Abstract
Behavioral treatments for morbid obesity have not been effective, possibly because of a poor understanding of the relations of psychosocial factors and exercise and eating behaviors. Recent research suggests that exercise program-induced improvements in self-efficacy and self-regulatory skills use may carry-over to self-efficacy and self-regulation for controlled eating. However, for individuals with morbid obesity, fatigue and anxiety may moderate these relationships. The purpose of this research was to evaluate this moderation. Adults with Grade 3 obesity (MBMI = 46.0 kg/m2) participated in 26 weeks of cognitive-behaviorally supported exercise paired with 12 weeks of either nutrition education (n = 95) or a cognitive-behavioral nutrition component (n = 109). There were significant improvements in self-regulation and self-efficacy for exercise, and self-regulation and self-efficacy for controlled eating, which did not differ by treatment condition. Bivariate relationships between changes in self-regulation for exercise and self-regulation for controlled eating (β = .63), and changes in exercise self-efficacy and self-efficacy for controlled eating (β = .51), were strong. Moderation of these relationships by fatigue and anxiety was either significant or marginally significant (ps < .01 and ps < .08, respectively). Both changes in self-regulation for controlled eating and self-efficacy for controlled eating significantly contributed to the explained variance in BMI change (R2 = .30). Implications of the findings for behavioral weight-loss treatment for those with morbid obesity were discussed.
Highlights
6% (13.5 million) of adults in the U.S have Grade 3, or morbid, obesity compared to the 34% that reach the threshold for Grade 1 obesity (BMI ≥ 30 kg/m2) or the 68% who are overweight (BMI of 25 to 29.9 kg/m2) or above (Flegal, Carroll, Ogden, & Curtin, 2010)
It is likely that the effect of these constructs on eating and exercise behaviors is distinct in persons with morbid obesity (Davies, 2007), and may require specific study (Annesi & Whitaker, 2010)
There was no significant difference in percentage of women, age, BMI, and racial make-up between participants randomly assigned to cognitive-behavioral exercise support plus nutrition education (Nutrition Education group; n = 95) and cognitive-behavioral exercise support plus cognitive-behavioral methods applied to nutritional change (Behavioral Nutrition group; n = 109)
Summary
6% (13.5 million) of adults in the U.S have Grade 3, or morbid, obesity (body mass index [BMI] ≥ 40 kg/m2) compared to the 34% that reach the threshold for Grade 1 obesity (BMI ≥ 30 kg/m2) or the 68% who are overweight (BMI of 25 to 29.9 kg/m2) or above (Flegal, Carroll, Ogden, & Curtin, 2010) Health risks such as hypertension, hyperlipidemia, and Type 2 diabetes increase exponentially as degree of excess weight increases (Mokdad et al, 2003). Examples of recently identified relationships having treatment implications include associations between self-regulation and self-efficacy improvements and improvements in exercise and eating behaviors; and carry-over effects of self-regulation for exercise to self-regulation for eating, and exercise-related self-efficacy to self-efficacy for controlling eating (Annesi & Marti, 2011; Hankonen, Absetz, Haukkala, & Uutela, 2009; Oaten & Cheng, 2006; Teixeira et al, 2010)
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