Academic journal article International Journal of Clinical and Health Psychology

Generalization of Theory-Based Predictions for Improved Nutrition to Adults with Morbid Obesity: Implications of Initiating Exercise

Academic journal article International Journal of Clinical and Health Psychology

Generalization of Theory-Based Predictions for Improved Nutrition to Adults with Morbid Obesity: Implications of Initiating Exercise

Article excerpt

Results of behavioral weight loss treatments have typically been disappointing (Mann et al., 2007). This is especially true for adults with morbid obesity (i.e., body mass index [BMI] ≥ 40 kg/m2), for whom bariatric surgery has evolved into the treatment of choice (Bult, van Dalen, & Muller, 2008). Educating individuals on the need and methods for healthy eating practices has been a prominent, but uniformly ineffective and atheoretical, strategy (Mann et al., 2007). Cognitive-behavioral methods (e.g., goal setting, cognitive restructuring) (Bandura, 1986, 1997), and emphases on building self-regulatory skills and feelings of ability (i.e., self-efficacy), have performed only somewhat better (Cooper et al., 2010; Powell, Calvin, & Calvin, 2007; Unick et al., 2011; Wing, 2006). Exercise appears to be the best predictor of maintained weight loss (Fogelholm & Kukkomen-Harjula, 2000), although mechanisms for this are unknown. What is clear is that individuals with morbid obesity typically cannot tolerate exercise volumes corresponding to the recommended 150 min per week of moderate intensity activity (Garber et al., 2011). Additionally, the effect of exercise on increasing muscle mass and metabolism accounts for only a small portion of lost weight (Donnelly et al., 2009).

Baker and Brownell (2000) theorized that exercise participation-induced changes in mood, body image, self-efficacy, self-esteem, and coping leads to increased motivation and psychological resources and, following from this, improved eating and weight loss. In extensions of that work, research from Portugal (Mata et al., 2009; Teixeira et al., 2010), Finland (Hankonen, Absetz, Haukkala, & Uutela, 2009) and the U.S. (Annesi, 2011; Annesi & Marti, 2011) suggested the value of exercise for improving mood, self-regulatory skills, and self-efficacy; where such changes generalize or "carry over" to improved eating. It was proposed that even low volumes of exercise may foster these productive changes because exercise program participation, rather than physical output, is the critical factor. In two studies, it was demonstrated that only about 2 days per week of moderate exercise, 15 to 30 min per session, was required to induce a significant improvement in mood (depression, anxiety, and overall negative mood), which was suggested to be associated with a reduction in emotional eating (Annesi, 2003, 2012). Generalization of findings to persons with morbid obesity is unclear - especially considering that psychosocial factors are generally more negative for them than individuals with lower degrees of obesity (Wadden et al., 2006). Although longitudinal testing of such relationships and outcomes are only in their early stages (Unick, Jakicic, & Marcus, 2010), it was thought that long-term maintenance of weight loss may also benefit from a focus on establishing resilient self-regulatory skills to address barriers to persistence with healthy eating behaviors (e.g., increased consumption of fruits and vegetables).

Although great benefit appeared from the proposed transfer of exercise-related self-regulatory skills to self-regulatory skills for eating, and exercise-related self-efficacy to self-efficacy for controlled eating (Annesi, 2012; Hankonen et al., 2009; Mata et al., 2009; Texeira et al., 2010), it was unclear if additional effects could be realized from the addition of a cognitive-behaviorally based nutrition treatment component. This is important because as such exercise-weight loss research moves into practice, the most reliable, effective, and efficient methods should be sought to address behaviors related to the pressing health risk of obesity in a large scale manner (even as related theory may continue to systematically progress).

Thus, this investigation was conducted to address research questions related to the generalizability of previous findings to adults with morbid obesity, and to extend findings toward the development of improved (behavioral) obesity treatments. …

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