Long-term weight loss maintenance after inpatient psychotherapy of severely obese patients based on a randomized study: Predictors and maintaining factors of health behavior (original) (raw)
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International Journal of Behavioral Nutrition and Physical Activity, 2009
Background: Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment.
Body Image, 2010
This study reports on outcomes from a behavioral obesity treatment program, evaluating if treatment-related changes in body image and psychological well-being are predictors of weight change during treatment and after follow-up. Participants were 142 overweight/obese women (BMI = 30.2 ± 3.7 kg/m2; age = 38.3 ± 5.8 years) participants in a behavioral treatment program consisting of a 4-month treatment period and a 12-month follow-up. Psychosocial variables improved during treatment and these changes were correlated with 4-month weight reduction. Short-term changes in body size dissatisfaction (p = .002) and mood (p = .003) predicted long-term weight loss. Additional results suggest that there might be a predictive role of short-term changes in body size dissatisfaction and self-esteem on long-term weight loss after accounting for initial weight change (p < .028). We conclude that, along with weight changes, cognitive and affect-related processes influenced during obesity treatment may be related long-term success, in some cases independently of initial weight loss.
Self-Reported Psychosocial Health in Obese Patients before and after Weight Loss
Journal of Obesity, 2010
Psychosocial profiles were examined in 255 morbidly obese patients attending a hospital service offering access to standard weight loss therapies. 129 patients were reassessed after at least 6-month follow-up. At baseline, 51.8% and 32.7% of patients, respectively, had evidence of anxiety and depressive disorders, 24% had severe impairments in self esteem, and 29.7% had an increased risk of eating disorders. At follow-up, weight loss from baseline was significant in all 3 therapies: diet only is 0.74 ± 1.8 kg; pharmacotherapy is 6.7 ± 4.2 kg; and surgery is 20.1 ± 13.6 kg. Anxiety scores improved in all three groups (P < .05). Patients having pharmacotherapy or surgery had significant improvements in physical and work function and public distress compared to those having dietary treatment only (P < .05). Our observational data suggest that weight management services can lead to psychosocial benefit in morbidly obese patients. Well-designed studies are necessary to examine the link between weight loss and emotional health.
Reciprocal effects among changes in weight, body image, and other psychological factors during …
International Journal of Behavioral Nutrition and Physical …
Background: Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. Methods: Participants (BMI = 31.1 ± 4.1 kg/m 2 ; age = 38.4 ± 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective wellbeing, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. Results: At 12 months, the intervention group had greater weight loss (-5.6 ± 6.8% vs.-1.2 ± 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed.
International Journal of Behavioral Nutrition and Physical Activity, 2009
Background: Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment.
Body Image, 2010
This study reports on outcomes from a behavioral obesity treatment program, evaluating if treatmentrelated changes in body image and psychological well-being are predictors of weight change during treatment and after follow-up. Subjects were 142 overweight/obese women (BMI = 30.2 AE 3.7 kg/m 2 ; age = 38.3 AE 5.8 years) participants in a behavioral treatment program consisting of a 4-month treatment period and a 12-month follow-up. Psychosocial variables improved during treatment and these changes were correlated with 4-month weight reduction. Short-term changes in body size dissatisfaction (p = .002) and mood (p = .003) predicted long-term weight loss. Additional results suggest that there might be a predictive role of short-term changes in body size dissatisfaction and self-esteem on long-term weight loss after accounting for initial weight change (p < .028). We conclude that, along with weight changes, cognitive and affect-related processes influenced during obesity treatment may be related long-term success, in some cases independently of initial weight loss. ß
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2013
Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change C0.5 kg) and 35 as a success (10-year body weight change \0.5 kg) of the MNT. Prior to the beginning of the weight-management program, both the Dieting Readiness Test (DRT) and the Hospital Anxiety and Depression Scale (HADS) were administered. At a 10-year follow-up after the MNT, self-reported questionnaires were administered: quality of life was assessed by the Obesity Related Well-Being (ORWELL 97) questionnaire, eating attitudes and behaviours by the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES) investigated the presence and severity of binge eating and the Symptom Checklist (SCL 90-R) was used to identify the psychopathological distress. The scores of the ORWELL 97 items concerning symptoms (P = 0.005), discomfort (P = 0.03) and the total score (P = 0.02) were significantly lower in the success group. The depression score of the HADS was positively correlated with the percentage of body weight change observed 10 years after the MNT (r = 0.22; P = 0.045). The scores of the shape concern (EDE-Q) (r = 0.35; P = 0.013) and of the discomfort (ORWELL 97) (r = 0.36; P = 0.012) were significantly correlated with the percentage of body weight change 10 years after the MNT. In conclusion, this study is in agreement with the possibility that the psychological quality of life is associated even with modest amounts of weight loss in the long run. Further research should support identifying successful predictors of weight loss.
Psychological interventions for overweight or obesity
Reviews, 1996
Background Overweight and obesity are global health problems which are increasing throughout the industrialised world. If left unchecked, they will continue to contribute to the ever increasing non communicable disease burden. Objectives To assess the effects of psychological interventions for overweight or obesity as a means of achieving sustained weight loss. Search methods Studies were obtained from searches of multiple electronic bibliographic databases. Selection criteria Trials were included if the fulfilled the following criteria: 1) they were randomised controlled clinical trials of a psychological intervention versus a comparison intervention, 2) one of the outcome measures of the study was weight change measured by any method, 3) participants were followed for at least three months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI > 25 kg/m 2) at baseline. Data collection and analysis Two people independently applied the inclusion criteria to the studies identified and assessed study quality. Disagreement was resolved by discussion or by intervention of a third party. Meta-analyses were performed using a fixed effect model. Main results A total of 36 studies met the inclusion criteria and were included in the review. Overall, 3495 participants were evaluated. The majority of studies assessed behavioural and cognitive-behavioural weight reduction strategies. Cognitive therapy, psychotherapy, relaxation therapy and hypnotherapy were assessed in a small number of studies. Behaviour therapy was found to result in significantly greater weight reductions than placebo when assessed as a stand-alone weight loss strategy (WMD-2.5 kg; 95% CI-1.7 to-3.3). When behaviour therapy was combined with a diet / exercise approach and compared with diet / exercise alone, the combined intervention resulted in a greater weight reduction. Studies were heterogeneous however the majority of studies favoured combining behaviour therapy with dietary and exercise interventions to improve weight loss. Increasing the intensity of the behavioural intervention significantly increased 8 Psychological interventions for overweight or obesity (Review)
Journal of The American Dietetic Association, 2009
Background The identification of process and treatment variables associated with successful weight loss could be a pivotal strategy to reduce attrition and improve effectiveness of dietary treatment in obesity and could help find new therapeutic strategies. Objective The aim of study is to identify the psychological predictors of weight loss in patients with obesity compliant to continuous treatment at medical centers. Design Longitudinal observation of a large cohort of obese subjects entering weight-loss programs in the years 2000-2002. Subjects/setting Five hundred obese patients who completed 12-month weight-loss treatment by Italian medical centers offering different programs (78.8% females; age 46.2Ϯ10.8 years; body mass index [BMI; calculated as kg/m 2 ] 37.3Ϯ5.6). Main outcome measured Measurements were obtained at baseline and after a 12-month weight-loss program. Psychological distress, binge eating, body uneasiness, and attitude toward eating were evaluated by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, Body Uneasiness Test, and Eating Inventory [Dietary Restraint, Disinhibition, and Hunger]), together with BMI changes. Weight-loss expectations and primary motivation for seeking treatment (health or improving appearance) were also recorded.