Weight ‘locus of control’ and weight management in an urban population

Background: To assess the extent to which Weight Locus of control relates to BMI and socio-economic status in an urban population. Methods: 232 people responded to a questionnaire relating to bodyweight, health, weight management and the ‘weight locus of control’. Questionnaires were sent to a sample of 2600 people in Sheffield, United Kingdom. The questionnaires were distributed into diverse 'ward' areas; data was collected in 2016. Results: In the present investigation BMI correlated with ward area (P<0.001) (BMI was 27.5kg/m² ± 6.8 in ward area 1 versus 23.6kg/m² ± 4.1 in ward area 4). The higher an individual's BMI the more 'external' they were in relation to their perception of factors affecting weight control (P=0.024). Higher status occupation was correlated with a greater likelihood of having an internal weight locus of control (P=0.004). Having a high BMI was correlated with concern over health (P=0.041). Conclusions: People of higher weight and lower occupational status have more external loci of control. Key theoretical and clinical approaches to behaviour change (e.g. Self-Determination Theory and Motivational Interviewing) suggest that 'internality' is a desirable locus of control orientation. Consideration of the findings from the present investigation conclude that for weight management practice, professionals could focus on developing 'internality'

Nutritional peak week and competition day strategies of competitive natural bodybuilders

Bodybuilders utilize peaking strategies in a bid to fine-tune their aesthetics for competition day. The most prevalent peaking strategies utilized by natural bodybuilders are unreported in the current literature. Eighty-one (M - 59, F - 22) natural bodybuilders were recruited from competitions during the 2016 and 2017 British Natural Bodybuilder Federation seasons. Competitors completed a 34-item questionnaire designed to investigate peaking and contest day strategies. The questionnaire listed commonly utilized peaking strategies and provided additional space for qualitative information. Analysis of the data indicated that carbohydrate (CHO), water and sodium manipulation were the most commonly utilized peak week strategies. The consumption of high glycemic index CHO was the most common competition day strategy. Only 6.2 % of competitors reported following their regular diet the week prior to competition. The CHO manipulation strategies were similar to classical CHO loading, whereby bodybuilders attempt to maximize muscle glycogen concentrations. Furthermore, bodybuilders attempted to remove superfluous water by exploiting the diuretic/polyuria effect associated with water loading/restriction. The potentially deleterious effects of peaking on bodybuilders' health is considered and the efficacy of these strategies to enhance appearance is discussed. The findings of the present investigation are likely to be of interest to bodybuilders and their coaches

A case study series of the health status and key anthropometry in very large strength athletes.

Strongmen are characterised by the large mass they use to perform feats of strength, but the effect this large mass has on the athlete's health is unknown. The aim of this study was to: characterise a group of strongmen and to compare observed values with established parameters for good health. We measured resting metabolic rate, body composition, skinfolds, lipid profiles, fasted glucose, blood pressure, power output, and grip strength in six competitive strongmen over six months. Blood pressure varied, with three of the strongmen recording hypertensive values. Fasted blood glucose levels aligned with values for healthy adults, but cholesterol/lipid profiles were more variable, suggesting that values are generally poorer in strongmen than in healthy adults. The large body mass of the strongmen corresponded with a large amount of adipose tissue, which may incur risk for non-communicable disease. Furthermore, the risk of disease may be further compounded by anabolic steroid use. Dietary considerations are made for protecting cardiovascular health and the potential for 'healthy' weight gain. To our knowledge this is the first such nested cohort study in the area of strongmen competitors. Larger studies are needed to confirm and further elucidate this data. The article also suggests considerations for protecting the health of competitive strongmen

Effectiveness of training final-year undergraduate nutritionists in motivational interviewing

Objectives - To assess the efficacy of a motivational interviewing (MI) training programme on trainee nutritionists. Methods - A repeated measures design was applied to assess clinician behaviours in a ‘helping’ conversation. Participants were 32 nutrition students, assessed at baseline and one-month follow-up. Results - The training significantly reduced the use of closed questions and MI non-adherent behaviours (MINA) (P for both = <0.001). Trainees significantly increased reflections, affirmations, summaries (P for all = <0.001) and the use of open questions (P = <0.013) which are all key indicators of MI beginner-competence. The talk-time ratio of the nutritionists also changed significantly, in favour of the client which serves as an indication of MI being used effectively. There were also significant increases in ‘global' scores for empathy, direction, autonomy/support, collaboration and evocation. Conclusions - Newly trained nutritionists 1 month post-training have a consultation style which suggested positive outcomes for clients. The trainees' scores at the one month post-training assessment were verifiable as ‘beginning proficiency'. Practice implications - Behaviour change counselling skills for nutritionists were enhanced, at one month post-training. MI training workshops with video feedback enhances communication skills which are likely to lead to positive consultation-behaviour changes in the trainee nutritionists

Pilot study of the influence of self-coding on empathy within an introductory motivational interviewing training

Background: Motivational interviewing (MI) is a framework for addressing behavior change that is often used by healthcare professionals. Expression of empathy during MI is associated with positive client outcomes, while absence of empathy may produce iatrogenic effects. Although training in MI is linked to increased therapeutic empathy in learners, no research has investigated individual training components' contribution to this increase. The objective of this study was to test whether a self-coding MI exercise using smartphones completed at hour 6 of an 8-h MI training was superior in engendering empathy to training as usual (watching an MI expert perform in a video clip for the same duration at the same point in the training). Methods: This was a pilot study at two sites using randomization and control groups with 1:1 allocation. Allocation was achieved via computerized assignment (site 1, United Kingdom) or facedown playing card distribution (site 2, United States). Participants were 58 students attending a university class at one of two universities, of which an 8-h segment was dedicated to a standardized MI training. Fifty-five students consented to participate and were randomized. The intervention was an MI self-coding exercise using smartphone recording and a standardized scoring sheet. Students were encouraged to reflect on areas of potential improvement based on their self-coding results. The main outcome measure was score on the Helpful Responses Questionnaire, a measure of therapeutic empathy, collected prior to and immediately following the 8-h training. Questionnaire coding was completed by 2 blinded external reviewers and assessed for interrater reliability, and students were assigned averaged empathy scores from 6 to 30. Analyses were conducted via repeated-measures ANOVA using the general linear model. Results: Fifty-five students were randomized, and 2 were subsequently excluded from analysis at site 2 due to incomplete questionnaires. The study itself was feasible, and overall therapeutic empathy increased significantly and substantially among students. However, the intervention was not superior to the control condition in this study. Conclusions: Replacing a single passive learning exercise with an active learning exercise in an MI training did not result in a substantive boost to therapeutic empathy. However, consistently with prior research, this study identified significant overall increases in empathy following introductory MI training. A much larger study examining the impact of selected exercises and approaches would likely be useful and informative

Nutritional strategies of British professional and amateur natural bodybuilders during competition preparation

Background: To prepare for competition, bodybuilders employ strategies based around: energy restriction, resistance training, cardiovascular exercise, isometric "posing", and supplementation. Cohorts of professional (PRO) natural bodybuilders offer insights into how these strategies are implemented by elite competitors, and are undocumented in the scientific literature. Methods: Forty-seven competitors (33 male (8 PRO, 25 amateur (AMA), 14 female (5 PRO, 9 AMA) participated in the study. All PROs were eligible to compete with the Drug Free Athletes Coalition (DFAC), and all AMAs were recruited from the British Natural Bodybuilding Federation (BNBF). Competitors in these organisations are subject to a polygraph and are drug tested in accordance with the World Anti-Doping Agency. We report the results of a cross-sectional study of drug free bodybuilders competing at BNBF qualifying events, and the DFAC and World Natural Bodybuilding Federation finals. Participants completed a 34-item questionnaire assessing dietary intake at three time points (start, middle and end) of competition preparation. Participants recorded their food intake over a 24-h period in grams and/or portions. Dietary intakes of PRO and AMA competitors were then compared. Repeated measures ANOVA was used to test if nutrient intake changed over time, and for associations with division. Results: Male PROs reported significantly (p < 0.05) more bodybuilding experience than AMAs (PRO: 12.3 +/- 9.2, AMA: 2.4 +/- 1.4 yrs). Male PROs lost less body mass per week (PRO: 0.5 +/- 0.1, AMA: 0.7 +/- 0.2%, p < 0.05), and reported more weeks dieting (PRO: 28.1 +/- 8.1, AMA: 21.0 +/- 9.4 wks, P = 0.06). Significant differences (p < 0.05) of carbohydrate and energy were also recorded, as well as a difference (p = 0.03) in the estimated energy deficit (EED), between male PRO (2.0 +/- 5.5 kcal) and AMA (- 3.4 +/- 5.5 kcal) competitors. Conclusions: Longer diets and slower weight loss utilized by PROs likely contributed towards a lower EED compared to the AMAs. Slower weight loss may constitute an effective strategy for maintaining energy availability and muscle mass during an energy deficit. These findings require corroboration, but will interest bodybuilders and coaches

Group motivational interviewing in the 'Small Changes' weight management project: a quasi-experimental trial

Background - Motivational interviewing has been recommended as an effective counselling intervention for weight management with overweight and obese individuals. Nevertheless, there is a paucity of research for the use of motivational interviewing in weight management groups and research in the area often lacks sufficient 'treatment fidelity', failing to accurately report the consistency, style, content and competence of those delivering the intervention. The current study examined the efficacy of the Small Changes weight management programme comparing motivational interviewing in groups to treatment as usual. Methods - Those in the motivational interviewing group intervention received 12 sessions of 2 hours, which comprised 9 group and 3 one to one sessions over 12 months. The motivational interviewing group were treated in a motivational interviewing consistent manner throughout; for example, change talk was identified, evoked and strengthened via specific micro-skills such as open questions, affirmations and reflections. In the treatment as usual group, subjects also received 9 group and 3 one to one sessions over a 12 month period. The treatment as usual group were required to self-select a 'Small Change' at each meeting with the facilitator. All subjects were measured at five time points: baseline, 3, 6, 9 and 12 months, outcome measures included: weight, body mass index, body-fat percentage, waist to hip ratio, number of minutes of daily physical activity, fruit and vegetable consumption and feelings of well-being. A treatment fidelity framework was applied to the motivational interviewing groups' intervention to ensure a consistent, reliable and reproducible approach. Results - After 12 months, improvements were shown for all variables measured in the motivational interviewing groups; only the composite measure of physical and psychological wellbeing improved statistically in the treatment as usual groups, . When comparing approaches: significant differences were found between motivational interviewing and treatment as usual in favour of the motivational interviewing intervention for mean percentage change in weight and body mass index but not for % body fat, waist to hip ratio, fruit and vegetable consumption, feelings of well-being or physical activity levels. The retention rates in the motivational interviewing groups were higher with 64% of subjects returning for the 12 month outcome measures versus 14% in the treatment as usual groups. Conclusions - This study indicates improvements to weight loss outcome measures after 12 months for an intervention implementing motivational interviewing for weight management groups when compared to an existing weight management programme. Future research is needed to establish the empirical basis for the use of motivational interviewing for weight management groups, with heterogeneity of dose and treatment fidelity as essential features. Keywords : Motivational interviewing, treatment fidelity, weight managemen

Weight loss is coupled with improvements to affective state in obese participants engaged in behavior change therapy based on incremental, self-selected “Small Changes”

The aim of this study was to investigate the effects of a group behavior change intervention involving self-selected, contextualized, and mediated goal setting on anthropometric, affective, and dietary markers of health. It was hypothesized that the intervention would elicit changes consistent with accepted health recommendations for obese individuals. A rolling program of 12-week “Small Changes” interventions during 24 months recruited 71 participants; each program accommodated 10 to 13 adults (body mass index [BMI] ≥30 kg/m2). Fifty-eight participants completed Small Changes. Repeated measures were made at baseline, 6 and 12 weeks. Anthropometric measures included height and weight (to calculate BMI), body composition, waist circumference, and blood pressure. Affective state was monitored using relevant validated questionnaires. Dietary assessment used 3-day household measures food diaries with Schofield equations to monitor underreporting. Relevant blood measures were recorded throughout. Across the measurement period, Small Changes elicited a significant reduction in body weight (baseline, 102.95 ± 15.47 vs 12 weeks 100.09 ± 16.01 kg, P < .0005), coupled with associated significant improvements in BMI, body fat percentage, and waist circumference measures. There were additional significant positive changes in measures of affective state including general well-being (baseline, 58.92 ± 21.22 vs 12 weeks 78.04 ± 14.60, P < .0005) and total mood disturbance (baseline, 31.19 ± 34.03 vs 12 weeks 2.67 ± 24.96, P < .0005). Dietary changes that occurred were largely consistent with evidenced-based recommendations for weight management and included significant reductions in total energy intake and in fat and saturated fat as a proportion of energy. The Small Changes approach can elicit a range of health-orientated benefits for obese participants, and although further work is needed to ascertain the longevity of such effects, the outcomes from Small Changes are likely to help inform health professionals when framing the future of weight management. Long-term follow-up of Small Changes is warranted

Is the Small Changes programme clinically effective for adults who are obese?

This thesis concerns the treatment of (N=148) male and female clients in a weight management programme: Small Changes the thesis compares treatment as usual with a new approach using motivational interviewing. Firstly a preface sets out the historical context of Small Changes and how it developed and was originally funded before the aims of the thesis and the detail encompassed in each chapter are set out. Following this an introduction chapter presents the key constructs and theories surrounding motivational interviewing. This leads into study 1, a systematic review addressing the question: What should be included in a comprehensive weight management programme? The conclusion to this question is a mixture of input from: nutrition and exercise expertise combined with a clear behavioural approach, measures that encompass important clinical parameters, other than just weight, and sufficient length of follow-up post treatment. This conclusion forms the basis of the study 2 literature review which focusses on the contribution of motivational interviewing for affecting exercise and nutrition behaviours with the aim of improving weight management outcomes. The literature review leads into the methodology for study 2 which outlines the measures used, the follow-up period and the detail of what was done in study 2; sufficiently clearly for others to replicate what was done. From this chapter a separate results chapter reveals the statistical results for the outcome measures included in study 2. The discussion chapter then follows and focusses on the interpretation, critique and analysis of the results and relates these back to the literature presented in the literature review for study 2. Finally conclusions and short-comings of the study 2 investigation are explored and further research considerations made

Biopsychosocial effects of competition preparation in natural bodybuilders.

Bodybuilders are judged on the subjective visual assessment of their muscular size, proportion, and leanness. This case series tracked four drug-free bodybuilders (3 male) during the off-season, pre-competition and recovery phases. This study aimed to comprehensively profile key biopsychosocial changes occurring pre/post competition in a group of British natural bodybuilders. We measured: resting metabolic rate (RMR), body composition (via BIA, ultrasound and sum of 7 skinfolds), lipid profiles, fasted glucose, blood pressure, power output (Wingate), grip strength, and carried out psychometric questionnaires (EAT-26, STAI, BUT) over an eight-month period. Mean weight loss from 5 months (5M) to pre-contest (PRE) was 8.6 +/- 4.1 kg, followed by an increase of 7.9 +/- 1.6 kg two months post contest (POST). The mean RMR of the cohort was stable from 1899 +/- 630 kcal (5M) to 1897 +/- 598 kcal (PRE), before decreasing to 1797 +/- 242 kcal (POST). Mean peak power declined from 770 +/- 113.0 w (5M), to 700.0 +/- 134.4 w (PRE), before increasing to 816.0 +/- 116.2 w (POST). Competition dieting had no effect on EAT-26 or BUT scores, suggesting no body dysmorphic or eating disorder concerns, although trait anxiety was elevated in three out of the four participants throughout the observation. Many of the biopsychosocial changes that occur to bodybuilders as they prepare for competition return to baseline measurements 2 months post competition