Body image change and improved eating self-regulation in a weight management intervention in women

<p>Abstract</p> <p>Background</p> <p>Successful weight management involves the regulation of eating behavior. However, the specific mechanisms underlying its successful regulation remain unclear. This study examined one potential mechanism by testing a model in which improved body image mediated the effects of obesity treatment on eating self-regulation. Further, this study explored the role of different body image components.</p> <p>Methods</p> <p>Participants were 239 overweight women (age: 37.6 ± 7.1 yr; BMI: 31.5 ± 4.1 kg/m²) engaged in a 12-month behavioral weight management program, which included a body image module. Self-reported measures were used to assess evaluative and investment body image, and eating behavior. Measurements occurred at baseline and at 12 months. Baseline-residualized scores were calculated to report change in the dependent variables. The model was tested using partial least squares analysis.</p> <p>Results</p> <p>The model explained 18-44% of the variance in the dependent variables. Treatment significantly improved both body image components, particularly by decreasing its investment component (<it>f²</it>= .32 vs. <it>f²</it>= .22). Eating behavior was positively predicted by investment body image change (p < .001) and to a lesser extent by evaluative body image (p < .05). Treatment had significant effects on 12-month eating behavior change, which were fully mediated by investment and partially mediated by evaluative body image (effect ratios: .68 and .22, respectively).</p> <p>Conclusions</p> <p>Results suggest that improving body image, particularly by reducing its salience in one's personal life, might play a role in enhancing eating self-regulation during weight control. Accordingly, future weight loss interventions could benefit from proactively addressing body image-related issues as part of their protocols.</p

Predictors of Psychological Well-Being during Behavioral Obesity Treatment in Women

This study examined the association of autonomy-related variables, including exercise motivation, with psychological well-being and quality of life, during obesity treatment. Middle-aged overweight/obese women (n = 239) participated in a 1-year behavioral program and completed questionnaires measuring need support, general self-determination, and exercise and treatment motivation. General and obesity-specific health-related quality of life (HRQOL), self-esteem, depression, and anxiety were also assessed. Results showed positive correlations of self-determination and perceived need support with HRQOL and self-esteem, and negative associations with depression and anxiety (P < .001). Treatment autonomous motivation correlated positively with physical (P = .004) and weight-related HRQOL (P < .001), and negatively with depression (P = .025) and anxiety (P = .001). Exercise autonomous motivation was positively correlated with physical HRQOL (P < .001), mental HRQOL (P = .003), weight-related HRQOL (P < .001), and self-esteem (P = .003), and negatively with anxiety (P = .016). Findings confirm that self-determination theory's predictions apply to this population and setting, showing that self-determination, perceived need support, and autonomous self-regulation positively predict HRQOL and psychological well-being

Keep on running – a randomized controlled trial to test a digital evidence-based intervention for sustained adoption of recreational running: rationale, design and pilot feasibility study

Background: This paper describes the rationale, intervention development, study design and results from the pilot feasibility study of the Keep On Running (KOR) trial. KOR aims to test a web-based brief theory-based intervention, targeting maintenance of recreational running behavior over time (i.e. relapse preventing). Methods: Intervention development was based both on Self- Determination Theory and on Self-Regulation Theory. As part of it, a pilot study was implemented (n=18) to measure intervention adherence and participant satisfaction in order to establish the feasibility and acceptability of the intervention toolkit. Furthermore, this pilot study was also used to test the feasibility and acceptability of the questionnaires selected to be part of the later RCT. Results: Pilot intervention acceptability was good, but overall adherence was low. Features such as feedback and social sharing should be added to the toolkit. The main trial should lessen questionnaire length and include data from usual monitoring gadgets and apps (APIs). The protocol of the RCT was adjusted to test the efficacy of the refined final version of the intervention, and the RCT that will test it, contributing to the understanding of recreational running sustainability, allowing the optimization of future interventions aimed at physical activity promotion.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/acceptedVersio

Physical activity promotion tools in the Portuguese primary health care : an implementation research

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Background: This paper aims to discuss how physical activity (PA) brief assessment, brief counseling, and self-monitoring tools were designed and implemented in the Portuguese National Health Service (NHS), and to report on their current use by health professionals and citizens. Methods: Three digital tools to facilitate PA promotion in primary health care (PHC) were developed: 1) a PA brief assessment tool was incorporated in the electronic health record platform “SClínico Cuidados de Saúde Primários“; 2) a brief counseling tool was developed in the software “PEM—Prescrição Eletrónica Médica” (electronic medical prescription); and 3) a “Physical Activity Card” was incorporated in an official NHS smartphone app called “MySNS Carteira”. Results: From September 2017 to June 2019, 119,386 Portuguese patients had their PA assessed in PHC. Between December 2017 and June 2019, a total of 7957 patients received brief intervention for PA by a medical doctor. Regarding the app “MySNS Carteira”, 93,320 users activated the “Physical Activity Card”, between February 2018 and December 2018. Conclusions: These tools represent key actions to promote PA among Portuguese citizens using PHC as a priority setting. Further initiatives will follow, including proper assessment of their clinical impact and training programs for health care professionals on PA promotion.info:eu-repo/semantics/publishedVersio

Providing office workers with height-adjustable workstation to reduce and interrupt workplace sitting time: protocol for the Stand Up for Healthy Aging (SUFHA) cluster randomized controlled trial

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Sedentary behavior (SB) has been linked to several negative health outcomes. Therefore, reducing SB or breaking up prolonged periods of SB improves functional fitness, food consumption, job satisfaction, and productivity. Reducing SB can be achieved by introducing a health-enhancing contextual modification promoted by a sit-stand desk in the workplace. The primary goal will be to test the effectiveness of this intervention in reducing and breaking up SB, while improving health outcomes in office-based workers during a 6-month intervention. Methods: A two-arm (1:1), superiority parallel-group cluster RCT will be conducted to evaluate the effectiveness of this intervention in a sample of office-based workers from a university in Portugal. The intervention will consist of a psychoeducation session, motivational prompts, and contextual modification promoted by a sit-stand desk in the workplace for 6 months. The control group will work as usual in their workplace, with no contextual change or prompts during the 6-month intervention. Three assessment points will be conducted in both groups, pre-intervention (baseline), post-intervention, and a 3-month follow-up. The primary outcomes include sedentary and physical activity-related variables, which will be objectively assessed with 24 h monitoring using the ActivPAL for 7 days. The secondary outcomes include (a) biometric indices as body composition, body mass index, waist circumference, and postural inequalities; and (b) psychosocial variables such as overall and work-related fatigue, overall discomfort, life/work satisfaction, quality of life, and eating behavior. Both the primary and secondary outcomes will be assessed at each assessment point. Discussion: This study will lean on the use of a sit-stand workstation for 6 months, prompted by an initial psychoeducational session and ongoing motivational prompts. We will aim to contribute to this topic by providing robust data on alternating sitting and standing postures in the workplace. Trial registration: The trial was prospectively registered, and the details are at: https://doi.org/10.17605/OSF.IO/JHGPW ; Registered 15 November 2022. OSF Preregistration.This study was funded by the ILIND “Fazer+” scientific program (Reference: FAZER+/ILIND/CIDEFES/1/2022).info:eu-repo/semantics/publishedVersio

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>Participants (BMI = 31.1 ± 4.1 kg/m²; 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 well-being, 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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.</p

Estudo da Basic Need Satisfaction in General Scale para a língua portuguesa

Este estudo descreve o processo de adaptação da versão portuguesa, de 21 itens, da Basic Need Satisfaction in General Scale da teoria de auto-determinação. O instrumento é composto por três subescalas que correspondem às três necessidades básicas (a) competência, (b) autonomia e (c) relações de pertença. Foi administrado em dois estudos independentes, 420 e 408 participantes respectivamente, com amostras de conveniência da comunidade. A primeira fase incluiu tradução, retroversão e retradução; inspecção da equivalência lexical e de conteúdo; e reflexão falada. No processo de adaptação é aferido se a validade de conteúdo está de acordo com a teoria original. O estudo métrico revela valores baixos na consistência interna em algumas das subescalas. Numa análise exploratória inicial, em ambos os estudos, emergem três factores no scree plot, a maioria dos itens apresenta carga factorial apropriada no primeiro factor. Os resultados sugerem que a escala poderá ser utilizada na população portuguesa assumindo os princípios teóricos definidos pelos autores originais e reconhecidos na investigação.Abstract: This paper describes the adaptation process of the Portuguese version, comprised of 21 items, of the Basic Need Satisfaction in General Scale of self-determination theory. This instrument consists of three subscales that correspond to the three basic needs of (a) competence, (b) autonomy and (c) relatedness. It was administered in two independent studies, with 420 and 408 participants respectively, with convenience samples extracted from the community. The first phase included translation, back translation and retroversion; inspection for lexical equivalence, content validity and cognitive debriefing. In the adaptation process we evaluated whether the content validity was consistent with the original theory. Psychometric properties reveal low internal consistency in some of the subscales. In an initial exploratory analysis, in both studies, three factors emerged in the scree plot and most of the items displayed appropriate factorial load in the first factor. The results suggest that the scale may be used in the Portuguese population assuming the theoretical principles defined by the original authors and recognized in research

Successful weight loss maintenance in Portugal and in the USA : comparing results from two national registries

RESUMO - O Registo Nacional de Controlo do Peso (RNCP) estuda as características dos adultos portugueses com sucesso na manutenção do peso perdido. O presente trabalho compara os comportamentos e estratégias usadas no RNCP com os reportados por participantes do National Weight Control Registry (NWCR), nos EUA. Os 198 indivíduos da amostra (idade: 39,7 ± 11,1 anos; IMC: 26,0 ± 3,9 kg/m2), 59% mulheres, completaram um questionário inicial, que incluiu variáveis demográficas, estratégias de perda e de manutenção do peso, atividade física e alimentação. Os indivíduos apresentaram uma perda do peso média de 17,4 kg e tempo médio de manutenção de 29 meses. Os participantes no RNCP são, em média, mais novos e mais pesados do que os participantes no NWCR. Em ambos os registos, a alteração conjunta dos hábitos de atividade física e de alimentação foi a estratégia de perda do peso mais usada (82 vs. 89%, no NWCR). No RNCP, 43% das pessoas passou a subir escadas, 91% passou a tomar o pequeno-almoço, 79% a selecionar os alimentos de forma diferente, 74% a reduzir porções e 86% a reduzir a gordura nos alimentos. O dispêndio energético médio com atividade física no RNCP é de 3 422 kcal/semana, correspondendo a cerca de 250 min de atividade física moderada ou vigorosa (2 621 kcal/semana no NWCR), sendo a ingestão calórica de cerca de 2 200 kcal/d (comparada com 1 379 no NWCR). Outras estratégias de manutenção do peso foram: selecionar conscientemente os alimentos (69 vs. 92% no NWCR), limitar alimentos ricos em gordura (87 vs. 38%), limitar as porções (63 vs. 49%), tomar o pequeno-almoço (98 vs. 78%) e automonitorizar o peso (65 vs. 75%). Esta análise revela que as estratégias de perda e manutenção do peso adotadas pelos participantes portugueses apontam globalmente no mesmo sentido que as reportadas pela amostra americana. As diferenças detetadas são discutidas neste artigo.ABSTRACT - The aim of this work is to compare participant characteristics and weight loss and weight loss maintenance strategies adopted by an initial cohort of the Portuguese Weight Control Registry (PWCR) with published results from the National Weight Control Registry’s (NWCR). Sample includes 198 adults (age: 39.7 ± 11.1 yr; BMI: 26.0 ± 3.9 kg/m2), 59% women, who voluntarily registered to the PWCR and completed one initial questionnaire including demographics, methods and strategies used to lose weight and/or to maintain weight, and a laboratory assessment. Individuals meeting inclusion criteria reported a weight loss of 17.4 kg, maintained for an average of 29 months. The PWCR sample is younger, heavier, and more gender-balanced than the NWCR sample. Modifying both dietary intake and physical activity (PA) levels was the most common weight loss strategy in Portuguese individuals (82%), while 89% reported it in NWCR. To lose weight, 43% of all PWCR participants started to use stairs, 91% started to eat breakfast every day, 79% chose “better foods”, 74% reported “limiting food quantities”, and 86% frequently limit fat intake. To keep weight loss, PWCR individuals engaged weekly in 250 minutes of moderate and vigorous physical activity and a weekly physical activity energy expenditure of 3422 kcal (NWCR: 2621 kcal). Other strategies were used: 69% chose “better foods” (NWCR: 92%), 87% frequently limiting fat intake (NWCR: 38%), 63% reported “limiting food quantities” (NWCR: 49%), 98% ate breakfast every day (NWCR: 78%), and 65% weighed themselves at least once a week (NWCR: 75%). Data from the first PWCR cohort show similarities with the larger US sample of successful maintainers but also some differences. This work discusses these differences.info:eu-repo/semantics/publishedVersio

Long-term Randomized Controlled Trial

Funding Information: The authors thank Sarah E Scott for her valuable contributions as the trial manager and in the user experience evaluation, and Susana Cunha for her contribution in conducting and reporting the focus groups. This project has received funding from the European Union?s Horizon 2020 research and innovation program under grant agreement number 643309. The material presented and views expressed here are the responsibility of the authors only. The European Union Commission does not take responsibility for any use made of the information set out.Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content.publishersversionpublishe