Project TEAMS (Talking about Eating, Activity, and Mutual Support): a randomized controlled trial of a theory-based weight loss program for couples

Dual-substance use disorder couples: An integrative review and proposed theoretical model

Committed romantic relationships between two individuals with Substance Use Disorder (or dual-SUD couples) are prevalent. Dual-SUD couples have poor treatment engagement and outcomes. Research has established a reciprocal link between relationship dynamics (e.g., conflict, intimacy) and substance use. Thus, the couple's relationship presents a distinct social context for both partner's substance use. Dual-SUD couples face unique challenges due to substance use being a shared behavior that may serve as a rewarding source of compatibility, closeness, and short-term relationship satisfaction despite it being at the cost of other alternative sources of substance-free reinforcement. Yet, treatment options for these couples are scarce. Dual-maladaptive health behaviors (e.g., dual-substance use) are challenging to treat; however, theory and preliminary research suggests that transformation of couple's joint motivation toward adaptive health behavior change may result in a more satisfying relationship and improved treatment outcomes for both individuals. The current paper reviews the extant literature on dual-SUD couples from theoretical, empirical, and treatment research and proposes an expanded paradigm regarding how we understand dual-SUD couples with the aim of informing basic research and treatment development.

Self-control and grit: associations with weight management and healthy habits

Weight management requires resisting immediate temptations in one's environment (self-control) as well as the ability to persevere towards one's long-term goals despite minor setbacks (grit). This study sought to establish relationships between self-control, grit, and behavioral and health outcomes in the context of a couples-based weight management intervention. Couples (n = 64 dyads) in a behaviorally based intervention completed measures of self-control and grit at study entry and the end of treatment (6 months). Habit automaticity for self-weighing and exercise as well as objective weights were measured at baseline, 6 months, and 12 months (maintenance). Self-control and grit increased during treatment; these increases were significantly associated with greater self-weighing habit automaticity at 6 months. Baseline self-control, changes in self-control, and baseline grit were also associated with 6-month exercise automaticity. Only baseline grit was associated with weight loss maintenance. No partner effects were observed. Findings suggest that self-control and grit are malleable constructs that may play an important role in health behavior habits associated with weight management.ClinicalTrials.gov: NCT02570009, October, 7, 2015.

Motivating Weight Loss Among Black Adults in Relationships: Recommendations for Weight Loss Interventions

BACKGROUND

Black men and women have the highest rates of obesity in the United States. Behavioral weight loss programs incorporating intimate partners may be effective in combating obesity among this population. Yet, current participation in these programs is low. Identifying motivations and triggers to weight loss may provide insight in designing programs to increase participation.

AIM

To determine triggers and motivations for weight loss among Black men and women in committed relationships to inform development of weight loss interventions.

METHOD

Twenty semi-structured interviews, based on an integrated theoretical framework of interdependence and communal coping and the social cognitive theory, were conducted among Black heterosexual couples where one or both individuals intentionally lost ≥5% of their body weight in the last 6 months in a metropolitan region in a southern state. Interviews were transcribed and coded. Themes were identified following multi-rater coding and direct and conventional content analysis. Recommendations were developed from emergent themes.

RESULTS

Among individuals with recent weight loss, personal relevancy and awareness (health awareness and self-awareness) were identified as personal triggers for weight loss initiation. Health concerns and appearance were general motivations among the total sample.

CONCLUSION

Emphasizing the impact of weight on daily functioning and quality of life, and increasing awareness of personal weight status and health consequences, may increase weight loss initiation and participation in weight loss programs among Black men and women in committed relationships. Findings also highlight strategies to improve recruitment and retention and guide intervention development and implementation for this population.

Evidence of the Associations between Individual and Partner Autonomy Support and Physiological Stress in the Context of Conversations about Weight among Couples Who are Overweight or Obese during a 6-Month Intervention

The aim of the study was to examine the impact of supportive communication on acute physiological stress responses during weight-related conversations taking place throughout a couples' weight loss program. Participants were 47 married or cohabitating couples where each partner had a BMI of 25-40 kg/m². Couples were randomized as a dyad into a traditional weight loss program or a program that also included training in providing support to one's partner throughout the weight loss process. Structured conversations between partners about weight management were videotaped at baseline and 6 months. Participants provided saliva samples before and after the conversations, which were assayed for cortisol and salivary alpha-amylase (sAA) to determine physiological stress and anxiety responses to conversations about weight. The results indicated that receiving support from one's partner when discussing weight-related issues was associated with greater physiological stress, as indicated by higher cortisol and sAA levels, whereas providing support to one's partner was associated with lower cortisol levels and higher sAA levels. The findings suggest that receiving support is not a universally positive experience, especially for populations facing health issues. The mixed findings for support provision align with previous studies identifying a negative association between affectionate communication and cortisol levels, as well as a positive association between sAA and anxiety and emotional arousal. The findings and their implications for understanding the physiological correlates of couples' conversations about weight are discussed.

Autonomy support in a couples weight loss trial: Helping yourself while helping others

INTRODUCTION

Self-determination theory proposes that autonomy-supportive environments produce better health outcomes, and evidence demonstrating the importance of autonomy support for health behavior change has become increasingly clear. The bulk of the previous research has focused on the effects of receiving autonomy support, whereas the present study focuses on the potential impact of providing autonomy support for improving the weight loss and relationship satisfaction of the support provider.

METHOD

Sixty-four couples were randomized to a standard weight loss intervention or to an intervention that included training to enhance autonomy support behavior (e.g., empathic responding, accepting personal choices, etc.). Groups met weekly for 6 months, with assessments at baseline, 3, 6, and 12 months. The assessment of provided autonomy support was based on ratings of videotaped interactions of the couple discussing weight loss issues and on partner report of the autonomy support they received.

RESULTS

The results did not show any condition effects; however, the results for both conditions indicated that beyond receiving autonomy support, providing autonomy support was associated with greater sustained weight loss for the support provider, and for men greater relationship satisfaction over time.

DISCUSSION

The results confirm the importance of couples-based interventions and autonomy support for behavior change. In addition, it appears that providing autonomy support is useful for both the recipient and the provider. These results point to the need for developing targeted interventions to facilitate the provision of autonomy support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dyadic Disruption Theory

Aspects of couples' romantic relationships are some of the most powerful psychosocial forces shaping mental and physical health, but even high-quality relationships are not universally beneficial for patients. Dyadic health theories have largely focused on chronic illness management that occurs after the couple understands the disease and prognosis, rather than focusing on couples' interdependence in the days and weeks following a sudden and disruptive medical event (e.g., an acute coronary syndrome [ACS] or a stroke). To address this gap, I propose Dyadic Disruption Theory to guide research on couples' reactions to acute medical events and their consequences for individual and dyadic mental health, physical health, and behavior. I propose that dyadic processes of social support, shared reality, and co-rumination can precipitate harmful patient and partner dynamics when couples are distressed early post-event and offer three propositions that inform testable hypotheses. Finally, I discuss implications for early dyadic intervention and future directions for research.

Long-term sustainability of a physical activity and nutrition intervention for rural adults with or at risk of metabolic syndrome

OBJECTIVE

To determine longer-term (18-month) sustainability of a six-month physical activity and nutrition intervention for 50-69-year-olds with or at risk of metabolic syndrome residing in a rural Australian community.

METHODS

Participants (n=151) were followed-up at 12 and 18 months post-intervention. Changes in nutrition behaviours (fat and fibre barometer); physical activity behaviours (IPAQ); anthropometry (waist-hip ratio, weight, BMI), blood pressure, blood parameters (triglycerides, glucose, LDL-, HDL-, non-HDL, total-cholesterol) were analysed using t-tests and repeated measures ANOVA.

RESULTS

Across three time points (6, 12 and 18 months) marginal decrease was observed for waist circumference (p=0.001), a modest increase was observed for diastolic blood pressure (p=0.010) and other outcome measures remained stable.

CONCLUSION

Maintenance and ongoing improvement of health behaviours in the longer-term is challenging. Future studies must look for ways to embed interventions into communities so they are sustainable and investigate new approaches to reduce the risk of chronic disease. Implications for public health: Metabolic syndrome is a major health issue in Australia and worldwide. Early identification and management are required to prevent the progression to chronic disease. This 18-month follow-up showed that outcomes measures remained relatively stable; however, there is a need to investigate opportunities for embedded community interventions to support long-term health behaviour change.

Why We Never Eat Alone: The Overlooked Role of Microbes and Partners in Obesity Debates in Bioethics

Debates about obesity in bioethics tend to unfold in predictable epicycles between individual choices and behaviours (e.g., restraint, diet, exercise) and the oppressive socio-economic structures constraining them (e.g., food deserts, advertising). Here, we argue that recent work from two cutting-edge research programmes in microbiology and social psychology can advance this conceptual stalemate in the literature. We begin in section 1 by discussing two promising lines of obesity research involving the human microbiome and relationship partners. Then, in section 2, we show how this research has made viable novel strategies for fighting obesity, including microbial therapies and dyad-level interventions. Finally, in section 3, we consider objections to our account and conclude by arguing that attention to the most immediate features of our biological and social environment offers a middle ground solution, while also raising important new issues for bioethicists.

Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children

OBJECTIVE

Spouses are known to influence the outcomes of an individual's attempt at weight loss, but little is known about the broader influence of, and on, the family. The objectives were to explore: (a) the effects of an adult weight management program on the family and (b) family factors that help or hinder patient weight loss.

METHODS

A qualitative design was employed to explore triadic family members' experiences of patient participation in a weight management program. Semi-structured interviews were conducted with patients, partners and children (ages 7-18). Questions included support for patient participation and weight loss, dietary choices, meal preparation, physical activity routines, the home-food environment, communication about health and family dynamics. Thematic analysis was used, where codes and categories of codes were then grouped together to create themes and subthemes.

RESULTS

Nineteen triadic interviews were conducted (57 total). Seven themes emerged, including four related to Outcomes (objective 1): (a) shift in family dynamics, (b) family behaviour change, (c) child observations of family change, (d) indirect benefit to partner; and three related to Process (objective 2): (e) level of accountability, (f) patient perception of support and (g) support is essential and flexible.

CONCLUSIONS

Future research and clinical applications from these themes should seek to determine the positive behaviour change that was evident in the families that were interviewed, where the culmination of family interactions, expectations and concurrent partner weight loss indicates the potential longevity of weight management programs beyond patients' own participation.

A randomized controlled trial of a theory-based weight-loss program for couples

OBJECTIVE

Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples.

METHOD

Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months.

RESULTS

Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02).

CONCLUSIONS

Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Feasibility and efficacy of a novel technology-based approach to harness social networks for weight loss: the NETworks pilot randomized controlled trial

OBJECTIVE

Harnessing social support from existing social ties represents a key weight control practice. This trial evaluated an intervention that provided health-promoting technologies for leveraging the influence of existing social ties.

METHODS

Volunteers (N = 36) with a body mass index between 25 and 55 kg m-2 were randomized to a 16-week, in-person, technology-supported behavioural weight-loss treatment (standard behavioural treatment) or the same programme supplemented by providing self-selected members of participants' social networks with a digital body-weight scale and Fitbit Zip physical activity tracker (ENHANCED).

RESULTS

Average weight losses from baseline to 16 weeks did not significantly differ between groups (standard behavioural treatment, 5.30%, SD =3.93%; ENHANCED, 5.96%, SD = 5.19%, p = 0.63). By the 1-year follow-up, standard behavioural treatment had lost 5.63%, SD = 8.14% of baseline weight versus 4.73%, SD = 9.43% for ENHANCED (p = 0.82). ENHANCED reported self-weighing on more days than did standard behavioural treatment (p = 0.03). Most participants reported high programme satisfaction. Similar improvements were observed in perceived social support for diet and exercise from baseline to 16 weeks in both groups (ps < 0.05) but regressed by 1 year (ps < 0.01).

CONCLUSION

Although feasible to implement, this technology-based, social support approach failed to enhance outcomes of a face-to-face, group-based behavioural weight-loss treatment.

Contributions of personality to social influence: Contingent associations between social network body size composition and BMI

Social influence is a key determinant of health behaviors and outcomes. Research in the social network tradition emphasizes social structural mechanisms like network content (i.e., the degree to which particular attitudes, attributes, or behaviors are present in the network) and social proximity (i.e., opportunities for social interaction). In contrast, psychologists are oriented toward the individual, identifying how personality traits like self-monitoring affect susceptibility to peer pressure. Here, we integrate social network and personality approaches, examining social influence on body size using surveys of 379 adults with dependent children. Our findings suggest that the association between social network body size composition and respondent BMI is contingent on both individual susceptibility to influence (i.e., high self-monitoring) and social proximity (i.e., opportunities for co-eating). These results indicate that individuals embedded in social networks bring unique sets of social skills and orientations to interactions, potentially influencing the flow of content across networks.

Weight Stigma in Men: What, When, and by Whom?

OBJECTIVE

This study assessed the weight stigma experiences of men, examining characteristics of men who experienced weight stigma versus men who did not.

METHODS

Data from three samples of men were examined (N = 1,513). Sample 1 consisted of men with obesity at elevated risk for weight stigma. Sample 2 comprised a convenience online panel. Sample 3 included men from a national online panel of US adults. Men in all samples completed almost identical questionnaires assessing demographics, anthropometrics, weight stigma, and dieting.

RESULTS

Approximately 40% of men reported experiencing weight stigma. Weight stigma was associated with increased odds of having a BMI consistent with underweight or obesity relative to normal weight. Verbal mistreatment was the most common form of weight stigma experienced across all life stages for men. The most common sources of weight stigma were peers, family members, and strangers. Men reporting weight stigma were younger and less likely to be married, had higher BMIs, and were more likely to have tried to lose weight in the past year relative to men not reporting weight stigma.

CONCLUSIONS

Understanding differences among men as a function of weight stigma is important for practitioners, as it can identify men who may most benefit from intervention.