Sam J. Zizzi

Survey of bariatric surgical patients' experiences with behavioral and psychological services.

BACKGROUND Bariatric surgery continues to grow in popularity as a treatment of obesity; however, weight regain and noncompliance with behavioral recommendations remain an issue. Little is known about the type and frequency of services completed by bariatric patients and their satisfaction with these services. However, preliminary research has shown that the use of behavioral and psychological services is less common after surgery. We assessed the behavioral and psychological services completed by bariatric patients before and after surgery, patient satisfaction with the surgery and services, and the relationship between the completed services and the outcomes. The participants were solicited for participation using an on-line support Web site dedicated to obesity and bariatrics. METHODS A convenience sample of 380 subjects were included in the present study. They completed an Internet-based survey that assessed the psychological, dietary, exercise, and lifestyle services completed before and after surgery, their satisfaction with these services, and their weight loss outcomes. RESULTS Overall, the participants reported completing more services before surgery. After surgery, the most frequently reported services completed were support groups and dietary consultation. More than one half of the participants did not meet with either a mental health professional or an exercise professional after surgery. The participants expressed high satisfaction with their surgery and services, with exercise services receiving the lowest satisfaction rating. A statistically significant relationship was found between the total number of postoperative psychological and behavioral services completed and a greater percentage of excess weight lost. The t tests showed that participants who completed group exercise sessions and nutritional consultation after surgery lost more weight than did those who did not complete these services. CONCLUSION The participants in the present sample reported completing few behavioral and psychological services after surgery. However, our findings showed that these services could promote greater weight loss and maintenance. Thus, it is recommended that bariatric facilities and insurance providers consider requiring patients to complete postoperative behavioral modification programs that target improvement in diet and physical activity behaviors.

A Mixed Methods Evaluation of a 12-Week Insurance-Sponsored Weight Management Program Incorporating Cognitive-Behavioral Counseling

Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive—behavioral weight management program and explore factors associated with weight loss. Quantitative data (N = 55) revealed program completion rate and mean percentage weight loss that compare favorably with other interventions, and differential psychosocial impacts on those losing more weight. Telephone interviews (n = 11) revealed four potential mechanisms for these differential impacts: (a) fostering accountability, (b) balancing perceived effort and success, (c) redefining ‘‘success,’’ and (d) developing cognitive flexibility.

Predictors of Clinically Significant Weight Loss and Participant Retention in an Insurance-Sponsored Community-Based Weight Management Program

Health insurance providers are a logical partner in providing third-party payment for behavioral weight loss programming, but little evidence of predictors of improved outcomes or retention in large, insurance-sponsored lifestyle programming is available. The purpose was to determine predictors of weight loss and retention in an insurance-sponsored, community-based weight management program. Current and former participants (N = 2,106) were recruited to complete a program evaluation survey. Respondents’ survey and objective outcome data (n = 766) were analyzed using logistic regression procedures to understand the factors predictive of clinically-significant (5%) weight loss and program retention (>6 months). Clinically significant weight loss was predicted by completing more than 6 months of the program, positive ratings of staff interaction, and social support from friends on success. Ratings of positive impact of site hours of operation, nurse calls, and availability of safe places to be active and feeling comfortable at the site were predictive of program retention. Modifiable intervention, social factors, and site-level factors were predictive of clinically significant weight loss and program retention, providing fodder for further study and dissemination to current providers and to a broader network of health promotion professionals.

Predictors of weight loss maintenance following an insurance-sponsored weight management program.

Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m2) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day.

Beyond weight loss: A qualitative exploration of participant expectations and strategies for measuring progress during a weight management program

Objectives: Previous research with participants in weight management has primarily focused on participant weight-loss expectations. The purpose of this study was to explore participant expectations and strategies for measuring progress during a community-based weight management program. Methods: Semi-structured interviews were completed with 22 participants with overweight or obesity, who were currently enrolled in a 2-year weight management program in order to understand their expectations and strategies for measuring their progress. Results: Aside from weight loss, participants’ expectations included improved health, fitness, and mood, gaining support, and developing new habits. Participants discussed measuring their success by focusing on weight loss and changes to their body, improved health, mood, and fitness, creation of new habits, and gaining additional support. Conclusion: The results of this study suggest that participant’s in a weight management program expected benefits beyond just weight loss.

A qualitative analysis of the role of emotions in different patterns of long-term weight loss

Objective: To explore participant perspectives of the impact emotions have on weight loss. Design: A qualitative design gathered data through semi-structured interviews with participants in a weight management programme. The interview addresses the following research questions: (1) how do individuals working to lose weight perceive the impact emotions have on their long-term success, and (2) what strategies do more or less successful participants use to regulate their emotions? Researchers conducted and transcribed the interviews then completed content analysis to create and organise themes. Results: Two broad themes emerged through the interviews with 21 participants: emotional impact and emotional regulation. Further subthemes captured emotions blocking action toward goals, strategies for regulating emotions (e.g. exercise, food) and the need for new strategies to regulate emotions. Themes were also split in to three groups based on weight outcomes: regainer, moderate success (3–6% loss) and large success (>7% loss). More successful participants, compared to regainers, shared being aware of the impact of their emotions and made efforts to develop healthy regulation strategies. Conclusions: Emotional awareness and regulation play an important role in participant’s weight management experience. Taking time to build emotional awareness and strategies to manage emotions is important to participants in weight management.

Three pathways to supervision in applied sport psychology: Challenges and strategies to deliver effective supervision in graduate programs

ABSTRACT Supervision is especially important for novice supervisees who tend to need more guidance and support. Literature about supervision in sport psychology includes a variety of method recommendations and examples of supervision cases that help a supervisor develop their supervision approach. Still, most of these cases do not discuss the daily challenges in using these approaches or strategies to overcome these challenges and deliver good-quality supervision in the context of graduate programs. The present article aims to describe three delivery methods of supervision, their contexts, challenges, strategies to overcome these challenges, and ethical considerations when using them.

Changes in Weight Loss, Health Behaviors, and Intentions among 400 Participants Who Dropped out from an Insurance-Sponsored, Community-Based Weight Management Program

The majority of weight management research is based on data from randomized controlled studies conducted in clinical settings. As these findings are translated into community-based settings, additional research is needed to understand patterns of lifestyle change and dropout. The purpose of this study was to examine reasons for and consequences associated with dropout (or removal) from an insurance-funded weight management program. Using a mixed methods approach with objectively measured changes in body weight and attendance along with quantitative and qualitative survey data, patterns of intention and behavior change were explored. The results from a sample of 400 respondents support the idea that there are both positive and negative consequences of program participation. Overall, 1 in 5 respondents lost a clinically significant amount of weight during the program (>5% of baseline body weight) and 1 in 3 experienced a positive consequence, while only 6% expressed a negative outcome of participation. Additionally, nearly 90% of all of the consequences that emerged from the data were positive. Attitude change was a major theme, including positive health intentions, perceived success, learning skills, and new appreciation of exercise.

Client Experiences With Dietary, Exercise, and Behavioral Services in a Community-Based Weight Management Program.

Compared with randomized trials, community-based interventions are delivered by a wider variety of professionals with varied training backgrounds. When evidence-based programs are scaled into larger formats and disseminated to a wider audience, little is understood about how clients experience these interventions. To understand the experience of clients after meetings with nutrition, exercise, and health behavior professionals, researchers surveyed participants after 6 months in a weight management program. A total of 958 participants were recruited in monthly cohorts beginning September 2011 to complete a program evaluation survey. Qualitative inductive analysis was completed on several open-text items querying respondents as to what they found helpful from meetings with a registered dietitian, personal trainer, and health behavior counselor. Results indicate participants benefitted from gaining knowledge, learning new behavioral skills, or from interpersonal interactions. Findings suggest that the various professional services are valued by clients and that professionals appear to stay within their scope of practice. Implications for those working in weight management are discussed.

In the Huddle

Sport and exercise psychology has predominately focused on performance improvement; however, as the world faces issues of globesity and other chronic illnesses, we find ourselves uniquely positioned to apply our expertise and training to address these larger issues of public health relevance, that is physical activity adoption and maintenance. In fact, children and adolescents are a population most vulnerable and after-school youth sport programs can be a solution to this public health crisis. However, the number one cited reason among both girls and boys for dropping out of youth sport is that it is no longer fun. Indeed, sport and exercise psychology consultants can play a pivotal role in the promotion of physical activity and wellness at this grassroots level through the provision of applied services that address issues of participation, namely retention and attrition from youth sport. Using self-determination theory and behavioral economics as guiding theoretical frameworks, practitioners can work with youth sport participants, parents, coaches, and league administrators to foster fun, choice-driven, and rewarding sport experiences such that children and adolescents want to participate in them. This is significant because children’s physical activity and health promoting behaviors track into adulthood. Thus, as practitioners, we are uniquely qualified to act as public health stewards in the health promotion and disease prevention of children, adolescents, and families through sport.