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BMC Med. 2015 Apr 16;13:84. doi: 10.1186/s12916-015-0323-6.

Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators.

Author information

1
Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal. pteixeira@fmh.ulisboa.pt.
2
Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal. ecarraca@fmh.ulisboa.pt.
3
Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal. martamarques@fmh.ulisboa.pt.
4
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK. harry.rutter@lshtm.ac.uk.
5
Department of Nutrition Pitié-Salpetrière (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France. jean-michel.oppert@psl.aphp.fr.
6
UREN (Nutritional Epidemiology Research Unit), Université Paris 13, Sorbonne Paris Cité, Inserm (U557), Inra (U1125), Cnam, F-93017, Bobigny, France. jean-michel.oppert@psl.aphp.fr.
7
Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. ilse.debourdeaudhuij@ugent.be.
8
Department of General Practice and Elderly Care, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. j.lakerveld@vumc.nl.
9
Department of Epidemiology and Biostatistics, The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. j.brug@vumc.nl.

Abstract

BACKGROUND:

Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults.

METHODS:

A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately.

RESULTS:

Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified.

CONCLUSIONS:

This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.

PMID:
25907778
PMCID:
PMC4408562
DOI:
10.1186/s12916-015-0323-6
[Indexed for MEDLINE]
Free PMC Article

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