Ping H. Johnson

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.

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.

Relative effects of reduced weight and increased physical activity on hemoglobin A1c: suggestions for behavioral treatments

Behavioral treatments for diabetes have often been unsuccessful and may benefit from a better understanding of the relative effects of two common treatment foci - decreased weight and increased volume of physical activity - on blood glucose. Overweight and obese adults (N = 59; Mage = 60 years) with hemoglobin A1c (HbA1c) values consistent with diabetes participated in a 6-month community-based behavioral treatment based on tenets of self- efficacy theory and social cognitive theory. The treatment was associated with significantly increased physical activity, reduced body mass index (BMI), and reduced HbA1c levels (ps < .001). Changes in BMI and physical activity accounted for a significant portion of the variance in change in HbA1c, R 2 = .13, p = .023. Change in volume of physical activity, β = −.36, p = .007, but not change in BMI, β = −.03, p = .792, significantly contributed to the variance in HbA1c change that was accounted for. There was no effect based on the sex of participants. Discussion focused on how findings might impact the efficacy, efficiency, and application of behavioral treatments for diabetes management.

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.

A Content Analysis of Health Education Teaching Strategy/Idea Articles: 1970–1998

Abstract A content analysis of health education teaching strategy/idea articles was conducted to determine the foci and trend of topic areas, teaching activities, target population, instructional objectives, and information about contributing author(s). All of the strategy/idea articles published by the Journal of Health Education (JOHE) (n=390) and the Journal of School Health (JOSH) (n=90) as of December 1998 were analyzed. Intercoder reliability was 92.6% and intracoder reliability was 95.7%. Various health education topics had been covered; however, the topic areas did not change much over nearly three decades. A variety of teaching activities had been introduced in both journals, with JOHE articles being more diverse. Many of the articles in both journals introduced several teaching and learning activities to teach one topic area. Student population was most often targeted. Significantly more JOSH articles than JOHE articles identified instructional objectives and the target population. University faculty members were the major body of contributors. It is recommended that in the future more topic areas should be covered and more population groups should be targeted. Future articles should provide the instructional objectives, identify the target population, and indicate the activity effectiveness. Authors other than university faculty should be encouraged to contribute innovative teaching strategies/ideas.

Does an Effective Theoretically Based Weight Loss Treatment for Middle-Aged Women Work for Young Women?

ABSTRACT Background: Young adults gain weight faster and suffer from chronic diseases at a younger age than their older counterparts. Existing behavioral obesity treatments included few young adults, and their effects on young adults remain unknown. Purpose: The purpose of this study was to explore whether a behavioral treatment that was effective in weight loss for mostly middle-aged women would be effective for young women. Methods: One hundred eleven female undergraduates with obesity recruited from a large public university in the Southeastern United States in 2014–2016 received treatment, including 6 individual exercise support sessions over 6 months and 20 biweekly group nutrition sessions. Measurements include weight, waist circumference, physical activity, diet, mood, and exercise- and eating-related self-regulation and self-efficacy at baseline and at months 3 and 6. Results: Attrition was 65.8% at month 3 and 87.4% at month 6. Paired t tests show significant reductions in weight and significant improvements in weight loss–related behaviors and psychological variables at month 3. More average weight was lost at month 6. Discussion: Despite high attrition, the treatment demonstrated some positive effects for the young college women who continued attending sessions. Translation to Health Education Practice: Health Educators should explore reasons for attrition among college students with obesity and develop treatment components to help them lose excess weight.