Faculty of Human Kinetics, Technical University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal.
Int J Behav Nutr Phys Act. 2009 Feb 9;6:9. doi: 10.1186/1479-5868-6-9.
Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment.
Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables.
At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed.
Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.
身体意象和主观幸福感变量（例如自尊）的变化常被报道为肥胖治疗的结果。然而，它们反过来也可能影响行为依从性和减肥的成功。本研究探讨了肥胖治疗相关变量之间的关联，即在行为肥胖治疗期间，体重变化、生活质量、身体意象和主观幸福感，探索它们作为中介和结果的作用。
参与者（BMI=31.1±4.1kg/m2；年龄=38.4±6.7y）为 144 名女性，参加了为期 12 个月的肥胖治疗计划，对照组（n=49）接受了一般健康教育计划。干预措施包括定期的小组会议，促进身体活动和饮食摄入的持久行为改变。在基线和治疗结束时测量身体意象、生活质量、主观幸福感和体重。通过多元回归和重新抽样方法测量间接效应来检验中介作用。治疗组分配为自变量，体重变化和心理社会变量的变化分别作为中介和因变量进行分析。
在 12 个月时，干预组体重减轻（-5.6±6.8%对-1.2±4.6%，p<0.001）和身体大小不满意程度降低更大（效应大小为 1.08 对 0.41，p<0.001）比对照组。两组所有其他心理社会变量均有显著改善（效应大小范围为 0.31-0.75，p<0.05）。中介分析表明，身体意象和体重的变化既是治疗的中介和结果，表明存在相互影响。体重减轻部分中介了治疗对生活质量和自尊的影响，但没有观察到反向效应。
在行为肥胖治疗过程中，体重和身体意象的变化可能相互影响。在分析的其他模型中没有发现相互关系的证据；然而，体重变化部分解释了治疗对生活质量和自尊的影响。在治疗期间，体重和心理社会变化同时发生，并且可能以尚未充分理解的方式动态地相互影响。本研究结果支持在体重管理计划中纳入旨在改善身体意象的干预内容。
