Body image change and improved eating self-regulation in a weight management intervention in women

International Journal of Behavioral Nutrition and Physical Activity

Pedro J Teixeira²  Luís B Sardinha²  Cláudia S Minderico²  Paulo N Vieira²  David Markland¹  Marlene N Silva²  Eliana V Carraça² 

[1] School of Sport, Health and Exercise Sciences, Bangor University, George Building, Holyhead road, Bangor, Gwynedd, UK;Faculty of Human Kinetics, Technical University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal

关键词: Obesity;    Weight Management;    Eating behavior;    Eating Self-regulation;    Body image;   

Others  :  1153860
DOI  :  10.1186/1479-5868-8-75

 received in 2010-10-14, accepted in 2011-07-18,  发布年份 2011

【 摘 要 】

Background

Successful weight management involves the regulation of eating behavior. However, the specific mechanisms underlying its successful regulation remain unclear. This study examined one potential mechanism by testing a model in which improved body image mediated the effects of obesity treatment on eating self-regulation. Further, this study explored the role of different body image components.

Methods

Participants were 239 overweight women (age: 37.6 ± 7.1 yr; BMI: 31.5 ± 4.1 kg/m²) engaged in a 12-month behavioral weight management program, which included a body image module. Self-reported measures were used to assess evaluative and investment body image, and eating behavior. Measurements occurred at baseline and at 12 months. Baseline-residualized scores were calculated to report change in the dependent variables. The model was tested using partial least squares analysis.

Results

The model explained 18-44% of the variance in the dependent variables. Treatment significantly improved both body image components, particularly by decreasing its investment component (f² = .32 vs. f² = .22). Eating behavior was positively predicted by investment body image change (p < .001) and to a lesser extent by evaluative body image (p < .05). Treatment had significant effects on 12-month eating behavior change, which were fully mediated by investment and partially mediated by evaluative body image (effect ratios: .68 and .22, respectively).

Conclusions

Results suggest that improving body image, particularly by reducing its salience in one's personal life, might play a role in enhancing eating self-regulation during weight control. Accordingly, future weight loss interventions could benefit from proactively addressing body image-related issues as part of their protocols.

【 授权许可】

   
2011 Carraça et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Flegal KM, Carroll MD, Odgen CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999-2008. Journal of The American Medical Association 2010, 303:235-241.
• [2]do Carmo I, Dos Santos O, Camolas J, Vieira J, Carreira M, Medina L, Reis L, Myatt J, Galvao-Teles A: Overweight and obesity in Portugal: national prevalence in 2003-2005. Obesity Reviews 2008, 9:11-19.
• [3]World Health Organization: Obesity: Preventing and managing the global epidemic. In WHO Technical Support Series No 894. Geneva: World Health Organization; 2000.
• [4]Franz MJ, Van Wormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, Bowman JD, Pronk NP: Weight loss outcomes: A systematic review and meta-analysis of weight loss clinical trials with a minimum 1-year follow-up. Journal of The American Dietetic Association 2007, 107:1755-1767.
• [5]Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN, Carraca EV, Santos TC, Sardinha LB: Mediators of Weight Loss and Weight Loss Maintenance in Middle-aged Women. Obesity (Silver Spring) 2010, 18:725-735.
• [6]Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, Sardinha LB, Lohman TG: Exercise motivation, eating, and body image variables as predictors of weight control. Medicine and Sciences in Sports and Exercise 2006, 38:179-188.
• [7]Foster GD, Wadden TA, Swain RM, Stunkard AJ, Platte P, Vogt RA: The Eating Inventory in obese women: clinical correlates and relationship to weight loss. International Journal of Obesity Related Metabolic Disorders 1998, 22:778-785.
• [8]Cooper Z, Fairburn CG, Hawker DM, (Eds): Cognitive-Behavioral Treatment of Obesity: A Clinician's Guide. New York: Guilford Press; 2003.
• [9]Sarwer DB, Wadden TA, Foster GD: Assessment of body image dissatisfaction in obese women: specificity, severity, and clinical significance. Journal of Consulting Clinical Psychology 1998, 66:651-654.
• [10]Schwartz MB, Brownell KD: Obesity and body image. In Body image: A handbook of theory, research, and clinical practice. Edited by Cash TF, Pruzinsky T. New York: Guilford Press; 2002:201-209.
• [11]Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, Sardinha LB, Lohman TG: Pretreatment predictors of attrition and successful weight management in women. International Journal of Obesity Related Metabolic Disorders 2004, 28:1124-1133.
• [12]Cash TF, Pruzinsky T, (Eds): Body image: A handbook of theory, research, and clinical practice. New York: Guilford Press; 2002.
• [13]Thompson JK, Heinberg LJ, Altabe M, Tautleff-Dunn S: Exacting Beauty: Theory, Assessment, and treatment of body image disturbance. Washington, D.C. American Psychological Association; 1999.
• [14]Cash TF, Deagle EA III: The nature and extent of body image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. International Journal of Eating Disorders 1997, 22:107-125.
• [15]Thompson JK, Coovert MD, Richards KJ, Johnson S, Cattarin J: Development of body image, eating disturbance, and general psychological functioning in female adolescents: Covariance structure modeling and longitudinal investigations. International Journal of Eating Disorders 1995, 18:221-236.
• [16]Pelletier LG, Dion SC: An examination of general and specific motivational mechanisms for the relations between body dissatisfaction and eating behaviors. Journal of Social and Clinical Psychology 2007, 26:303-333.
• [17]Stice E: Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 2002, 128:825-848.
• [18]Neumark-Sztainaer D, Paxton SJ, Hannan PJ, Haines H, Story M: Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health 2006, 39:244-251.
• [19]Stice E: A prospective test of the dual-pathway model of bumilic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology 2001, 110:124-135.
• [20]Striegel-Moore RH, Franko DL: Body image issues among girls and women. In Body Image: A Hanbook of Theory, Research, and Clinical Practice. Edited by Cash TF, Pruzinsky T. New York: Guilford Press; 2002:183-191.
• [21]Cash TF, Melnyk SE, Hrabosky JI: The assessment of body image investment: an extensive revision of the appearance schemas inventory. Int J Eat Disord 2004, 35:305-316.
• [22]Cash TF: Body image attitudes: Evaluation, investment, and affect. Perceptual and Motor Skills 1994, 78:1168-1170.
• [23]Cash TF, Phillips KA, Santos MT, Hrabosky JI: Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population. Body Image 2004, 1:363-372.
• [24]Bruch H: Perceptual and conceptual disturbances in anorexia nervosa. Psychosomatic Medicine 1962, 24:187-194.
• [25]Dalle Grave R, Cuzzolaro M, Calugi S, Tomasi F, Temperilli F, Marchesini G: The effect of obesity management on body image in patients seeking treatment at medical centers. Obesity (Silver Spring) 2007, 15:2320-2327.
• [26]Foster GD, Wadden TA, Vogt RA: Body image in obese women before, during, and after weight loss treatment. Health Psychology 1997, 16:226-229.
• [27]Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 2000, 55:68-78.
• [28]Deci EL, Ryan RM: Intrinsic Motivation and Self-Determination in Human Behavior. New York: Plenum; 1985.
• [29]Silva MN, Vieira PN, Coutinho SR, Minderico CS, Matos MG, Sardinha LB, Teixeira PJ: Using self-determination theory to promote physical activity and weight control: a randomized control trial in women. Journal of Behavioral Medicine 2010, 33:110-122.
• [30]Silva MN, Markland D, Minderico CS, Vieira PN, Castro MM, Coutinho SR, Santos TC, Matos MG, Sardinha LB, Teixeira PJ: A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description. BMC Public Health 2008, 8:234-246. BioMed Central Full Text
• [31]Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods 2002, 7:147-177.
• [32]Graham JW: Missing data analysis: Making it work in the real world. Annual Review of Psychology 2008, 60:549-576.
• [33]Thompson JK: Assessing Body Image Disturbance: Measures, Methodology, and Implementation. In Body Image, Eating Disorders, and Obesity. Edited by Thompson JK. Washington DC: American Psychiatric Association; 1996:49-82.
• [34]Stunkard AJ, Sorensen T, Schulsinger F: Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983, 60:115-120.
• [35]Cooper PJ, Taylor MJ, Cooper Z, Fairburn CG: The Development and Validation of the Body Shape Questionnaire. International Journal of Eating Disorders 1987, 6:485-494.
• [36]Rosen JC, Jones A, Ramirez E, Waxman S: Body Shape Questionnaire: studies of validity and reliability. Int J Eat Disord 1996, 20:315-319.
• [37]Mazzeo SE: Modification of an Existing Measure of Body Image Preoccupation and Its Relationship to Disordered Eating in Female College Students. Journal of Counseling Psychology 1999, 46:42-50.
• [38]Hart EA, Leary MR, Rejeski WJ: The Measurement of Social Physique Anxiety. Journal of Sport and exercise Psychology 1989, 11:94-104.
• [39]Herman CP, Polivy J: The self-regulation of eating: Theoretical and practical problems. In Handbook of self-regulation: Research, theory, and applications. Edited by Baumeister RF, Vohs KD. New York: Guilford Press; 2004:492-508.
• [40]Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS: Self-efficacy in weight management. Journal of Consulting Clinical Psychology 1991, 59:739-744.
• [41]Stunkard A, Messick S: The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research 1985, 29:71-83.
• [42]Westenhoefer J: Dietary restraint and disinhibition: is restraint a homogeneous construct? Appetite 1991, 16:45-55.
• [43]Bond MJ, McDowell AJ, Wilkinson JY: The measurement of dietary restraint, disinhibition, and hunger: An examination of the factor structure of the Three Factor Eating Questionnaire (TFEQ). Int J Obes 2001, 25:900-906.
• [44]Cohen J: Statistical power analysis for the behavioral sciences. 2nd edition. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.
• [45]Ringle CM, Wende S, Will A: SmartPLS 2.0 M3. [http://www.smartpls.de] webciteBook SmartPLS 2.0 M3 (Editor ed.^eds.) City: Hamburg: University of Hamburg; 2005.
• [46]Fornell C, Bookstein FL: Two Structural Equation Models: LISREL and PLS Applied to Consumer Exit-Voice Theory. Journal of Marketing Research 1982, 19:440-452.
• [47]Frank FR, Miller NB: A primer for soft modeling. Akron, OH: University of Akron Press; 1992.
• [48]Chin WW: The partial least squares approach for structural equation modeling. In Modern methods for business research. Edited by Marcoulides GA. Hillsdale, NJ: Lawrence Erlbaum Associates; 1998:295-336.
• [49]Hulland J: Use of partial least squares (PLS) in strategic management research: A review of four recent studies. Strategic Management Journal 1999, 20:195-204.
• [50]Fornell C, Larcker DF: Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research 1981, 18:39-50.
• [51]MacKinnon DP, Lockwood CM, Williams J: Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behavioral Research 2004., 39
• [52]Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology Bulletin 1986, 51:1173-1182.
• [53]Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 1986, 51:1173-1182.
• [54]Shrout PE, Bolger N: Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods 2002, 7:422-445.
• [55]Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN, Carraca EV, Santos TC, Sardinha LB: Mediators of Weight Loss and Weight Loss Maintenance in Middle-aged Women. Obesity (Silver Spring) 2009.
• [56]Sarwer DB, Thompson JK, Cash TF: Body image and obesity in adulthood. Psychiatric Clinics of North America 2005, 28:69-87.
• [57]Ramirez EM, Rosen JC: A comparison of weight control and weight control plus body image therapy for obese men and women. Journal of Consulting Clinical Psychology 2001, 69:440-446.
• [58]Rosen JC: Obesity and Body Image. In Eating disorders and obesity: A comprehensive handbook. 2nd edition. Edited by Fairburn CG, Brownell KD. New York: Guilford; 2002:399-402.
• [59]Rosen JC: Improving Body Image in Obesity. In Body Image, Eating Disorders, and Obesity. Edited by Thompson JK. Washington DC: American Psychiatric Association; 1996:425-441.
• [60]Palmeira AL, Markland DA, Silva MN, Branco TL, Martins SC, Minderico CS, Vieira PN, Barata JT, Serpa SO, Sardinha LB, Teixeira PJ: Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis. International Journal of Behavioral Nutrition and Physical Activity 2009, 6:9. BioMed Central Full Text
• [61]Schwartz MB, Brownell KD: Obesity and body image. Body Image 2004, 1:43-56.
• [62]Cash TF: Cognitive-Behavioral Perspectives on Body Image. In Body image: A handbook of theory, reserach, and clinical practice. Edited by Cash TF, Pruzinsky T. New York: Guilford Press; 2002:38-46.
• [63]Stein KF: The Self-Schema Model: A Theoretical Approach to the Self-Concept in Eating Disorders. Archives of Psychiatric Nursing 1996, 10:96-109.
• [64]Cash TF, Santos MT, Williams EF: Coping with body image threats and challenges: Validation of the body image coping strategies inventory. Journal of Psychosomatic Research 2005, 58:191-199.
• [65]Williamson DA, Davis CJ, Bennett SM, Goreczny AJ, Gleaves DH: Development of a simple procedure for assessing body image disturbances. Behavioral Assessment 1989, 15:57-68.
• [66]Valutis SA, Goreczny AJ, Abdullah L, Magee E, Wister JA: Weight preoccupation, body image dissatisfaction, and self-efficacy in female undergraduates. Journal of Psychiatry, Psychology and Mental Health 2009., 3
• [67]Kraemer HC, Wilson GT, Fairburn CG, Agras WS: Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 2002, 59:877-883.
• [68]Powell L, Calvin J III, Calvin J jr: Effective obesity treatments. American Psychologist 2007, 62:234-246.
• [69]Cash TF: The Body Image Workbook: An Eight-Step Program for Learning to Like Your Looks. Oakland, CA: New Harbinger Publications; 2008.
• [70]Mata J, Silva MN, Vieira PN, Carraça EV, Andrade AM, Coutinho SR, Sardinha LB, Teixeira PJ: Motivational "spill-over" during weight control: Increased self-determination and exercise intrinsic motivation predict eating self-regulation. Health Psychology 2009, 28:709-716.
• [71]Lindroos AK, Lissner L, Mathiassen ME, Karlsson J, Sullivan M, Bengtsson C, Sjostrom L: Dietary intake in relation to restrained eating, disinhibition and hunger in obese and non-obese Swedish women. Obesity Research 1997, 5:175-182.