Handbook of Health Psychology

By Andrew Baum; Tracey A. Revenson et al. | Go to book overview
Moreover, performance of a coping response appears to be related to surviving the relapse crisis. When subjects were asked if they had used any behavioral and/or coping strategies to keep them from overeating, the main difference between lapses that were successfully survived versus those that were not was the performance of any coping responses. Grilo, Shiffman, and Wing (1989) showed that behavioral coping stategies (such as leaving the room) and cognitive coping responses (devaluing the food) are equally effective in preventing lapses, but that the combination of a behavioral and cognitive strategy is the most effective response.Given this, it is interesting to ask whether the ability to generate coping responses to hypothetical high risk situations would be related to success at long-term weight loss. The answer appears to be “yes.” In a study by Drapkin, Wing, and Shiffman (1995), dieters were asked at the beginning of a weight loss program to listen to four scenarios describing high risk situations (i.e., family celebration with food, TV, anger, frustration at work), They rated the difficulty of each of these situations and generated as many coping responses to each scenario as they could. Participants who were able to generate more coping responses to the hypothetical situation subsequently lost more weight. Moreover, participants were able to accurately anticipate which situation would be most difficult for them. Participants who noted the negative affect situation as most difficult were later most likely to lapse in situations involving negative affect. These results suggest the possibility of individually tailoring treatment and teaching patients to deal with those situations that cause them personally the greatest difficulty.Perri and colleagues have done the most systematic research on the maintenance process (Perri, Nezu, & Viegner, 1992). They showed, for example, that relapse prevention training followed by continued therapist contact improves long-term weight maintenance (Perri, Shapiro, Ludwig, Twentyman, & McAdoo, 1984). Relapse prevention training was provided to one group during the last 6 weeks of the treatment program; these participants were taught about the process of relapse, and practiced skills needed to identi and cope with high risk situations and to recover from acute lapses. Then, during the first 6 months after treatment, half of the participants were asked to maintain weekly contact with therapists by mailing in postcards with information about their progress, which was followed by a telephone call from the therapist. The group that received both relapse prevention training and continue therapist contact had significantly better weight maintenance than any other group, losing an additional 1.6 lb over the year of follow-up (compared to weight regains of 12.3 lb with relapse training only, and 6.5 lb with contact only).Because so few participants in clinical weight loss programs go on to successfully maintain their weight loss, some researchers have begun to recruit and study individuals who have successfully lost weight and maintained the weight loss. Wing, at the University of Pittsburgh, and Hill, at the University of Colorado, developed a national registry of individuals who have successfully lost 30 lb (regardless of method) and maintains the loss for at least a year; registry members are recruited primarily through media coverage (i.e., magazine, radio, newspaper). Although this is not a representative sample of all successful losers, it provides a rare opportunity to study weight maintenance. The initial cohort of 784 individuals in the registry reported an average weight loss of 66 lb, which they had kept off for 5 years. Nearly all of the registry members used both diet and exercise to lose weight and to maintain their weight loss (Klem, Wing, McGuire, Seagle, & Hill, 1997b). Reported calorie and fat intake were low (averaging 1, 380 kcal/day with 24% as fat) and exercise levels were very high (2, 800 kcal/week). These data suggest the continued importance of these two behavioral strategies for long-term weight control.
CONCLUSIONS
This chapter has broadly reviewed obesity, with a focus on areas relevant to health psychology. Obesity has long been a focus of health psychologists because behavior plays such an important role in the etiology and treatment of this highly prevalent disorder, which is associated with poor health outcomes, including heart disease and diabetes. Several areas of obesity research offer exciting new areas for research, including:
1. The interaction between genes, such as the ob and leptin receptor genes, and behavior in the etiology of obesity.
2. The determinants of food choice, including availability, cost, and preference.
3. Prevention of weight gain, both in the general population and in identified high risk groups.
4. The effect of low fat and fat modified foods on weight. 5. The use of exercise in weight control and weight maintenance (e.g., appropriate levels, how best to facilitate the adoption of exercise habits, decreasing sedentary activity).
5. The combination of behavior therapy with pharmacological agents.
6. Maintenance of weight loss.

Advances in genetic research and pharmacotherapy have heightened interest in obesity research, and it is vitally important that health psychologists continue to work with scientists and practitioners in these fields, using a multidisciplinary approach to further understand the determinants of obesity, and how best to prevent and treat this condition.


REFERENCES

Algert, S., Shragg, I?., & oigswrth D. R. (1985). Moderate caloric restctinin obese widen with gestationsdiabetes. Obstetrics and Gynechology, 65, 487–49

Bandini, L. G., Schoeller, D. A., Cyr, H. N., & Dietz, W. H. (1990). Validity of reported energy intake in obese and nonobese adolescents. American Journal of Clinical Nutrition, 52, 421–425.

Birch, L. L., & Fisher, J. A. (1996). The role of experience in the development of chifdren's eating behavior. In E. D. Capatdi(Ed.), Wry we eat boat we eat: eycgy Washigton, DC: American Psychological Association, of eating (pp. 113–141).

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