Abstract
BackgroundA better understanding of interrelations of exercise and improved eating, and their psychosocial correlates of self-efficacy, mood, and self-regulation, may be useful for the architecture of improved weight loss treatments. Theory-based research within field settings, with samples possessing high probabilities of health risks, might enable rapid application of useful findings.MethodsAdult volunteers with severe obesity (body mass index [BMI] 35–50 kg/m2; age = 43.0 ± 9.5 y; 83% female) were randomly assigned to six monthly cognitive-behavioral exercise support sessions paired with either group-based nutrition education (n = 145) or cognitive behavioral methods applied to improved eating (n = 149). After specification of mediation models using a bias-corrected bootstrapping procedure, a series of reciprocal effects analyses assessed: a) the reciprocal effects of changes in exercise and fruit and vegetable intake, resulting from the treatments, b) the reciprocal effects of changes in the three psychosocial variables tested (i.e. self-efficacy, mood, and self-regulation) and fruit and vegetable change, resulting from change in exercise volume, and c) the reciprocal effects of changes in the three psychosocial variables and exercise change, resulting from change in fruit and vegetable intake.ResultsMediation analyses suggested a reciprocal effect between changes in exercise volume and fruit and vegetable intake. After inclusion of psychosocial variables, also found were reciprocal effects between change in fruit and vegetable intake and change in mood, self-efficacy for controlled eating, and self-regulation for eating; and change in exercise volume and change in mood and exercise-related self-regulation.ConclusionFindings had implications for behavioral weight-loss theory and treatment. Specifically, results suggested that treatments should focus upon, and leverage, the transfer effects from each of the primary weight-loss behaviors (exercise and healthy eating) to the other. Findings on psychosocial correlates of these behavioral processes may also have practical applications.
Highlights
A better understanding of interrelations of exercise and improved eating, and their psychosocial correlates of self-efficacy, mood, and self-regulation, may be useful for the architecture of improved weight loss treatments
There was no significant difference in proportion of women, age, BMI, and racial make-up between participants assigned to a treatment of cognitive-behavioral exercise support plus nutrition education and the same cognitive-behavioral exercise support plus cognitivebehavioral nutrition methods through simple random sampling
There was a time × treatment type interaction for volume of exercise (F(1, 292) = 4.11, p = .04, η2p = .01), fruit and vegetable intake (F(1, 292) = 10.24, p < .01, η2p = .03), and self-regulation for eating (F(1, 292) = 7.72, p < .01, η2p = .03), indicating greater improvements in those variables associated with the cognitive-behavioral nutrition group
Summary
A better understanding of interrelations of exercise and improved eating, and their psychosocial correlates of self-efficacy, mood, and self-regulation, may be useful for the architecture of improved weight loss treatments. The use of cognitive-behavioral methods have had somewhat better behavior-change outcomes [4,5], it is still rare for weight loss of even 5 to 10% of one’s original body weight to be maintained beyond the short term [3]. Consistent with this stark viewpoint, invasive and expensive surgical methods (with considerable health risks themselves, and questionable long-term effects) are becoming the treatment of choice for obesity [7,8]
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