Moderation of Fatigue and Stress in the Carry-over of Self-Regulation and Self-Efficacy for Exercise to Self-Regulation and Self-Efficacy for Managed Eating

James J. Annesi

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DOI: 10.4236/psych.2011.27106                

Abstract

Behavioral treatments for morbid obesity have not been effective, possibly because of a poor understanding of the relations of psychosocial factors and exercise and eating behaviors. Recent research suggests that exercise program-induced improvements in self-efficacy and self-regulatory skills use may carry-over to self-efficacy and self-regulation for controlled eating. However, for individuals with morbid obesity, fatigue and anxiety may moderate these relationships. The purpose of this research was to evaluate this moderation. Adults with Grade 3 obesity (MBMI = 46.0 kg/m2) participated in 26 weeks of cognitive-behaviorally supported exercise paired with 12 weeks of either nutrition education (n = 95) or a cognitive-behavioral nutrition component (n = 109). There were significant improvements in self-regulation and self-efficacy for exercise, and self-regulation and self-efficacy for controlled eating, which did not differ by treatment condition. Bivariate relationships between changes in self-regulation for exercise and self-regulation for controlled eating (β = .63), and changes in exercise self-efficacy and self-efficacy for controlled eating (β = .51), were strong. Moderation of these relationships by fatigue and anxiety was either significant or marginally significant (ps < .01 and ps < .08, respectively). Both changes in self-regulation for controlled eating and self-efficacy for controlled eating significantly contributed to the explained variance in BMI change (R2 = .30). Implications of the findings for behavioral weight-loss treatment for those with morbid obesity were discussed.

Keywords

Self-Regulation, Self-Efficacy, Exercise, Obesity, Nutrition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379-387. doi:10.1037/0278-6133.27.3.379
[2]	American College of Sports Medicine (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise, 42, 459-471.
[3]	Annesi, J. J. (2011). Self-regulatory skills usage strengthens the relations of self-efficacy for improved eating, exercise, and weight in the severely obese: Toward an explanatory model. Behavioral Medicine, 37, 71-76. doi:10.1080/08964289.2011.579643
[4]	Annesi, J. J., & Marti, C. N. (2011). Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss. Psychology and Health, 26, 1081-1098. doi:10.1080/08870446.2010.534167
[5]	Annesi, J. J., & Unruh, J. L. (2007). Effects of The Coach Approach intervention on drop out rates among adults initiating exercise programs at nine YMCAs over three years. Perceptual and Motor Skills, 104, 459-466. doi:10.2466/pms.104.2.459-466
[6]	Annesi, J. J., & Whitaker, A. C. (2010). Psychological factors discriminating between successful and unsuccessful weight loss in a behavioral exercise and nutrition education treatment. International Journal of Behavioral Medicine, 17, 168-175. doi:10.1007/s12529-009-9056-2
[7]	Baker, C. W., & Brownell, K. D. (2000). Physical activity and maintenance of weight loss: Physiological and psychological mechanisms. In C. Bouchard (Ed.), Physical activity and obesity (pp. 311-328). Champaign, IL: Human Kinetics.
[8]	Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
[9]	Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: Freeman.
[10]	Baranowski, T., Lin, L. S., Wetter, D. W., Resnicow, K., & Hearn, M. D. (1997). Theory as mediating variables: Why aren’t community interventions working as desired? Annals of Epidemiology, 7, S89- S95. doi:10.1016/S1047-2797(97)80011-7
[11]	Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. doi:10.1037/0022-3514.51.6.1173
[12]	Bult, M. J., van Dalen, T., & Muller, A. F. (2008). Surgical treatment of obesity. European Journal of Endocrinology, 158, 135-145. doi:10.1530/EJE-07-0145
[13]	Clark, M. M., Abrams, D. B., Niaura, R. S., Eaton, C. A., & Rossi, J. S. (1991). Self-efficacy in weight management. Journal of Consulting and Clinical Psychology, 59, 739-744. doi:10.1037/0022-006X.59.5.739
[14]	Cooper, Z., Doll, H. A., Hawker, D. M., Byrne, S., Bonner, G., Eeley, E., Fairburn, C. G. et al. (2010). Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behavior Research and Therapy, 48, 706-713. doi:10.1016/j.brat.2010.03.008
[15]	Cooper Z., Fairburn C. G., & Hawker, D. M. (2003). Cognitive-beha- vioral treatment of obesity: A clinician’s guide. New York: Guilford.
[16]	Davies, M. (2007). Psychological assessment of candidates for bariatric surgery. Irish Journal of Psychological Medicine, 24, 99-102.
[17]	Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241. doi:10.1001/jama.2009.2014
[18]	Fogelholm, M., & Kukkomen-Harjula, K. (2000). Does physical activity prevent weight gain—A systematic review. Obesity Reviews, 1, 95-111. doi:10.1046/j.1467-789x.2000.00016.x
[19]	Frazier, P. A., Tix, A. P., & Barron, A. P. (2004). Testing moderator and mediator effects in counseling psychological research. Journal of Counseling Psychology, 51, 115-134. doi:10.1037/0022-0167.51.1.115
[20]	Garber, C. E., Blissmer, B., Deschenes, M. R. Franklin, B. A., Lamonte, Michael, J., David P. et al. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine & Science in Sports & Exercise, 43, 1334-1359. doi:10.1249/MSS.0b013e318213fefb
[21]	Glasgow, R. E. (2008). What types of evidence are most needed to advance behavioral medicine? Annals of Behavioral Medicine, 35, 19-25.
[22]	Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413-433. doi:10.1146/annurev.publhealth.28.021406.144145
[23]	Glymor, M. M., Weuve, J., Berkman, L. F., Kawachi, I., & Robins, J. M. (2005). When is baseline adjustment useful in analyses of change? An example with education and cognitive change. American Journal of Epidemiology, 162, 267-278. doi:10.1093/aje/kwi187
[24]	Greenberg, I., Perna, F., Kaplan, M., & Sullivan, M. A. (2005). Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. Obesity Research, 13, 244-249. doi:10.1038/oby.2005.33
[25]	Hagger, M. S., Wood, C., Stiff, C., & Chatzisarantis, N. L. D. (2010). Ego depletion and the strength model of self-control: A meta-analy- sis. Psychological Bulletin, 136, 495-525. doi:10.1037/a0019486
[26]	Hankonen, N., Absetz, P., Haukkala, A., & Uutela, A. (2009). Socioeconomic status and psychosocial mechanisms of lifestyle change in a Type 2 diabetes prevention trial. Annals of Behavioral Medicine, 38, 160-165. doi:10.1007/s12160-009-9144-1
[27]	Kaiser Permanente Health Education Services (2008). Cultivating Health weight management kit (8th ed.). Portland, OR: Kaiser Permanente.
[28]	Klem, M. L., Wing, R. R., McGuire, M. T., Seagle, H. M., & Hill, J. O. (1997). A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66, 239-246.
[29]	Maggard, M. A., Shurgarman, L. R., Suttorp, M., Maglione, A., Sugerman, H. H., Livingston, E. J., Li, Z. et al. (2005). Meta-analysis: Surgical treatment of obesity. Annals of Internal Medicine, 142, 547- 559.
[30]	Mann, T., Tomiyama, J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62, 220-233. doi:10.1037/0003-066X.62.3.220
[31]	Marcus, B. H., Selby, V. C., Niaura, R. S., & Rossi, J. S. (1992). Self- efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport, 63, 60-66.
[32]	McAuley, E., & Mihalko, S. L. (1998). Measuring exercise-related self-efficacy. In J. L. Duda (Ed.), Advances in sport and exercise psychology measurement (pp. 371-390). Morgantown, WV: Fitness Information Technology.
[33]	McNair, D. M., & Heuchert, J. W. P. (2005). Profile of Mood States technical update. North Tonawanda, NY: Multi-Health Systems.
[34]	Mokdad, A. H., Ford, E. S., Bowman, B. A., Dietz, W. H., Vinicor, F., Bales, V. S., & Marks, J. S. (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Journal of the American Medical Association, 289, 76-79. doi:10.1001/jama.289.1.76
[35]	Nackers, L. M., Ross, K. M., & Perri, M. G. (2010). The impact of rate of initial weightloss on long-term success in obesity treatment: Does slow and steady win the race? International Journal of Behavioral Medicine, 17, 161-167. doi:10.1007/s12529-010-9092-y
[36]	Oaten, M., & Cheng, K. (2006). Longitudinal gains in self-regulation from regular physical exercise. British Journal of Health Psychology, 11, 717-733. doi:10.1348/135910706X96481
[37]	Puhl, R., & Brownell, K. D. (2002). Stigma, discrimination, and obesity. In C. G. Fairburn, & K. D. Brownell (Eds.). Eating disorders and obesity (2nd ed., pp. 108-112). New York: Guilford.
[38]	Saelens, B. E., Gehrman, C. A., Sallis, J. F., Calfas, K. J., Sarkin, J. A., & Caparosa, S. (2000). Use of self-management strategies in a 2-year cognitive-behavioral intervention to promote physical activity. Behavior Therapy, 31, 365-379. doi:10.1016/S0005-7894(00)80020-9
[39]	Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147-177. doi:10.1037/1082-989X.7.2.147
[40]	Svetkey, L. P., Stevens, V. J., Brantley, P. J., Appel, L. J., Hollis, J. F., Loria, C. M., Aicher, K. et al. (2008). Comparison of strategies for sustaining weight loss. Journal of the American Medical Association, 299, 1139-1148. doi:10.1001/jama.299.10.1139
[41]	Teixeira, P. J., Silva, M. N., Coutinho, S. R., Palmeira, A. L., Mata, J., Viera, P. N., Sardinha, L. B. et al. (2010). Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity, 18, 725-735. doi:10.1038/oby.2009.281
[42]	Tice, D. M., & Bratslavsky, E. (2000). Giving in to feel good: The place of emotion regulation in the context of general self-control. Psychological Inquiry, 11, 149-159. doi:10.1207/S15327965PLI1103_03
[43]	Warziski, M. T., Sereika, S. M., Styn, M. A., Music, E., & Burke, L. E. (2008). Changes in self-efficacy and dietary adherence: The impact on weight loss in the PREFER study. Journal of Behavioral Medicine, 31, 81-92. doi:10.1007/s10865-007-9135-2