Participation In Weight Loss Programs Research Articles

Valuing the benefits of weight loss programs: an application of the discrete choice experiment.

Obesity is a leading health threat. Determination of optimal therapies for long-term weight loss remains a challenge. Evidence suggests that successful weight loss depends on the compliance of weight loss program participants with their weight loss efforts. Despite this, little is known regarding the attributes influencing such compliance. The purpose of this study was to assess, using a discrete choice experiment (DCE), the relative importance of weight loss program attributes to its participants and to express these preferences in terms of their willingness to pay for them. A DCE survey explored the following weight loss program attributes in a sample of 165 overweight adults enrolled in community weight loss programs: cost, travel time required to attend, extent of physician involvement (e.g., none, monthly, every 2 weeks), components (e.g., diet, exercise, behavior change) emphasized, and focus (e.g., group, individual). The rate at which participants were willing to trade among attributes and the willingness to pay for different configurations of combined attributes were estimated using regression modeling. All attributes investigated appeared to be statistically significant. The most important unit change was "program components emphasized" (e.g., moving from diet only to diet and exercise). The majority of participants were willing to pay for weight loss programs that reflected their preferences. The DCE tool was useful in quantifying and understanding individual preferences in obesity management and provided information that could help to maximize the efficiency of existing weight loss programs or the design of new programs.

Estimating a Preference-Based Single Index for the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) Instrument from the SF-6D

Objective To facilitate economic evaluations of interventions for treating obesity, we estimated a preference-based single index for the Impact of Weight on Quality of Life-Lite (IWQOL-lite) instrument by mapping it onto the SF-6D preference-based index. Methods A heterogeneous sample of 1972 individuals, composed of community volunteers and participants in weight loss programs, clinical trials, and gastric bypass studies, completed the IWQOL-lite, an obesity-specific measure of health-related quality of life (HRQOL), and the SF-36, a generic measure of HRQOL converted into the preference-based SF-6D. Models of the relationship between the IWQOL-lite and SF-6D of increasing complexity were estimated by regression analyses. Results The best fitting model for predicting SF-6D index scores entered levels for each item as independent variables ( R 2 = 0.530 in the cross-validation sample, with a mean absolute error of 0.0976). This model (1) makes fewer assumptions than those using total score, dimension scores or item scores as dependent variables and (2) provides a robust unbiased estimate of a preference-based index from IWQOL-Lite data where a preference-based measure was not used. The addition of age and body mass index (BMI) led to a slight improvement in the model. Conclusions It is possible to facilitate economic evaluations using results obtained from disease-specific instruments using this approach. A weakness of this approach is that there may be aspects of the condition that have not been properly reflected in the SF-6D index. It is, however, useful when a preference-based measure has not been administered and when it would be impractical to conduct a full valuation survey.

WEIGHTING THE BENEFITS OF WEIGHT LOSS PROGRAMS

Obesity is a leading health threat. Determination of optimal therapies for long-term weight loss remains a challenge. Evidence suggests that successful weight loss depends on the compliance of weight loss program participants with their weight loss efforts. Despite this, little is known regarding the attributes influencing such compliance. PURPOSE To assess the relative importance of weight loss program attributes to its participants, and to express these preferences in terms of their willingness to pay (WTP) for such attributes in a sample of 165 overweight adults enrolled in community weight loss programs using a discrete choice experiment (DCE). METHODS A DCE survey was used to obtain participant preferences for the following attributes of a weight loss program: cost, travel time required to attend, extent of physician involvement (e.g., none, monthly, every 2 weeks), components (e.g., diet, exercise, behavior change) emphasized, and focus (e.g., group, individual). The rate at which participants were willing to trade between attributes and the WTP for different configurations of combined attributes were estimated using regression modeling. RESULTS All attributes investigated appeared to be important. For example, participants were willing to pay \$72.00 more for a level more of physician involvement in their 3-month weight management program. The most important unit change (moving from one attribute level to another) was “program components emphasized” (e.g., moving from diet only to diet and exercise). CONCLUSION The majority of participants were willing to pay for weight loss programs that reflected their preferences. These preferences are important to include in policy-level decision-making. The DCE tool was useful in quantifying and understanding individual preferences in obesity management, and provided information that could help to maximize the efficiency of existing weight loss programs or the design of new programs.

A Conceptual Model of Weight Loss and Weight Regain: An Intervention for Change

Obesity is considered one of the most prevalent health problems in the United States. The controversy surrounding the causes of obesity and its incidence of illness as well as the less-than-promising statistics for long-term weight loss raise questions about present treatment modalities. Statistics indicate that the majority of persons who lose weight regain the weight within 1 to 5 years. Statistics also indicate that 95% of the participants in weight loss programs are women. Based on the findings of a qualitative study, Wysoker developed a model of weight loss and weight regain. The model offers a framework for treatment and includes three different approaches: (a) one can lose weight and keep it off; (b) it may be impossible to lose weight and keep it off; and (c) women will continue to try to lose weight, despite the long history of losing weight and gaining the lost weight back.

THE EFFECTS OF A CLINICAL WEIGHT MANAGEMENT PROGRAM ON BEHAVIORAL PROCESSES FOR EXERCISE

Participants in weight loss programs often experience weight regain following program completion. Exercise is a key determinant in maintaining weight loss. Acquisition of cognitive and behavioral skills may promote the continuation of exercise behavior and thus weight loss maintenance. This study examined the effects of a clinical weight management program on the use of behavioral processes for exercise. Subjects (n = 123; age, 49.4 ± 8.3 yr; BMI, 32.9 ± 3.7) participated in a six month weight management program based on the Transtheoretical Model. The curriculum targeted 5 behavioral and 5 experiential processes, self-efficacy and decisional balance (pros and cons). The program included a 3-month intensive phase (two, 2-hour sessions per week) and a 3-month tapering phases (eight, 1-hour sessions). During the intensive phase subjects exercised 4 days/week (2 supervised, 2 unsupervised) and attended one nutrition and one behavioral session/week. Exercise was conducted at 60–70% of HRmax; duration increased progressively from 15 to 45 minutes/day. Measurements were taken at baseline (T1), 3 months (T2) and 6 months (T3). Body weight decreased (T1, 89.7 ± 14.5; T2, 85.3 ± 13.4; T3 84.9 ± 13.9 kg; P < 0.01) and VO2max increased (T1, 2.41 ± .79; T2, 2.58 ± .86 L/min; p < 0.01) across time. Composite process scales, self-efficacy and decisional balance were averaged on a 5-point scale:TableThe clinical weight management program was effective in improving behavioral processes for exercise. Self-efficacy, behavioral and experiential processes and cons changed in the direction that is predictive of exercise maintenance. Longitudinal follow-up will determine the maintenance of regular exercise and weight loss. Supported by American Cancer Society CRTG-98-261-01

Dieting, Weight, and Health: Reconceptualizing Research and Policy

The damaging side effects of the thinness pursuit are a growing social problem and public health threat causing concern for many health professionals. This concern stems from several areas of research outlined by the authors of this issue. First, research has consistently shown that weight loss programs do not have long‐term positive outcomes. Continued participation in weight loss programs is associated with repeated weight loss and regain. This may cause problems, as weight fluctuation is associated with increased mortality and cardiovascular disease. Additionally, chronic restrictive dieting is a significant risk factor for the development of binge behavior and eating disorders. Direct adverse effects of weight loss programs and dangerous weight loss strategies such as laxative use, smoking cigarettes, very‐low‐calorie diets, prescription and over‐the‐counter diet pills, pose serious health risks. In a weight‐centered approach toward health, thinness is viewed as a crucial goal for optimum health, and thus one to be strived for by all. Although thinness is believed to be synonymous with good health, this conclusion reflects only selective interpretations of research. There is considerable need to reinterpret previous data filtered through a thinness‐biased lens that has led to inaccurate conclusions. The following past conclusions are reevaluated by the authors of this journal issue and summarized here: people can change their weight at will, dieting works and improves health, dieting makes you feel good, and fatness equal disease while thinness equals optimal health. Implications of this reconceptualization for a scientific and policy paradigm shift are discussed, and alternatives are proposed.

Reducing Barriers to Participation in Weight-loss Programs in Low-Income Women

Reducing Barriers to Participation in Weight-loss Programs in Low-Income Women

Burned out binge eaters: a preliminary investigation.

The purpose of this study was to compare individuals who meet all the diagnostic criteria for binge eating disorder (BED), except loss of control, to individuals with BED and eating disorder not otherwise specified (EDNOS) on weight history variables. Subjects were solicited among new participants in weight loss programs, with 35 meeting BED criteria, 47 meeting criteria for EDNOS, and 6 meeting criteria for BED without loss of control. Groups were not found to differ on age of onset of overweight or dieting, age of first binge, rate of largest weight loss, or number of times of losing 10 + lb. Groups did differ on highest weight ever and current body mass index (BMI). Subjects with BED without loss of control had a significantly higher highest weight and current BMI than both BED and EDNOS subjects. The results suggest that individuals reporting all the symptoms of BED except loss of control may be "former" BEDs who have "given up" on efforts to control their binge eating.

Factors Associated with Weight Control in Older Adults

Dieting behaviors in a sample of 183 overweight older adults were studied to assess how they were influenced by six cognitive, behavioral, emotional, and social variables. Membership in a weight control program was also evaluated to assess whether it affected these relationships. Responses indicated that reports of high quality dieting behaviors were associated with higher levels of depression and less effective coping skills. Dieting behaviors among subjects who were participants in weight loss programs were not as strongly associated with less effective coping skills, but were associated with external health locus-of-control. The degree of social support had a limited impact on dieting behaviors, while measures of optimism and health status were unrelated to dieting behaviors. We concluded that older adults, especially those who diet independently, are likely to experience significant stress associated with weight loss efforts. Weight loss programs for older adults might produce better outcomes if they focus on reducing depression and stress associated with dieting.

The development and validation of an Eating Self-Efficacy Scale

Following from Bandura's (1977a) self-efficacy theory, an Eating Self-Efficacy Scale (ESES) was developed and its psychometric properties established. Factor analysis of the 25-item scale yielded two reliable factors—one concerned with eating when experiencing negative affect (NA) and the other with eating during socially acceptable circumstances (SAC). The ESES demonstrated good internal consistency, test-retest reliability, and convergent validity. A clinical study using this measure found that increases in ESES scores were significantly related to weight losses among weight loss program participants. A laboratory study using a mood induction procedure found that NA subscale scores predicted food consumption irrespective of whether negative affect was induced. This finding may indicate that people have difficulty accurately discriminating the specific circumstances under which their eating difficulties occur and/or that eating difficulties tend to be global in nature. The significant correlation of the two ESES subscales (r =.39, p <.001) supports these possibilities. The clinical and research utility of the ESES and the implications of the findings are discussed.