Kandice J. Porter

Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating

CONTEXT For decades, behavioral weight-loss treatments have been unsuccessful beyond the short term. Development and testing of innovative, theoretically based methods that depart from current failed practices is a priority for behavioral medicine. OBJECTIVE To evaluate a new, theory-based protocol in which exercise support methods are employed to facilitate improvements in psychosocial predictors of controlled eating and sustained weight loss. METHODS Women with obesity were randomized into either a comparison treatment that incorporated a print manual plus telephone follow-ups (n = 55) or an experimental treatment of The Coach Approach exercise-support protocol followed after 2 months by group nutrition sessions focused on generalizing self-regulatory skills from an exercise support to a controlled eating context (n = 55). Repeated-measures analysis of variance contrasted group changes in weight, physical activity, fruit and vegetable intake, mood, and exercise- and eating-related self-regulation and self-efficacy over 24 months. Regression analyses determined salient interrelations of change scores over both the weight-loss phase (baseline-month 6) and weight-loss maintenance phase (month 6-month 24). RESULTS Improvements in all psychological measures, physical activity, and fruit and vegetable intake were significantly greater in the experimental group where a mean weight loss of 5.7 kg (6.1% of initial body weight) occurred at month 6, and was largely maintained at a loss of 5.1 kg (5.4%) through the full 24 months of the study. After establishing temporal intervals for changes in self-regulation, self-efficacy, and mood that best predicted improvements in physical activity and eating, a consolidated multiple mediation model suggested that change in self-regulation best predicted weight loss, whereas change in self-efficacy best predicted maintenance of lost weight. CONCLUSIONS Because for most participants loss of weight remained greater than that required for health benefits, and costs for treatment administration were comparatively low, the experimental protocol was considered successful. After sufficient replication, physician referral and applications within health promotion and wellness settings should be considered.

Reciprocal Effects of Exercise and Nutrition Treatment-Induced Weight Loss with Improved Body Image and Physical Self-Concept

Improvements in self-image and mood are often reported as outcomes of obesity interventions. However, they may also concurrently influence weight loss, suggesting a reciprocal effect. Although previously reported for overweight women, such relationships were untested in morbidly obese women whose psychosocial responses to treatment may be different, and health-risks greater. Women (N = 161, Meanage = 42 years) with morbid obesity (MeanBMI = 45.1 kg/m2) participated in a 6-month, behaviorally based physical activity and nutrition treatment. Significant within-group improvements in weight-loss behaviors (physical activity and eating), weight, body satisfaction, physical self-concept, and depression were found. After controlling for age, mediation analyses indicated that, as a result of the treatment, weight loss was both an outcome and mediator of improvements in body-areas satisfaction and physical self-concept (reciprocal effects), but not depression. Results replicated findings from women with lower degrees of overweight, and suggested that weight-loss treatments emphasize changes in self-perception.

Carry-Over of Self-Regulation for Physical Activity to Self-Regulating Eating in Women With Morbid Obesity

Poor outcomes from behavioral treatments of severe obesity have led to a dependence on invasive medical interventions, including surgery for morbidly obese individuals. Improved methods to self-regulate eating will be required to reduce obesity. The use of self-regulation methods for completing physical activity may carry over to increased self-regulation for eating through improved feelings of competence (self-efficacy) and mood. The study recruited women (Meanage = 43 years) with morbid obesity (MeanBMI = 44 kg/m2) to participate in 26 weeks of cognitive-behavioral support of physical activity paired with either nutrition education (n = 51) or cognitive-behavioral nutrition (n = 51) methods. Data collected were from 2011 and 2012. Significant improvements in self-regulation for physical activity, self-regulation for eating, overall mood, and self-efficacy for eating, with greater improvement in self-regulation for eating, were observed in the cognitive-behavioral nutrition group. Changes in mood and self-efficacy for eating significantly mediated the relationship between changes in self-regulation for physical activity and self-regulation for eating. When subscales of overall mood and self-efficacy were entered into separate regression equations as mediators, the only significant mediators were vigor, and controlling eating when socially pressured and when increased cues to overeat were present.

Pilot testing a cognitive-behavioral protocol on psychosocial predictors of exercise, nutrition, weight, and body satisfaction changes in a college-level health-related fitness course.

Abstract Objective: Small-scale pilot testing of supplementing a required college health-related fitness course with a cognitive-behavioral exercise-support protocol (The Coach Approach). Participants: Three classes were randomly assigned to Usual processes (n = 32), Coach Approach–supplemented: Mid-size Groups (n = 32), and Coach Approach–supplemented: Small Groups (n = 34) conditions. Methods: Repeated-measures analyses of variance (ANOVAs) assessed overall and between-class changes in the behavioral/physiological factors of exercise, fruit/vegetable intake, and body mass index (BMI); and the psychosocial factors of self-regulation, exercise self-efficacy, mood, and body satisfaction. Dependent t tests evaluated within-class changes. Multiple regression analyses tested prediction of exercise by changes in self-regulation, self-efficacy, and mood. Results: Significant improvements in self-regulation and fruit/vegetable intake were found in all classes. The Coach Approach–supplemented classes demonstrated significant increases in exercise. Significant improvements in BMI, self-efficacy, and body satisfaction were found in only The Coach Approach–supplemented: Small Groups class. Psychosocial changes predicted increased exercise. Self-regulation was the strongest contributor. Conclusions: Overall, results were positive and warrant more comprehensive testing.

Autism Knowledge among Pre-Service Teachers Specialized in Children Birth through Age Five: Implications for Health Education.

Abstract Background: Autism prevalence has grown dramatically. Early interventions are effective in helping children with autism develop behavior patterns similar to children without the condition. It is important for health educators and teachers to recognize common autism symptoms among preschool children so they will benefit from early intervention. Purpose: To examine autism knowledge among pre-service teachers specialized in children birth through age five (B-5). Method: After an IRB approval was obtained, a self-administered paper-pencil survey was conducted in four undergraduate B-5 programs in the Southeastern United States. Data were collected from 148 of the 176 preservice B-5 teachers. Results: The mean age was 32 and 139 (93.9%) were female. 75.0% of the participants had limited experience interacting with autistic children. The mean score of perceived knowledge was 3.7 on a 7-point Likert scale with 7 being very knowledgeable and 1 being no knowledge. The mean actual knowledge score was 19.1 out of 26. Discussion: Many participants lacked autism knowledge, which is influenced by age, perceived autism knowledge, past experience in working with autistic children and the number of sources where participants received autism information. Translation to Health Education: Health educators should plan, implement, administer and manage health education, especially autism education, for B-5 teacher preparation programs.

Bi-Directional Relationship Between Self-Regulation and Improved Eating: Temporal Associations With Exercise, Reduced Fatigue, and Weight Loss

ABSTRACT. Severely obese men and women (body mass index ≥ 35 ≤ 55 kg/m2; Mage = 44.8 years, SD = 9.3) were randomly assigned to a 6-month physical activity support treatment paired with either nutrition education (n = 83) or cognitive-behavioral nutrition (n = 82) methods for weight loss. Both groups had significant improvements in physical activity, fatigue, self-regulation for eating, and fruit and vegetable intake. Compared to those in the nutrition education group, participants in the behavioral group demonstrated greater overall increases in fruit and vegetable intake and physical activity. These group differences were associated with changes that occurred after Month 3. Increased physical activity predicted reduced fatigue, β = −.19, p =.01. A reciprocal relationship between the mediators of that relationship, which were changes in self-regulation and fruit and vegetable intake, was identified. There was significantly greater weight loss over six months in the behavioral nutrition group when contrasted with the nutrition education group. Self-regulation for eating and fruit and vegetable intake were significant predictors of weight loss over both three and six months. Findings enabled a better understanding of psychosocial effects on temporal aspects of weight loss and may lead to more effective behavioral treatments for weight loss.

Behavioural support of a proposed neurocognitive connection between physical activity and improved eating behaviour in obese women.

PROBLEM An explanation of the association between physical activity and improved eating behaviours has recently been posited via the effect of physical activity on executive functions of the brain resulting in a reduction in the hedonic drive to overeat. Decomposition and clarification of embedded relationship through a behavioural/psychological framework was sought. METHODS Changes in theory-based psychosocial factors over 26 weeks were tested with 134 severely obese women (age 41.7±10.4 years) initiating a physical activity support treatment. Mediation and reciprocal effects analyses incorporating these changes were then computed. RESULTS Significant improvements in mood, self-regulation for eating, and self-efficacy for controlled eating were found. Emanating from mood change, a reciprocal relationship between changes in the self-regulation and self-efficacy measures was found. Thus, each factor reinforced the others change. CONCLUSION Findings suggest a convergence of neurocognitively and behaviourally based explanations of the relations of physical activity and controlled eating. Implications for behavioural weight-loss theory and treatments were suggested.

Effects of Instructional Physical Activity Courses on Overall Physical Activity and Mood in University Students

ABSTRACT Purpose: The aim of this research was to assess the association between university-based instructional physical activity (PA) courses and changes in overall PA levels and negative mood and their interrelations. The study also sought to determine the amount of change in PA required to significantly improve mood in course enrollees. Method: Participants were university students initially completing PA below the level recommended for health who were either presently enrolled in an elective instructional PA course (treatment group, n = 52, 69% female) or not presently enrolled in such a course (comparison group, n = 32, 69% female). Validated surveys assessed volumes of PA completed per week and overall negative mood from baseline to course end. Mediation analyses assessed group effects on mood through PA changes and reciprocal relations between PA and mood changes. Results: There was a significantly greater increase in PA and significantly more reduction in negative mood in the treatment group. Change in PA completely mediated the relationship between group and change in negative mood, and change in mood completely mediated the relationship between group and PA. These findings indicated a reciprocal, mutually reinforcing relationship between changes in PA and mood. An increase in PA of at least 2 days/week was associated with a significant reduction in negative mood, with no greater effect for more increase. Conclusions: Results provided an improved understanding of the effects of university-based instructional PA courses and how they might be leveraged to improve students’ mental health and possibly contribute to their academic success.

Self-Regulatory Skills for Controlled Eating Emanating from Newly Initiated Physical Activity

The relationship of physical activity with weight loss may largely be due to its association with psychosocial factors. The goal of this research was to clarify such relationships using a field design lasting 24 weeks. In Study 1, change in self-regulation for controlled eating, but not energy expenditure, mediated the relationship between changes in physical activity and weight in formerly sedentary, severely obese adults (n = 174). In Study 2 (n = 148), the addition of a cognitive-behavioral nutrition treatment was associated with significantly greater improvement in self-regulation for eating. Physical activity-related self-regulation changes were related to those improvements. Changes in self-efficacy for controlled eating and mood mediated the prediction of changes in eating-related self-regulation from changes on physical activity-related self-regulation. Change in body satisfaction was not a significant mediator. Based on the findings, practical uses of physical activity to enhance self-regulatory skills for controlled eating were suggested.