Abstract
BackgroundChanges 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.MethodsParticipants (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.ResultsAt 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.ConclusionChanges 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.
Highlights
Changes in body image and subjective well-being variables are often reported as outcomes of obesity treatment
No evidence of reciprocal relationships was found for the other models under analysis; weight changes partially explained the effects of treatment on quality of life and self-esteem
Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs
Summary
Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. One recent meta-analysis on the role of subjective well-being in obesity treatment suggested that self-esteem increases are dependent on weight loss, regardless of treatment group, whereas reductions in depression are independent of weight loss, but strongly associated with treatment [11]. Another metaanalysis showed that neither depression nor self-esteem improvements were associated with treatment condition; this study did not report associations between these variables and weight change [12]. Several authors have recommended that psychosocial changes should be analyzed as mechanisms that can potentially contribute to better weight results, for example by mediating intervention effects on behavioral adherence and weight loss [16,17]
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