title: Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Intervention-mediated effects for adult physical activity: A latent growth curve analysis. Behavioral Mediators of Treatment Effects in the Weight Loss Maintenance Trial A 3-Year Randomized Trial of Lifestyle Intervention for Cardiovascular Risk Reduction in the Primary Care Setting: The Swedish Björknäs Study Mediating Effects of Group Cohesion on Physical Activity and Diet in Women of Color: Health is Power Mediators of weight loss and weight loss maintenance in middle-aged women. Theoretical integration in health psychology: unifying ideas and complementary explanations. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Exercise autonomous motivation predicts 3-yr weight loss in women. Examining the Behavioral Processes through which Lifestyle Interventions Promote Weight Loss: Results from the PREMIER Trial Motivational "spill-over" during weight control: increased self-determination and exercise intrinsic motivation predict eating self-regulation. Self-Regulatory Skills Usage Strengthens the Relations of Self-Efficacy for Improved Eating, Exercise, and Weight in the Severely Obese: Toward an Explanatory Model Reciprocal effects of treatment-induced increases in exercise and improved eating, and their psychosocial correlates, in obese adults seeking weight loss: a field-based trial Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Psychobehavioural Factors Are More Strongly Associated with Successful Weight Management Than Predetermined Satiety Effect or Other Characteristics of Diet Maintaining large weight losses: the role of behavioral and psychological factors. Weight loss by mobile phone: a 1-year effectiveness study. Changes in cognitive measures associated with a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). The relationship between restraint and weight and weight-related behaviors among individuals in a community weight gain prevention trial Self-determined, autonomous regulation of eating behavior is related to lower body mass index in a nationwide survey of middle-aged women. Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. Effects of treatment differences on psychosocial predictors of exercise and improved eating in obese, middle-age adults. Weight loss and psychologic gain in obese women-participants in a supported exercise intervention. Outcome expectations and realizations as predictors of weight regain among dieters. Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT). Efficacy of a theory-based behavioural intervention to increase physical activity in an at-risk group in primary care (ProActive UK): a randomised trial A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence Temporal Aspects of Psychosocial Predictors of Increased Fruit and Vegetable Intake in Adults with Severe Obesity: Mediation by Physical Activity Relationship of Exercise Program Participation with Weight Loss in Adults with Severe Obesity: Assessing Psychologically Based Mediators The roles of self-efficacy and motivation in the prediction of short- and long-term adherence to exercise among patients with coronary heart disease. The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.
abstract: Background Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention Data from two r and omized clinical trials ( RCT ) were used to examine the extent to which a health promotion intervention affected changes in growth trajectories of psychosocial constructs and if so , whether these constructs in turn explained changes in  physical activity ( PA ) . PA and psychosocial measures on 842 overweight adults in the United States were collected in two RCTs evaluating Internet-based behavior change interventions with assessment s at baseline , 6 and 12 months . A physical activity latent variable at 12 months was created using indicators of self-reported walking and leisure time activities . Intervention-mediated effects on  PA  at 12 months were found via latent growth curves representing self-efficacy and behavioral strategies , where increasing growth curves across time were associated with higher  PA values at 12 months . These findings provide some evidence that web-based self-help intervention programs worked through targeted behavior change constructs to influence physical activity levels in overweight adults Background The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss .  Personal contact was superior to interactive technology and self-directed conditions . Purpose We aim ed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms . Methods Overweight/obese adults at risk for cardiovascular disease ( n = 1,032 ) who lost at least 4 kg were r and omized to personal contact , interactive technology , or self-directed . After 30 months , 880 participants had data on weight and behavioral strategies . Results Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology .  Increased intake of fruits and vegetables , more frequent self-weighing , and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed . Conclusion Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials . ( Clinical Trials.gov number NCT00054925 Background Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility . The objective of this study was to test whether intensive lifestyle modification , shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals , can reduce cardiovascular risk factor levels in the primary care setting . Methodology / Principal Findings The Swedish Björknäs study was a r and omized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3 , 12 , 24 and 36 months . A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were r and omly assigned to either an intensive lifestyle intervention ( n = 75 ) or control ( n = 76 ) group . The intervention was based broadly on the protocol of the Diabetes Prevention Program . The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling , followed by regular group meetings during three years . The control group was given general advice about diet and exercise and received st and ard clinical care . Outcomes were changes in anthropometrics , aerobic fitness , self-reported physical activity , blood pressure , and metabolic traits . At 36 months post-r and omisation , intensive lifestyle modification  reduced waist circumference ( −2.2 cm : p = 0.001 ) , waist-hip ratio ( −0.02 : p<0.0001 ) , systolic blood pressure ( −4.9 mmHg : p = 0.036 ) , and diastolic blood pressure ( −1.6 mmHg : p = 0.005 ) , and improved aerobic fitness ( 5 % ; p = 0.038 ) . Changes in lipid or glucose values did not differ statistically between groups . At 36 months , self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group ( p<0.001 ) . Conclusion / Significance A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals . Trial Registration Clinical Trials.gov Purpose . To determine the effects and mediating factors of a physical activity ( PA ) or vegetable and fruit ( VF ) group cohesion intervention . Design . Longitudinal design . Setting . Harris County and Travis County , Texas . Participants . Community-dwelling African-American and Hispanic or Latina women . Intervention . Three hundred ten women were r and omized to a PA ( n = 204 ) or VF ( n = 106 ) intervention group . Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption . Measures . Women completed the International PA  Question naire , National Cancer Institute VF and fat screeners , PA Group Environment Question naire , and 7-day accelerometer protocol at baseline and post-intervention . Analyses . The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model , controlling for baseline values and covariates using path analysis . Results . Women were middle aged ( mean = 44.4 years ) and overweight or obese ( mean body mass index = 34.0 kg/m2 ) .  PA increased and fat consumption decreased for both groups , whereas  VF consumption increased for women in VF group only ( all p < . 05 ) . Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes . Conclusions . Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women , but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5.0 % ( 24-month ) in the intervention group and -1.7 + /- 5.0 % and -2.2 + /- 7.5 % in controls . Change in most psychosocial variables was associated with 12-month weight change , but only flexible cognitive restraint ( P < 0.01 ) , disinhibition ( P < 0.05 ) , exercise self-efficacy ( P < 0.001 ) , exercise intrinsic motivation ( P < 0.01 ) , and body dissatisfaction ( P < 0.05 ) predicted 24-month weight change . Lower emotional eating , increased flexible cognitive restraint , and fewer exercise barriers mediated 12-month weight loss ( R(2 ) = 0.31 , P < 0.001 ; effect ratio : 0.37 ) , but only flexible restraint and exercise self-efficacy mediated 24-month weight loss ( R(2 ) = 0.17 , P < 0.001 ; effect ratio : 0.89 ) . This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance , in a large sample of overweight women . Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss . For long-term success , interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy Theoretical approaches to behaviour change are now pervasive in the health psychology literature ( Abraham & Michie , 2008 ; Michie , Johnston , Francis , Hardeman , & Eccles , 2008 ) . Many are developed in the social psychology literature and applied in health context s to provide a hypothesis-testing framework for empirical investigations into health behaviours and outcomes ( Michie , Rothman , & Sheeran , 2007 ) . Numerous theoretical perspectives have been applied in the health sphere : the health action process model ( Schwartzer , 1992 ) , the health belief model ( Becker , 1974 ) , protection motivation theory ( PMT ; Rogers , 1975 ) , self-determination theory ( Deci & Ryan , 1985 ) , self-regulation theory ( Leventhal , Leventhal , & Contrada , 1998 ) , social cognitive theory ( B and ura , 1977 ) , subjective expected utility theory ( Edwards , 1954 ) , the theories of reasoned action ( Ajzen & Fishbein , 1980 ) and planned behaviour ( Ajzen , 1985 ) , the theory of interpersonal behaviour ( Tri and is , 1977 ) , and the transtheoretical model ( Prochaska & DiClemente , 1982 ) to name but a few . While meta-analytic review s of cross-sectional , prospect i ve , experimental , and intervention studies have indicated that these theories have varying degrees of utility in explaining variance in health behaviour and outcomes ( Armitage & Conner , 2001 ; Hardeman et al. , 2002 ; Milne , Sheeran , & Orbell , 2000 ; Sibley & Abraham , 2008 ) , a substantial variance in health behaviour remains unexplained ( Ogden , 2003 ; Weinstein , 2007 ) . There is a further problem ; when the impact of past behaviour or previous experience is accounted for , the efficacy of the theories in explaining health behaviour tends to fall dramatically ( Hagger , Chatzisarantis , & Biddle , 2002 ; Sutton , 1994 ) . This makes the identification of the psychological constructs that account for behaviour uniquely and independent of past behaviour paramount . Furthermore , theories of health behaviour have become increasingly complex , with additional variables being incorporated as additional predictors , mediators , or moderators to test , with increasing detail , the limitations and boundaries of each theory ( Ajzen , 1998 ; Armitage & Conner Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more PURPOSE This study evaluated exercise-related predictors of  successful long-term weight control in women by analyzing the extent to which sustained exercise participation and self-determination theory (SDT)-based exercise motivation variables mediated the impact of a behavioral weight control intervention on 3-yr weight change . METHODS Longitudinal r and omized controlled trial consisting of a 1-yr SDT-based intervention and a 2-yr follow-up with 221 female participants ( means ± SD : age = 37.6 ± 7 yr , body mass index = 31.6 ± 4.1 kg·m(-2 ) ) . The tested model incorporated experimentally manipulated perceived need support , motivational regulations , and 2-yr exercise adherence as mediators of the intervention 's impact on 3-yr weight change . Paths were tested using partial least squares analysis . Where there were significant intervening paths , tests of mediation were conducted . RESULTS Treatment had significant effects on 1- and 2-yr autonomous regulations , 2-yr physical activity , and 3-yr weight change , fully mediated by the tested paths ( effect ratio = 0.10 - 0.61 ) . Moderate and vigorous exercise at 2 yr had a significant effect ( P < 0.001 ) on weight loss success at 3 yr and partially mediated the effect of treatment on weight change . The 2-yr autonomous regulation effects on follow-up weight change were only partially mediated by physical activity ( effect ratio = 0.42 ) . CONCLUSIONS This application of SDT to physical activity and weight management showed that not all types of motivation predict long-term behavioral outcomes and that sustained moderate and vigorous exercise mediated long-term weight change . It provides strong evidence for a link between experimentally increased autonomous motivation and exercise and long-term weight loss maintenance . Results highlight the importance of interventions targeting the internalization of exercise behavioral regulation and making exercise and physical activity positive and meaningful experiences rather than simply focusing on immediate behavior change in overweight/obese women Objective To examine the behavioral processes through which lifestyle interventions impacted weight loss . Design and Methods We limited our analyses to overweight and obese Black and White adults r and omized to a PREMIER lifestyle intervention ( N = 501 ) . Structural equation modeling was conducted to test the direct and indirect relationships of session attendance , days of self-monitoring diet and exercise , change in diet composition and exercise , and six month weight change . Results Greater session attendance was associated with increased self-monitoring , which was in turn significantly related to reduction in percent energy from total fat consumed . Change in percent energy from fat and self-monitoring was associated with six-month percent change in weight . Both a decrease in fat intake and increase in self-monitoring are potential mediators of the relationship between attendance and weight change . Conclusions Our findings provide a reasonable model that suggests regular session attendance and use of behavioral strategies like self-monitoring are associated with improved behavioral outcomes that are associated with weight loss OBJECTIVE Successful weight management relies on at least two health behaviors , eating and exercise . However , little is known about their interaction on a motivational and behavioral level . Based on the Hierarchical Model of Motivation the authors examined whether exercise-specific motivation can transfer to eating regulation during a lifestyle weight control program . The authors further investigated whether general , treatment-related , and exercise motivation underlie the relation between increased exercise and improved eating regulation . DESIGN Overweight/obese women participated in a 1-year r and omized controlled trial ( N = 239 ) . The intervention focused on promoting physical activity and internal motivation for exercise and weight loss , following Self-Determination Theory . The control group received general health education . MAIN OUTCOME MEASURES General and exercise specific self-determination , eating self-regulation variables , and physical activity behavior . RESULTS General self-determination and more autonomous exercise motivation predicted eating self-regulation over 12 months . Additionally , general and exercise self-determination fully mediated the relation between physical activity and eating self-regulation . CONCLUSION Increased general self-determination and exercise motivation seem to facilitate improvements in eating self-regulation during weight control in women . These motivational mechanisms also underlie the relationship between improvements in exercise behavior and eating regulation Lack of success with behavioral weight-management treatments indicates a need for a better underst and ing of modifiable psychological correlates . Adults with class 2 and 3 obesity ( N = 183 ; Mean BMI = 42.0 kg/m2 ) volunteered for a 26-week nutrition and exercise treatment , based on social cognitive theory , that focused on self-efficacy and self-regulation applied to increasing cardiovascular exercise and fruit and vegetable consumption .  Improved self-efficacy for controlled eating significantly predicted increased fruit and vegetable consumption ( R 2 = .15 ) . Improved self-efficacy for exercise significantly predicted increased exercise ( R 2 = .46 ) . When changes in self-regulatory skill usage were stepped into the 2 previous equations , the variances accounted for significantly increased . Increases in fruit and vegetable consumption and exercise significantly predicted weight loss ( R 2 = .38 ) . Findings suggest that behavioral theory should guide research on weight-loss treatment , and a focus on self-efficacy and self-regulatory skills applied to specific nutrition and exercise behaviors is warranted Background A better underst and ing 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 setting s , with sample s possessing high probabilities of health risks , might enable rapid application of useful findings . Methods Adult volunteers with severe obesity ( body mass index [ BMI ] 35–50 kg/m2 ; age = 43.0 ± 9.5 y ; 83 % female ) were r and omly 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 , result ing 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 , result ing from change in exercise volume , and c ) the reciprocal effects of changes in the three psychosocial variables and exercise change , result ing from change in fruit and vegetable intake . Results Mediation 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 . Conclusion Findings had implication s 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 BACKGROUND Rural counties in the United States have higher rates of obesity , sedentary lifestyle , and associated chronic diseases than nonrural areas , yet the management of obesity in rural communities has received little attention from research ers . METHODS Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties ( n = 234 ) were r and omized to extended care or to an education control group .  The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face . Control group participants received 26 biweekly newsletters containing weight-control advice . RESULTS Mean weight at study entry was 96.4 kg . Mean weight loss during the initial 6-month intervention was 10.0 kg . One year after r and omization , participants in the telephone and face-to-face extended-care programs  regained less weight ( mean [ SE ] , 1.2 [ 0.7 ] and 1.2 [ 0.6 ] kg , respectively ) than those in the education control group ( 3.7 [ 0.7 ] kg ; P = .03 and .02 , respectively ) . The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies , and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention . CONCLUSIONS Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone . Telephone counseling constitutes an effective and cost-efficient option for long-term weight management . Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services . Trial Registration clinical trials.gov Identifier : NCT00201006 This study aim ed to investigate factors associated with weight management , especially whether satiety value of food as a part of a weight-maintenance diet would affect self-regulation of food intake and weight management . Altogether 82 obese subjects completed the study consisting of weight-loss and weight-maintenance ( WM ) periods . During the WM , subjects were r and omized into higher- and lower-satiety food groups . No differences were observed in the changes in body weight , energy intake , or eating behaviour between the groups , even despite the different macronutrient compositions of the diets . However , when regarding all study subjects , success in WM was most strongly associated with a greater increase in the flexible control of eating and experience of greater easiness of WM and control of food intake and a greater decrease in uncontrollable eating and psychological distress . Psychobehavioural factors seem to be more strongly associated with successful weight management than the predetermined satiety effect or other characteristics of the diet Few studies have examined predictors of weight regain  after significant weight losses . This prospect i ve study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet . Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain , both as main effects and as interactions with treatment group . Decreases in physical activity were related to weight regain across all 3 groups , and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group . Increases in depressive symptoms , disinhibition , and hunger were also related to weight regain in all groups . Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group , the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain . Future programs should focus on maintaining physical activity , dietary restraints , and frequent self-weighing and should include stronger components to modify psychological parameters OBJECTIVE To investigate the short- and long-term effectiveness and the predictors of weight loss in a mobile phone weight-loss programme  among healthy overweight adults . DESIGN One hundred and twenty-five healthy , overweight ( BMI = 26 - 36 kg/m2 ) , 25 - 44-year-old , screened volunteers were r and omized to an experimental group ( n 62 ) to use a mobile phone-operated weight-loss programme or to a control group ( n 63 ) with no intervention . Via text messaging , the programme instructed a staggered reduction of food intake and daily weight reporting with immediate tailored feedback . Assessment s were at 0 , 3 , 6 , 9 and 12 months for the experimental group ; at 0 and 12 months for the control group . Main outcome variables were changes in body weight and waist circumference . RESULTS By 12 months the experimental group had lost significantly more weight than the control group ( 4.5 ( sd 5.0 ) v. 1.1 ( sd 5.8 ) kg ; F(1,80 ) = 8.0 , P = 0.006 ) and had a greater reduction in waist circumference ( 6.3 ( sd 5.3 ) v. 2.4 ( sd 5.4 ) cm ; F(1,80 ) = 55.2 , P = 0.0001 ) . Early weight loss , self-efficacy , contact frequency , attitudes towards the medium , changes in work and family life and changes made in dietary habits were the strongest predictors of weight loss . CONCLUSIONS This mobile phone weight-loss programme was effective in short- and long-term weight loss . As a minimum-advice , maximal-contact programme , it offers ideas for future weight-loss programmes Cognitive changes are reported infrequently in programs targeting cardiovascular risk . We examined self-efficacy , behavioral barriers and health beliefs in a lifestyle program for drug-treated hypertensives that aim ed to reduce blood pressure , antihypertensive drug needs and cardiovascular risk . In a r and omized controlled trial , we compared usual care ( controls ) and a 4-month program focusing on weight loss , diet and exercise . Outcomes were assessed at baseline , 4 months and 1-year follow-up . Of 241 individuals r and omized , 102/123 in the program and 90/118 of controls completed follow-up . In the program group , dietary barriers fell by 14 % at 4 months ( controls 2 % , P = 0.025 ) and by 8 % at follow-up ( controls 3 % , P = 0.010 ) . Exercise barriers fell by 11 % at 4 months ( controls 3 % , P = 0.020 ) and 17 % ( controls 4 % , P = 0.002 ) at follow-up . Dietary self-efficacy improved by 3 % at 4 months ( controls -1 % , P = 0.003 ) and by 2 % at follow-up ( controls -1 % , P = 0.051 ) . Exercise self-efficacy increased by 8 % at 4 months ( controls 3 % , P < 0.001 ) and by 5 % at follow-up ( controls 3 % , P = 0.130 ) . Changes in cognitive variables predicted changes in health-related behaviors at 4 months and follow-up . A cognitively based lifestyle program in treated hypertensives is associated with improvements in cognitive measures in the shorter and longer term PURPOSE : The present study evaluated the cross-section and prospect i ve associations between the Eating Inventory 's ( EI ) total , flexible and rigid dietary restraint scales and changes in weight and behaviors in a community sample of adults enrolled in a 3 y weight gain prevention study . METHODS : Subjects were participants in the Pound of Prevention ( POP ) study , a community-based weight gain prevention trial . RESULTS : Higher levels of baseline total , flexible and rigid dietary restraint were related to lower weight and more weight-controlling behaviors at the baseline assessment . Baseline restraint measures positively predicted increases in weighing frequency over the 3 y follow-up . Increases in restraint over the follow-up period were related to decreases in weight , energy intake and television watching , and increases in self-weighing and physical activity . CONCLUSION : The EI 's total , flexible and rigid restraint scales were not differently associated with weight and behaviors in this heterogeneous sample of adults who were attempting to lose weight . Developing methods to increase behavioral and cognitive strategies to control weight may help to prevent weight gain in clinical and community sample s . International Journal of Obesity ( 2001 ) 25 , BACKGROUND The associations among people 's level of autonomy in regulating their eating behaviors , food patterns , and degree of obesity have not been investigated in a general adult population . OBJECTIVES Our objectives were to cross-sectionally examine , in a nationally representative sample of adult New Zeal and women , the associations between different styles of eating behavior regulation  and body mass index ( BMI ) , with specific food and eating habits as hypothesized mediators . DESIGN During May 2009 , a sample of 2,500 New Zeal and women aged 40 to 50 years was r and omly selected from the nationwide electoral rolls . A 66 % ( n=1,601 ) participation rate was achieved . Potential participants were mailed a self-administered question naire containing the Regulation of Eating Behavior scale , questions on specific food and eating habits ( frequency of binge eating , speed of eating , usual daily servings of fruits and vegetables , usual frequency of intake of several high-fat and /or high-sugar foods ) , and height and weight . STATISTICAL ANALYSES Univariate linear regression models were used to examine the associations among demographic , health and behavioral variables , and BMI . Multivariate linear regression models were developed to investigate the relationships between autonomous and controlled forms of  eating behavior regulation and BMI , with specific food and eating habits as mediators . RESULTS After adjusting for potential confounders as well as specific food and eating habits that were potential mediators , BMI was statistically significantly lower by 2 % ( 95 % CI -2.7 % to -1.4 % ; P<0.001 ) for every 10-unit increase in autonomous regulation , and statistically significantly higher by 1.4 % ( 95 % CI 0.4 % to 2.3 % ; P=0.005 ) for every 10-unit increase in controlled regulation . The relationships between autonomous regulation and BMI as well as controlled regulation and BMI were only partially mediated by the specific food and eating habits measured . CONCLUSIONS Although the direction of causality requires confirmation , the results provide support for the applicability of Self-Determination Theory , and suggest that developing more autonomous motivation for eating behavior is likely to facilitate healthier food habits and lower BMI in middle-aged women Assessment of habitual physical activity in epidemiologic and health education studies has been difficult . A seven-day physical activity recall interview was developed and administered in a community health survey , a r and omized clinical trial , and two worksite health promotion programs during 1979 - 1982 . These studies were conducted in several population s in California , Texas , Pennsylvania , and New Jersey . Energy expenditure estimates from the physical activity recall conformed to expected age- and sex-specific values in the cross-sectional community survey . Estimates of energy expenditure were also congruent with other questions on physical activity and job classification . In a r and omized , one-year exercise trial , the physical activity recall detected increases in energy expenditure in the treated group and was positively associated with miles run during training ( p less than 0.05 ) . Changes in energy expenditure were associated with changes in maximal oxygen uptake ( VO2max ( r = 0.33 , p less than 0.05 ) and body fatness ( r = -0.50 , p less than 0.01 ) at six months , and in high density lipoprotein-cholesterol ( r = 0.31 , p less than 0.05 ) and triglyceride ( r = -0.41 , p less than 0.01 ) at one year . The physical activity recall detected significant ( p less than 0.01 ) increases in energy expenditure in treatment groups in two worksite health promotion projects . These data suggest that the physical activity recall provides useful estimates of habitual physical activity for research in epidemiologic and health education studies BACKGROUND Behavioral interventions for weight-loss have been largely unsuccessful . Exercise is the strongest predictor of maintained weight loss and much of its effects may be from associated changes in psychosocial factors . METHODS Middle-aged , formerly sedentary adults with severe obesity were r and omly selected to 6-month treatments of cognitive-behavioral exercise support paired with either st and ard nutrition education ( n = 99 ) or nutrition change supported by cognitive-behavioral means with an emphasis on self-regulation ( n = 101 ) . RESULTS Overall improvements in self-efficacy and self-regulation for both exercise and managed eating , and mood , were found , with significantly greater improvements associated with the cognitive-behavioral nutrition condition in self-regulation for eating and mood . Change scores trended toward being stronger predictors of increased exercise and fruit and vegetable intake than scores at treatment end . Multiple regression analyses indicated that significant portions of the variance in both increased volume of exercise ( R2 = 0.45 ) and fruit and vegetable intake ( R2 = 0.21 ) were explained by changes in self-regulatory skill usage , self-efficacy , and mood . CONCLUSIONS Cognitive-behavioral methods for improved eating paired with behavioral support of exercise may improve weight loss through effects on the psychosocial factors of self-regulation , self-efficacy , and overall mood more than when st and ard nutrition education is incorporated BACKGROUND Physical activity is a predictor of maintained weight loss ; however , causal mechanisms are unclear . Behavioral theories suggest that associated psychologic changes may indirectly affect weight loss . OBJECTIVE We sought to test the association of a behaviorally based exercise support protocol ( The Coach Approach [ CA ] ) , with and without a group-based nutrition education program ( Cultivating Health ) , with adherence to exercise and changes in physiologic and psychologic factors , and to assess theory-based paths to weight and body-fat changes . SETTING The study took place in YMCA wellness centers . STUDY SUBJECTS Study participation was open to formerly sedentary obese women . DESIGN Study participants were r and omly assigned to the CA Only ( CA ; n = 81 ) , The CA Plus Cultivating Health ( CA/CH ; n = 128 ) , or the control ( n = 64 ) group . We contrasted dropout and attendance rates and changes in self-efficacy ( SE ) , physical self-concept ( PSC ) , total mood disturbance ( TMD ) , body areas satisfaction ( BAS ) , and select physiologic factors during a six-month period . We also analyzed proposed paths to weight loss . RESULTS The CA and CA/CH groups had significantly lower exercise dropout rates ( χ(2 ) = 44.67 , p < 0.001 ) and higher attendance rates ( F = 10.02 ; p < 0.001 ) than the control group did . Improvements in body fat , body mass index ( BMI ) , and waist circumference were significant for only the CA and CA/CH groups . Significant improvements in TMD , PSC , and BAS scores were found for all groups , with effect sizes greater in the groups incorporating the CA protocol . Within the five paths assessed , entry of changes in TMD and BAS scores into multiple-regression equations , along with SE and PSC scores , increased the explained variance in exercise session attendance from 5 % ( p = 0.01 ) to 16 % ( p < 0.001 ) . Exercise session attendance was significantly associated with changes in body fat ( r = -0.41 ; p < 0.001 ) and BMI ( r = -0.46 ; p < 0.001 ) . CONCLUSION Counseling based on social cognitive and self-efficacy theory may increase exercise adherence and improve variables indirectly related to weight and body-fat reductions . Although decreases in body fat and BMI were obtained , they appeared less pronounced than psychologic improvements . Additional research on interrelations of physical activity , psychologic factors , and weight change is warranted for development of obesity treatments This prospect i ve study tested whether ( a ) baseline outcome expectations regarding the benefits of a weight-loss diet , ( b ) 6-month outcome realizations regarding perceived benefits actually experienced , and /or ( c ) the interaction between them predicted 6 - 12-month weight regain among overweight/obese women r and omized to one of four popular weight-loss diets  ( N=311 ) . Positive 6-month realizations regarding improvements in physical shape and appearance predicted less 6 - 12-month weight regain among  Atkins diet participants only ( n=70 ) , controlling for baseline expectations , the expectations-realization interaction , and initial weight loss .  Atkins participants displayed three distinct patterns of regain based on levels of 6-month realizations and initial weight loss . Experimental research should investigate whether improving realizations leads to reduced weight regain in response to this popular diet We aim ed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth , Australia . We collected data at baseline , 4 months ( post-intervention ) and 1-year follow-up in a r and omized controlled trial of a program that focused on  weight loss , diet , and exercise . Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits . Outcomes examined were saturated fat intake ( % energy ) and physical activity ( hours per week ) . In total , 90/118 individuals r and omized to usual care and 102/123 to the program-completed follow-up . Sex was a moderator of response post-intervention for diet and physical activity , with a greater response among women with usual care and among men with the program .  Change in self-efficacy was a mediator of dietary change post-intervention [ effect size ( ES ) -0.055 , 95 % confidence interval ( CI ) -0.125 , -0.005 ] and at follow-up ( ES 0.054 , 95 % CI -0.127 , -0.005 ) , and in physical activity post-intervention ( ES 0.059 , 95 % CI 0.003 , 0.147 ) . These findings highlight different responses of men and women to the program , and the importance of self-efficacy as a mediator . Mediators for physical activity in the longer term should be investigated in other models , with appropriate cognitive measurements , in future trials BACKGROUND Declining physical activity is associated with a rising burden of global disease . Efforts to reverse this trend have not been successful . We aim ed to assess the efficacy of a facilitated behavioural intervention to increase the physical activity of sedentary individuals at familial risk of diabetes . METHODS We enrolled 365 sedentary adults who had a parental history of type 2 diabetes . They were recruited from either diabetes or family history registers at 20 general practice clinics in the UK . Eligible participants were r and omly assigned to one of two intervention groups , or to a comparison group . All participants were posted a brief advice leaflet . One intervention group was offered a 1-year behaviour-change programme , to be delivered by trained facilitators in participants ' homes , and the other the same programme by telephone . The programme was design ed to alter behavioural determinants , as defined by the theory of planned behaviour , and to teach behaviour-change strategies . The principal outcome at 1 year was daytime physical activity , which was objective ly measured as a ratio to resting energy expenditure . Analysis was by intention to treat . This study is registered as IS RCT N61323766 . FINDINGS Of 365 patients , we analysed primary endpoints for 321 ( 88 % ) for whom we had data after 1 year of follow-up . At 1 year , the physical-activity ratio of participants who received the intervention , by either delivery route , did not differ from the ratio in those who were given a brief advice leaflet . The mean difference in daytime physical-activity ratio , adjusted for baseline , was -0.04 ( 95 % CI -0.16 to 0.08 ) . The physical-activity ratio did not differ between participants who were delivered the intervention face-to-face or by telephone ( mean difference -0.05 ; 95 % CI -0.19 to 0.10 ) . INTERPRETATION A facilitated theory-based behavioural intervention was no more effective than an advice leaflet for promotion of physical activity in an at-risk group ; therefore health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services As maintenance of lifestyle change and risk factor modification following completion of cardiac rehabilitation has been shown to be notoriously difficult , we developed a brief self-regulation lifestyle program for post-cardiac rehabilitation patients . R and omized-controlled trial . Following completion of cardiac rehabilitation 210 patients were r and omized to receive either a lifestyle maintenance program ( n = 112 ) or st and ard care ( n = 98 ) . The program was based on self-regulation principles and consisted of a motivational interview , 7 group sessions and home assignments . Risk factors and health behaviors were assessed at baseline ( end of cardiac rehabilitation ) , and 6 and 15 months thereafter . ANCOVAs showed a significant effect of the lifestyle program on exercise behavior at 15-month follow-up . Mediation analysis demonstrated that the treatment effect on exercise behavior could be explained by self-regulation skills . Chi squared tests showed that patients in the intervention group had significantly fewer uncontrolled risk factors as compared to the control group . Finally , the lifestyle intervention program was associated with a 12 % reduction in self-reported cardiac hospital admission rates . This trial indicates that a relatively brief , theory-based lifestyle program is capable of inciting and maintaining improvements in exercise adherence . It is suggested that patients may need ongoing attention and guidance , for example in the form of ( internet-based ) booster sessions , as long-term consolidation of changes is arduous Effective and reliable obesity treatments are lacking because of a poor underst and ing of the health behavior change process . Community-based organizations with the capacity to train existing staff members are particularly well-positioned to implement evidence -based treatment protocol s to impact obesity-related behaviors such as unhealthy eating and lack of physical activity . The aim of this study was to assess temporal aspects of psychosocial predictors ( self-regulation , mood , and self-efficacy ) on increased fruit and vegetable intake in adults with severe obesity , while also accounting for mediation by physical activity volume . A 6-month , r and omized field investigation was conducted . Severely obese adults volunteered for behavioral support of physical activity coupled with nutrition education ( n = 73 ) or cognitive-behavioral methods for nutrition change ( n = 71 ) . Improvements in self-regulation , mood , self-efficacy , fruit and vegetable intake ( FV ) , and physical activity ( PA ) were significant , with significantly greater self-regulation at month 6 for the cognitive-behavioral group . Increase in FV was predicted by changes in the above psychosocial variables over 6 months , with mood change over 3 months also a significant predictor . Change in PA mediated the above relationships , with a reciprocal effect between changes in PA and FV . Findings have implication s for the large-scale behavioral treatment of obesity Background : Although exercise is related to weight loss , minimal energy expenditures typical in deconditioned persons explain only small portions of this reduction . Thus , it has been suggested that exercise-induced changes in psychological variables associated with appropriate eating may be mediators . Methods : Adults with obesity ( N = 106 ; Mean BMI = 42.0 ; SD = 6.0 kg/m2 ) , volunteering for a cognitive-behavioral exercise support program and group nutrition information , were assessed on overall mood , self-efficacy for controlled eating , self-regulation skills usage for appropriate eating , recalled volume of physical activity , body mass index ( BMI ) , and waist circumference at baseline and at month six . Results : All within-subject changes were significant ( P < 0.001 ) and as expected , changes in volumes of physical activity were significantly related to BMI ( & bgr ; = -0.52 ) and waist circumference ( & bgr ; = −0.63 ) changes . These relationships were partially mediated by changes in self-efficacy and self-regulation scores . Mediation of mood changes did not , however , reach statistical significance . Conclusion : In severely obese persons initiating behaviorally supported exercise , weight loss may be better accounted for by changes in psychological predictors of improved eating such as self-efficacy and self-regulation than by direct energy expenditure . Implication s for weight loss theory development and clinical applications were discussed OBJECTIVES Poor adherence to regular exercise is a documented challenge among people with heart disease . Identifying key determinants of exercise adherence and distinguishing between the processes driving short- and long-term adherence to regular exercise is a valuable endeavor . The purpose of the present study was to test a model of exercise behavior change , which incorporates motivational orientations and self-efficacy for exercise behavior , in the prediction of short- and long-term exercise adherence . METHOD Male and female patients ( N = 801 ) hospitalized for coronary heart disease were recruited from 3 tertiary care cardiac centers and followed for a period of 1 year after hospital discharge . A prospect i ve , longitudinal design was used to examine the roles of motivation and self-efficacy ( measured at recruitment and at 2 and 6 months after discharge ) in the prediction of exercise behavior at 6 and 12 months . Baseline measures of exercise and clinical and demographic covariates were included in the analyses . RESULTS Structural equation modeling showed that both autonomous motivation and self-efficacy were important determinants of short-term ( 6-month ) exercise behavior regulation , but that only autonomous motivation remained a significant predictor of long-term ( 12-month ) exercise behavior . Self-efficacy partially mediated the relationship between motivation for exercise and 6-month exercise behavior . CONCLUSIONS This research confirmed the roles of autonomous motivation and self-efficacy in the health behavior change process and emphasized the key function of autonomous motivation in exercise maintenance . Theoretical and cardiac rehabilitation program applications of this research are discussed Despite considerable clinical interest , attempts to link perceived self-efficacy with successful weight control have had mixed success . Definitive data on prospect i ve associations between self-efficacy and weight loss are particularly sparse . This study examined relationships between self-efficacy beliefs , weight control behaviors , and weight change among individuals participating in a weight loss trial ( N = 349 , 87 % women ) . Cross-sectionally , eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors . Self-efficacy beliefs prospect ively predicted weight control behavior and weight change during active treatment but not during follow-up . Mediational models indicate that people 's weight control behaviors mediate the impact of self-efficacy on weight change
target: Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation , self-efficacy/barriers , self-regulation skills ( such as self-monitoring ) , flexible eating restraint , and positive body image .
  For physical activity , significant putative mediators were high autonomous motivation , self-efficacy , and use of self-regulation skills .
  For dietary intake , the evidence was much less clear , and no consistent mediators were identified .
  Conclusions This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions .
  Despite limited evidence , higher autonomous motivation , self-efficacy , and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes ; for weight control , positive body image and flexible eating restraint may additionally improve outcomes .
  These variables represent possible targets for future lifestyle interventions in overweight/obese population
background: Background Relapse is high in lifestyle obesity interventions involving behavior and weight change .
  Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment , including re source allocation .
  This article review s the most consistent self-regulation mediators of medium- and long-term weight control , physical activity , and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults .