Annesi James J
California State University Monterey Bay, Seaside, California, USA.
J Eval Clin Pract. 2025 Feb;31(1):e14267. doi: 10.1111/jep.14267.
Obesity is an increasing medical issue not responding well to behavioural treatments beyond their initial weeks/months.
Before suggesting surgical or pharmacological interventions, medical professionals might consider referrals to cost-effective, community-based behavioural treatments if stronger theoretical/empirical bases were demonstrated. Thus, evaluation of such is warranted.
Women with obesity were randomly assigned to 6-month treatments emphasizing either behavioural theory-based methods focused on exercise-associated psychological changes generalizing to dietary changes (n = 101), or typical instruction in weight-control methods (n = 53). Theory-driven psychosocial, behavioural and weight changes were assessed over 12 months.
Improvements in all measured variables were significantly greater in the behavioural theory group. In the evaluation of hypothesized theory-based relationships-which have overarching bases in social cognitive theory-(1) self-efficacy theory was supported by self-regulation-associated increases in self-efficacy predicting later positive changes in exercise and the diet; (2) coaction theory was reinforced by the identified transfer of changes in self-regulation of exercise to self-regulation of eating; (3) the mood-behaviour model was sustained by improved mood predicting exercise and dietary improvements through (mediated by) self-regulation changes; (4) self-regulation theory was bolstered through early improvements in self-regulation supporting its longer-term increase, especially under conditions of self-regulatory skills practice and (5) operant conditioning theory was supported through results indicating a reinforcing effect from exercise-associated mood improvement to reduced emotional eating. Across the theories, relationships among tested variables were generally stronger in the behavioural theory group. Improvements in exercise and dietary behaviours were significant independent predictors of reduced weight.
Findings support the addressed behavioural theories within a community-based obesity treatment model that emphasized exercise for its psychosocial impacts on dietary behaviours and sustained weight loss. Based on the present empirical supports, medical professionals should consider referral to such approaches before (or in combination with) surgical or pharmacological methods.
