associations between various sociodemographic variables and the Binge Eating Scale and Weight Efficacy Lifestyle Questionnaire (WEL). At baseline, nonwhite participants or those with fewer years of education exhibited more confidence resisting eating when food was available. Moreover, nonwhite participants reported more self-confidence eating under social pressure and had higher total WEL scores than white participants. However, at six months, nonwhite participants' WEL scores decreased. White participants increased their total WEL scores and obtained a higher percent weight change by the end of the intervention. Additional investigations on the dynamics affecting the development of self-efficacy are warranted.

The Effect of Self-Efficacy on Behavior and Weight in a Behavioral Weight-Loss Intervention

OBJECTIVE

To determine whether eating self-efficacy (ESE) and physical activity self-efficacy (PASE) are predictive of dietary intake, physical activity, and weight change within a behavioral weight-loss intervention, and whether dietary intake and physical activity mediate relationships between self-efficacy and weight change.

METHOD

The study sample included 246 participants from a randomized trial with complete data on study variables at 12 months. ESE, PASE, calories consumed, minutes of moderate-to-vigorous physical activity (MVPA), and weight were measured at baseline, 6, and 12 months.

RESULTS

ESE at baseline was associated with 12-month percent weight loss (PWL), and was mediated by average calories consumed at 6 and 12 months. Change in ESE from baseline to 6 months was associated with calories consumed at 12 months and 12-month percent weight loss, but the mediated relationship was not significant. Baseline PASE was not associated with average MVPA at 6 and 12 months or 12-month PWL, but change in PASE from baseline to 6 months was associated with 12-month PWL through its effect on MVPA at 12 months.

CONCLUSION

Increases in ESE and PASE during the active phase of the intervention are predictive of dietary intake, physical activity and weight loss at later points, but further research should include explorations of the reciprocal relationship between behavior and self-efficacy to better inform intervention strategies that target self-efficacy and promote behavior change. (PsycINFO Database Record

Longitudinal Weight Loss Patterns and their Behavioral and Demographic Associations

BACKGROUND

Identification of weight change patterns may allow tailored interventions to improve long-term weight loss.

PURPOSE

To identify patterns of weight change over 18 months, and assess participant characteristics and intervention adherence factors associated with weight change patterns in a sample of 359 overweight/obese adults.

METHODS

Weight loss (0-6 months) was achieved with reduced energy intake and increased physical activity (PA). Maintenance (7-18 months) provided adequate energy to maintain weight and continued PA.

RESULTS

Latent profile analysis identified three weight change profiles. During weight loss/maintenance, participants in profiles 2 and 3 (18-month weight loss ∼14 %) attended more behavioral sessions and performed more PA compared with profile 1 (18-month weight loss <1 %). Self-efficacy for both weight management and exercise barriers were higher in profiles 2 and 3 compared with profile 1 following weight loss and during maintenance.

CONCLUSION

Weight change patterns can be identified and are associated with both participant characteristics and intervention adherence.

Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors

BACKGROUND

Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors.

METHODS/DESIGN

Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up.

DISCUSSION

This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life.

TRIAL REGISTRATION

U.S. Clinicaltrials.gov number: NCT02482506, April 2015.

Psychosocial predictors of weight loss by race and sex

This paper examined the psychosocial predictors of weight loss among race and sex subgroups. Analyses included overweight and obese participants from the PREMIER study, a previously published randomized trial that examined the effects of two multi-component lifestyle interventions on blood pressure among pre-hypertensive and stage 1 hypertensive adults. Both intervention conditions received behavioural recommendations for weight loss and group sessions. Weight and psychosocial measures of self-efficacy and social support for diet and exercise were assessed at baseline and at 6 months. There were 157 African-American (AA) women, 46 AA men, 203 non-AA women and 182 non-AA men with an average age of 50 years and average body mass index of 34 at baseline. Multiple predictor regression models were performed individually by race and sex subgroup. Among AA women, increases in diet self-efficacy were associated with weight loss. Among AA men, increases in diet-related social support and self-efficacy, along with increases in family support to exercise, were associated with weight loss (all Ps <0.05). Among non-AA women, increases in friends' support to exercise and exercise-related self-efficacy were associated with weight loss, and among non-AA men only increases in diet self-efficacy were associated with weight loss (all Ps <0.05). These results emphasize the need for targeted interventions based on race and sex to optimize the impact of lifestyle-based weight loss programmes.

Validation and Standardization of the Weight Control Perceived Self-Efficacy Inventory in a Mexican College Population

Purpose: The purpose of the study was to evaluate if the Weight Control Perceived Self-efficacy Inventory (WC-PSE) is reproducible in a Mexican college population. Methods and materials: This is an observational and prolective process study. Sixty subjects from two geographical regions of Mexico were invited to answer the WC-PSE on two separate occasions. Findings: The Content Validity Index was 0.96. The mean difference in the test retest was <4 in all domains; the intra-class correlation coefficient was >0.7; Cronbach’s coefficient was α=.95. The inventory was sensitive to detecting differences according to gender and degrees of body mass index. Conclusion: The WC-PSE inventory is reproducible and sensitive for application to a Mexican college population.

Predictors of initial weight loss among women with abdominal obesity: a path model using self-efficacy and health-promoting behaviour

AIM

To identify predictors of initial weight loss among women with abdominal obesity by using a path model.

BACKGROUND

Successful weight loss in the initial stages of long-term weight management may promote weight loss maintenance.

DESIGN

A longitudinal study design.

METHODS

Study participants were 75 women with abdominal obesity, who were enrolled in a 12-month Community-based Heart and Weight Management Trial and followed until a 6-month assessment. The Weight Efficacy Lifestyle, Exercise Self-Efficacy and Health Promoting Lifestyle Profile-II measured diet self-efficacy, exercise self-efficacy and health-promoting behaviour respectively. All endogenous and exogenous variables used in our path model were change variables from baseline to 6 months. Data were collected between May 2011-May 2012.

FINDINGS

Based on the path model, increases in both diet and exercise self-efficacy had significant effects on increases in health-promoting behaviour. Increases in diet self-efficacy had a significant indirect effect on initial weight loss via increases in health-promoting behaviour. Increases in health-promoting behaviour had a significant effect on initial weight loss.

CONCLUSION

Among women with abdominal obesity, increased diet self-efficacy and health-promoting behaviour were predictors of initial weight loss. A mechanism by which increased diet self-efficacy predicts initial weight loss may be partially attributable to health-promoting behavioural change. However, more work is still needed to verify causality. Based on the current findings, intensive nursing strategies for increasing self-efficacy for weight control and health-promoting behaviour may be essential components for better weight loss in the initial stage of a weight management intervention.

Effect of self-efficacy on weight loss: a psychosocial analysis of a community-based adaptation of the diabetes prevention program lifestyle intervention

Objective. Weight loss is the most effective approach to reducing diabetes risk. It is a research priority to identify factors that may enhance weight loss success, particularly among those at risk for diabetes. This analysis explored the relationships between self-efficacy, weight loss, and dietary fat intake among adults at risk for developing type 2 diabetes. Methods. This pilot, site-randomized trial was designed to compare group-based Diabetes Prevention Program lifestyle intervention delivery by YMCA staff to brief counseling alone (control) in 92 adults at risk for diabetes (BMI ≥ 24 kg/m(2), ≥ 2 diabetes risk factors, and a random capillary blood glucose of 110-199 mg/dl). Self-efficacy was measured using the Weight Efficacy Lifestyle questionnaire. Data were collected at baseline, 6 months, and 12 months. A paired t test was used to determine within-group changes in self-efficacy and weight at 6 and 12 months. Using a fitted model, we estimated how much of an increase in self-efficacy was related to a 5% weight reduction at 6 and 12 months. Results. Self-efficacy was associated with a 5% reduction in baseline weight at 6 and 12 months but was not related to fat intake. Conclusion. These findings suggest that it is important to assess the level of self-efficacy when counseling adults at high risk for diabetes about weight loss. Certain aspects of self-efficacy seem to play a greater role, depending on the stage of weight loss.

Translation, adaptation, validation and performance of the American Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) to a Norwegian version: a cross-sectional study

Background. Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients' adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes. Objectives. We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions' psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery. Design. Cross-sectional Methods. A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach's alpha and alpha if item deleted. Results. The PCA resulted in one factor with eigenvalue > 1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p < 0.001). The WEL-SF was associated with body mass index (BMI) (p < 0.001) and changes in BMI (p = 0.026). A very high item response was obtained with only one missing value (0.4%). The ceiling effect was in average 0.9 and 17.1% in the non-operated and operated sample, respectively. Strong internal consistency (r = 0.92) was obtained, and Cronbach's alpha remained high (0.86-0.92) if single items were deleted. Conclusion. The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients.

Predictors of Weight Loss for African-American Women in the Faith, Activity, and Nutrition (FAN) Study

BACKGROUND

Understanding predictors of weight loss can assist in developing targeted evidence-based programs to reduce obesity in faith-based settings. The purpose of this study was to examine predictors of weight loss for a sample of African-American women taking part in in a church-based study.

METHODS

Participants (N = 350) completed physical assessments and comprehensive surveys at baseline and 15 months later. Analyses examined baseline variables and change in variables from baseline to posttest, as predictors of ≥ 5% weight loss at posttest. Demographic, health-related, and behavioral variables were examined.

RESULTS

Lower baseline stress predicted greater likelihood of weight loss. Increased leisure-time physical activity (LTPA) from baseline to posttest was predictive of greater weight loss. The odds of ≥ 5% weight loss was 38% lower for every 1-point increase in baseline stress (OR = 0.62, CI = 0.39, 0.98, P = .04) and 6% greater for every 1-hour increase in posttest LTPA (OR = 1.06, CI = 1.0, 1.12, P = .049).

CONCLUSIONS

Increased LTPA appears to be an independent predictor of modest but meaningful reductions in weight among African-American women. African-American women reporting higher levels of stress at baseline may require more intense strategies emphasizing increased LTPA to lose weight.

Self-efficacy for temptations is a better predictor of weight loss than motivation and global self-efficacy: evidence from two prospective studies among overweight/obese women at high risk of breast cancer

OBJECTIVES

Identifying predictors of weight loss could help to triage people who will benefit most from programs and identify those who require additional support. The present research was designed to address statistical, conceptual and operational difficulties associated with the role of self-efficacy in predicting weight loss.

METHODS

In Study 1, 115 dieting overweight/obese women at high risk of breast cancer were weighed and completed questionnaires assessing motivation, global self-efficacy and self-efficacy for temptations. The main outcome measure was weight, measured 3-months post-baseline. Study 2 was identical (n=107), except changes in psychological variables were computed, and used to predict weight 6-months post-baseline.

RESULTS

In Study 1, self-efficacy for temptations was a significant predictor of weight loss at 3-month follow-up. In Study 2, improved self-efficacy for temptations between baseline and four-weeks was predictive of lower weight at 6 months.

CONCLUSION

The key finding was that self-efficacy for temptations, as opposed to motivation and global self-efficacy, was predictive of subsequent weight loss.

PRACTICE IMPLICATIONS

The implication is that augmenting dieters' capability for dealing with temptations might boost the impact of weight loss programs.

The effects of a community-based, culturally tailored diabetes prevention intervention for high-risk adults of Mexican descent

PURPOSE

This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors.

METHODS

The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy.

RESULTS

There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time.

CONCLUSIONS

Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

How accurate are Americans' perceptions of their own weight?

As obesity/overweight has increased in the United States (Centers for Disease Control and Prevention, 2009 ), studies have found that Americans' perceptions of their own weight often are not aligned with their actual body mass index (BMI; Brener et al., 2004 ; Christakis, 2003; Johnson-Taylor et al., 2008 ). Taylor, Funk, and Craighill ( 2006 ) found that half of Americans whose BMI indicated they were overweight perceived their weight to be just about right. The purpose of this study was to examine factors that influence the accuracy of weight self-perceptions and whether accuracy influences health behaviors. Using data from the 2007 Health Information National Trends Survey, the authors compared respondents' weight self-perceptions to their actual BMI to determine the accuracy of their weight self-perceptions. About 28%of respondents were obese, 35%were overweight, 35%were of normal weight, and 2%were underweight. About three quarters of the sample's self-perceptions of weight were aligned with their BMI. About 10%of the sample had a BMI that indicated they were overweight, but they perceived themselves to be of normal weight; about 10%were of normal weight but perceived themselves to be overweight; and about 5%of respondents were of normal weight but thought they were underweight. Gender, race, and education were associated with the accuracy of respondents' weight perceptions. Results suggest that asking patients about their weight self-perceptions could be useful in clinical settings and that weight perception accuracy could be used to segment audiences and tailor messages.

Effects of education in an obesity control program for obese homemakers on body fat and flexibility in Korea

The study aims to investigate the effects of education in an obesity-control program (EOCP) on the percentage of body fat and flexibility in obese women in Korea. Women with over 30% body fat were offered EOCP between July 2012 and October 2012. The EOCP consisted of an educational program, exercise program, and counseling. The numbers of participants both in the EOCP and control group were 17. The study was analyzed by Wilcoxon signed-rank test using the Statistical Analysis System package. The EOCP participants presented statistically significant increases in the degree of forward trunk flexion, but only the percentage of the body fat showed differences within the EOCP group. The EOCP improved flexibility in obese women, and can be used in local obesity-control programs.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was to provide a comprehensive review of the literature to identify lifestyle and behavioral modification obesity intervention studies for Black women. We included articles published between February 1992 and January 2013. This search identified 28 articles from the PsycInfo, MEDLINE, CINAHL, and SPORTDiscus databases. Results of these studies were summarized primarily into six categories. The importance of modest improvements in health outcomes that result from adapting healthier behaviors was highlighted. Future research is required for identifying the most salient intervention component or combination of components that lead to the best outcomes for ensuring intervention success and minimizing weight regain postintervention.

Self-efficacy as a predictor of weight change and behavior change in the PREMIER trial

OBJECTIVES

Determine whether self-efficacy independently predicted weight loss in a behavioral intervention and explore factors that influence the path between self-efficacy and weight change.

DESIGN

Secondary analysis of the PREMIER trial, a randomized controlled trial testing effects of lifestyle interventions on blood pressure.

SETTING

Four academic medical centers.

PARTICIPANTS

PREMIER recruited adults (n = 810) with pre-hypertension/stage 1 hypertension, not currently receiving medication. This analysis excluded participants in the control arm, resulting in n = 537.

INTERVENTIONS

Participants were randomly assigned to 1 of 3 groups: advice only, established lifestyle recommendations, or established lifestyle recommendations plus Dietary Approaches to Stop Hypertension dietary pattern.

MAIN OUTCOME MEASURES

Self-efficacy (dietary self-efficacy [DSE], exercise self-efficacy [ESE]), dietary intake, fitness.

ANALYSIS

Pearson correlations, 1-way analysis of variance, mediation analyses.

RESULTS

Despite an overall decrease in DSE/ESE, change in DSE/ESE significantly predicted weight change at 6 (β = -.21, P < .01; β = -.19, P < .01, respectively) and 18 months (β = -.19, P < .01; β = -.35, P < .01). Change in percent calories from fat partially mediated the DSE/weight change relationship at 6 months. Change in fitness partially mediated the ESE/weight change relationship at 18 months.

CONCLUSIONS AND IMPLICATIONS

Changes in DSE/ESE were not associated with behavior change as hypothesized. Additional research is needed to identify mediators between self-efficacy and adoption of behaviors that influence weight loss.

Weight-loss study in African-American Women: lessons learned from project take HEED and future, technologically enhanced directions

INTRODUCTION

African-American women are more overweight and have greater difficulty maintaining weight loss than do Caucasian women. Evidence suggests that African-American women are more successful with culturally tailored weight-loss programs.

METHODS

Begun in 2005, an 18-month randomized clinical trial, Project Take HEED (Healthy Eating and Exercise Decisions), culturally adapted an evidence-based dietary approach and exercise program to fit the female African-American population in an attempt to improve program attrition rates. The study was conducted with 223 African-American women (120 women in the experimental group; 103 controls), age 35 to 65 years, with a body mass index of 30 kg/m(2) or higher. The experimental group received education and instruction at 24 group sessions and were asked to record their daily food intake and physical activity. Cultural adaptation included social and spiritual components. Controls received usual care (referral to a dietitian).

RESULTS

After 18 months, Project Take HEED demonstrated the following outcomes: ATTRITION: the treatment group consisted of 12 African-American women at the end of month 18-(an attrition rate of 87%). (It had been 70% at the end of month 15.)FACTORS CONTRIBUTING TO ATTRITION INCLUDED: caregiver responsibilities, transportation difficulties, work schedules, and others. Those clients that did remain, however, provided the impetus for our next study. The remaining participants had, by and large, begun the study as being low in self-efficacy regarding weight loss and weight loss maintenance.

CONCLUSION

Initial Findings: The high self-efficacy that some women had at the beginning of the intervention did not translate into the desired behavior change. The inverse relationship seen in this study suggests that treatments that improve participants' self-efficacy may result in greater weight loss. New Directions: A new study, commencing in 2013, will use at-home Web-based and virtual reality technology (avatars) in an attempt to enhance client motivation to persist in long-term weight management programs. Bandura's pioneering work on self-efficacy will be the theoretical foundation of the pilot study, also enrolling African-American women.

Eating self-efficacy: development of a short-form WEL

Self-efficacy for eating is an important predictor of the successful adoption and maintenance of weight management behaviors. The Weight Efficacy Lifestyle Questionnaire (WEL) is a commonly used measure of eating self-efficacy consisting of 20-items and five situational factors. The aim of this study was to develop a short-form WEL (WEL-SF) for use in clinical practice and research. Factor analysis methodology was used with a sample of obese patients (N=1012) seeking weight loss treatment to develop the WEL-SF. The hypothesis was that the WEL would contain highly correlated items within the factors, and consequently could be shortened with minimal loss of clinically important information. Results revealed a one-factor solution. Given this unexpected finding, factor analysis was abandoned and alternative selection criteria were implemented. WEL-SF items were selected based upon: (1) lack of a ceiling effect for individual items, (2) high variability in patient responses, (3) lack of a strong correlation with other WEL items, (4) strong correlation with total WEL score, and (5) clinical judgment regarding importance and interpretability of individual items. These criteria resulted in an 8-item measure. The correlation between the WEL-SF total score and WEL total score was extremely strong, with a Pearson's r value of 0.968 and corresponding r(2) value of 0.937. Based on these findings, the 8-item WEL-SF appears to be a psychometrically valid measure of eating self-efficacy that accounts for 94% of the variability in the original version.

A concept analysis of self-efficacy among Chinese elderly with diabetes mellitus

AIM

This paper is a report of concept analysis of self-efficacy in elderly with diabetes in China.

METHODS

Literature was systematically retrieved from 2000 to 2011 using five databases: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, OVID, PsycInfo, and Web of Science. The key words used in the search were self-efficacy, diabetes, type 2, aged, self-care, and China. The electronic search was supplemented by a manual search of current issues of periodicals and follow-up of other cited materials, where appropriate. A total of 45 articles were retrieved. After a careful review of the 45 articles most relevant to the topic, 31 articles remained. They were used to complete a concept analysis using Walker and Avant's technique.

RESULTS

Four defining attributes of self-efficacy were identified: (a) cognitive recognition of requisite specific techniques and skills required to undertake diabetes self-management, (b) perceived expectations of the outcomes of self-management, (c) confidence in the capability to perform self-management, and (d) sustained efforts in self-management of diabetes.

CONCLUSIONS

Self-efficacy has been an important determinant in self-management among elderly with diabetes. The application of self-efficacy should be incorporated into decision-making and problem-solving procedures when caring for older adults with diabetes.

Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study

BACKGROUND

As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.

METHODS

This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.

RESULTS

In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.

CONCLUSION

These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.

Factors associated with weight resilience in obesogenic environments in female African-American adolescents

This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivity and undermines healthy weight behaviors. During 2005 to 2008, weight-resilient (n=32) and obese (n=35) African-American female adolescents (12 to 17 years) living in Detroit, MI, and their caregivers completed measures of individual, family, and extrafamilial weight-resilience factors. Variables related to weight resilience in bivariate analyses were subjected to multivariate analysis using logistic regression to test the hypothesis that these factors independently predicted adolescent membership into the weight-resilient or obese group. As hypothesized, the odds of an adolescent being weight resilient were predicted by lower caregiver body mass index (calculated as kg/m(2)) (odds ratio [OR]=0.790; 95% confidence interval [CI]: 0.642 to 0.973), lower caregiver distress (OR=0.796; 95% CI: 0.635 to 0.998), higher caregiver monitoring and supervision of exercise (OR=5.746; 95% CI: 1.435 to 23.004), more frequent full-service grocery store shopping (OR=5.147; 95% CI: 1.137 to 23.298), and more peer support for eating (OR=0.656; 95% CI: 0.445 to 0.969). Contrary to prediction, lower eating self-efficacy (OR=0.597; 95% CI: 0.369 to 0.965) also predicted weight resilience. The model correctly classified 92.5% of all cases. Findings suggest that increasing psychosocial weight-resilience factors across multiple systems might be an important intervention strategy for obese African-American female adolescents residing in obesogenic environments.

Predictors of weight loss success. Exercise vs. dietary self-efficacy and treatment attendance

Pre-treatment diet and exercise self-efficacies can predict weight loss success. Changes in diet self-efficacy across treatment appear to be even stronger predictors than baseline levels, but research on changes in exercise self-efficacy is lacking. Using data from a pilot study evaluating tangible reinforcement for weight loss (N=30), we examined the impact of changes in diet and exercise self-efficacy on outcomes. Multiple regression analyses indicated that treatment attendance and changes in exercise self-efficacy during treatment were the strongest predictors of weight loss. Developing weight loss programs that foster the development of exercise self-efficacy may enhance participants' success.

Self-efficacy scale for weight loss among multi-ethnic women of lower income: a psychometric evaluation

OBJECTIVE

This study examined test-retest reliability, internal consistency, and construct and predictive validity of the Physical Activity and Nutrition Self-Efficacy (PANSE) scale, an 11-item instrument to assess weight-loss self-efficacy among postpartum women of lower income.

METHODS

Seventy-one women completed the PANSE scale and psychosocial measures at baseline and at 7 and 13 weeks of a pilot study of weight loss.

RESULTS

Test-retest reliability of PANSE scores was r = 0.55 (P < .01). Cronbach α was r = 0.89. Construct validity was supported by correlations with less-healthful behaviors (r = -0.33, P = .005), perceived stress (r = -0.24, P = .04), and decisional balance (r = 0.25, P = .03). PANSE change scores correlated with intervention group weight changes (r = -0.54, P < .01), although baseline scores did not. One factor emerged (loadings .80 to .57).

CONCLUSIONS AND IMPLICATIONS

The PANSE scale demonstrated adequate reliability, internal consistency, construct validity, and moderate predictive validity. Replication is needed to confirm study findings.

Ethnic-Specific Weight-Loss Interventions for Low-Income Postpartum Women

Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo ( n = 23), African American ( n = 25), and Hispanic low-income postpartum women ( n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated significantly with self-efficacy (Spearman r = .50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r = .48) for African American women. In follow-up interviews, women felt interventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control groups (mailed interventions later) were generally more pleased with their assignment than intervention groups.

The impact of lifestyle modification in preventing or delaying the progression of type 2 diabetes mellitus among high-risk people in Jordan

Purpose: To investigate (1) the effectiveness of educational interventions in reducing the risk for developing type 2 diabetes mellitus (DM) among Jordanian adults at high risk, and (2) whether levels of self-esteem and self-efficacy affect the responses of participants towards educational interventions in reducing risks for developing type 2 DM.

Design: A comparative experimental pretest–post-test control group design was used. One hundred and thirteen participants at high risk for developing type 2 DM were randomly assigned to a study group ( n = 57) and a control group ( n = 56) based on the matching technique according to the risk factors.

Methods: The participants in the study group received 12 educational sessions about healthy diet guidelines and five educational sessions about guidelines for moderately intense physical activity. Participants in the control group received general written information about diet and exercises, but no specific individualised interventions were offered to them.

Results: The risk of type 2 DM among the study group was reduced by 28%. The results also indicated that participants in the study group had significant reduction in their body weight, and body mass index, and fasting blood sugar level. Participants in the study group with higher self-esteem and self-efficacy levels before receiving interventions achieved lower weight loss comparing to those who had lower self-esteem and self-efficacy levels.

Implications: The findings of the present study confirmed that lifestyle interventions concerned with educational sessions about dietary behaviours and exercises illustrate promising results in preventing or delaying the risk of developing type 2 DM by modifying its risk factors.