Thirteen retarded adult subjects were first exposed to a 12-week behavior therapy weight reduction program followed by a ten-month weekly weigh-in. Then the subjects were randomly assigned to an experimental maintenance booster session group (n=7) or a control post-treatment maintenance group (n=6) for 12 months. The results indicated that when weight control or maintenance procedures were in effect, the subjects lost weight. However, a 12-month follow-up check revealed that the long-term success of the treatment and maintenance procedures was not well maintaned

Fox, Robert

Matson, Johnny

Rotatori, Anthony F.

Sexton, David

Wade, Patricia

Zinkgraf, Stephen

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteCollege of Education Faculty Research andPublications Education, College of4-1-1986The Effect of Two Weight Reduction MaintenanceStrategies for Moderately/Mildly Retarded AdultsAnthony F. RotatoriUniversity of New OrleansStephen ZinkgrafUniversity of New OrleansJohnny MatsonNorthern Illinois UniversityRobert FoxMarquette University, robert.fox@marquette.eduDavid SextonUniversity of New OrleansSee next page for additional authorsPublished version. The Journal of Obesity and Weight Regulation, Vol. 5, No. 1, (1986): 18-22. © 1986Human Sciences Press. Used with permission.AuthorsAnthony F. Rotatori, Stephen Zinkgraf, Johnny Matson, Robert Fox, David Sexton, and Patricia WadeThis article is available at e-Publications@Marquette: https://epublications.marquette.edu/edu_fac/205The J ourna l ()f Obcf' ity and Wf::!igh l. Reg ula t ion VoL 5, No. t. Spring 1986 The Effect of Two Weight Reduction Maintenance Strategies for Moderately/Mildly Retarded Adults ANTHONY F. ROTATORI, STEPHEN ZINKGRAF, JOHNNY MA TSON, ROBERT FOX, DAVID SEXTON, and PATRICIA WADE ABSTRACT: Thi r teen retarded ad ult subj ects w er e fir st ex posed to a 12-week behavior thera i)y weight reduction program followed by a to-month weekly weig h-in. Then the subj cct~ were rnndomly assigned to an ex-per irnental maintenance booster session group (n =7) or a control POS{.-t rea tmenL main t enance group (n= 6) for 12 months. The results indicated t hat when weight c.: ontl'o] or main tenance procedures were in effect. the subjects lost weight. I lowever. a ] 2-month follow-up check revea led t.hat t he long· term . sllceess of the treatment and mainten anc:.c procedures was not well main-taLncd . Approaches to sustaining weight loss after behavioral treatments have var ied , but two common ones frequently appear in the li terature (I3rownell . 1982; LeBow. 1981). One approach is post-treatment meetings with the diet leader. Typicall y , the post-treatment meetings involve weight-checks and reinforcement for weight loss (Polly and Keenan. 1976; Rotatori , Switzky, and Fox. 19801. Another approach is after·care booster sessions (Ashby and Wilson, 1977; Domke, Lando, and Robinson, J 978; Hall. Hall, Borden, and Hanson, 1975; Kingsley and Wilson, 1977; Rotatori and Fox, 1980; Stuart and Guire, 19781. These booster sessions provided subjects with varying degrees of facil itative behavioral technology. The effectiveness of the above ap-proaches has been mixed and inconclusive (Lel3ow, 1984). However . neither of these approaches have been attempted with the retarded. Thus. the purpose of this study was t o compare the effectiveness of A. Rotatori , S. Zink gl'l1 f. Ilnd David Sc};ton are with the l.}),h'"8r sity of New Orleans. J . l\·l ,l.t ~on is at Norther n Illinois Uni\·crsi t.y. R. Fox is at :vrarquette University. P . V.!lldc is at Fair Acre ~ School. Reqllcst :::; for !'cprint s can be sent to Anthony F. Rotatori , DepnrtmeUl. ofSped al Ed u('.ntion, Univers ity of New Orleans. ~ew Orlenn:.>. LA 70148. 29 so TIlt' .lemma! ol Obesity and l-t'ei/!ht i?ex"/alioll two maintenance approaches, namely post-treatment meetings and af-ter-care booster sessions, with overweight mentally retarded adults. METHOD Thirteen ovenveight, mentaUy retarded adult subjects who were at-tending a vocational training center participated in the study_ AJl clients wcre living with their families. The o-verwcight elients were randomly assigned to an experimental maintenance booster session group or a control post-treatment group. The experimental group included seven subjects, five females and two males (mean age = 26.6 years, SD = 4 . .5 years; mean percenL overweight = -14.6, SD = 19.9; mean IQ = 53.1, SD = 5.8), The control group included six subjects. three females and three males (mean age = :-35.7 years, SD = 8.8; mean percent overweight = 54.6, SD = 8.4: mean IQ = 4:3.2, Sf) = 2.9)_ T-tests computed for age and percent ovenveight variables Iyvealcd no significant differences between the two groups. PROCEDURES Phase 1112 Weeks} All subjects were exposed to a weight awareness curriculum for moderately and mildly handicapped individuals (Rotatori, V;iade, Litton, and Fox, 1985). The curriculum \vhich \\'85 directed by a school nurse involved group instruction in the following procedures: decre<:lsing extra recreational/social eating (e.g., eating at coffee breaks or at a social dance hour at the center); self-monitoring techniques (e.g .. recording daily weight and eating habit change): food-cue elimination techniques !e.g .. taking only one helping and smaller portions at meals); increase energy expenditure Ie. g., engage in daily calisthenics, home chores, and recreational sports); changing the act of eating (e.g., slow down eating, chew food completely before taking anot.her bile); making low calorie food choices at meals (e.g., selecting a ser" ving of fish rather than roast.ed lamb or having two percent milk rather than chocolate milk); using snacking to supplement one's diet (e.g., having a cheese sandwich to make up for nnt having any food from the milk group that day~; maintaining a balanced diet (e.g., choosing foods from the four basic food groups); and determining the proper serving portions for each food group to maintain a healthy diet (e.g., meat., 1.\\-'0 t.hree-ounce servings daily and fruit., four servings daily). Home reinforcers. The clients received individual reinforcers for weight loss each week. The reinforcers were agreed upon by the clients and their family members prior to the start. of Phase 1. A specially designed cert.ificate was used to communicate to the clients' families n;garding the c.1icnts and eligibility for the agreed-upon reinforcer. --Family contact.. The diet leader made a weekly contact, with each client.'s family by note or telephone. Educational materials such as suggested low calorie packed lunches, fact sheets about so-called "diet foods." calorie values /lu lhon}' F. n ora/ori ei at. ,']1 of fast. foods . calorie char ts , and di et fu llacics, were sent t o t.he su bjects ' families. Every other week t he leader displ:Ilched l etter~ of CllCQUrageme.nt to the family with a reques t. tha t they contact- t.he leader with their qu (~s tions or concerns. Also, \'leekl y reminders \vere sent home on the night prior to each class. reminding the d ient and his or her family no t to forget his or her ·work-book t.he next. day. ,~~() c ial recognition . T he diet leader posted t he total pounds lost for each clien t in a promi nent place in t. he workshop. and encouraged all staff members to be vocal with positive rein fo rcement for dieters and to encourage peer rein-forcemen t as well. Peer reinforcement , in fae t , reached such a high level that being a participant. in the progra m afforded a grea t deal of prestige. R ecording by th~ (amily. 1\ weekly meal and eXl~rcise record were developed to a ssess t he type a nd amoun t of food eatcn as well <l S lhe tim e t.he clien t spent in exercis{'. A family m ember was respons ible fo r t.he above re-cording ea<.: h week. It wa s suggested t ha t t.he recording be rot.ated among the <Idolescenl and adult members of the family to increase t heir invoh,:elnent in t.he program. Phase Il(IO A1on ths) All s ubjects were \'./cighed once a week. The social r ecognition aspect men-tioned above was con tinued throughout this phase. There was no contact wi.t h the subjects ' fu milies rega rd ing t he weigh-ins during this phase. Phase lIT (52 Week s) Dur ing th is phase. the exper imental subj ects reecived il repeat of all the components in Phase I (12 \',feeks) fo llowed b.y a weekly weigh-in and. socia l recognition for weigh t loss (40 w(!eksj. I n contrast , t he cont rol subjects were weighed weekly and received social recognition for weight loss throughout this pha se. Phase IV Twelve mon ths follOWing the conclu sion of Phase Ill, all subj ects were \\'eighed. No formal t.reatment was in effect d uring t his t ime. DESIGN AND ANALYS IS T he d esign for this stud y was a 2 X 5 (Group X Phase) fadorial wit.h repeated measures over tile las t fa ctor. The d ependent measure, percent over" weight (PO), was calculated by the following formula: present weigh l - desirable weight PO = - -<---.----- - X 100 desirable weight PO was measured at five times points: a pre-tes t (PT) before the im-plementation o f Phase I, and then after each of the four phases. Thi,s design 32 Th e ,Journal of Obesity lln d We /:ght R egula /.ioli was analyzed via the appropriate 2 X 5 repeated measures AT\TOVA . The omega-squa red {w 2, s ta t ist ic was calculated for significnnt effect!'> in the ANOV A. The omega-squared statis t.ic is used to estimate t he proport ion of variance in the dependent variable, P O, accounted by the P hase effl~d. Omega-squ af(~d is an index of strength of association and has been used as a measure of practic.al significance of experimenial results (Kirk, 1982) . Along with the 2 X 5 repeated measures ANOVA , five a pri or i com-parisons -were specified. Dunnett's procedu re (Kirk , 1982) was used to oompa l-e the lUeaD PO of each of the fo ur phases t.o the mean PO of PT. the control condition. The fif t h comparison compared the mean difference ill PO from the end of Pll to the end of PIll of the two groups. The latl.er com-parison was selected t o test t he exper imen tal effect of retreating Group 1 during Phase III. And, JastIr, the effect of the weight control procedures were investigated with respect to individual subjects. Because t he mean PO can be a ffected by ext.reme gains or Josses, verHying whi(~h t reatment is relatively consistent across subjecLs is impor tant. RESULTS Analysis of Variance The 2 X 5 repeated measures ANOV A showed a significant Phase effect, F(4 ,44 ) = 8.50, P < .05, MSe = 73.64. The Group by Phase in-teraction effects were not significant. The mean PO 's for each are found in Table 1. The omega-squared stati stic for the significant Phase was calculated to be .11. Because thi s calculation was based on a repeated measures ANOV A, rules discussed by Halderson and Glasnapp (1972) were used. This result indicated that approximately 11 % of the variance in percent overweight is accounted for by the Table 1 Mean Percent Overweight for the Five Time Points - - -PRE- TEST PHASE I PHASE II PHASE III PHASE IV Mean 49.37. 39.9% 32.37. 32. 9% 41.27. SD 16.07. 1S.8% 18.0% 18.7% 18.87. Note l. F (4 , 44) = 8 . 50, * <.05 MSe .00736 Note 2. n = 13 at each p ase A nthollY F. Rowturi pt al. Phase effect. The Phase effect was considered to be both sta tistically and practically sign ificant. A Priori Comparisons When using Dunnett's procedure to compare the mean PO of the pretest to those of P I-PlV, the results indicated that the mean PO 's were significantly lower for PI. PlI, PIlI when compared to PT. The mean PO for PlY was found not to be significantly different from PT. The mean decreases in PO from PT to PI , PII, PITT, and PIV respec· tively were 9.4%,16.9%.16.4% and 8% . The last a priori comparison compared the average change in PO from PI! to PIlI between groups. This comparison yielded a significant difference in mean PO change from PI! to PIll with Group I (the experimental group] logging an average of 1. 7% and Group II gaining 3.1 % (t "" 2.61, df = 11, p < .05] . Table 2 shows the group PO 's after PII and PIlI . Indiv idual Differences Because the mean PO at any t ime point could have been affected by extreme scores and because of the relatively small group sample sizes, individual changes at adjacent measurement points were in-vestigated. This was done to determine the consistency of changes in PO for each subject. The first indices of consistency of change were the correlations of PO scores at adjacent time points (i.e., PT vs. PI, PI vs. P II, PI! vs. PIlI, and PIlI VB. PIVI. This analysis was done regarding group membership of the study since the 2 X 5 ANOV A showed no group effect. The average of the four correlations, using Fisher' s , ·transformation, was .92 and correlations ranged from .81 to .98. This result indicated t hat even while the mean PO's changed from phase to phase. each subject's ranking within the group remained relatively constant. In other words, the subjects ' individual changes in PO were very similar to mean changes in PO. To take the analysis a step fur-ther, we looked at the proportion of subjects that changed PO from PT to PI and from PIll to P IV. A consistent drop in PO from PT to PI was found with all subjects . These drops ranged from 3% to 19% with a mean of 9.4%. An increase in PO from the end of PITr, the last treat· ment phase. was expected. Again, there was a consistent effect across subjects with every subj ect increasing from 2% to 36% with a mean in· crease of 8.3%. Similar analyses were done with respect to the a priori comparison .14 Th~ JO/..mol of Obcsit y an d W eig ht R f?g"Ia lioll -------~~---~- --. of group changes from PII to PIlI. When lookin g at individual sub-jects within each group, 6 of 7 subjects in Group I decreased in PO and 5 out of 6 subjects in Group II stayed the same or increased in PO. Once again, the effect of trea t.ment is relatively consistent aCross sub-jects_ DlSCUSSION The program was successful in promoting weight loss during ac-t ive t reatment periods, Subjects in both groups lost significantly and clinically meaningfu l amounts of weight . In fact , the mean weight per-cent decreases attained by t he subjects is among the highest ever recorded in t he literature with mentally retarded subjects (Jackson and Thorbecke, 1982; Rotatori, Switzky, and Fox, 1983). This finding support s Rotatori' s (1978) contention th at extended treatmen t programs are needed to allow mentally retarded subjects to lose clinically meaningful amounts of weight. I\n interesting facet of this study was the effect on the weigh· in plus reinforcement treatment condition in Phase II and III. During Phase II this treatment stra tegy resulted in continued weight loss by all subjects . In contras t. . the strategy in Phase III maintained the weight loss for the control group subjects~ More importantly, when the experimental subjects were given an after-care booster session followed by weekly weigh-ins plus reinforcements, the subjects in this group continued to lose weight. The latter effect lends support to t he position findings reported in studies (Domke, Lando , and Robinson , 1978; Kingsley and Wilson, 1977) that used after-care sessions with normal subjects. Table 2 ____ 1_1:..;ean Percents Overweight for Phase II and Phase_I_I_I _ _ _ Phase II Phase III Group Hean SD Mean SD Group I 28 . 6% 18. 3% 26. 9% I B. 6% Group II 36.8% 18 . 4% 40.0% 17. 87. Alilhol.' }' F J1 (J totorr el. a t. 3:) The follow-up weight measure at t.he end of Phase IV show s that t he long-term success of this t reatment was not. maintained . This fi nd-ing has been report.ed consistently in a number of review studies (Bright well and Sloan, 1977; Stankard & Penick, 1979) concerned with lon g-term efficacy of behavior weight reduct ion treatment programs. This continuing problem has resulted in LeBow (1 981) recommending tha t the reapplication or reinst..it.utjon of treatment procedures occur after subj ects begin to gain small amounts of weight rather than as a routine after-care booster session . The present findings 'v,rould warrant an invest iga tion int o the above suggestions as well a s other procedures to measure the long-term effi cacy of behavior therapy for weight reduction. REFERENCES Ash by , \\' . .'\ .. & Wili;on, G , T . (197 7). Behavior t herapy for obesity: Booster sessions and long-term main ten:mcc of weight lo~s. B eh ul!ior R~,<; earch and Thera py. 15, 151-46,1. Br ight.well , D ., & Sloan, C, (1 97 7). Long-term resul t:; of behavior ther<l PY for obesity, . B ehaIJior T herapy . S, 898-90fl. Brow nell , K D. 11982). Obesit y: Unders ta nd ing and trenli ng a serious prevalent re rrac-tory disorder. J Ollr!lal of Co nsll ll.ing and Ch:n ical P sy chology, 50, 820-840. Domke • .J. A .. Lando, H, A., &. RD binsoIl, D . C. (1 9781. Efficacy of (O/lOk'- Up /)()() ster sessioll !; iii trea.t ing obe!it (v_ Paper prcse_nted at· t he meet ing of the :\m~rica n Psychological Association. Toront o, Canada. Halderson, J. S., & Glasnapp, D_ P . (1 97 2). Ge neralized ruleg for ca l.cu latill f!: lhe magn itude of an effed in fac toria l and rep eated mcasures ANO V A desig ns. Amel1eOl l Ednca tiorwl R es€(uch ,l o tlrnaf, 9. 301-3 10. Hall , S . M., H alL It G. , Borden, B. L. , & Hansen, J{, W. (1975). Pollow-up st ra t cgie:o; in t he beh ov ioral t reat men t of overweigh t. B (J 'wln:o]' Re.~e arch and Therapy , 13, H\7-J72. .laclr son, H , J.. & T horbecke, P. H. (l 9R2-l. Treat ing obesity in ment a lly reLa rded ado lescent!; and adults: An exploratory progra m. American JOfJrnui of M ental IJeficic flcy. 87. 30 2-:108. King s ley, It. (i .. & \",'i1son , G , T. (1977), Behavior therapy for obesity : A compiH ll l..i vc in-vestigat.ion of long-tcrm eff icacy. Jo urna l o f Con sulting and Clinica l Psyc hology, 4,5. 2R8-298. Kirk. R. E. {l 982J. Procedure,,> {or tlUi' belw l)iorai sci(!ll ces {2nd ed.1. Belmont , CA: Brook~/Co l es, Le13ow, M. D . (1981) . We ight (.'()n l.T'o/: T he be/J 0 1;I:()ral s trategie s. New York: John Wiley & Sons. LeBow, M , D, (198'1 ), Trea ting I:hildlw od ohesity. :"J l' W Vorl. : Springer P ublishing Com-pany. Poll \-', S, J ., & Kecn an. C- A. (1 97 6). Self-management, I,mining with vario us boo ster . treatmen ts: E f fect ::. on Ihe modifica tion a l/d Tfwin lelWHce of weigh!.. Paper presen-ted at the me~t.ing of the Associa t ion for t he Advancement of Beh avior Therapy , New York. !totatod, A . F. (19181. The effect of different reinforcement schedules on the main · tena nce of weig ht. loss with re t a rded overweigh t adult s prcviou ~ly exposed to a beh<lvioral weight reduction tr ea tmen t package. D£sscrt,atlon International, 38, 4738-N . Thr'.Iounwl 0/ Olli,yily (lnd "\frighl Rl'gylallcm Rotntor-i, A. F" & Fox, R. (1~J80)_ /\ comparison of two weighl reduction programs for moderately retarded adolescents. Bchrwiur Thl!roPY, 11, 410-416 Rollltori, A. F., Fox, R" & Swil.zky, 11, /\. (1980). \1ulticomponenc behavioral program for achieving weight loss in the adlllt retarded. AIental Retm'dotion, 18, 31-33. Rotatori. A. F .. \Vadc, P .. Litton, F .. ,~ Fox. R. 1198;')), Teaching Il!<fn:tiun. e.rerciq> alld u..'c(/?ht control to Ihe modetate!y/mildly Jwndicapped. Springfield, 1L: Charl€s C. 'I'homas Stuart, 11., ]3., & Guire, K. (1978). Some correlates of the maintenance of weight loss through behavior modification. Jllir?rnafiollafJourno/ IJ(Obl'sity, 2,225-2:-35. Stunkard, A J .. & Penick, S. B. (19791. Bebavior modi fica Lion in the treatment of obesity: The problem of maintaining weighlloss /1/'c/;iue:, of Gf'l1eraf Psychict,.},. 36, 801·806. 

The Effect of Two Weight Reduction Maintenance Strategies for Moderately/Mildly Retarded Adults

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1206&amp;context=edu_fac

The Effect of Two Weight Reduction Maintenance Strategies for Moderately/Mildly Retarded Adults

Abstract

Similar works

Full text

Available Versions

epublications@Marquette