Gender in the treatment of obesity – Do Women and Men report different cognitive-behavioral factors that promote or impede long-term weight loss maintenance?

Abstract

Long-term weight loss is a challenge for people with overweight and obesity. There is evidence that individuals who successfully lost weight (weight maintainers) differ from individuals who repeatedly fail to maintain weight loss (weight regainers) with regard to cognitive-behavioural factors that promote or impede weight loss. These findings suggest that psychological factors exist that are relevant for a successful long-term weight loss. Furthermore, gender differences in the effectiveness of weight loss were detected that have not been considered in the identification of cognitive-behavioural factors of successful weight loss reduction so far. The aim of this qualitative study design was to determine gender-specific psychological predictors that are associated with successful weight loss. Twelve female (body mass index: 23.97±3.49 kg/m²) and eight male (BMI: 26.97±2.71 kg/m²) weight maintainers (≥10% weight loss; weight maintenance lasts 12.8±8.93 months) as well as 15 female (BMI: 36.54±9.90 kg/m²) and six male (BMI: 37.80±12.07 kg/m²) weight regainers were included in the study. We conducted eight semi-structured focus groups in which the participants were asked about relevant psychological factors for their weight development (e.g. self-regulation, self-efficacy, coping). The identification of relevant psychological aspects occurred theory based and interpretive based on data. Gender-specific cognitive-behavioral factors that promote or impede weight loss and weight loss maintenance were assessed by qualitative content analysis. Gender differences in male and female weight maintainers were observed with respect to self-perception, self-regulation and perception of social support. Women who successfully maintained weight loss reported that strict control behaviour, giving up specific food and social events and the development of body awareness were decisive for long-term weight loss. In contrast, male weight maintainers compensated their self-determined losses of control over eating through physical activity. Exposure to alcohol was reported as a challenge during weight loss from male weight regainers as well as male weight maintainers, but seldom from female participants. Both female and male weight regainers named a dysfunctional impulse control and low levels of self-efficacy as cognitive-behavioural factors that impede successful weight loss. The results indicate that gender differences with regard to behavioural-cognitive factors (self-regulation, self-efficacy and cognitive processing of failure) should be considered in the treatment of overweight and obesity to improve the long-term effectiveness of weight loss programs for female and male individuals. In the future, appropriate interventions should be developed and evaluated with respect to their effectiveness.