M.Q. Werrij

Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity

OBJECTIVE The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment. METHODS Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise. RESULTS Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight. CONCLUSION Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity.

The role of coping appraisal in reactions to fear appeals: do we need threat information?

Fear appeal theory postulates a multiplicative relationship between threat information and coping appraisal on fear control (e.g. avoid thinking about breast cancer to reduce feelings of fear) and danger control (e.g. motivation to perform monthly breast self-examination to detect breast cancer). That is, the effects of threat information on measures of both coping modes are moderated by beliefs about one’s ability to cope with the presented threat. However, in the present study no support for an interaction between threat information and coping appraisal was found on both coping modes. Instead threat information seems to contribute positively to fear control and not to danger control, whereas coping appraisal contributed positively to danger control and negatively to fear control. The results thus suggest that we might do without threatening information in persuading peopo adopt healthpromoting behaviours.

Self-efficacy moderates message-framing effects: The case of skin-cancer detection.

Health-promoting messages can be framed in terms of the gains associated with healthy behaviour, or the losses associated with unhealthy behaviour. Studies show inconsistent results as to which type of framing is more effective. In this study, we examined the influence of self-efficacy to perform skin self-examination on the effects of gain- and loss-framed skin-cancer detection messages among 124 university students. For participants with high self-efficacy, a loss-framed message resulted in a higher intention to perform skin self-examination than a gain-framed message. For participants with low self-efficacy, there were no differences in intention between the gain- and loss-framed message conditions. Our results suggest that self-efficacy levels play an important role in message-framing effects. For health communication strategies promoting the active detection of skin-cancer symptoms, messages stressing losses may be more effective than messages stressing gains, but only in persons with high self-efficacy. In addition, our results suggest that health promoting messages can be framed to match recipients’ self-efficacy levels.

Investigating message-framing effects in the context of a tailored intervention promoting physical activity

Health-promoting messages can be framed in terms of the gains associated with healthy behaviour or the losses associated with unhealthy behaviour. It has been argued that gain-framed messages promoting physical activity (PA) are more effective than loss-framed messages, but empirical findings are inconsistent. Also, no previous studies investigated the effects of gain- and loss-framed messages in the context of a computer-tailored PA intervention. In this study, we provided participants with computer-generated tailored feedback concerning their PA levels. In total, 787 participants entered in the study, of whom 299 completed all measures at a 3-month follow-up. We investigated whether gain- and loss-framed messages promoting PA affected information acceptance, attitude, intention and behaviour differently. The results showed that gain-framed messages resulted in stronger intentions to be physically active than loss-framed messages. This did not result in a significant increase in actual PA, however, as measured by a 3-month follow-up assessment. For information acceptance and attitude, a non-significant advantage of gain-framed messages was found. All effects had small effect sizes. Thus, whereas gain-framed information might be more persuasive than loss-framed information when it comes to promoting PA, the differences between gain- and loss-framed messages are likely to be small.

Does perceived risk influence the effects of message framing? A new investigation of a widely held notion

Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This ‘risk-framing hypothesis’, as we call it, was derived from prospect theory, has been central to health message framing research for the last two decades, and does not cease to appeal to researchers. The present paper examines the validity of the risk-framing hypothesis. We performed six empirical studies on the interaction between perceived risk and message framing. These studies were conducted in two different countries and employed framed messages targeting skin cancer prevention and detection, physical activity, breast self-examination and vaccination behaviour. Behavioural intention served as the outcome measure. None of these studies found evidence in support of the risk-framing hypothesis. We conclude that the empirical evidence in favour of the hypothesis is weak and discuss the ramifications of this for future message framing research.

Self-efficacy as a potential moderator of the effects of framed health messages

This study focuses on self-efficacy as a potential moderator of the effects of gain- and loss-framed health messages. Undergraduate students (N = 124) received a gain- or loss-framed message about consuming ecological meat. The data revealed that for participants high in self-efficacy, the gain-framed message resulted in consuming more ecological meat than the loss-framed message. Moreover it was found that — within the gain-frame condition — participants low in self-efficacy scored higher on measures of defensive processing than participants high in self-efficacy. This study provides further evidence for the role of self-efficacy as a potential moderator of the effects of framed health messages.

Does perceived risk influence the effects of message framing? Revisiting the link between prospect theory and message framing.

ABSTRACT Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This ‘risk-framing hypothesis’, which was derived from prospect theory, has been central to health message-framing research for the better part of two decades and has enduring appeal to researchers and practitioners. It has found its way into several health communication handbooks and is communicated to the general public. The present article examines the validity of the risk-framing hypothesis anew by providing a review of the health message-framing literature. In spite of its ongoing appeal, we conclude that the hypothesis has severe theoretical flaws. In addition, we find that the empirical evidence in favour of the hypothesis is weak and inconsistent. It seems that, in applying prospect theory’s tenets to a health-promotion context, some of the theory’s key aspects have been lost in translation. At the close of the article, we offer a research agenda for the future, arguing that, above all, new methodology is needed to bring the message-framing literature further.

Early associations with palatable foods in overweight and obesity are not disinhibition related but restraint related

Obese people prefer and overconsume high-fat foods. At the same time they often attempt to lose weight. In two studies we investigated relations between palatable high-fat food words and disinhibition related concepts (study 1) and palatable high-fat food words and restraint related concepts (study 2) within the semantic priming paradigm. In study 1, 24 overweight/obese and 19 healthy weight women participated. There was no association between palatable high-fat food words and disinhibition. In study 2, 27 obese and 29 healthy weight women participated. The presentation of palatable high-fat food words facilitated the accessibility of restraint related concepts as hypothesized, but independent of weight status. Clearly, early associations with palatable high-fat food words are restraint related in both healthy weight and obese people.

Dietary treatment for obesity reduces BMI and improves eating psychopathology, self-esteem and mood

Objectives: In the present study, the hypothesis was tested that a regular dietary treatment for obesity that is primarily directed at decreasing weight will also decrease concerns about shape, weight and eating, will reduce binge eating, and will improve mood and self-esteem. Moreover, we investigated whether a group treatment and an individual treatment were equally effective.Method: Fifty-four obese participants followed either a group treatment (n = 31) or an individual treatment (n = 23) provided by dieticians.Results: The data showed that overall, BMI, weight concerns and depressive symptoms decreased and self-esteem increased. The percentage of bingers decreased marginally significantly. For dietary restraint, eating concerns and shape concerns group treatment led to greater changes than individual treatment.Conclusion: Although the dietary treatment was not aimed at changing psychological characteristics, patients significantly improved on measures of eating-related and general psychopathology. (Netherlands Journal of Psychology, 64, 8-15.)

The Value of Indirect Measures for Assessing Food Preferences in Abnormal Eating

Abstract.Indirect measures have been used for the assessment of food preferences. These measures are indirect in the sense that the researcher does not ask a participant directly for his food preference, but derives his preference from a behavior. Typically, the affective priming paradigm and the Implicit Association Test have been used. The relevant processes in these paradigms are relatively automatic. One of the advantages of these paradigms is that responses are less likely to be influenced by socially desirable response tendencies and do not rely on the participant’s introspection. This paper provides an overview of research about relatively automatic associations with food in general and specifically for anorexia nervosa patients, dieters, and obese people. Multiple studies suggest that these paradigms can uncover food likes and dislikes. In most studies, no differences in food preferences were found between obese and lean people, or between restrained and unrestrained eaters. Possibly there simply are no group differences in automatic food associations. Alternatively, the employed indirect measures are not sensitive enough to detect truly existent differences. Interestingly, it was found that anorexia nervosa patients displayed a reduced sensitivity to the palatability of foods. Another interesting finding is that the presence of an immediate food related context influenced the automatic food associations. For now, the use of indirect measures in explaining differences between obese and lean people, and restrained and unrestrained eaters, does not seem a very viable approach. It might be for a clinical disorder such as anorexia nervosa.Zusammenfassung (Redaktion).In diesem Beitrag wird gezeigt, wie das Verhalten der Verbraucher bei der Auswahl von Lebensmitteln auf indirekte Weise erfasst werden sollte. Dies Verfahren ist insofern indirekt, als der Projektleiter den jeweiligen Probanden nicht direkt danach befragt, welche Lebensmittel er bevorzugen würde, sondern dies aus dessen Verhalten ableitet. Grundsätzlich wurden dabei das ,,affective priming paradigm” und der ,,Implicit Association Test” eingesetzt. Die relevanten Prozesse erfolgen bei diesen beiden Paradigmen relativ automatisch; einer ihrer Vorteile ist es, dass die Reaktionen der Probanden weniger durch gesellschaftlich wünschenswerte Tendenzen beeinflusst werden und sich nicht durch eine etwaige Selbsterkenntnis der Probanden begründen lassen. Es werden Untersuchungen vorgestellt, die sich generell mit den mit Lebensmitteln verbundenen Assoziationen befassen und im Besonderen mit denen von Magersüchtigen, Übergewichtigen und Personen, die sich bei der Nahrungsaufnahme bewusst beschränken. Verschiedene Studien scheinen zu suggerieren, dass mit diesen Paradigmen die Vorliebe für bestimmte Lebensmittel bzw. ihre Ablehnung ermittelt werden kann. In den meisten Studien unterschieden sich die Präferenzen für bestimmte Lebensmittel nicht bei übergewichtigen und schlanken Personen oder bei Personen, die sich bei der Nahrungsaufnahme bewusst beschränkten, und solchen, die sich nicht an solche Regeln hielten. Möglicherweise gibt es entweder keine gruppenspezifischen Unterschiede bei den automatisch mit Lebensmitteln verbundenen Assoziationen oder aber die angewandten indirekten Messverfahren sind nicht sensitiv genug, um tatsächlich bestehende Unterschiede aufspüren zu können. Interessanterweise konnte nachgewiesen werden, dass bei Magersüchtigen das Gespür für die Schmackhaftigkeit von Lebensmitteln weniger ausgeprägt ist. Von Interesse ist auch, dass das augenblickliche, auf ein Lebensmittel bezogene Umfeld Einfluss haben kann auf die automatischen, mit diesem Lebensmittel verbundenen Assoziationen. Es zeigte sich, dass die indirekten Verfahren derzeit nicht geeignet scheinen, um Unterschiede zwischen den Personengruppen mit verschiedenen Eßgewohnheiten erklären zu können. Sie mögen aber hinreichen für die Analyse klinischer Erscheinungsbilder wie zum Beispiel der Magersucht.