ABSTRACT Behavioral treatments for morbid obesity have not been effective, possibly because of a poor understanding of the relations of psychosocial factors and exercise and eating behaviors. Recent research suggests that exercise program-induced improvements in self-efficacy and self-regulatory skills use may carry-over to self-efficacy and self-regulation for controlled eating. However, for individuals with morbid obesity, fatigue and anxiety may moderate these relationships. The purpose of this research was to evaluate this moderation. Adults with Grade 3 obesity (MBMI = 46.0 kg/m2) participated in 26 weeks of cognitive-behaviorally supported exercise paired with 12 weeks of either nutrition education (n = 95) or a cognitive-behavioral nutrition component (n = 109). There were significant improvements in self-regulation and self-efficacy for exercise, and self-regulation and self-efficacy for controlled eating, which did not differ by treatment condition. Bivariate relationships between changes in self-regulation for exercise and self-regulation for controlled eating (β = .63), and changes in exercise self-efficacy and self-efficacy for controlled eating (β = .51), were strong. Moderation of these relationships by fatigue and anxiety was either significant or marginally significant (ps < .01 and ps < .08, respectively). Both changes in self-regulation for controlled eating and self-efficacy for controlled eating significantly contributed to the explained variance in BMI change (R2 = .30). Implications of the findings for behavioral weight-loss treatment for those with morbid obesity were discussed.
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nullAnnesi, J. (2011). Moderation of Fatigue and Stress in the Carry-over of Self-Regulation and Self-Efficacy for Exercise to Self-Regulation and Self-Efficacy for Managed Eating. Psychology, 2, 694-699. doi: 10.4236/psych.2011.27106.
 Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379-387.
 American College of Sports Medicine (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise, 42, 459-471.
 Annesi, J. J. (2011). Self-regulatory skills usage strengthens the relations of self-efficacy for improved eating, exercise, and weight in the severely obese: Toward an explanatory model. Behavioral Medicine, 37, 71-76. doi:10.1080/08964289.2011.579643
 Annesi, J. J., & Marti, C. N. (2011). Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss. Psychology and Health, 26, 1081-1098.
 Annesi, J. J., & Unruh, J. L. (2007). Effects of The Coach Approach intervention on drop out rates among adults initiating exercise programs at nine YMCAs over three years. Perceptual and Motor Skills, 104, 459-466. doi:10.2466/pms.104.2.459-466
 Annesi, J. J., & Whitaker, A. C. (2010). Psychological factors discriminating between successful and unsuccessful weight loss in a behavioral exercise and nutrition education treatment. International Journal of Behavioral Medicine, 17, 168-175.
 Baker, C. W., & Brownell, K. D. (2000). Physical activity and maintenance of weight loss: Physiological and psychological mechanisms. In C. Bouchard (Ed.), Physical activity and obesity (pp. 311-328). Champaign, IL: Human Kinetics.
 Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
 Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: Freeman.
 Baranowski, T., Lin, L. S., Wetter, D. W., Resnicow, K., & Hearn, M. D. (1997). Theory as mediating variables: Why aren’t community interventions working as desired? Annals of Epidemiology, 7, S89- S95. doi:10.1016/S1047-2797(97)80011-7
 Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182. doi:10.1037/0022-3518.104.22.1683
 Bult, M. J., van Dalen, T., & Muller, A. F. (2008). Surgical treatment of obesity. European Journal of Endocrinology, 158, 135-145.
 Clark, M. M., Abrams, D. B., Niaura, R. S., Eaton, C. A., & Rossi, J. S. (1991). Self-efficacy in weight management. Journal of Consulting and Clinical Psychology, 59, 739-744.
 Cooper, Z., Doll, H. A., Hawker, D. M., Byrne, S., Bonner, G., Eeley, E., Fairburn, C. G. et al. (2010). Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behavior Research and Therapy, 48, 706-713.
 Cooper Z., Fairburn C. G., & Hawker, D. M. (2003). Cognitive-beha- vioral treatment of obesity: A clinician’s guide. New York: Guilford.
 Davies, M. (2007). Psychological assessment of candidates for bariatric surgery. Irish Journal of Psychological Medicine, 24, 99-102.
 Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241.
 Fogelholm, M., & Kukkomen-Harjula, K. (2000). Does physical activity prevent weight gain—A systematic review. Obesity Reviews, 1, 95-111. doi:10.1046/j.1467-789x.2000.00016.x
 Frazier, P. A., Tix, A. P., & Barron, A. P. (2004). Testing moderator and mediator effects in counseling psychological research. Journal of Counseling Psychology, 51, 115-134.
 Garber, C. E., Blissmer, B., Deschenes, M. R. Franklin, B. A., Lamonte, Michael, J., David P. et al. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine & Science in Sports & Exercise, 43, 1334-1359. doi:10.1249/MSS.0b013e318213fefb
 Glasgow, R. E. (2008). What types of evidence are most needed to advance behavioral medicine? Annals of Behavioral Medicine, 35, 19-25.
 Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413-433.
 Glymor, M. M., Weuve, J., Berkman, L. F., Kawachi, I., & Robins, J. M. (2005). When is baseline adjustment useful in analyses of change? An example with education and cognitive change. American Journal of Epidemiology, 162, 267-278. doi:10.1093/aje/kwi187
 Greenberg, I., Perna, F., Kaplan, M., & Sullivan, M. A. (2005). Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. Obesity Research, 13, 244-249.
 Hagger, M. S., Wood, C., Stiff, C., & Chatzisarantis, N. L. D. (2010). Ego depletion and the strength model of self-control: A meta-analy- sis. Psychological Bulletin, 136, 495-525. doi:10.1037/a0019486
 Hankonen, N., Absetz, P., Haukkala, A., & Uutela, A. (2009). Socioeconomic status and psychosocial mechanisms of lifestyle change in a Type 2 diabetes prevention trial. Annals of Behavioral Medicine, 38, 160-165. doi:10.1007/s12160-009-9144-1
 Kaiser Permanente Health Education Services (2008). Cultivating Health weight management kit (8th ed.). Portland, OR: Kaiser Permanente.
 Klem, M. L., Wing, R. R., McGuire, M. T., Seagle, H. M., & Hill, J. O. (1997). A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition, 66, 239-246.
 Maggard, M. A., Shurgarman, L. R., Suttorp, M., Maglione, A., Sugerman, H. H., Livingston, E. J., Li, Z. et al. (2005). Meta-analysis: Surgical treatment of obesity. Annals of Internal Medicine, 142, 547- 559.
 Mann, T., Tomiyama, J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62, 220-233.
 Marcus, B. H., Selby, V. C., Niaura, R. S., & Rossi, J. S. (1992). Self- efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport, 63, 60-66.
 McAuley, E., & Mihalko, S. L. (1998). Measuring exercise-related self-efficacy. In J. L. Duda (Ed.), Advances in sport and exercise psychology measurement (pp. 371-390). Morgantown, WV: Fitness Information Technology.
 McNair, D. M., & Heuchert, J. W. P. (2005). Profile of Mood States technical update. North Tonawanda, NY: Multi-Health Systems.
 Mokdad, A. H., Ford, E. S., Bowman, B. A., Dietz, W. H., Vinicor, F., Bales, V. S., & Marks, J. S. (2003). Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Journal of the American Medical Association, 289, 76-79. doi:10.1001/jama.289.1.76
 Nackers, L. M., Ross, K. M., & Perri, M. G. (2010). The impact of rate of initial weightloss on long-term success in obesity treatment: Does slow and steady win the race? International Journal of Behavioral Medicine, 17, 161-167. doi:10.1007/s12529-010-9092-y
 Oaten, M., & Cheng, K. (2006). Longitudinal gains in self-regulation from regular physical exercise. British Journal of Health Psychology, 11, 717-733. doi:10.1348/135910706X96481
 Puhl, R., & Brownell, K. D. (2002). Stigma, discrimination, and obesity. In C. G. Fairburn, & K. D. Brownell (Eds.). Eating disorders and obesity (2nd ed., pp. 108-112). New York: Guilford.
 Saelens, B. E., Gehrman, C. A., Sallis, J. F., Calfas, K. J., Sarkin, J. A., & Caparosa, S. (2000). Use of self-management strategies in a 2-year cognitive-behavioral intervention to promote physical activity. Behavior Therapy, 31, 365-379. doi:10.1016/S0005-7894(00)80020-9
 Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147-177.
 Svetkey, L. P., Stevens, V. J., Brantley, P. J., Appel, L. J., Hollis, J. F., Loria, C. M., Aicher, K. et al. (2008). Comparison of strategies for sustaining weight loss. Journal of the American Medical Association, 299, 1139-1148. doi:10.1001/jama.299.10.1139
 Teixeira, P. J., Silva, M. N., Coutinho, S. R., Palmeira, A. L., Mata, J., Viera, P. N., Sardinha, L. B. et al. (2010). Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity, 18, 725-735. doi:10.1038/oby.2009.281
 Tice, D. M., & Bratslavsky, E. (2000). Giving in to feel good: The place of emotion regulation in the context of general self-control. Psychological Inquiry, 11, 149-159.
 Warziski, M. T., Sereika, S. M., Styn, M. A., Music, E., & Burke, L. E. (2008). Changes in self-efficacy and dietary adherence: The impact on weight loss in the PREFER study. Journal of Behavioral Medicine, 31, 81-92. doi:10.1007/s10865-007-9135-2