Rozprawy doktorskie na temat „Weight management”

Abstract Background: Obesity, in addition to being a serious condition in its own right, is causally associated with many chronic non-communicable diseases, and its prevention, identification and treatment is a public health priority. Results: The main findings of the present thesis were that 1) many drugs, used in the management of chronic disease, have an adverse effect on body weight with weight change of +10kg observed as a real side effect of some. 2) Identification and management of obesity is not a formal part of current practice in many secondary care clinics. While acknowledging the adverse health effects of obesity within their specialist areas, clinicians felt under-skilled and insufficiently resourced to provide effective management. 3) Improvements in iron status in pre-menopausal women can be achieved during weight loss, using eating plans that either include or exclude red meat. The data while in-conclusive suggest that a diet including red meat may confer greater benefits on iron status. Discussion: Weight gain is an adverse effect of many drugs used to treat chronic diseases. This should be discussed with patients prior to treatment and advice provided on how to avoid or minimise weight gain. NHS secondary care consultants are concerned about obesity and its impact on their patient’s health. Most have no weight management strategy and would like one. This will require additional training and resources. Excluding red meat did not adversely affect iron status in pre-menopausal women. A larger study is required for definitive health promotion advice. Conclusion: Pharmacotherapy is a significant factor in the rising prevalence of obesity. Weight management is not an integral part of patient care in secondary care clinic settings. The exclusion of red meat during weight management does not compromise iron status in pre-menopausal women with low iron stores.

The World Health Organisation ([WHO], 2007) declared obesity as the public health threat of the 21st century. Currently, the Maltese adult population ranks as the heaviest in the Euro‐Mediterranean region. In response to a gap in Maltese research on the area of obesity and food consumption, this PhD aimed to gather local data to unearth behavioural‐psychological factors that could be implemented in local interventions. The focus of the PhD was narrowed to women with families based on literature that has identified motherhood as a salient point of transition that amplifies the weight trajectories for adult women. A mixed‐methods approach guided the methodology of the PhD programme with four studies carried out sequentially in two phases. The findings of the qualitative phase revealed that weight management for Maltese mothers was enmeshed with gender norm expectations surrounding motherhood. For mothers with a higher BMI, their relationship to food was a significant barrier to weight loss maintenance. Mothers with a lower BMI or who maintained their weight pointed at their food planning ability to manage their diet. The quantitative phase extended literature on the dimensional validity of the Dutch Eating Behaviour Questionnaire (DEBQ) (Van Strien et al., 1986) by reproducing its factor structure and ascertaining its reliability among Maltese women. This was the first validation of an eating behaviours assessment tool in Maltese and the first validation of the DEBQ in a Semitic language. Finally, Structured Equation Modelling revealed how food planning could act as a mediator to restrained and external eating styles to increase fruit and vegetable snacking and decrease high calorie snacking. In addition to the implications to theory, it is believed that these findings have worthy practical implications through tailored eating behaviour interventions, by targeting food planning to counterbalance the impact of external eating among Maltese mothers.

There is significant research evidence to demonstrate that physical activity can produce weight loss, weight maintenance and positive health effects in the overweight and obese. However, it can be difficult to get this population sufficiently active to achieve these benefits. This thesis reports on a series of studies that explore physical activity used alone and in conjunction with other weight management strategies. The primary aim was to gain a greater understanding about how weight loss and continued long term weight maintenance could be achieved. The first study was a systematic review on the dose of physical activity associated with weight loss and weight maintenance, it investigated if the current treatment dose was appropriate. The findings correlated with the recently published new CDC guidelines. In the second study, semi-structured interviews were employed to explore the attitudes and experiences of overweight and obese individuals towards weight loss and health. It was reported by participants that they prefer autonomy and personalisation to tailor weight loss and health strategies to their own lifestyles. It was also found that their knowledge base was confused and outdated. In the final study, a sample of overweight and obese adults took part in participatory action research with the aim to design and assess their own weight management programme. A multi-strategy weight management programme emerged that could be tailored to individual lifestyle. Tips and ideas were also devised to aid weight maintenance. This thesis found that the overweight and obese appeared to favour a multi-strategy weight management intervention that could be incorporated, personalised and tailored to their everyday lives. Physical activity (that was enjoyable, lifestyle or accomplished through accumulated bouts), dietary changes, education/improved knowledge base, support and weight monitoring all appeared to be important factors to aid weight management.

Research suggests that female athletes, in particular, experience “sport-environment” pressures such as: weight, performance, and body image demands from their coaches, teammates, and judges. These influences in tandem with society’s portrayal of the thin ideal are thought to considerably increase the risk of developing disordered eating problems in this population. Although numerous studies have been conducted over the past decade on the prevalence of eating disorders and pathogenic weight control behaviors among female athletes, few have examined in detail the weight pressures that exist within the sport environment, such as whether or not (and how often) athletes are weighed by their coaches, and how athletes respond to those pressures in terms of weight management practices. In the proposed study, we will examine the weigh-in environment, weight satisfaction, weight management practices, menstrual health, and reported source of nutritional guidance. The sample includes 414 NCAA Division I female collegiate swimmers/divers and gymnasts drawn from 26 universities across the U.S. Participants anonymously completed a series of questionnaires as part of a larger study on student-athlete health and well-being. This study found that 41% of athletes were weighed, and most often by an athletic trainer in private. Despite most weigh-ins were reportedly conducted in a positive manner, the majority of the athletes who were weighed (75%) reported using at least one strategy to manage their weight prior to weigh-ins (e.g. restrict food, increase exercise). Athletes desire to lose weight, caloric intake, and menstrual cycles were not related to whether athletes were or were not weighed. The majority of athletes received qualified nutritional guidance about how to healthfully manage their weight. Overall, weighing is occurring in a more positive manner than expected; however, athletes are continuing to report using unhealthy weight management strategies at a high rate. It seems important for athletic departments to set policies regarding weighing and to continue to provide support and education to coaching and support staff regarding eating disorder identification, referral, and treatment.

Applications of locus of control theory to weight loss programs have yielded inconsistent results. This study attempts to clarify "control" by looking at two different factors. Maximum control is the degree of perceived control inherent in the event itself, and personal control is the degree to which the event is perceived controllable by the individual. These two factors were also examined in two types of situations to determine whether individuals have one global outlook on control, or if they make a distinction between control in some situations as opposed to control in other situations. Seventy-four female subjects completed a 16 item questionnaire on their perceived control in weight-related and non-weight-related situations. Subjects demonstrated that attitudes of control are situation specific. The two separate attitudes, maximum control and personal control, operate independently. Some individuals who felt that events were highly controllable, still felt they had very little control. Converse perceptions were also demonstrated.

The prevalence of obesity is high and the primary care setting enables treatment to be offered to large numbers of people. This thesis investigates behavioural weight management interventions in primary care. A noninferiority analysis was used to examine whether four behavioural weight management programmes differed in weight loss at three and 12 months. Commercial programmes resulted in similar weight losses and the NHS programme was inferior at three months, with an inconclusive result at 12 months. GPs can refer patients to commercial weight management programmes, however not all people use these types of programmes. There is a need to find simple effective interventions that can be offered in primary care. Self-weighing may be one such strategy for weight loss; a randomised controlled trial investigated this. There were no significant differences in weight loss between baseline and three months. Self-weighing may be more effective for weight loss maintenance as people have developed skills to manage their weight. A quasi randomised controlled trial was used to investigate this and found encouragement to self-weigh prevented 0.7 kg weight regain. A systematic review and meta-analysis investigated the effect of self-weighing. Overall, self-weighing as part a multicomponent weight loss intervention resulted in greater weight loss but isolated there was no evidence of effectiveness. In conclusion commercial weight management programmes result in similar weight losses and patients could be referred to such programmes by primary care. Self-weighing may be an effective strategy that primary care practitioners could advise patients to use combined with other behavioural strategies.

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Weight management is more than just cutting back on carbohydrate or fat. Controlling calories is key to achieving and maintaining a healthy weight. This publication reviews how calories count, not matter what type of diet you choose to follow.

The prevalence of overweight and obese individuals has risen dramatically in populations around the world over the last 30 years (Popkin et al., 2012) representing a rapidly growing burden to public health services (Wang et al., 2011). Reliance on lifestyle modification, although initially promising, has proven to be unsuccessful over the longer term (Barte et al., 2010) and there are currently a lack of successful treatment options. Capsaicinoids are a bio-active group of compounds, naturally occurring in the fruit of the plant from the genus capsicum. Initial research suggests these compounds may have beneficial effects on weight loss outcomes when ingested (Lejeune et al., 2003). A systematic review of the available literature on capsaicinoids found evidence that ingestion may increase energy expenditure by around 210kJ/day and lipid oxidation by around 20%. Ingestion may also reduce energy intake although evidence has been conflicting and the size of the effect unclear. To further aid understanding, a meta-analysis was undertaken involving intervention trials assessing the effects of capsaicinoids on energy intake. Analysis suggested capsaicinoid ingestion prior to a meal reduced ad libitum energy intake energy intake by 251kJ (60kcal) per meal (95% confidence interval of 337 – 166kJ) p < 0.001. Caution should be applied to this result however, due to the small size of the reduction and the short term nature of the trials involved. Longer term trials are needed to assess potential changes in body composition as a result of capsaicinoid interventions. To this end, a six-week placebo control intervention study was conducted to assess changes in body fat in 60 Caucasian women. Results of a sensitivity analysis found a small, statistically significant decrease in body fat percentage (0.64%, p = 0.022) and total body fat (0.67kg, p = 0.007) in the intervention group. However, the robustness of these findings are called into question by the results of an interaction analysis which of observed no significant difference between placebo control and intervention groups over time for these outcomes. The effect was also small and therefore longer term supplementation would be required to produce a medically beneficial changes in body composition.

Methadone is a mu-opioid agonist used in the treatment of patients with an opioid use disorder in an outpatient addiction treatment clinic. A recognized knowledge gap exists among nurses managing overweight and obese patients in an outpatient methadone treatment center in the northeastern United States. The goal of this project was to develop a weight management toolkit to assist nurses in the identification, evaluation, and management of overweight and obese patients receiving methadone treatment at the center. The evidence-based weight management toolkit incorporated practice guidelines from the American Heart Association, American Association of Clinical Endocrinologists, America College of Cardiology, and the Obesity Medical Association. The project was evaluated by 8 content experts in primary care and addiction medicine. A 5-point Likert-scale survey was used to measure experts' responses. The survey evaluated the relevance of the weight management educational toolkit in relation to nurses' preparedness to assess, identify, and manage patients on methadone treatment with negative weight gain. Results indicated that toolkit content was beneficial in guiding nurses on the use of evidence-based guidelines to promote weight management treatment for patients on methadone. The toolkit supports social change by providing nurses with the tools necessary to increase their knowledge and skills to manage patients' weight gain on methadone, thus promoting improved patient outcomes.

Black River Memorial Hospital identified obesity as a priority health concern in its rural service area; this concern was in line with the county's needs assessment. It was identified that women of childbearing age affect the lifestyle and health choices of their families and that they are at higher risk for the additional health risks associated with obesity affecting pregnancy and birth. Despite the identification of these risk factors, the factors that affect healthy weight management have not been well understood. Using the life course theory, a qualitative inquiry in the form of a structured interview was developed with local community experts and stakeholders. Sixteen women, aged 18-44, were recruited from the area Women Infant Children (WIC) program, the local food pantry, and area businesses. Audio-taped interviews were conducted. Data were analyzed using open and axial coding. The findings suggest that the health literacy among this sample of women was low with regards to healthy weight (BMI) and the risks posed by obesity. The most cited barriers to healthy nutrition were the cost of healthy food, food preferences, and the time to prepare healthy food. The most cited barriers to healthy activity were lack of motivation, lack of child care and lack of fun, affordable activities, and severe weather. The most common motivators for pursuing a healthy lifestyle were identified as the respondents' children, the encouragement of significant others and friends, and the participation of the family in healthy lifestyle choices. Based on the literature review, knowledge of community resources, and these findings, broad recommendations to enhance the culture of healthy weight management were provided to local community stakeholders to facilitate community planning for a healthier population.

A clinical trial was conducted to determine whether incorporating social media into a weight management program would assist overweight and obese participants to achieve greater improvements in weight loss and metabolic syndrome risk factors than following the same program in written form alone. Psychological and behavioural outcome measures were also examined to elucidate the particular aspects of social media that assist participants to achieve the greater improvements in weight loss and other outcome measures.

Obesity rates in Australia have reached all-time highs, and the primary healthcare setting has been identified as a key area for the management of obesity. Community pharmacies are well positioned to provide weight management initiatives due to their accessibility and potential to identify at-risk consumers. In recent years, there has been a shift in pharmacy practice, with a growing focus on the provision of professional pharmacy services to better support public health needs. Pharmacies are a major outlet for over-the-counter weight-loss products, and there is opportunity for pharmacists to deliver evidence-based and sustainable interventions in this domain. The overarching aim of this thesis was to develop and test a best practice model for weight management services in community pharmacy in Australia, and to identify competencies related to weight management required by pharmacists to inform the development of an educational workshop. The research involved a comprehensive systematic needs assessment conducted through consultation with stakeholders, including pharmacists, consumers, experts in the field and representatives of the leading pharmacy professional organisations, to inform the development of a service model, which was subsequently pilot tested in community pharmacies. In addition, an educational workshop to upskill pharmacy students in weight management was developed and evaluated.

Background: Obesity is now considered to be a global epidemic, with rates of obesity continuing to rise. Despite the increase in public health messages, many obese individuals struggle to manage their weight. Moreover, obese individuals are frequently subjected to stigma, which becomes internalized and may have an impact on weight management outcomes. Interestingly, the psychological construct of self-compassion has been identified as a potential protective factor against Internalized Weight Stigma (IWS) in obese adults and has been found to be related to better weight management outcomes. Thesis Portfolio Aims: This thesis explores the role of IWS and self-compassion during weight management in obese adults. Weight management behaviours were defined as any adaptive or maladaptive behaviours to increase, maintain or reduce weight. Design: A systematic review and mixed-methods synthesis was conducted to explore what is currently known about the role of IWS on weight management behaviours in overweight and obese adults. Weight management behaviours were categorised into physical activity and eating behaviours. The empirical paper explored the influence of self-compassion during weight management in nine obese adults accessing NHS Tier 3 weight management services, using a qualitative constructivist Grounded Theory Lite approach. Results: Fifteen studies met the inclusion criteria for the systematic review, of which, ten were quantitative and five were qualitative. The results from the systematic review highlighted that IWS was related to maladaptive eating behaviours and reduced engagement in physical activity. The empirical paper presents a grounded theory of self-compassion during the weight management process. Five categories were constructed within the data: relating to self, interacting with others, relating to food, difficulty managing weight and developing self-compassion. Conclusions: IWS and self-compassion may have fundamental roles in weight management for obese adults. Findings are discussed in relation to the current literature and recommendations for future research are suggested.

Background: The rate of obesity in adolescents is rising, presenting both physical and psychological difficulties. To date, biomedical literature has dominated with few studies investigating quality of life in adolescents following surgery. Aims: To critically evaluate the quality of life outcomes of adolescents after bariatric surgery. Specifically, changes in physical health, perceptions of self-image and mood disorders are considered. Method: PsycINFO, Medline Ovid, Scopus and Web of Science were searched, along with citation and reference list searches of identified articles. Eleven articles met the inclusion criteria. Results: An increase in self-image and reduction in depression is indicated up to one year following surgery. Furthermore, a reduction in BMI and obesity related comorbidities were reported. Conclusion: Despite improvements in physical health, self-image and mood in the short term, longer term outcomes remain equivocal. This review highlights the need for longer term follow up studies to ascertain if such benefits are sustainable. Such research is particularly pertinent given the increasing prevalence of obese adolescents accessing bariatric surgery as a means to manage their weight.

The relationship between dieting and food cravings has been studied extensively; however, due to varied methodology, questionnaire measures and construct definitions, the evidence is conflicting. The present study was conducted in order to investigate the relationship between cravings, dieting and weight loss using a craving specific measure and gathering data at two different time points during active weight management. A large national sample of individuals (N=2932) enrolled in a commercial weight loss organisation completed two questionnaires approximately seven weeks apart. Information was collected on craving experiences, mood, restraint and weight change. Cross-sectional analysis found those ‘dieting to lose weight’ reported significantly fewer, less intense and more easily controlled food cravings than those ‘watching their weight’. In longitudinal analyses, there was a significant reduction in cravings that could not be accounted for by change in mood or dietary restraint. Frequency of ‘eating in response to food cravings’ at Time 1 explained 7.1% of the variance in overall weight change, such that those more likely to eat in response to food cravings lost less weight over the period of observation. A significant positive relationship was observed between weight loss and participants’ sense of control over their food cravings. Clinical implications draw attention to the contribution of momentary self-regulatory inhibition when explaining the variance in weight loss, and the reciprocal relationship between perceived control of cravings and weight regulation. The potential benefit of incorporating psychological strategies into weight-loss programmes to help support individuals struggling to cope with food cravings is discussed.

Thesis (M.A.)--Kent State University, 2009.
Title from PDF t.p. (viewed Mar. 31, 2010). Advisor: Jason McGlothlin. Keywords: Childhood; obesity; overweight; weight management; parenting; mental health Includes bibliographical references (p. 149-178).

The increasing prevalence of obesity has been accompanied by an increase in the number of individuals at the extreme end of the obesity spectrum. The detrimental impacts of extreme obesity, defined as BMI ≥ 40.0kg/m2, on affected individuals' physical and psychological health have not been fully established. Furthermore, it remains unclear whether medical and behavioural interventions are effective at facilitating weight loss for individuals with extreme obesity. The efficacy of two treatment pathways within the Heart of England NHS Foundation Trust Specialist Weight Management Service were examined, with both demonstrated to facilitate clinically and statistically significant weight loss. A detailed profile of the characteristics of individuals entering the service highlighted the substantial physical and psychological co-morbidity associated with extreme obesity, revealing widespread impairment in quality of life and mental health. A systematic review of primary research examining the efficacy of medical and behavioural weight management interventions within lesser-researched extreme obese populations demonstrated the value of medically-supported programmes and also revealed the limited body of good quality research. This thesis has enhanced current understanding of extreme obesity, and recommendations generated from this work have been made in order to improve primary research examining weight management interventions and service provision for affected individuals.

Thesis title: Health Professional-patient communication in relation to weight managementBackground: Global obesity levels have doubled since 1980 and are expected to rise. It is associated with key health risks such as heart disease, some cancers and osteoarthritis and hence has considerable economic consequences for health care resources. Key policy guidelines recommend that all health professionals (HPs) should discuss weight management with their patients making every contact count. However, we know HPs find discussions about weight challenging due to lack of time, training and skills. Knee Osteoarthritis (KO) and obesity are inextricably linked and together with a rise in obesity levels and growing numbers of older citizens rates of KO are set to escalate. As obesity is the key modifiable risk factor for KO, discussions about weight are paramount. This thesis explored this relationship further from the perspectives of patient and HPs, focusing on KO as an exemplar condition where there is scope for improved weight management. Methods: Utilising qualitative methods, three studies were undertaken. Firstly, a systematic review and thematic synthesis was conducted of published literature of physicians' views and experiences of discussing weight management within routine clinical consultations, not specific to KO. Secondly, HPs' experiences of discussing weight in consultations with KO patients through semi-structured interviews were conducted with 26 HPs. Interviews were audio recorded and analysed using TA. A final study recruited 25 overweight/obese patients with KO and investigated their experiences of talking about weight with HPs. Results: Overarching themes were identified across the studies. Firstly, HPs are pessimistic about patients' desire to lose weight and their capacity to help them. Several factors lead physicians and HPs to be reticent to accept responsibility for discussions about weight. Within routine consultations and between HPs and KO patients, weight was viewed as a sensitive topic. Both HPs and patients recognized the difficult cycle of pain, reduced mobility and weight gain. Patients with KO desire patient-centred (PC) care but, despite HPs recognizing its value, they do not receive it. Both physicians and HPs lack communication skills in weight management. Conclusions: The work undertaken in this thesis demonstrates that barriers preventing effective clinical interactions about weight identified in routine consultations still exist, even when two conditions such as KO and obesity are inextricably linked. Although HPs and patients hold similar understanding of these interrelationships and recognise the value of PC discussions, HPs struggle in effective behavior change talk. HPs expressed impatience with the efforts of their patients. To readdress this imbalance all consultations about weight should be PC. Both physicians and HPs were inadequately trained to discuss weight and patients' views supported this. HPs working with overweight patients should be trained in evidence-based behaviour change techniques and PC communication techniques to increase their confidence to support patients in weight management. Finally, health psychologists have the skills to both deliver and guide discussions about weight.

Obesity is a crucial health care issue that has a global effect on the health care industry. Not only does obesity decrease the patients' quality of life, it also places an astronomical burden on health care delivery systems. The purpose of this quality improvement project was to establish a weight management program derived from evidence-based research. The research question is can the utilization of mindfulness meditations and practices with traditional weight loss methodologies produce sustainable weight loss? Pender's health belief model was the conceptual framework utilized to guide and provides structure for this project. The health belief model has been utilized in numerous health care studies and has provided researchers with tremendous insight on various health care issues. The goal of the project was to provide the inhabitants in a metropolitan city located in the Midwest region of the United States with weight management strategies that would support a declination in the number of patients struggling with obesity in that region. This project developed a turnkey solution to a community health problem consisting of the following strategies: executing mindfulness meditations and practices as part of their daily rituals, reading food labels and making healthier food selections, exercising 30 to 40 minutes a day, and documenting their progression or obstacles in a journal. Since the project consisted of only 20 participants, it is recommended that a larger population and region be utilized for future studies. This project has the potential for societal change by improving the quality of life of and productivity of patients struggling with obesity by decreasing their chances of developing chronic illnesses which can become debilitating.

Over the last few decades, prevalence of excess body weight has escalated among populations. Addressing this ‘obesity epidemic’ requires strategies for preventing population weight gain, particularly among groups with above average risk, such as young adults. The overarching aim of this research was to develop and evaluate a lifestyle program for the prevention and management of weight gain in young adults. Existing randomised controlled trials (RCTs) were systematically reviewed to identify characteristics of effective programs for young adults. These included self-monitoring of weight-related behaviours, tailoring feedback to be personally relevant, providing an initial consultation with subsequent support, increasing physical activity and reducing dietary energy density. Findings from this review informed the development of a mobile phone-based program which was piloted in a RCT with N=52 young adults. Participants achieved some short-term positive changes in their weight, diet and physical activity, although not significantly different from controls. Process findings from this pilot, including a preference for set weight targets, personalised regular contact, and support with planning meals and activity schedules, informed TXT2BFiT (‘Text to be fit’), a multi-component, nine-month, mobile phone-based program aimed at assisting young adults with managing their weight and weight-related dietary and physical activity behaviours. Efficacy of the TXT2BFiT program was tested in a primary RCT with a preliminary sample of N=118 young adults, found to be effective for reducing participants’ body weight, total energy intake, and frequency of energy-dense takeaway meals. Future research will test efficacy of the TXT2BFiT program among the target sample (N=352). If demonstrated to be effective, with wide reach regardless of socio-demographic profile, it may provide an equitable, cost-effective solution for the prevention and management of weight gain in young adults.

Weight bias/stigma is discrimination on the basis of body size, and body dissatisfaction refers to the often intense negative thoughts and feelings about one’s body. Young women are particularly vulnerable to weight bias, which, when internalised (weight bias internalisation), has been associated with harmful levels of body dissatisfaction and significant physical and psychological morbidity. It is also known that responses to weight bias can sabotage long-term weight loss success. Despite this, few studies have evaluated the effect of addressing weight bias and weight bias internalisation in weight loss interventions, and fewer have investigated weight management interventions designed specifically for young women. As such, this thesis explores whether weight bias internalisation can be reduced in young women (18-25y) with overweight and obesity, and if this is associated with improved weight management in this group. The thesis also investigates novel dietary interventions, including the use of Chrononutrition, for weight management which specifically targets young women and their unique lifestyles, with the overarching aim of improving long term weight loss and health trajectories.

Background: The majority of adults in the UK are overweight or obese, and many embark on weight loss attempts, often without professional support. This dissertation set out to hone in on the cognitive and behavioural strategies used by adults with overweight and obesity attempting to lose weight, particularly in self-guided attempts, and to test the relationship between use of these strategies and weight loss success. Methods: A new taxonomy and questionnaire were developed to provide a framework to identify the cognitive and behavioural strategies used by individuals during weight loss attempts. The taxonomy was used in a systematic review and meta-analysis of self-help interventions for weight loss and in a systematic review of qualitative studies of self-directed weight loss. The questionnaire was used in an observational cohort study in adults with overweight and obesity trying to lose weight. Results: The taxonomy and questionnaire consist of 117 strategies. The qualitative review illuminated a range of attitudes and beliefs towards these strategies and highlighted the centrality of interpretation of self-monitored data. The quantitative review found that self-help interventions led to greater weight loss than unsupported attempts to lose weight at six months. In the cohort study, despite heterogeneity in the strategies employed, coherent patterns of behaviours emerged for individual participants. Strategies related to motivational support, dietary impulse control, and weight loss planning and monitoring were associated with greater weight loss. Conclusion: This dissertation demonstrates that self-help interventions can lead to significant weight loss and provides results to guide the content of such interventions. It maps out a previously uncharted area and provides a set of tools for further research and intervention development.

Thesis (Ph. D.)--University of Kentucky, 2006.
Title from document title page (August 3, 2006). Document formatted into pages; contains ix, 146 p. : ill. Includes abstract and vita. Includes bibliographical references (p. 137-143).

This thesis used fifty hours of naturally occurring video and audio taped data from the ‘weigh-in' section of four commercial weight management groups in the East Midlands of England. This thesis is a discursive psychological and conversation analytic investigation of the turn-taking organization of the talk, examining what the group leaders and members make relevant in their talk about food and dieting. The data was transcribed using the Jeffersonian method. Group members attend the group weekly, and are weighed - their weight gain, loss or maintenance is recorded on a membership card. The analytic chapters follow the format of the ‘weigh-in' section of the meeting exploring firstly how the group leaders and members manage the practices of getting ready to be weighed; then how the ‘news' of weight gain, loss or maintenance is told and receipted; before exploring how ‘advice-giving' is constructed and the final analytic chapter deals with the issues of morality and accountability in the leaders' and members' talk. Analysis shows that the ‘pre-weigh in practices' involved before the group members are weighed consists of two robust patterns, 1) the practice of getting undressed is not oriented to by either the group members or group leaders and the group leaders avoided direct eye contact and concerned themselves with other business or 2) when no undressing practices took place, the group leaders were much more comfortable with direct eye contact. These sequences show how the body and its practices are constructed in particular ways within, and as part of the practices of getting ready to be weighed. Analysis showed the telling and receipting of weight news gets done differently depending on whether the group members have gained, lost or maintained weight. When the news concerned weight gain, the sequence included a ‘pre-announcement' and the news TCU was punctuated with marked trouble. When the news concerned weight loss, only the group members produced a pre-account and the news TCU contained no marked trouble. Finally, when the group members had maintained weight, the news TCU was delivered bluntly, and there was no evidence of trouble. In relation to advice-giving, analysis showed that group members repeatedly worked to assert their epistemic priority to avoid having to acknowledge the advice and the advice was receipted minimally. Finally, analysis showed that group members produced accounts with reference to a moral evaluation, such as blame or culpability. Sometimes an account was produced to circumvent being held publicly accountable for the event or action. It became apparent that both the group leaders and group members could not orient to themselves, their behaviour or food without it being constructed within a moral or accountable framework. Therefore, the thesis is an exploration of how group leaders and members manage the ‘dieting-practices' involved in getting weighed in a commercial weight management group and how using DP and CA can show the intricate turn by turn organization of such practices.

While body image disturbances continue to be seen in individuals living in Western society, research has shown that both weight loss and exercise participation can decrease body image disturbance in both men and women. The purpose of the study was to examine the effect of a weight management clinic on body perception of obese individuals. Thirty nine participants were a part of a three-month weight management program with caloric restrictive diets and weekly exercise recommendations. The 34-item Multidimensional Body Self Relation Questionnaire, Body Assessment Scale and Social Physique Anxiety Questionnaire were administered at baseline and 12 weeks. All physiological measurements were conducted at baseline and 12 weeks. Based on participant’s weight loss, they were divided into two groups: weight loss and no weight loss. A 2 (baseline, 12 week) X 2 (weight loss achieved, weight loss not achieved) repeated measures ANOVA was conducted with difference between ideal and current body position as the dependent variable to examine the relationship between weight loss and body perception. A 2 (baseline, 12 week) X 2 (weight loss achieved, weight loss not achieved) repeated measures ANOVA with social physique anxiety as the dependent variable was conducted to examine the relationship between weight loss goal achieved and body perception. A 2 (baseline, 12 week) X 2 (weight loss achieved, weight loss not achieved) repeated measures ANOVA with the MBRSQ-AS subscales as the dependent variable was conducted to examine the relationship between weight loss goal achieved and body perception. A Pearson correlation was run to predict weight loss from the MBSRQ-AS subscales, SPA and BAS. The results of this study indicate that there was a significant difference in body perception from baseline to 12 weeks, regardless of weight loss achieved by participants. Additionally, there was no correlation between weight loss and body perception variables.

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships. Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As educational experiences. Linear mixed models were used to determine associations between educational experiences and perceived skills. Semi-structured interviews (n=12) and a survey were administered to primary care preceptors (n=77). Interviews described individual, inter-personal and institutional factors associated with preceptors’ WMC. The survey described preceptors’ frequency of modeling WMC behaviors, perceived WMC skills, and attitudes. Results: Students perceived themselves to be moderately skilled (M=2.6, SD=0.05, range 1-4). Direct patient experiences and specific instruction were associated with higher perceived skill. Preceptors support WMC curricula but do not perceive themselves to be experts in WMC. Preceptors perceive themselves to be moderately skilled (M=2.8, SD=0.06, range 1-4) but only sometimes model WMC (M=3.3, SD=0.05, range 1-5) to students during clerkships. Conclusion: Preceptor modeling WMC may not be feasible or necessary during primary care clerkships. Providing specific WMC instruction and working with patients may provide more benefit as they were more strongly associated with students’ perceived skills.

According to self-determination theory (SDT; Ryan & Deci, 2000), the quality of support (autonomy support versus controlling) from important others is an important predictor of psychological need satisfaction, and subsequent engagement in health-conducive behaviours, such as physical activity and healthy eating. In this dissertation, four research studies grounded on SDT are presented. Results from these studies highlighted the important link between autonomy support and psychological need satisfaction. In turn, these studies showed that need satisfaction supported better psychological well-being and health-conducive behaviours. The findings also underscored the detrimental effects of controlling behaviours. For instance, such behaviours were found to be related to the thwarting of psychological needs, and in turn higher psychological ill-being and maladaptive outcomes, such as unhealthy eating behaviours. Motivation contagion effects were also examined in one study. The results suggested that practitioners’ quality of support provided may vary as a function of their perceived motivation of a client. Findings from our studies have implications for researchers and important others (e.g. spouse) of individuals engaging in weight management. Possible areas for future research, such as the design of new interventions based on the tenets of SDT, are discussed.

Obesity ascending rates are still a public health priority. The primary aim of the study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pre and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support and physical activity were assessed at baseline and at 12 weeks. Text messages were sent biweekly to the intervention but not to the control group. At 12 weeks, the intervention group had lost significant weight as compared to the control group. There was a trend toward an improvement in eating behaviors, exercise and nutrition self-efficacy in the intervention group, with no significant difference between groups. A total of 79% of participants stated that text messages helped in adopting healthy behaviors. Tailored text messages appear to enhance weight loss in a weight management program at a community setting. Large scale and long term intervention studies are needed to confirm these findings.

Over two thirds of adults in the United States are affected by overweight or obesity. Weight management, which requires multi-component, intensive interventions targeting dietary and physical activity behaviors, should be offered as part of routine primary care services. Unfortunately, there is a paucity of evidence to guide the implementation of feasible and effective strategies within primary care settings. This DNP Project utilized a cross-sectional descriptive needs-assessment to survey obese patients' perceptions and preferences regarding weight and the primary care provider role in weight management. The findings from the needs assessment were used to inform the development of a feasible, patient-centered, weight management program.

The focus of this project was to determine if a relationship existed between weight loss as a result of follow-up visits and adherence as a result of follow-up visits in patients with BMI >26 kg/m² enrolled in the weight loss program during 12 weeks of treatment. The project was based on two clinical questions which include: In patients with BMI >26 kg/m ², how do follow-up visits affect weight loss during 12 weeks of treatment? In patients with BMI >26 kg/m², how do follow-up visits affect adherence during 12 weeks of treatment? The practice improvement project utilized a quantitative methodology with a correlational design. The primary investigator’s clinical questions were tested using two-way mixed analysis of variance (ANOVA) (within-subjects and between-subjects) and one-way ANOVA. The location of the project was at a weight loss clinic located in Southern California, and 156 patients’ charts were used for retrospective chart reviews and a sample of 156 participants answered the MOS-SAS (short version) questionnaire. The theoretical underpinnings for the practice improvement project included the Health belief model and Integrated theory of health behavior change. The results of the project concluded that weekly follow-up visits had significant impact on weight loss, specifically, in the first six weeks of the program. Results also showed weekly follow-up visits (M = 4.51, SD = .317, n = 91) produced significantly greater levels of adherence compared to bimonthly follow-up visits (M = 3.69, SD = .480, n = 61) during 12 weeks of treatment. The future nursing, practice, and research implications of the study include focusing on strong implementation of weekly follow-up visits, additional contact support, integrating weight loss teaching sessions, and determining perceived barriers to exercise adherence.

Commercial weight loss programmes (CWLPs) are structured weight loss programmes, which are provided to the public by commercial organisations for profit. These programmes offer a weight management service for overweight or obese adults who are willing and able to pay for their participation. There are few studies that have shown CWLPs are more effective than either usual or standard care in various healthcare settings. The extent to which elements of CWLPs contribute to weight reduction is not clear from these studies. The studies presented in this thesis aimed to i) systematically review the effectiveness of CWLPs in randomised controlled trials and ii) to evaluate the effectiveness of a pharmacist-led weight management clinic, Boots Pharmacy Weight Loss Programme (BPWLP), in achieving meaningful weight loss of the initial body weight at three months in overweight and obese clients who received a combination of orlistat, and diet and exercise advice. The systematic review evaluated percentage weight loss or change and used a narrative synthesis. Nine electronic databases (1980-2011) were searched. The review studies published in English were included and their quality was assessed, including assessment of risk of bias. The number of total titles, abstracts and full articles reviewed were 8484, 772 and 153, respectively. The final number of papers included in the review was 20 randomised studies of CWLPs, which were selected based on the application of inclusion and exclusion criteria. The evaluation of the BPWLP involved analysis of data from randomly collected customer record forms (CRFs) for clients who participated in the programme from January 2006 to January 2009. Five hundred and fifty-seven records were collected from 10 Boots pharmacies. Demographics data, history information, biometric data and information about the supply of orlistat were collected. Change in body weight (kg) was compared at baseline and three months using Wilcoxon Signed Rank Test. Seventy percent of the studies included in the systematic review were conducted in the US. There were three potential elements of effective CWLPs, which were calorie restriction, exercise and support. At 12 weeks, mean weight loss ranged from 3.3 to 12.7 kg. The mean weight loss in the BPWLP was 5.8 kg (p < 0.001). Similarly, sensitivity analysis using last-observation-carried-forward (LOCF) showed a statistically significant weight loss (p < 0.001) associated with the BPWLP. Sixty-two percent of clients, who completed the BPWLP, lost at least 5% of their initial body weight at three months. Although the BPWLP had a high dropout rate (70%), clients mainly left the programme because they achieved their desired weight loss. The studies presented in this thesis have shown that CWLPs are effective in helping clients to lose weight. The systematic review shows that the combination of calorie restriction, structured exercise and support is an effective first-line strategy in obesity treatment. The BPWLP, which uses orlistat 120 mg in combination with advice and support on diet and exercise, was shown to be effective in achieving weight loss for clients and is considered a second-line treatment. Health care professionals and policy makers should acknowledge and adopt such strategies in order to tackle the problem of obesity. In particular, pharmacists have an important role to play in facilitating effective weight reduction through the provision of dietary and exercise advice and the prescribing of orlistat. Further study should focus on the factors which contribute to long-term weight maintenance and the cost-effectiveness of CWLPs.

This thesis is an investigation into women’s experiences of repeatedly attempting to lose weight and maintain a weight they find acceptable, and the implications of this for health education. This was an interpretivist inquiry which generated data through narrative interviews. The data was analysed using three different strategies to enable deeper understanding of the participants’ experiences. To set the context health education resources relating to body weight, healthy eating and activity were collected from local community and health settings. A former local practice nurse was also interviewed about her role in assisting women with weight loss. A literature review revealed an emphasis on research and policy that focuses on the dangers of overweight and obesity, prioritising individual behaviour and energy-deficit approaches to losing weight. A qualitative method was used to collect data from a convenience sample of five women. Data from interviews and autobiographical writing were recorded, transcribed and analysed within a narrative analysis framework. Analysis of the findings using three interpretive lenses are presented first as re-storied accounts of the women’s narratives, and secondly thematic analysis addressing issues of control, pleasure and pain, and embodiment and alienation. Finally a relational analysis reveals the ways in which participants position themselves in relation to themselves, other characters and the interviewer in order to build their desired identities. The data shows that the participants had followed a wide and diverse range of diets, eating and exercise plans, none of which had been successful in both reducing their weight and maintaining it at a level they were happy with, even after repeated attempts. Whilst biomedical literature suggests a dividing line between pathological eating disorders such as anorexia nervosa/bulimia and normality, the disordered eating and emotional difficulties described by the participants supports the view that a broad range of eating and body-image problems may be more culturally normative than is generally recognised. Dieting and weight cycling were common experiences. The findings of the thesis suggest that contrary to current public policy, the views of these women who are unhappy with their body weight are complex, idiosyncratic and demonstrate resistance to health messages that target individual responsibility for weight management. Their views are developed from personal experiences - the findings suggest that these women are stigmatised. However, one response to this can be to stigmatise other people whom they see as more overweight than themselves. Normative femininity is increasingly centred on appearance and women who do not comply with the requirements risk alienation and pain. The identities that the women construct are relevant for health education but not taken into account when national policy and strategies are developed to address overweight and obesity. The risks to health of weight cycling are also not addressed by policy. The implications of the thesis are discussed in relation to the embodied experiences and gendered roles of women, the role of health education and its relationship with biomedicine.

Thesis (MSc Nutrition Science)--Stellenbosch University, 2004.
ENGLISH ABSTRACT: First-year female students (FYFS), studying at the University of Stellenbosch were previously identified as a high-risk group for gaining weight. A four-year follow-up of these female students indicated that a large percentage experience weight fluctuations throughout their university careers. The unique weight management needs of the FYFS were also identified in the longitudinal study. The integration of these results with an extensive search and assessment of the weight management literature led to the development of a multidimensional weight-management paradigm for application in the development of weight-management interventions for female students. Subsequently, a self-help weight-management manual, which follows the multidimensional approach proposed in the mentioned paradigm, was developed to address the unique weight-management needs of female students. The aim of the current study was to evaluate the impact of the multidimensional self-help weightmanagement manual (the Manual) on the weight status and associated factors of FYFS at the University of Stellenbosch over an eight-month period. For this purpose a non-randomized quasi-experimental design was used, including purposively selected experimental and control groups. Data were obtained during February (Baseline), May (three months after baseline = Follow-up I) and October 2002 (eight months after baseline = Follow-up 2). All students in the experimental group received the Manual at Baseline for use during the eight-month study period. Because this was a low-intensity intervention programme, no further contact was made with either group during the study period, except when Followup I data were obtained. Measures that were taken and instruments that were completed include the following: weight, height, triceps skinfoid, mid-upper ann circumference, hip circumference, waist circumference, Adolescent Self-Concept Scale (self-concept), Body Shape Questionnaire (body shape concerns), Eating Attitudes Test (eating attitudes and behaviours), General Health Questionnaire (general psychological well-being), 90-item Semi-quantified Food Frequency Questionnaire (dietary intake from nine food groups), and the Baecke Questionnaire of Habitual Physical Activity (physical activity). Additional questions on weight related perceptions and practices, dissatisfaction with body parts, reasons for eating and socio-demographic factors were also included. The Baseline characteristics of the FYFS involved in this study, which did not differ between the experimental and control groups for all key variables, identified them as a typical group of young female adults who are healthy but are not realistic about their weight status and who experience numerous problems related to their weight status. The implementation of the Manual was found to be significantly effective in limiting weight gain among the FYFS in the experimental group. The control group experienced almost a full unit increase in BMI (0.93 kg/m²), while the increase found for experimental group was 0.53 kg/m² (p=0.004). Although the weight of both groups increased initially the experimental group went on to lose weight, while the control group continued to gain weight during the last five months of the intervention. The impact of the Manual is further illustrated by the fact that the FYFS in the experimental group who indicated that they did Lise the Manual extensively experienced a significantly lower rise in their weight (change in BMI over study period = 0.37 kg/m²) than those in the experimental group who indicated that they did not use the Manual (change in BMI over study period = 0.89 kg/m²). Factors that are possibly linked to the success attained with the Manual were identified and include more reasonable weight goals; the use of sound weightreduction methods such as a balanced diet and physical activity; improvements in self-concept; maintenance of physical activity levels, especially during the first three months at university; improvement in general psychological well-being; decreased intake of foods from the "other" (includes mainly high fat, sugar based foods such as doughnuts, cookies, cake, tart), beverage and grains food groups; and possibly less concerns with body shape from the start. Factors for which no link with weight management success could be established include changes in body composition; perceptions of own weight; weight loss attempts; foods from the vegetables, fruit, milk and cheese, meat, fish and chicken, fats and fast foods food groups; physical activity over the total eight-month period; reasons for eating; eating attitudes and behaviour; dissatisfaction with body parts; and body shape concerns. It is recommended that the implementation of the Manual on the campus of the University of Stellenbosch to prevent weight gain of FYFS should be considered, bearing in mind some of the recommendations formulated by the FYFS in the experimental group.
AFRIKAANSE OPSOMMING: Eerstejaar damestudente wat aan die Universiteit van Stellenbosch studeer is voorheen geïdentifiseer as 'n hoë risiko groep vir gewigstoename. 'n Vier-jaar opvolg van hierdie damestudente het aangedui dat 'n groot persentasie vir die duur van hul universiteitsloopbane gewigsfluktuasies ondervind. Die unieke gewigshanteringsbehoeftes van die eerstejaar damestudente is ook tydens die longitudinale studie geïdentifiseer. Die integrasie van hierdie resultate met 'n uitgebreide soektog en ontleding van die literatuur wat betrekking het op gewigshantering het aanleiding gegee tot die ontwikkeling van 'n multidimensionele gewigshanteringsparadigma wat gebruik kan word tydens die ontwikkeling van gewigshanteringsintervensies vir damestudente. As 'n volgende stap is 'n self-help gewigshanterings handleiding, wat die multidimensionele benadering voorgestel in die genoemde paradigma volg, ontwikkelom die unieke gewigshanteringsbehoeftes van damestudente aan te spreek. Die doel van die huidige studie was om die impak van die multidimensionele self-help gewigshanteringshandleiding (die Handleiding) op die gewigstatus en geassosieerde faktore van eerstejaar damestudente aan die Universiteit van Stellenbosch oor 'n tydperk van agt maande, te evalueer. Vir hierdie doeleinde is 'n nie-gerandomiseerde kwasi-eksperimentele ontwerp gebruik, wat doelbewus geselekteerde eksperimentele en kontrole groepe ingesluit het. Data is gedurende Februarie (Basislyn), Mei (drie maande na basislyn = Opvolg-I) en Oktober (agt maande na basislyn = Opvolg-2) 2002 versamel. Alle studente in die eksperimentele group het die Handleiding tydens Basislyn ontvang vir gebruik tydens die agt maande studieperiode. Omdat dit 'n lae-intensiteit intervensie program was, is geen verdere kontak gedurende die studieperiode met beide die groepe gemaak nie, behalwe tydens die versameling van Opvolg-I data. Metings wat geneem is en instrumente wat voltooi is, sluit die volgende in: gewig, lengte, triseps velvou, mid-bo-armomtrek, heupomtrek, middelomtrek, "Adolescent Self- Concept Scale" (self-konsep), "Body Shape Questionnaire" (besorgdheid oor liggaamsvorm), "Eating Attitudes Test" (eetgedrag en -houding), "General Health Questionnaire" (algemene sielkundige welstand), 90-item semi-gekwantifiseerde voedselfrekwensievraelys (dieetinname van nege voedselgroepe), en die "Baecke Questionnaire of Habitual Physical Activity" (fisieke aktiwiteit). Addisionele vrae aangaande gewigsverwante persepsies en praktyke, ontevredenheid met liggaamsdele, redes vir eet en sosio-demografiese faktore is ook ingesluit. Die Basislyn eienskappe van die eerstejaar damesstudente wat aan hierdie studie deelgeneem het, het nie tussen die eksperimentele en kontrole groepe vir alle sleutelveranderlikes verskil nie. Hierdie inligting het ook daarop gedui dat die studente 'n tipiese groep jong vroulike volwassenes is wat gesond is maar, onrealisties is oor hul gewigstatus en baie gewigstatusverwante probleme ondervind. Die resultate toon dat die implementering van die Handleiding beduidend effektief was om die gewigstoename by eerstejaar damestudente in die eksperimentele groep te beperk. Die gewig van die kontrole groep het byna 'n volle LMI eenheid (0.93 kg/m²) toegeneem terwyl die toename vir die eksperimentele groep 0.53 kg/m² was. Alhoewel die gewig van beide groepe aanvanklik toegeneem het, het die eksperimentele groep daarna gewig verloor terwyl die kontrole groep se gewig gedurende die laaste vyf maande van die intervensie verder toegeneem het. Die impak van die Handleiding word verder geïllustreer deur die feit dat die eerstejaar damesstudente in die eksperimentele groep wat aangedui het dat hul wel die Handleiding ekstensief gebruik het, 'n beduidend laer toename in gewig (LMI verandering gedurende studieperiode = 0.37 kg/m²) ondervind het as die studente in die eksperimentele groep wat aangedui het dat hul nie die Handleiding gebruik het nie (LMI verandering gedurende studieperiode = 0.89 kg/m²). Faktore wat moontlik gekoppel kan word aan die sukses verkry met die Handleiding is geïdentifiseer en sluit die volgende in: meer redelike gewigsdoelwitte; die gebruik van veilige gewigsverlies metodes soos 'n gebalanseerde dieet and fisieke aktiwiteit; verbetering van self-konsep; handhawing van fisieke aktiwiteitsvlakke, veral gedurende die eerste drie maande op universiteit; verbetering van algemene sielkundige welstand; verlaagde inname van voedsel van die "ander-" (sluit hoofsaaklik hoë vet, suiker gebasseerde voedsels soos oliebolle, koekies en tert in), drankies- en graanvoedselgroepe; en moontlik minder besorgdheid oor liggaamsvorm van die begin af. Faktore waarvoor geen verband met sukses met gewigshantering gevind is nie sluit die volgende in: liggaamsamestelling; persepsies van gewig; gewigsverliespogings; voedselinname uit die groente-, vrugte-, melk en kaas-, vleis, vis en hoender-, vette- en kitskosse-voedselgroepe; fisieke aktiwiteit gedurende die totale agtmaande periode; redes vir eet; eetgedrag en -houding; ontevredenheid met liggaamsdele; en besorgdheid oor liggaamsvorm. Dit word aanbeveel dat die implementasie van die Handleiding op die kampus van die Univérsiteit van Stellenbosch oorweeg word om gewigstoename van eerstejaar damesstudente te voorkom. Dit word ook aanbeveel dat die aanbevelings van die studente in die eksperimentele groep in hierdie verband, in ag geneem moet word.

Overweight and obesity in pregnancy, alongside excessive gestational weight gain, present increased risks of adverse maternal and child outcomes. In the UK, there are no evidence-based guidelines for appropriate weight gain in pregnancy, and NICE (2008) antenatal guidance recommends weighing only at the booking-in appointment. However, in parallel with the general population, prevalence rates of overweight and obesity in pregnancy are increasing, presenting challenges to the healthcare system. NICE (2010) guidance on weight management and pregnancy have specified research recommendations to determine effective approaches to help women to manage their weight before, during and after pregnancy, and to determine whether available Institute of Medicine (2009) guidelines on gestational weight gain from the USA are suitable for use in a UK population. These research recommendations form the basis for the aims and objectives of the PhD thesis, broadly, exploring the issue of weight management before, during and after pregnancy. An exploratory approach was used to address the research objectives; qualitative interview studies were used to explore the issue of weight management and pregnancy, and routine weighing, from the perspective of health professionals, pregnant women and postnatal women. Feasibility studies were utilised to investigate approaches to raising awareness of preconception care among women of childbearing-age. Feasibility studies suggest it is plausible to raise awareness of preconception care in community pharmacy and family planning clinic settings. Qualitative research presented in this thesis found women do not report making significant changes to health behaviours in preparation for pregnancy, and health professionals viewed the preconception period as an appropriate time to target weight management. Women are concerned about their weight in pregnancy and seek out additional information on the issue, feeling health professionals are well placed to provide this support. Conversely, health professionals perceive women to be unaware of the risks associated with obese pregnancy and sensitive to having it discussed. Postnatal women who were weighed throughout pregnancy reported several benefits to the practice, suggesting the practice is acceptable to pregnant women.

The aim of this thesis is to explore the management of accountability and identity in an online commercial weight loss group. The commercial weight loss context is socially significant because it is a space which foregrounds women's efforts to control their bodies and behaviour in order to conform to culturally prescribed norms of 'femininity' through continued selfsurveillance and restriction of consumption. The analysis examines 2219 individual posts in 422 message threads over a 24 hour period on a message board on the Weight Watchers website. The site explicitly promotes itself as a space in which members can obtain advice and emotional support from fellow dieters in an encouraging and egalitarian environment, and is therefore intended to be used as an aid to becoming a more successful 'weight watcher' (and consequently a 'better woman'). Using a feminist hybrid discourse analytic method, and drawing on Coffman's notion of 'face', the empirical chapters explore the interactional management of progress reports by group members. The commercial weight loss group provides a space in which the confession of transgression is encouraged, and analysis of the message threads reveals that members of the message board community are accountable to both societal gender norms and to their fellow weight watchers. In these confessional exchanges group members realign themselves with social norms of 'femininity', and renew their commitment to the body modification project. Group members employ face-protective mitigation strategies in their delivery of confessions, and responses to confessional posts orient to group norms of solidarity and support while rehabilitating the transgressing members back into the eating regime. The analysis also explores the use of humour in the construction of the confessional message which, despite its potential to undermine the regime, appears to perform a face-management function, and is used to display 'expertise' about the regime while fostering group solidarity. In message threads where group members report 'inexplicable' failure to lose weight, the group work to maintain commitment to the regime by explaining lack of success in ways which are protective of the reputation of the regime as an effective means of losing weight, thus ensuring continued dedication to the body modification project. The community offers solutions which provide the member with new 'expertise', helping her to become a 'better weight watcher'.

Obesity results from complex interactions between biological, behavioural, social and environmental factors. The focus of this thesis, both the collection of papers presented and the extended abstract, is on community-based approaches to the prevention and treatment of obesity across five important key life stages. The importance of early life influences, including the intrauterine environment, and the subsequent impact on body fatness across the life-course is discussed. Published research included considers the impact of interventions which aim to limit gestational weight gain on baby’s’ birthweights and the wider influence on sustained breastfeeding. However research presented also suggests that pregnant women receive limited information from healthcare professionals and whilst pregnancy should provide an ideal opportunity for public health intervention, the postnatal period may be more acceptable as a time to provide support and advice. The prevalence of childhood obesity has continued to increase. The most significant predictor of childhood obesity is parental obesity. A paper is presented which demonstrates that engaging adults in lifestyle programmes can have a positive impact on both the diet and activity habits of their family. A systematic review considers how TV viewing during meal-times may influence the foods and drinks consumed with the findings suggesting that the practice of eating whilst watching TV has a negative impact on the diet quality. It is recognised that sugar-sweetened beverages (SSBs) contribute significantly to the free sugar dietary intake, particularly the %total energy intake of children and adolescents. A further published review asks the question, which interventions that aim to reduce the intake of SSBs lead to reduced body fatness in children. There is a need for both primary prevention activities to prevent unhealthy weight gain and interventions to treat overweight and obese children/adolescents. Published data provides evidence for an intervention which does lead to weight loss in obese adolescents, leading to enhanced self-esteem which helps to improve their lifestyles behaviours. Young adulthood represents a period of change with increasing independence. There may be few occasions to discuss weight management with young adults but a presented paper explores the opportunities in primary care. Obesity is associated with a number of chronic diseases, one example being type 2 diabetes which is now presenting in adolescents and young adults. Losing weight can have a significant clinical impact on the glycaemic control of people with diabetes and thus reduce the health burden associated with the condition. Type 2 diabetes is now reversible if significant weight loss is achieved. A paper is presented which evaluates weight management in people with diabetes and the associated impact on glycaemic control. Prevalence data suggests that 25 million adults in the UK are either overweight or obese. Given the health burden to both the individual and society, scalable solutions are required which are delivered in a community setting. Through collaboration with a commercial weight management organisation (CWMO), a series of papers are presented which explore the feasibility and effectiveness of referral from primary care to CWMOs. CWMOs, using behavioural strategies, are well placed to support the large numbers of people who need weight management guidance and a referral scheme may address the health inequalities seen in obesity prevalence. One example of a well-established behavioural strategy, target setting, is considered in more detail with evidence of the importance of target setting presented. As with all research, weight management research is confounded by methodological issues. Community- based programmes are often more complex than clinical trials and contamination may be an issue. The extended abstract explores the methodological issues related to the presented papers in more detail. Whilst we can continue to improve our methodology it is important that we advance our knowledge as to what works to reduce the obesity epidemic. Sadly there will probably not be one solution which is effective at an individual level given the psychosocial complexities of obesity. Ideally we need to promote a nutritionally balanced diet and adequate levels of daily activity which enable children and adults to maintain a healthy weight across the life-course starting at the very beginning of conception.

Obesity is a serious health concern in modern society. One way to reduce caloric intake is with nonnutritive sweeteners (NNS). However, recent research suggests they may be compounding the obesity problem. Nonnutritive sweeteners have been linked to increased body mass in a few studies and may be a barrier to effective weight management for some individuals. Under the framework of the health belief model, the research question was: Does this pattern of NNS-BMI covariance exist in young adults at the University of North Florida and, if so, are there other dietary or activity differences that might partially explain this relationship? A sample of 113 students completed an online survey based on the Youth Risk Behavior Surveillance Survey to answer this question. Their responses quantified BMI, activity level estimates, NNS intake, and produce consumption. There was a no trend of covariance between BMI and NNS intake overall. However, there was a significant relationship between length of NNS usage and both BMI (p<0.01) and NNS intake (p<0.05). A positive correlation also existed between NNS usage and fruit and vegetable intake (p<.005). Weight variability was positively related to NNS due to the maintenance of previous weight loss (p<0.005). There was no correlation between NNS and activity. There is a tendency to have a higher BMI the longer NNS is consumed. This pattern does not appear to be explained by nutrient intake or activity. However, it may be due to increased tolerance towards sweets over time. Nurse practitioners can make recommendations that facilitate healthy behaviors amongst their patients. Therefore, this is an important issue for advanced practice nursing.

Media promotion of the ideal body as slimness for women and muscularity for men, has led to increasing numbers of both genders reporting dissatisfaction with their bodies and trying to change using weight control products. It has been suggested that pharmacists can play a key role in promoting healthy lifestyles and weight management. The main aim of the research study was to examine the impact of media on body image perception and to investigate the role of pharmacists in weight management. This thesis consists of three studies: an evaluation of weight control websites, a body image survey of young adults and interviews with pharmacists. The results from the evaluation study showed that the quality of most weight loss (64%) and weight gain product advertisements (80%) was generally poor, principally due to the use of misleading claims and a lack of useful information. These data complement the survey that university students reported rarely being influenced by weight control product adverts and hardly considered using these products as a method for changing weight. The survey also showed that most participants of both genders (71%) felt satisfied with their body image. However, the findings in this study indicated that there was a relationship between a high level of body image concern and self-perception of being overweight and the attempt to lose weight. Interviews with pharmacists showed that they were unlikely to be actively involved in reducing obesity problems and promoting healthy lifestyles in the community. Although the prevalence of body dissatisfaction and the use of weight control products among these young adults may not be as high as has been reported elsewhere, healthcare professionals, including pharmacists, need to be aware of this problem when providing advice or consultations for young adults. Healthcare professionals should promote the benefits of healthy lifestyles as well as providing information about potential problems of harmful weight control strategies. The effect of ethnicity and culture on body image concern warrants further. The availability of weight control products and quality of information provided should also be further examined.

Just as scientists develop general conceptual explanations of the phenomena they investigate, individuals also develop intuitive theories about such human characteristics as intelligence, personality, and athletic ability. These theories, unlike scientist's theories, are not explicitly articulated or documented, and so they are termed implicit theories. Implicit theories, in achievement motivation, distinguish between the belief that human attributes are fixed (entity theory) or malleable (incremental theory) and have been shown to have far-reaching consequences for motivation, goal-orientations, and regulatory strategies in an array of domains. This dissertation extended implicit theories research to the domain of body-weight management. Drawing from an elaborate theoretical framework on implicit theories and health behavior research, the present work predicted that (a) individuals differ systematically in their beliefs about the malleability of body weight and (b) these implicit beliefs are related to coping and self-regulation strategies following dieting setbacks. To test these hypotheses, I first developed the Implicit Theories of Weight Management Scale and examined its psychometric properties. Results revealed internal reliability and convergent and discriminant validity. Implicit theories of weight management were moderately related to health and dieting locus of control but were distinct from personality dimensions such as the Big Five and trait optimism. Psychometric properties of the scale are presented and discussed. Next, I tested the hypothesis that implicit theories of weight management would be related to adaptive regulatory strategies (e.g., increased motivation) and to maladaptive coping (e.g., avoidance) following dieting setbacks and that this relation would be mediated by feelings of helplessness and optimism, and by attributions. Results largely supported these conjectures, revealing that even after controlling for constructs related to successful dieting (e.g., dieting self-confidence, trait self-control), believing more strongly that weight is changeable was related to lower reported use of avoidance when coping with setbacks and more effort. Additionally, feelings of helplessness and optimism mediated the implicit theories-self-regulatory relations. Results are discussed in terms of how implicit theories create the structure in which meaning is assigned to events and are therefore important for achievement and motivation. Implications and avenues for future research are presented.