YMCA of Metropolitan Atlanta, GA.
Perm J. 2020;24. doi: 10.7812/TPP/19.235. Epub 2020 Apr 10.
Behavioral (nonsurgical/nonpharmacologic) weight loss treatments have been overwhelmingly unsuccessful beyond the short term. Rather than incorporating accepted behavioral change theory, most have inadequately relied on providing exercise and nutrition information. Although adherence is a challenge, exercise has emerged as the most robust predictor of sustained weight reduction. However, exercise might be more associated with long-term weight loss through the relationship of its associated psychological changes with improved nutrition than through direct effects of energy expenditures, which are typically minimal in deconditioned individuals.
To facilitate improved helping methods through a proposed theory-based causal chain model in which supported exercise predicts sustained weight loss through successive changes in exercise-related, then eating-related, self-regulation, self-efficacy, and mood.
Segments of the model predict that 1) exercise and eating behaviors will be sequentially improved through increased self-regulatory skill use and self-efficacy and 2) exercise-induced mood improvements will foster greater self-regulation and reduced emotional eating. Short-term psychosocial changes can be leveraged to carry over to longer-term changes and maintained weight reductions. Suggested interventions emerging from the model and supporting research include using self-regulation to enable a habit of regular moderate exercise, facilitating a transfer of self-regulatory skills from an exercise to eating context, and leveraging mood improvements associated with manageable volumes of exercise to improve eating behaviors.
The model presents an evidence-based explanation of the exercise-weight loss association through psychosocial mechanisms. It also informs the development of practical methods to facilitate sustainable reductions in weight and health risks in adults with obesity.
行为（非手术/非药物）减肥治疗在短期内已经取得了压倒性的失败。大多数治疗方法没有充分利用已被接受的行为改变理论，而只是提供了运动和营养信息。尽管坚持是一个挑战，但运动已成为持续减肥的最强预测因素。然而，通过与其相关的心理变化与改善营养之间的关系，运动可能与长期体重减轻更相关，而不是通过能量消耗的直接影响，因为在缺乏运动的个体中，能量消耗通常很小。
通过一个基于理论的因果链模型来促进改进的帮助方法，其中支持性的运动通过运动相关的、然后是与饮食相关的、自我调节、自我效能和情绪的连续变化来预测持续的体重减轻。
该模型的各个部分预测，1）通过增加自我调节技能的使用和自我效能，运动和饮食行为将依次得到改善；2）运动引起的情绪改善将促进更好的自我调节和减少情绪化进食。短期的心理社会变化可以被利用来实现更长期的变化和维持体重减轻。该模型提出的干预措施和支持性研究包括利用自我调节来养成定期进行适度运动的习惯，促进自我调节技能从运动到饮食环境的转移，并利用与可管理的运动量相关的情绪改善来改善饮食行为。
该模型通过心理社会机制为运动与减肥之间的关联提供了一个基于证据的解释。它还为开发实用方法提供了信息，以促进肥胖成年人可持续地减轻体重和降低健康风险。
