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Behavioral Interven.ons for Obesity: An Evidence-‐Based Perspec.ve
Dawn K. Wilson, Ph.D. President of the Society for Health Psychology (Division 38),
American Psychological AssociaAon Professor of Psychology, University of South Carolina
Obesity Among U.S. Adults 2014 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
A Bioecological Framework for Health Promo.on
Adapted from Ins$tute of Medicine, 2005
Individual Factors
Social Factors
Norms and Values
§ Family
§ Social Support
§ Peers
§ Modeling
§ Paren.ng
§ Gene.cs
§ Psychosocial
§ Other Personal Factors
§ Industry
§ Agriculture
§ Educa.on
§ Media
§ Government
§ Public Health Systems
§ Healthcare
§ Community-‐ and Faith-‐based Organiza.ons
§ Safety and Access
§ Neighborhood Supports
Environmental Factors
§ Underserved Communi.es
§ Socio-‐cultural factors
§ Heritage
Health Behaviors (Physical Ac.vity, Sedentary
Behavior, Diet)
Needs SaAsfacAon of Autonomy Competence Relatedness
Autonomy SupporAve vs.
Controlling Health Care Climate
Personality Differences in Autonomy
Intrinsic vs. Extrinsic Life AspiraAons
Mental Health Less Depression Less SomaAzaAon
Less Anxiety Quality of Life
Physical Health Not Smoking Exercising Weight Loss
Glycemic Control Healthier Diet Dental Hygiene
Mechanisms for Social Climate
Ng et al. (2012). Perspec$ves on Psychological Science.
Gorin et al. (2010). Interna$onal Journal of Obesity; ShaVuck, White, & Kristal (1992). American Journal of Public Health
Look AHEAD Weight Loss Trial
*p < 0.05
0
20
40
60
80
100
Overall sample*
Untreated husbands*
Untreated wives*
Wei
ght (
kg)
Baseline 1 Year
Diabetes Preven.on Program Trial • Risk reducAon of 31% for meZormin vs. 58% for lifestyle
• Lifestyle resulted in 7% (14 pounds) loss of body weight
• Lifestyle resulted in 150 minutes/week of moderate intensity physical acAvity
• Outcomes for risk reducAon were maintained over 4 years
Diabetes PrevenAon Program Research Group (2003). Diabetes Care.
Cost Effec.veness of the Diabetes Preven.on Program
Cost of DPP Interventions vs. Metformin over 3 Years
Note: QOL = Quality of Life
Diabetes PrevenAon Program Research Group (2003). Diabetes Care.
ParenAng and moAvaAonal approach for weight loss in African American families
200-‐300 calorie reducAon in energy intake 100-‐200 calorie increase in energy expenditure
8 week face-‐to-‐face sessions 8 week online program
Wilson et al (2015). Contemporary Clinical Trials
Behavioral Weight Loss Techniques
PosiAve climate: autonomy-‐supporAve Self-‐monitoring: track energy intake/expenditure Goal sebng: set specific, measurable goals Reinforcement: use praise and rewards SAmulus control: control environmental cues EmoAon regulaAon: replacements for emoAonal eaAng Relapse prevenAon: predict high-‐risk situaAons
Communica.on Skills Strategies for posiAve family communicaAon
– In-‐session discussions and acAviAes (e.g., problem-‐solving acAvity)
– Group ground rules – Weekly take-‐home family bonding acAviAes
Support strategies (descripAve praise, autonomy support)
“Push” vs. “Pull” Language
You must You might
It’s important because In what ways is this important?
We have the answer You have the answer
Let us tell you Let us help you find your way
You should because Why might you consider?
Here’s how to change How might you possibly go about it?
†p<.10; *p<.05; **p<.01
Change Variable M+FWL Group BH Group
BMI† -‐0.21 (0.74) 0.24 (0.76)
BMI z-‐score† -‐0.01 (0.04) 0.02 (0.08)
Energy Intake (kcals) -‐138.87 (253.11) -‐0.86 (305.59)
Total daily fat intake† -‐13.04 (20.46) 2.40 (20.50)
Daily fruit intake* 0.91 (1.37) -‐0.66 (1.82)
Adolescent moAvaAon for diet** 0.49 (0.51) -‐0.05 (0.48)
Adolescent moAvaAon for PA* 0.39 (0.44) 0.09 (0.36)
Project FIT Results
Kitzman-‐Ulrich, Wilson et al. (2011). Childhood Obesity
Interac.on of Treatment Condi.on and Parent Communica.on
St. George, Wilson, et al. (2013). Journal of Pediatric Psychology.
113.72
140.43 145.89
57.88 50
70
90
110
130
150
170
Communica.on Low Communica.on High
Control
Treatment
Sede
ntary Be
havior (h
rs/w
k)
Parent Moderate-‐to-‐vigorous Physical Ac.vity
0
5
10
15
20
25
30
Interven.on Comparison
Min/day
Baseline Post
St. George, Wilson, et al. (2013). Journal of Pediatric Psychology.
Wilson (2015). Annals of Behavioral Medicine.
Physical Ac.vity and Mental Health
Behavioral intervention (n=401 overweight women)
Kerr et al. (2008). Depression and Anxiety.
0
1
2
3
4
5
6
7
8
Baseline 6 months 12 months
CES
D S
core
Intervention Control
Eating self-regulation Mata et al. (2009). Health Psychology
Interven.ons for Mul.ple Health Behaviors
Weight loss RCT (n=239 women)
INTRINSIC MOTIVATION PHYSICAL ACTIVITY
WEIGHT LOSS
Outcome R2
Eating self-efficacy
.27
Eating restraint
.17
Eating disinhibition .16
External eating .15
Emotional eating .12
Werch et al. (2007). Journal of Adolescent Health; Werch et al. (2010). Preventive Medicine.
Mechanisms of Interven.ons that Target Mul.ple Behaviors
Image-based behavioral counseling
Fitness goal/ Health
behavior contract
↑ FRUIT &
VEGETABLE INTAKE
↑ RELAXATION
ACTIVITIES
Intervention
Self-Efficacy Healthy Eating
Fruit & Veg Intake
Self Efficacy Stress Mgmt
Relaxation Activities
Mechanisms for Behavior Change
COGNITIVE SOCIAL
CogniAve-‐Behavioral
Skills
Domain-‐specific CogniAve Constructs
Mental Health
Physical Health
Self-‐Regula.on as a Causal Mechanism
Global CogniAve Constructs
Annesi (2011). Psychological Reports; McPhie & Rawana (2012). Mental Health and Physical Ac$vity; Minnix et al. (2011). Nico$ne and Tobacco Research; Surkan et al. (2012). Maternal and Child Health Journal
Cogni.ve Mediators of the Exercise-‐
Depression Rela.onship EXERCISE-DEPRESSION RELATIONSHIP Authors Design Sample Mediators
Dishman et al., 2006
Cross-sectional 1,250 adolescent girls
§ Physical Self-Concept § Self-Esteem
Ryan, 2008 Cross-sectional 376 undergraduates § PA Self-Efficacy § Physical Self-Esteem § Global Self-Esteem
Pickett, Yardley, & Kendrick, 2012
Cross-sectional 164 adults § PA Self-Efficacy
McPhie & Rawana, 2012
Prospective 4204 adolescents § Self-Esteem
Petty et al., 2009 Dose-Response, Randomized Intervention
207 adolescents § Physical Self-Worth § Global Self-Worth
Posi.ve Ac.on for Today’s Health
22
Wilson et al. (2013) Spatial and Spatio-temporal Epidemiology; Coulon et al. (2012). American Journal of Public Health; ; Wilson et al. (2015) Annals of Behavioral Medicine.
PATH Trial Outcomes
Wilson et al. Annals of Behavioral Medicine (2015)
PATH Results-‐ Social Interac.on
24%
12%
6%
12%
47%
Health Aspects Safety Fun Other Social Aspects
What do you like most about the PATH to Health Walks?
Wilson et al. (2011). Health Psychology; Zarrett et al. (2012). Evaluation and Program Planning
Ac.ve by Choice Today (ACT)
Conclusions • Behavioral
intervenAons key to obesity treatment
• MulAple systems need to be targeted for obesity treatment
• PosiAve social environment key
• Behavioral skills training essenAal
• Need to target mulAple behaviors
Grant Funding
This research is funded through grants from the U.S. NaAonal InsAtutes of Health
• R01DK067615, NIDDK – PI: Dawn K. Wilson, PhD – Co-‐InvesAgators:
– Brent Egan, PhD – Melinda Forthofer, PhD – Sarah Griffin, PhD – Heather Kitzman-‐Ulrich, PhD – M. Lee Van Horn, PhD – Abe Wandersman, PhD
• F31AG039930, NIA • PI/Fellow: Sandra Coulon, PhD • Sponsor: Dawn K. Wilson, PhD
• R01HD072153, NICHD – PI: Dawn K. Wilson, PhD – Co-‐InvesAgators:
– Heather Kitzman-‐Ulrich, PhD – Ron Prinz, PhD – Ken Resnicow, PhD – M. Lee Van Horn, PhD
• F31HD066944, NICHD – PI/Fellow: Sara M. St. George, PhD – Sponsor: Dawn K. Wilson, PhD
