Traci Mann

Medicare's search for effective obesity treatments: Diets are not the answer.

The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.

Don't Mind If I Do: Disinhibited Eating Under Cognitive Load

Past research has shown that strong emotional or motivational states can cause normally restrained eaters to overeat. In this article it is argued that simple cognitive load can also disinhibit eating by restrained eaters. Two studies examined this disinhibition effect. In Study 1, restrained and unrestrained eaters were given the opportunity to consume high-calorie food while performing either a high cognitive-load or low cognitive-load task. Restrained eaters consumed more food when under high cognitive load than when under low cognitive load; unrestrained eaters showed the opposite pattern. Study 2 replicated the disinhibition effect and ruled out stress, diminished awareness of food consumption, and ironic rebound as probable mediators. Results suggest that cognitive load may disinhibit consumption by preventing restrained eaters from monitoring the dietary consequences of their eating behavior. Implications for theories of self-regulation are discussed.

Affirmation of Personal Values Buffers Neuroendocrine and Psychological Stress Responses

Stress is implicated in the development and progression of a broad array of mental and physical health disorders. Theory and research on the self suggest that self-affirming activities may buffer these adverse effects. This study experimentally investigated whether affirmations of personal values attenuate physiological and psychological stress responses. Eighty-five participants completed either a value-affirmation task or a control task prior to participating in a laboratory stress challenge. Participants who affirmed their values had significantly lower cortisol responses to stress, compared with control participants. Dispositional self-resources (e.g., trait self-esteem and optimism) moderated the relation between value affirmation and psychological stress responses, such that participants who had high self-resources and had affirmed personal values reported the least stress. These findings suggest that reflecting on personal values can keep neuroendocrine and psychological responses to stress at low levels. Implications for research on the self, stress processes, health, and interventions are discussed.

Dispositional Motivations and Message Framing: A Test of the Congruency Hypothesis in College Students

The authors examined the congruency hypothesis that health messages framed to be concordant with dispositional motivations will be most effective in promoting health behaviors. Undergraduate students (N=63) completed a measure of approach/avoidance orientation (behavioral activation/inhibition system) and read a gain- or loss-framed message promoting flossing. Results support the congruency hypothesis: When given a loss-framed message, avoidance-oriented people reported flossing more than approach-oriented people, and when given a gain-framed message, approach-oriented people reported flossing more than avoidance-oriented people. Discussion centers on implications for health interventions and the route by which dispositional motivations affect health behaviors through message framing.

Are Two Interventions Worse Than None? Joint Primary and Secondary Prevention of Eating Disorders in College Females

Prevention programs for eating disorders attempt to simultaneously prevent new cases from arising (primary prevention) and encourage students who already have symptoms to seek early treatment (secondary prevention), even though ideal strategies for these 2 types of prevention may be incompatible with each other. In the present study, an eating disorder prevention program was evaluated in a simple of female college freshmen. In the intervention, classmates who had recovered from eating disorders described their experiences and provided information about eating disorders. At follow-up, intervention participants had slightly more symptoms of eating disorders than did controls. The program may have been ineffective in preventing eating disorders because by reducing the stigma of these disorders (to encourage students with problems to seek help), the program may have inadvertently normalized them.

Predicting Persuasion-Induced Behavior Change From the Brain

Although persuasive messages often alter peoples self-reported attitudes and intentions to perform behaviors, these self-reports do not necessarily predict behavior change. We demonstrate that neural responses to persuasive messages can predict variability in behavior change in the subsequent week. Specifically, an a priori region of interest (ROI) in medial prefrontal cortex (MPFC) was reliably associated with behavior change (r = 0.49, p < 0.05). Additionally, an iterative cross-validation approach using activity in this MPFC ROI predicted an average 23% of the variance in behavior change beyond the variance predicted by self-reported attitudes and intentions. Thus, neural signals can predict behavioral changes that are not predicted from self-reported attitudes and intentions alone. Additionally, this is the first functional magnetic resonance imaging study to demonstrate that a neural signal can predict complex real world behavior days in advance.

Barriers to antiretroviral medication adherence in HIV-infected women

Little is known about the barriers which women living with HIV/AIDS encounter that impede their adherence to antiretroviral medication regimens. Yet in order to design effective interventions to improve womens adherence, it is first imperative to identify the factors that contribute to their non-adherence. The purpose of this study was to explore, from HIV-infected womens own perspectives, the barriers they faced in adhering to combination antiretroviral therapies. Twenty HIV-infected women were asked to keep a personal journal for a period of one month. In the journals, women wrote about what their lives were like while taking antiretroviral medications. Line-by-line open coding was done to identify major ideas and themes within the journal entries. Results showed that women faced six main barriers to adherence, those related to: (1) medication regimens, (2) side effects, (3) social relationships, (4) medication beliefs, (5) daily schedules, and (6) body weight. The findings underscore the difficult nature of the antiretroviral regimens and illuminate the daily obstacles women face in adhering to therapy. Interventions that target womens unique barriers are needed to improve adherence to antiretroviral medication regimens.

Self-regulation of health behavior: social psychological approaches to goal setting and goal striving.

OBJECTIVE The goal of this article is to review and highlight the relevance of social psychological research on self-regulation for health-related theory and practice. METHODS We first review research on goal setting, or determining which goals to pursue and the criteria to determine whether one has succeeded. We discuss when and why people adopt goals, what properties of goals increase the likelihood of their attainment, and why people abandon goals. We then review research on goal striving, which includes the planning and execution of actions that lead to goal attainment, and the processes that people use to shield their goals from being disrupted by other competing goals, temptations, or distractions. We describe four types of strategies that people use when pursuing goals. RESULTS We find that self-regulation entails the operation of a number of psychological mechanisms, and that there is no single solution that will help all people in all situations. We recommend a number of strategies that can help people to more effectively set and attain health-related goals. CONCLUSIONS We conclude that enhancing health behavior requires a nuanced understanding and sensitivity to the varied, dynamic psychological processes involved in self-regulation, and that health is a prototypical and central domain in which to examine the relevance of these theoretical models for real behavior. We discuss the implications of this research for theory and practice in health-related domains.

Low Calorie Dieting Increases Cortisol

Objective: To test the hypothesis that dieting, or the restriction of caloric intake, is ineffective because it increases chronic psychological stress and cortisol production—two factors that are known to cause weight gain; and to examine the respective roles of the two main behaviors that comprise dieting—monitoring ones caloric intake and restricting ones caloric intake—on psychological and biological stress indicators. Methods: In a 2 (monitoring vs. not) × 2 (restricting vs. not) fully crossed, controlled experiment, 121 female participants were assigned randomly to one of four dietary interventions for 3 weeks. The monitoring + restricting condition tracked their caloric intake and restricted their caloric intake (1200 kcal/day); the monitoring only condition tracked their caloric intake but ate normally; the restricting only condition was provided 1200 kcal/day of food but did not track their calories, and the control group ate normally and did not track their intake. Before and after the interventions, participants completed measures of perceived stress and 2 days of diurnal saliva sampling to test for cortisol. Results: Restricting calories increased the total output of cortisol, and monitoring calories increased perceived stress. Conclusions: Dieting may be deleterious to psychological well-being and biological functioning, and changes in clinical recommendations may be in order. HPA = hypothalamic-pituitary-adrenocortical; PSS = Perceived Stress Scale; CAR = cortisol awakening response.

From ‘I Wish’ to ‘I Will’: Social-Cognitive Predictors of Behavioral Intentions:

We tested the ability of several social-cognitive models to predict intentions to engage in two different health behaviors (resisting dieting and performing breast self-exam). All constructs from the health belief model (with and without self-efficacy), the theory of planned behavior (with and without perceived behavioral control) and the motivational process of the health action process approach were measured simultaneously in two subject samples. We hypothesized that models that include self-efficacy (or the related construct of perceived behavioral control) would be more effective than the models that do not include it. Our results supported this prediction. The health action process approach was the best predictor of intentions to engage in both behaviors. Implications for selecting appropriate models on which to base interventions are discussed.