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An experimental study on locus of control, instructor follow-up contact and weight loss during and after… Morrison, Diane Elizabeth 1979

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AN EXPERIMENTAL STUDY ON LOCUS OF CONTROL, INSTRUCTOR FOLLOW-UP CONTACT AND WEIGHT LOSS DURING AND AFTER AN INSTRUCTIONAL PROGRAM ON SELF-MANAGEMENT SKILLS FOR WEIGHT CONTROL by DIANE MORRISON A THESIS SUBMITTED IN THE REQUIREMENTS MASTER PARTIAL FULFILLMENT OF FOR THE DEGREE OF OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Faculty of Education, Department of Adult Education) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1979 f- © Diane Morrison, 1979 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e Head o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t n f JL^. CriLtuSJt ^C^U The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 w e s b r o o k P l a c e V a n c o u v e r , C a n a d a V6T 1W5 D E - 6 B P 7 5 - 5 1 1 E ABSTRACT The purpose of t h i s study was to investigate the r e l a t i o n s h i p between Locus of Control scores, i n s t r u c t o r follow-up telephone con-tact and weight loss by p a r t i c i p a n t s during and 6 months a f t e r an i n s t r u c t i o n a l program on weight co n t r o l . The i n s t r u c t i o n a l program was designed to teach p a r t i c i p a n t s self-management s k i l l s to a s s i s t them to change eating and exercise habits s i g n i f i c a n t l y enough for weight loss to occur and be maintained over time. The research sample consisted of 24 adult women (ages 19 - 74) who registered for a night school class on weight control. Locus of Control was measured by the Rotter and the James Internal-External Locus of Control t e s t s . Weight loss was measured by pounds l o s t and percentage of body weight change attained. On the basis of the Locus of Control scores, p a r t i c i p a n t s were divided into three equal groups of low, medium and high external scores. An equal number of p a r t i c i p a n t s from each of these three groups was randomly assigned into e i t h e r a one or four telephone c a l l i n s t r u c t o r follow-up group. A 2 x 3 analysis of variance test with four repeated measures was used to determine the difference between the weight change means of each of the groups (three locus of control groups and two follow-up groups). The r e s u l t s of t h i s s t a t i s t i c a l t e s t i n g indicated that there were no s t a t i s t i c a l l y s i g n i f i c a n t (.05) r e l a t i o n s h i p s between weight loss and e i t h e r Locus of Control score or i n s t r u c t o r follow-up contact schedule. i i i . The e f f e c t s of several s i t u a t i o n a l and biographical v a r i a b l e s on amount of weight loss was also examined. A multiple regression anal-y s i s of eleven v a riables to predict weight loss showed that only attend-ance was s t a t i s t i c a l l y s i g n i f i c a n t and then only at the end of the 6 month follow-up period. However weight change on i t s own was shown to be s i g n i f i c a n t over the repeated measures both for pounds l o s t and percent of body weight change. The weight change was s i g n i f i c a n t for the p a r t i c i p a n t s i n the program but was not predictable either by Locus of Control score or i n s t r u c t o r telephone follow-up contact schedule. Reasons for lack of s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t s were discussed and recommendations for future research suggested. ACKNOWLEDGEMENTS I would l i k e to thank Dr. Roger Boshier and Dr. John C o l l i n s f th e i r cooperation and assistance during the wr i t i n g of t h i s t h e s i s . Special thanks also to Odette Jobidon who assisted i n the f i n a l preparation of th i s manuscript. V. TABLE OF CONTENTS CHAPTER Page I. INTRODUCTION AND STATEMENT OF THE PROBLEM 1 A. Self-Management S k i l l s Training for Weight 1 Loss B. Statement of the Problem 8 Research Questions 8 De f i n i t i o n s 9 Assumptions 10 Hypotheses 11 II . REVIEW OF THE LITERATURE 12 A. Self-Management Procedures and Weight 12 Control Weight Control as a C r i t i c a l Problem 12 Obesity and Exercise 15 Onset of Obesity 15 Measurement of Obesity 16 Measurement of Weight Change Versus 17 Change i n Eating and Exercise Behaviors Success of Weight Control Programs 18 Antecedent Stimulus Control 20 Consequent Control of Behavior 22 Aversive Control 24 Self-Monitoring 25 Effectiveness of Behavioral Programs 26 Versus Other Programs Problems Remaining i n Behavioral 27 Management Programs B. Weight Control I n s t r u c t i o n a l Program 29 Curriculum Content 29 Instructor/Helper Variables 30 Pa r t i c i p a n t Variables 31 C. Locus of Control 32 Locus of Control as a Generalized 32 Expectancy Development of Tests to Measure I n t e r n a l - 34 External Locus of Control Internal-External Locus of Control and 37 Weight Control Programs CHAPTER Page I I I . DESIGN AND METHODOLOGY OF THE STUDY 39 A. I n s t r u c t i o n a l Program 39 Program P a r t i c i p a n t s 39 Intake Session 40 Program Continuation 41 Follow-up Contact A f t e r I n s t r u c t i o n a l Program B. Experimental Procedures Administration and Scoring of I n t e r n a l -External Locus of Control Tests Assignment of P a r t i c i p a n t s to Groups Record of Weight Control Success 44 Analysis of Weight Control Success 45 IV. PRESENTATION OF THE DATA 47 A. Description of the Results Obtained from the 47 Analysis of Variance B. Description of the Results Obtained from the 53 M u l t i p l e Regression Analysis C. Summary of the Results 58 V. CONCLUSIONS, DISCUSSION, AND RECOMMENDATIONS FOR 60 FUTURE RESEARCH A. Conclusions 60 B. Discussion 61 C. Summary of Program Findings 64 D. Recommendations for Future Research 65 Revision of the Eight Session I n s t r u c t i o n a l 66 Program Design and Testing of Follow-up Contact 69 Schedules Testing of Program with D i f f e r e n t Instructors 70 Incentive Plan to Encourage Attendance 70 Internal-External Locus of Control and 71 P o t e n t i a l for Self-Control Tests and Weight Loss Success E. Research Design for Further Study 71 I n s t r u c t i o n a l Program as Part of Future 71 Study Experimental Conditions 72 F. Summary 74 REFERENCES 76 v i i . APPENDIX Page A. DESCRIPTION OF THE INSTRUCTIONAL PROGRAM 83 B. INTERNAL-EXTERNAL LOCUS OF CONTROL TESTS 92 C. PERSONAL WEIGHT HISTORY QUESTIONNAIRE 100 D. DESCRIPTION OF PARTICIPANTS 102 E. PREDICTED RESULTS FOR PROPOSED RESEARCH DESIGN 103 V l l l , LIST OF TABLES TABLE Page Mean Weights i n Pounds Over Eight Months 48 Effe c t s of Locus of Control and Follow-up Schedules 49 on Pounds Change i n Body Weight (Analysis of Variance Summary Table) Mean Percentage of Body Weight Over Eight Months 51 Effe c t s of Locus of Control and Follow-up Schedules 52 on Percent of Change i n Body Weight (Analysis of Variance Summary Table) Pred i c t i o n of Weight Loss Success by End of Eight 54 Week In s t r u c t i o n a l Program (Multiple Regression Summary Table) 6. Pr e d i c t i o n of Weight Loss Success at End of Six Month 55 Follow-up Period (Multiple Regression Summary Table) IX. LIST OF FIGURES FIGURE Page 1. Weight Loss Success i n Pounds Lost at 56 Three Time Periods 2. Weight Loss Success i n Pounds Lost and Percent Body Weight Change Over Four Repeated Measures 57 1. CHAPTER I INTRODUCTION AND STATEMENT OF THE PROBLEM As part of t h i s study, an i n s t r u c t i o n a l course was developed to t r a i n adults i n self-management of eating and exercise habits. Research was con-ducted on the r e l a t i v e weight loss success of p a r t i c i p a n t s who attended the course. The study explored the r e l a t i o n s h i p between weight loss and the pa r t i c i p a n t s ' Internal-External Locus of Control scores as measured by the Rotter (1966) scale. The study also investigated the r e l a t i o n s h i p between weight loss and two d i f f e r e n t schedules of i n s t r u c t o r follow-up i n the form of telephone contact and considered the i n t e r a c t i o n e f f e c t of p a r t i c i p a n t s ' locus of co n t r o l , i n s t r u c t o r follow-up contact schedule, and subsequent suc-cess i n weight l o s s . A. SELF-MANAGEMENT SKILLS TRAINING FOR WEIGHT LOSS Adult educators are concerned with learning outcomes and attempt to design systematic i n s t r u c t i o n a l programs to a s s i s t the adult learner ac-quire and maintain new knowledge, attitudes and s k i l l s . The learner should be able to apply the acquired s k i l l s i n a v a r i e t y of s i t u a t i o n s . The par-t i c i p a n t ' s performance of the new behaviors i s the measure of success of the i n s t r u c t i o n a l program. Two challenges which face adult educators are re l a t e d to the design of i n s t r u c t i o n a l programs. Instructors must a t-tempt to design programs that w i l l help each p a r t i c i p a n t achieve success. Secondly, i n s t r u c t o r s need to design programs that w i l l help people con-tinue to improve performance a f t e r the i n s t r u c t i o n a l program i s completed. 2. Most adults already have developed self-management s k i l l s that they use i n d a i l y personal and working l i f e . However, some adults have behav-i o r patterns that they have unsuccessfully t r i e d to change. Such habits range from n a i l - b i t i n g to alcoholism. Eating and exercise patterns are examples of habits that have been d i f f i c u l t f o r people to change on t h e i r own. Training individuals, i n 'self-management techniques based on p r i n c i p l e s of learning may help p a r t i c i p a n t s s u c c e s s f u l l y change behavior during _ and a f t e r the i n s t r u c t i o n a l program. Obesity i s a prevalent problem throughout North America. Numerous factors contribute to the obesity problem i n our society. Food processing techniques and fast food outlets have increased access to food with high sugar and f a t content. V i v i d advertising has focused attention on food products. At the same time, mechanical devices have decreased the amount of ph y s i c a l a c t i v i t y that i n d i v i d u a l s are l i k e l y to get. Numerous myths e x i s t on how to lose weight including fad d i e t s of doubt-f u l value which may jeopardize health. Many people have attempted to lose weight on t h e i r own and have also sought assistance from others including doctors, public health nurses, r e c r e a t i o n a l workers, teachers of exercise classes, friends and acquaintances. Though adult learners seem motivated to lose weight and ask others for assistance, overweight problems continue. In order for an i n d i v i d u a l to lose weight he must change the c a l o r i c b a l -ance so that c a l o r i e output exceeds:.input. Obesity i s a problem d i r e c t l y r e l a t e d to eating and exercise behavior patterns and i s an excellent can-didate for attention by adult educators. Programs need to be designed to teach i n d i v i d u a l s how to develop and maintain optimal eating and exercise habits i n order to lose weight and maintain weight l o s s . 3. Early research i n the use of a behavioral approach to weight control focused on behavior management treatment administered by therapists (Abramson, 1973; Stunkard, 1972). Many psychologists found behavioral approaches to weight control to be the most successful techniques i n the on-going b a t t l e of the bulge. Though behavioral management strategies have given new hope, psychologists have not had unqu a l i f i e d success i n t h e i r programs. Behavior management techniques seem to work f o r some peo-ple some of the time. Success i s not l i k e l y to be maintained over time. As weight control i s a r e s u l t of continuous control over eating and exer-c i s e choices, no external therapy program can include a consistent a p p l i -cation of behavior management techniques to the i n d i v i d u a l c l i e n t unless i n an i n s t i t u t i o n a l treatment program. Only the person himself can apply treatment needed to change behavior. Thus the emphasis must s h i f t from external therapist a p p l i c a t i o n of behavior management techniques to t r a i n -ing i n d i v i d u a l s i n self-management s t r a t e g i e s . Increasing attention i s being focused on the importance of each i n d i -vidual's eating and exercise choices as a major determinant i n weight con-t r o l and health maintenance (McAlister e t . . a l . , 1976). Research has shown that behavior management techniques can be su c c e s s f u l l y used to help par-t i c i p a n t s change eating and exercise habits to lose weight (Stuart & Davis, 1972; Stunkard & Mahoney, 1976). Behavioral management programs assume a l l s o c i a l l y relevant behaviors are learned and maintained through i n t e r -action between the i n d i v i d u a l and relevant persons and s i t u a t i o n s i n h i s environment (Stuart & Davis, 1972). This approach proceeds from recogni-t i o n of the importance of environmental forces and t h e i r e f f e c t on i n d i -v i d u a l s ' eating and exercise choices. Treatment begins with the measure-4. merit.of the form and rate of observable behaviors. Intervention focuses on the modification of antecedents and consequences of the s p e c i f i c be-haviors to be changed. Building p o s i t i v e health habits involves a complex chain of behaviors. For weight loss to occur, an i n d i v i d u a l must learn to change h i s eating and exercise habits. However, the p a r t i c i p a n t often has had a lengthy h i s t o r y of f a i l u r e with weight loss attempts. New health habits are thus d i f f i c u l t to acquire and maintain. Long-term maintenance of weight control depends on the extent to which the i n d i v i d u a l can learn how to manage be-havior change strategies on h i s own. Adult educators should examine t h i s problem and design programs that can be employed with adults requesting assistance i n overcoming obesity. I n s t r u c t i o n a l programs should be designed to teach adults to use learning p r i n c i p l e s to make changes i n behavior patterns so weight loss w i l l occur. Programs must take into consideration i n d i v i d u a l differences and the spe-c i f i c habit patterns to be changed. The educator must consider d i f f i c u l -t i e s associated with adopting new behavior, the complexity of the behavior chain, the timing of reinforcements as w e l l as the supportiveness of the l e a r n e r 1 s personal environment. If a program can be designed and e f f e c t i v e l y delivered as a continuing education course, then nurses, counsellors, r e c r e a t i o n a l leaders, exercise i n s t r u c t o r s , n u t r i t i o n i s t s or others could be trained to use the program to teach self-management strategies f or weight co n t r o l . Thus the f i r s t part of t h i s study involved the design of a continuing education course on weight control which was given i n a Vancouver night school centre. This program attempted to teach each p a r t i c i p a n t how-to apply self-management ' 5. s k i l l s to eating and exercise c o n t r o l . It was designed to promote the ac-q u i s i t i o n of new habits so that each i n d i v i d u a l could modify the balance between c a l o r i c intake and energy expenditure to the extent needed to over-come obesity. Any self-management t r a i n i n g program must be designed to f a c i l i t a t e development and maintenance of self-management s k i l l s over time and across s i t u a t i o n s . People may be able to change habits during a short period of time e s p e c i a l l y when the external support of an i n s t r u c t i o n a l program i s a v a i l a b l e . However, they may not have learned new s k i l l s s u f f i c i e n t l y to maintain them when t h i s support i s no longer a v a i l a b l e on a regular basis. Many p a r t i c i p a n t s show weight increases a f t e r program completion (Hagen, 1974; Wollersheim, 1970; Harris & Bruner, 1971). The a v a i l a b i l i t y and timing of external support may be an important f a c t o r i n the i n s t r u c t i o n a l design of self-management t r a i n i n g whether for weight loss or other a p p l i -cations. For some people, d a i l y contact may be necessary; for others weekly or monthly contact may be s u f f i c i e n t . The nature and schedule of support a v a i l a b l e a f t e r the i n i t i a l i n s t r u c t i o n a l period may influence con-tinued weight loss and weight loss maintenance. The use of booster sessions to maintain improvement of habit change has been advocated (Hunt & Matarazzo, 1973; O'Leary & Wilson, 1975), but systematic research on i t has been lacking. The research c a r r i e d out by Kingsley and-Wilson i s perhaps the f i r s t comprehensive i n v e s t i g a t i o n of the p o t e n t i a l advantages of incorporating r e g u l a r l y scheduled booster sessions into a comprehensive behavioral treatment framework (Kingsley-& Wilson, 1.1977 p. 297).. The schedule used by Kingsley and Wilson included booster meet-ings two weeks a f t e r the l a s t c l a s s , then another one three weeks l a t e r , 6. followed by another four weeks a f t e r that with a f i n a l booster session f i v e weeks l a t e r . They were able to get excellent attendance at the boost-er sessions p a r t l y by withholding the i n d i v i d u a l ' s deposit which was r e -turned contingent on attendance at classes and booster sessions. As maintenance of weight loss i s a d i f f i c u l t y of weight control pro-grams, :this study included an exploration of the r e l a t i o n s h i p of follow-up i n s t r u c t o r contact and weight l o s s . The night school class format l i m i t e d the kind of follow-up contact that could be made with p a r t i c i p a n t s . There-fore, the i n s t r u c t o r had to decide what was the r e a l i s t i c extent and na-ture of follow-up contact that could be used without arousing a negative reaction from p a r t i c i p a n t s ( e s p e c i a l l y from those who had gained weight or l o s t i n t e r e s t i n weight l o s s ) . Because of l o g i s t i c a l problems with follow-up sessions, low p r o b a b i l i t y of attendance by a l l members, and recent suc-cesses i n use of telephone contact i n distance education courses, a t e l e -phone follow-up contact was used. Every p a r t i c i p a n t was t o l d to expect f o l -low-up contact by telephone but given no i n d i c a t i o n of the number or timing of telephone c a l l s . The second v a r i a b l e to consider was the length of the follow-up period. Kingsley and Wilson (1977) point out that of nineteen c o n t r o l l e d studies performed before 1972 as reviewed by H a l l and H a l l (1974), only two reported follow-up of more than s i x months. Harris and Bruner (1971) found s i g n i f i c a n t weight loss over a three month treatment period but the loss was not maintained seven months a f t e r the program f i n i s h e d . Foreyt and Kennedy (1971) reported s i g n i f i c a n t success of behavior groups over no treatment control groups nine months a f t e r the program. H a l l (1973) and H a l l , H a l l , Hansen and Borden (1974), found that a s e l f - c o n t r o l behavioral 7. program produced s i g n i f i c a n t differences from co n t r o l groups at the end of the program but not at the end of a s i x month follow-up period. Six months was chosen by the experimenter of the present study as a r e a l i s t i c follow-up period i n order to assess the permanence of the weight loss achieved by p a r t i c i p a n t s . Few guidelines from research were a v a i l a b l e on planning a follow-up contact schedule. The number of i n s t r u c t o r telephone contacts i n t h i s study was designed on the basis of the i n t e r v a l schedule outlined by Kingsley and Wilson (1977) but adapted to a s i x month follow-up period. The follow-up schedule included four telephone c a l l s at weeks three, eight, fourteen and twenty-one for one group. A sing l e contact at the half-way point (week fourteen) was the schedule f o r the second group. Those people i n the four follow-up c a l l group were expected to continue to lose more weight than those r e c e i v i n g only one telephone c a l l . Although successful weight control has been achieved through behavior management programs, wide v a r i a t i o n i n weight loss success i s evident. Some people acquire new eating and exercise patterns more r e a d i l y than do others. Individual differences i n success are reported by Penick et. a l . (1971), Horan and Johnson (1971), Mahoney (1974) and Rozensky and Bellack (1976). Research on self-management based weight reduction programs has shown that subjects who administer self-management procedures as instructed generally lose weight (Rozensky & Bellack, 1976). However, i t i s d i f f i c u l t to keep pa r t i c i p a n t s using the techniques r e g u l a r l y and contingently. Behavior management programs appear to o f f e r promising r e s u l t s but only for some i n d i v i d u a l s . So f a r i t has not been possible to c o n s i s t e n t l y predict which i n d i v i d u a l s w i l l be successful weight losers during and a f t e r 8. programs focusing on behavior management s t r a t e g i e s . However the i n d i -vidual's b e l i e f regarding personal control over the events i n h i s l i f e as measured by the Rotter Internal-External Locus of Control scale has been i d e n t i f i e d as one va r i a b l e that may predict success i n weight control (Balch & Ross, 1975; Manno & Marston, 1972). ..This study provided an op-portunity to explore the r e l a t i o n s h i p between Internal-External Locus of Control score and p a r t i c i p a n t s ' r e l a t i v e weight loss success during and af t e r the classes. As t h i s i n s t r u c t i o n a l program focused on self-manage-ment s k i l l s and the control of one's own weight loss program, i t was ex-pected that p a r t i c i p a n t s with low external Locus of Control scores would be more successful weight losers than those with either medium or high ex-te r n a l scores and that i n d i v i d u a l s with low external scores would perform better i n the four c a l l follow-up group than i n the sing l e c a l l group. If Locus of Control as measured by Rotter's Internal-External scale i s found to predict weight loss success then the test could be used i n the i n i t i a l assessment of p a r t i c i p a n t s registered i n self-management weight con-t r o l programs. This Rotter I-E Locus of Control test may a l e r t i n s t r u c t o r s to s i g n i f i c a n t i n d i v i d u a l differences that may predict l i k e l i h o o d of suc-cess i n a weight control program based on i n s t r u c t i o n i n self-management s k i l l s . The i n s t r u c t o r can then modify i n s t r u c t i o n a l strategies and l e v e l of support for i n d i v i d u a l p a r t i c i p a n t s i n the program i n an attempt to as-s i s t each i n d i v i d u a l achieve and maintain success. B. STATEMENT OF THE PROBLEM Research Questions This study included the design of an i n s t r u c t i o n a l program i n s e l f -9. management of eating and exercise habits. The program was offered as a group class i n a Vancouver School Board night school centre. The re-search tested the r e l a t i o n s h i p between three l e v e l s of i n i t i a l I nternal-External score (low, medium, and high externals) and weight loss during and a f t e r the program. Moreover, the experimental design included two i n s t r u c t o r follow-up contact schedules (one telephone c a l l and four t e l e -phone c a l l s ) . The r e l a t i o n s h i p between these two follow-up contact sched-ules and maintenance of weight los s s i x months a f t e r the program was exam-ined. In addition, the i n t e r a c t i o n between the Internal-External scores and the follow-up contact schedules was studied. The study was structured to answer the following questions: 1. Is there a r e l a t i o n s h i p between Internal-External Locus of Control score and success i n weight los s during and a f t e r t h i s weight co n t r o l program? 2. Is there a r e l a t i o n s h i p between schedule of i n -structor follow-up c a l l s used i n t h i s study and success i n weight loss? 3. Is there an i n t e r a c t i o n between Internal-External Locus of Control score, i n s t r u c t o r follow-up t e l e -phone c a l l schedule and success i n weight loss? D e f i n i t i o n s Operational d e f i n i t i o n s used for t h i s study were as follows: 1. I n s t r u c t i o n a l Program i n Weight Control The i n s t r u c t i o n a l program was based p r i m a r i l y on : the behavior management approach described by Stuart and Davis (1972). A d e s c r i p t i o n of the program i s included i n Appendix A. The program was conducted as part of a Vancouver School Board night school program and ran one evening a week for eight weeks. 2. Instructor Follow-Up Two d i f f e r e n t schedules of i n s t r u c t o r follow-up con-tact occurred over a s i x month period. One group received a telephone c a l l fourteen weeks a f t e r the 10. f i n a l c l a s s . The other group received telephone c a l l s at weeks three, eight, fourteen and twenty-one a f t e r the f i n a l c l a s s . Both groups were con-tacted for a f i n a l weight report twenty-six weeks af t e r the l a s t c l a s s . 3. Internal-External Locus of Control Groups The Internal-External Locus of Control of Rein-forcement v a r i a b l e (I-E) derived from Rotter's (1954) S o c i a l Learning Theory. Measurement of I-E Locus of Control was based on the p a r t i c i -pants' scores on the Rotter (1966) scale. The Internal-oriented individual.sees reinforce--ment as contingent on h i s own behavior while the External-oriented i n d i v i d u a l sees reinforcement as unrelated to h i s own behavior and beyond per-sonal c o n t r o l and r e s p o n s i b i l i t y (Lefcourt, 1966; Rotter, 1966). P a r t i c i p a n t s i n the program completed two paper and p e n c i l versions of the I-E scale, the Rotter and the James scales (see Appendix B). - P a r t i c i -pants were divided into three groups on the basis of t h e i r score on the Rotter I-E t e s t . The James test was used as a d d i t i o n a l information i n order to separate i n d i v i d u a l s with the same Rotter I-E score. 4. Weight Control Success The success of the p a r t i c i p a n t s i n the i n s t r u c t i o n -a l program was measured as the number of actual pounds l o s t , as w e l l as the percentage of body weight change achieved. Assumptions It was assumed that: weight change i s d i r e c t l y r e l a t e d to change of eat-ing and exercise behavior by the i n d i v i d u a l ; Locus of control o r i e n t a t i o n can be measured by a paper and p e n c i l t e s t ; no great confounding treatment effectiveness r e s u l t -ed from the f a c t that the course i n s t r u c t o r and the experimenter were one and the same. Hypotheses Hi Low externals w i l l have a higher average weight loss than medium or high externals at the end of the i n s t r u c t i o n a l program and at the end of the s i x month follow-up period. H Q There w i l l be no s t a t i s t i c a l l y s i g n i f i c a n t d i f -ference i n the average weight loss by the low ex ternals as compared to medium or high externals at any time period. H 2 The average weight los s i n the four c a l l follow-up group w i l l be higher than the average weight loss i n the one c a l l follow-up group. H Q There w i l l be no s t a t i s t i c a l l y s i g n i f i c a n t d i f -ference i n the average weight loss i n the four c a l l follow-up group and the one c a l l follow-up group. H 3 The average weight loss of the low externals i n the four c a l l follow-up group w i l l be higher than the average weight loss of the medium or high externals i n ei t h e r of the two follow-up groups. H Q When the average weight loss of low externals i s compared to the average weight loss of e i t h e r of the other two I-E groups i n eit h e r the one- c a l l •or four c a l l follow-up group, no s t a t i s t i c a l l y s i g n i f i c a n t difference w i l l be found. 12. CHAPTER II REVIEW OF THE LITERATURE This l i t e r a t u r e review presents major research evidence on s e l f -management weight co n t r o l programs and an overyiew of the Internal-Exter-nal Locus of Control construct. A. SELF-MANAGEMENT PROCEDURES AND WEIGHT CONTROL Regardless of s p e c i f i c factors that led to a weight problem, control i s r e l a t e d to an i n d i v i d u a l ' s a b i l i t y to learn new eating and exercise pat-terns. Programs based on behavior management have attempted to help par-t i c i p a n t s learn new knowledge and s k i l l s i n behavior change strategies and to use them to improve eating and exercise behaviors enough f o r weight loss to occur. Behavior change f o r weight control r e s t s on p r i n c i p l e s of l e a r n -ing and s o c i a l learning theory. Eating behavior and overeating are viewed as s i m i l a r to other learned behavior patterns (Ullman & Krasner, 1965). It i s beyond the scope of t h i s study to f u l l y examine l i t e r a t u r e i n t h i s area but appropriate to present the conceptual basis for t r a i n i n g i n behavior change strategies f or the c o n t r o l of eating and exercise behaviors. Weight Control as a C r i t i c a l Problem The maintenance of f i t n e s s and health i s a pressing problem facing Canadians. Health care costs are r a p i d l y increasing, and while i t i s d i f -f i c u l t to know p r e c i s e l y what i s spent i n Canada, Robertson (1973) suggests that: 1. Health costs comprise a s u b s t a n t i a l part of the nation a l expenditure. 13. 2. Costs are r i s i n g r a p i d l y . 3. By far the biggest element i n health costs are those connected with running h o s p i t a l s ; these are the most r a p i d l y r i s i n g of a l l costs. 4. Expenditures for physicians' service are the second biggest element i n costs and are also r i s i n g r a p i d l y . In the mid-1950's, expenditures on personal health care amounted to 3 percent of the Gross National Product. By 1969, the proportion had r i s e n to 5.5 percent. The proportion of personal income the i n d i v i d u a l spent on health care rose by one-half from 4.28 percent i n 1957 to 6.35 percent i n 1969. T o t a l expenditures on personal health care increased from $1,047,403,000 i n 1957 to $3,887,467,000 i n 1969 - almost quadrupling dur-ing t h i s twelve year period (Robertson, 1973, pp. 108-109). Hospitals and insurance expenses are not the only costs. Other costs r e l a t e to work time and p r o d u c t i v i t y l o s s , s o c i a l and family c r i s e s from i l l n e s s and death of family and community members, and losses i n the q u a l i t y of people's l i v e s due to poor health and disease. Obesity has been associated by Mayer (1968) with four types of health hazards: 1. Changes i n normal body functioning. 2. Increased r i s k of developing c e r t a i n diseases. 3. Detrimental e f f e c t s on established diseases. 4. Adverse psychological reactions. Obesity may be a co-existing rather than a causal factor i n i l l n e s s . However, the greater the obesity, the more l i k e l y are severe abnormalities to occur and to be complicated by obesity. Fat people have been noted to have less exercise tolerance, more d i f f i c u l t y i n normal breathing and high-14. er frequency of r e s p i r a t o r y i n f e c t i o n s than people of normal we igh t . Mayer (1968) concluded tha t there i s a c o r r e l a t i o n between weight and hear t d i s e a s e . Insurance company r e p o r t s suggest excess ive m o r t a l i t y r a t e d e c l i n e s fo r overweight p a t i e n t s ab le to reduce t h e i r weight enough to a t -t a i n a lowered insurance r a t e . These s t a t i s t i c s show an a s s o c i a t i o n b e t -ween o b e s i t y and e a r l y m o r t a l i t y (Mayer, 1968). M c A l i s t e r e t . a l . (1976) con f i rm tha t c a r d i o v a s c u l a r d i s e a s e s , no t ab ly conges t ive hear t f a i l u r e , s t r o k e , and coronary hear t d i s e a s e , are a s s o c i a t e d w i t h o b e s i t y . There are many c o n d i t i o n s i n which s i g n i f i c a n t b e n e f i t s are ob ta ined w i t h l o s s of excess we igh t , p a r t i c u l a r l y i n d i seases of the c i r c u l a t o r y and locomotor systems. Among c o n d i t i o n s aggravated by o b e s i t y a r e : angina p e c t o r i s , hype r t ens ion , conges t ive hear t f a i l u r e , i n t e r m i t t e n t c l a u d i c a -t i o n , rup ture of i n t e r v e r t e b r a l d i s c s , o s t e o a r t h r i t i s , v a r i c o s e v e i n s , and o ther v a r i e t i e s o f bone or j o i n t d i s e a s e . Obese people f r e q u e n t l y have an impai red carbohydrate t o l e r a n c e and are unable to u t i l i z e g lucose p r o p e r l y . Such people need to reduce t h e i r weight to avo id c o m p l i c a t i o n s caused by h i g h b lood sugar , such as need f o r i n s u l i n , and to reduce episodes of a c i -d o s i s . Obese d i a b e t i c p a t i e n t s u s u a l l y b e n e f i t by weight r e d u c t i o n . Obes-i t y i s a l s o a hazard f o r pregnant women. Toxemia i n d e l i v e r y and d i f f i -c u l t i e s w i t h the fe tus are more common i n f a t women than i n those of n o r -mal weight (Mayer, 1968; M c A l i s t e r e t . a l . , 1976) . I s the obese person who i s o therwise i n e x c e l l e n t h e a l t h more l i k e l y to develop a major d i sease or d i e sooner than persons of e q u a l l y good h e a l t h and normal weight? Mayer (1968) concluded tha t o b e s i t y does c rea te an e x t r a hazard fo r o therwise hea l t hy peop le , a l though the f i g u r e s to sup-por t t h i s c o n c l u s i o n were obta ined from insurance company and m i l i t a r y s t a -15. t i s t i c s — data with imperfect v a l i d i t y . Obesity and Exercise Although there has been no conclusive demonstration l i n k i n g diseases and p h y s i c a l i n a c t i v i t y , exercise helps c o n t r o l high r i s k f a c t o r s such as obesity, mental stress and high blood pressure. Exercise helps c o n t r o l appetite, r e l i e v e s tension, allows weight reduction without severely r e -s t r i c t i n g c a l o r i e s and n u t r i e n t s , stimulates c i r c u l a t i o n , aids digestion, and helps maintain good muscle tone. Vigorous p h y s i c a l exercise has been shown to lower l e v e l s of c e r t a i n f a t s c i r c u l a t i n g i n the blood. High blood pressure i s associated with cardiovascular diseases and p h y s i c a l exercise may exert a h e l p f u l e f f e c t on t h i s condition. F i n a l l y , exercise may have a d i r e c t b e n e f i c i a l e f f e c t on the a r t e r i e s and vessels of the heart as well as help develop extra c i r c u l a t i o n routes and increase c o l l a t e r a l c i r -c u l a t i o n (Stuart & Davis, 1972). The optimal amount of physical exercise and vigour i s s t i l l under study, however epidemiological data indicates that i n d i v i d u a l s engaged i n a c t i v e occupations have a lower incidence of ischemic heart disease and a better recovery record than i n d i v i d u a l s i n sedentary occupations (Stuart & Davis, 1972). Onset of Obesity There have been numerous attempts to explain the causes of and pre-disposing factors leading to obesity. Existence of numerous forms of i n -herited obesity i n animals and the ease with which adiposity can be pror duced by s e l e c t i v e breeding suggest that genetic factors can play a deter-mining r o l e i n obesity (Mayer, 1968). Seltzer and Mayer (1964) demonstrate that obesity occurs with greater--frequency in: some phys i c a l types t h a n I n 16. others. Preliminary studies by Withers (1964) suggest that somatypes are h e r i t a b l e . Obesity that started i n childhood tends to be r e s i s t a n t to treatment (Abraham & Nordsieck, 1960; Stunkard & Burt, 1967). Studies of adipose tissues may help explain the persistence of obesity that began during childhood. Many persons obese from childhood show marked increase i n the t o t a l number of adipocytes i n the subcutaneous t i s s u e and i n other depots. With weight reduction, i n d i v i d u a l c e l l s shrink but t o t a l f a t c e l l numbers remain constant (Hirsch & K n i t t l e , 1971). Obesity onset v a r i e s from i n d i v i d u a l to i n d i v i d u a l . Mayer (1968) has concluded that whatever the predisposing f a c t o r s , obesity has as i t s root cause a p o s i t i v e energy balance for that i n d i v i d u a l . Self-management re -search does not focus on the causes of obesity but on the a p p l i c a t i o n of behavior management techniques to reverse the energy balance to a negative p o s i t i o n so more c a l o r i e s are burned than consumed. The intent of s e l f -management i n s t r u c t i o n i s to help the learner examine and modify eating and exercise habits. Measurement of Obesity Mayer (1968) notes that obesity (excessive fatness) may not be con-s i s t e n t with overweight (weight i n excess of average). He suggests s k i n -f o l d measurement as a better means of assessing obesity than weight meas-urement. Skinfold measurements are usually taken at three sample spots although Mayer (1968) suggests r i g h t arm s k i n f o l d density as an adequate measure. Problems occur with the use of s k i n f o l d measurement i n weight control i n s t r u c t i o n a l programs. . For the measurement to be r e l i a b l e , the person taking the measurement must have t r a i n i n g and experience. Skinfold measures cannot be e a s i l y used by p a r t i c i p a n t s to get regular feedback about progress. Weight measurement has thus been the widely accepted measure of suc-cess i n weight co n t r o l programs. Outcomes are e a s i l y and d i r e c t l y meas-urable. Weight measures are also used to describe the extent of obesity i n our society. Most standard-setting work has been done by insurance companies. Comparing an i n d i v i d u a l or group i n terms of heights and weights with a set of averages does not give the complete measure of obes-i t y but comparisons can be used as guidelines f or s e t t i n g i d e a l weight goals. In most weight co n t r o l research, comparisons are not based on skin-f o l d averages or height-weight tables but on the r e l a t i v e success of each i n d i v i d u a l compared to h i s own weight scores at separate times and to the weight scores of other i n d i v i d u a l s . Measurement of Weight Change Versus Change i n Eating and Exercise Behaviors The emphasis i n weight control programs i s on changing eating and ex-er c i s e habits i n order to change weight measurement. If weight loss does not occur, health hazards w i l l not be avoided. However, the i n d i v i d u a l can learn to improve eating and exercise patterns even without noticeable weight change i f there has not been a s i g n i f i c a n t reversal.of the energy balance. Hence weight changes measure the extent of the change of energy balance but may not measure a l l improvements i n eating and exercise behav-i o r s of the i n d i v i d u a l . Learners may be able to improve eating choices and exercise habits without s i g n i f i c a n t l y a l t e r i n g t h e i r weight. Individual d i f f e r e n c e s i n weight loss may r e f l e c t i n i t i a l amount of overweight, f l u i d r etention, 18. constipation, menstrual cycle, or change of f a t to muscle t i s s u e . When success of i n d i v i d u a l s i n d i f f e r e n t experimental conditions are compared, differences i n success of weight loss may r e f l e c t d i f f e r i n g p h y s i o l o g i c a l parameters of the i n d i v i d u a l s . While random s e l e c t i o n to various condi-tions may average out these differences i n large enough samples, most weight co n t r o l research has been done eit h e r on i n d i v i d u a l cases or with r e l a t i v e l y small groups of i n d i v i d u a l s . Secondly, weight loss may be attained^by;individuals, able to change eating a n d rexercise patterns enough to achieve a negative energy balance but who endanger t h e i r health as a r e s u l t . They may lose weight by extreme measures such as f a s t i n g , use of d i u r e t i c s , induced vomiting or fad d i e t s . I n s t r u c t i o n based on the d i a b e t i c food exchange described by Stuart and Davis (1972) and regular exercise u s u a l l y r e s u l t s i n a maximum loss, of one to two pounds a week. This i s considered an acceptable rate of change that l i k e l y means an adequate nutrient intake i s s t i l l being maintained. Self-management programs have generally shown slow weight losses of 0.5 to 1.0 pound per week (Harris, 1969; Wollersheim, 1970; H a l l et. a l . , 1974; J e f f r y , 1974). Weight change measures do not always r e f l e c t improved eating and ex-e r c i s e habits. However, measurement of actual eating and exercise behav-i o r s usually depends on s e l f - r e p o r t s by c l i e n t s . Questions about the r e -l i a b i l i t y of s e l f - r e p o r t measurement are more extensive than are these concerns about the v a l i d i t y of measurement of weight change to assess d i f -ferences .in eating and exercise behaviors. Success of Weight Control Programs 19. T r a d i t i o n a l medical, d i e t a r y , and psychotherapeutic approaches to obesity have f a i l e d to produce encouraging r e s u l t s . Stunkard concluded, "Most obese persons w i l l not stay i n treatment for obesity. Of those who stay i n treatment most w i l l not lose weight and of those who do lose weight, most w i l l regain i t " (1958, p. 79). Psychological explanations have not been useful i n helping the control of obesity. No research has shown a s t a t i s t i c a l l i n k with obesity and psychological disturbance (Stunkard, 1959). He adds that i t has not been possible to define psycho-l o g i c a l c h a r a c t e r i s t i c s of obese patients which w i l l c o n s i s t e n t l y d i s t i n -guish them from non-obese persons. One of the f i r s t published accounts that proposed a behavioral model for t r e a t i n g obesity was presented by Ferster, Nurmberger and L e v i t t (1962). These writers presented a t h e o r e t i c a l basis for weight loss which depended upon stimulus c o n t r o l techniques. They analyzed the extent to which nat-u r a l i s t i c cues e l i c i t and c o n t r o l eating responses and suggested techniques to progressively r e s t r i c t both the range and frequency of cues associated with eating. Stuart (1967) used these techniques i n what became known as the breakthrough study i n weight c o n t r o l . His work showed great promise for the behavioral treatment of obesity as opposed to the disappointing r e s u l t s of psychologically based i n s i g h t oriented treatments. Underlying the psychological treatment approach i s the view that per-s o n a l i t y f a c tors set the occasion for behaviors l i k e appropriate and inap-propriate eating choices. E f f o r t s to use t h i s approach i n treatment of overeating have met with l i t t l e success. Stuart and Davis (1972) reviewed some of the possible explanations for the disappointing r e s u l t s of person-a l i t y - o r i e n t e d treatments. These included the high degree of speculation 20. necessary i n forming hypotheses to guide treatment, the tendency to focus on problems rather than solutions and the l i k e l i h o o d of attaching g u i l t and blame to the i n d i v i d u a l rather than focusing on s o c i a l and environ-mental factors which maintain inappropriate eating and exercise behaviors. A range of treatment approaches have been t r i e d . Behavioral management programs seem to be the best options to date (Stuart & Davis, 1972; Stunkard & Mahoney, 1976; H a l l et. a l . , 1974). Antecedent Stimulus Control One of the important p r i n c i p l e s relevant to changes of eating behav-i o r i s antecedent stimulus c o n t r o l . Research suggests that obese i n d i v i d -uals eat i n response to s t i m u l i other than p h y s i o l o g i c a l signals of hunger while normal weight subjects tend to be guided by i n t e r n a l cues (Stunkard, 1959; Schachter, 1971). Bruch (1961) hypothesized that the obese have not learned to discriminate between p h y s i o l o g i c a l symptoms accompanying food deprivation and arousal c h a r a c t e r i s t i c of emotional states such as fear, anger and anxiety. There i s evidence that the obese do not l a b e l g a s t r i c contractions as hunger. Using a g a s t r i c balloon to measure contractions, Stunkard and Koch (1964) have shown that f o r obese subjects there i s l i t t l e correspondence between the state of the stomach and s e l f - r e p o r t s of hunger. In contrast there i s a r e l a t i v e l y close correspondence between the state of the stomach and reports of hunger for normal weight subjects. Stunkard (1959) concluded that cues for hunger were d i f f e r e n t f o r obese and non-obese persons. Studies by Schachter, Goldman and Gordon (1968) also found a c o r r e l a -t i o n between the state of the v i s c e r a and amounts eaten by normal weight 21. subjects and l i t t l e correspondence for f a t subjects. In normal weight subjects, f e e l i n g s associated with g a s t r i c m o t i l i t y and hypoglycemia ap-pear to t r i g g e r eating. What t r i g g e r s eating i n the obese? The standard answer i n the past was that psychic states p r e c i p i t a t e eating i n the obese, and treatment was focused on why i n d i v i d u a l s overeat. As a r e s u l t , most treatments were psychotherapy or i n s i g h t oriented. Yet there has been no c l e a r i n d i c a t i o n of c h a r a c t e r i s t i c s d i f f e r e n t i n normal weight and over-weight subjects except a p o s i t i v e energy balance for t h e i r a c t i v i t y l e v e l (Schachter, Goldman & Gordon, 1968). This led to the speculation that ex-t e r n a l food relevant cues t r i g g e r eating responses i n obese subjects. Schachter and associates (1971) have done several studies showing that obese i n d i v i d u a l s are more responsive to external environmental food cues than normal weight i n d i v i d u a l s who are more responsive to i n t e r n a l physio-l o g i c a l cues. By manipulating perceived time with normal and obese sub^ j e c t s , i t was shown that obese subjects w i l l more l i k e l y eat i f environ-mental cues i n d i c a t e i t i s mealtime while normal weight subjects tend to be guided by i n t e r n a l cues to eat (Schachter & Gross, 1968). Obese sub-j e c t s who thought i t was not yet time to be hungry ate l e s s than those who thought i t was time to eat, while non-obese subjects ate l e s s when they, believed t h e i r dinner hour had a r r i v e d though i t had not. In two separate studies, Ross and Johnson (c i t e d by Stuart & Davis, 1972, p. 47) studied the eating behavior of obese and non-obese i n d i v i d u a l s when food was highly v i s i b l e . Each study manipulated the v i s i b i l i t y of food through c o n t r o l l i n g the amount of i l l u m i n a t i o n i n which i t could be viewed or through wrapping the food i n transparent rather than non-trans-parent paper. Each study experimentally v a l i d a t e d the supposition that the v i s i b i l i t y of food i s a greater influence on the behavior of obese as opposed to non-obese persons. A study by Nisbett (1968) also supports the notion that obese persons are more subject to the influence of food cues than are non-obese persons. Both Ferster et. a l . (1962) and Goldiamond (1965) have pointed out that eating behavior occurs i n a wide range of s i t u a t i o n s and i s under the contr o l of many s t i m u l i other than those p h y s i o l o g i c a l cues causing hunger. Thus there i s a need to examine antecedent d i s c r i m i n a t i v e s t i m u l i a f f e c t i n g food consumption. Programs should a s s i s t i n d i v i d u a l s intervene between prevalent food cues and subsequent inappropriate eating responses. As the person w i l l be c o n t i n u a l l y faced with these food cues i n the environment, programs should include stimulus co n t r o l t r a i n i n g . Stuart and Davis (1972) suggest a v a r i e t y of s p e c i f i c suggestions to help the person reduce h i s v u l n e r a b i l i t y to food cues and to develop alternate non-eating responses to these s t i m u l i . Other studies have outlined procedures to reduce the strength of antecedent s t i m u l i that lead to eating including techniques f o r food buying, st o r i n g , preparing, serving and eating (Hagen, 1974; Ferster, Nurmberger & L e v i t t , 1962). Consequent Control of Behavior The second major cla s s of v a r i a b l e s i s con t r o l of the consequences of behavior. One of the major d i f f i c u l t i e s i n implementing change i n be-haviors such as eating, smoking, drinking, and drug taking r e l a t e s to the consummatory nature of the response to be eliminated. The p o s i t i v e conr sequence of consuming the food i s immediate whereas the p o s i t i v e conse-quence of r e s t r a i n i n g (weight loss) i s f a r removed from the moment of eat-23. ing and the distant p o s i t i v e consequences of r e s t r a i n i n g . Studies have considered the effectiveness of therapist reinforcement, group support by others i n the program, environmental and s o c i a l r e i n -forcement outside the program and self-administered reinforcement. Rein-forcement has been used for actual weight loss and for d a i l y improvements i n eating and exercise behaviors. Wollersheim (1970) found that c l i e n t s who received therapist and-group s o c i a l reinforcement for weight loss l o s t more weight than c l i e n t s given non-specific treatment, t r a d i t i o n a l i n s i g h t therapy or no treatment at a l l . Penick, F i l i o n , Fox and Stunkard (1971) also used therapist and group s o c i a l reinforcement to achieve weight l o s s . Group reinforcement may be important for some i n d i v i d u a l s . However, a d i f f i c u l t y a r ises when the program i s over and the i n d i v i d u a l i s l e f t on h i s own to maintain the new behavior. Other studies have included the disbursement of tangible rewards such as tokens, previously deposited valuables and money. Reinforcement for weight loss r e s u l t s i n r e l a t i v e l y rapid i n i t i a l losses ( H a l l , 1973; Harris & Bruner, 1971). Harmatz and Lapuc (1968) found that paying subjects con-tingent on weight loss was e f f e c t i v e for i n i t i a l l o s s . Other studies f i n d -ing success i n the use of tangible rewards included work done by Mann (1972) who repaid subjects with deposited money and H a l l (1972) who paid subjects from a research grant. However, these studies discovered problems. Mann (1972) found that patients resorted to d i u r e t i c s , s t a r v a t i o n and induced vomiting to reach goals. D i f f i c u l t i e s also arose with lack of maintenance once the program was completed. Thus s o c i a l and tangible reinforcement i s u s e f u l to produce i n i t i a l weight loss but e f f e c t s achieved during the pro-24. gram are not always maintained a f t e r the program i s . completed. The second c r i t i c a l area of consequent co n t r o l i s environmental s o c i a l reinforcement. Maintenance of weight loss might be improved i f people im-portant to the p a r t i c i p a n t a c t i v e l y r e i n f o r c e ? h i s - e f f o r t s , to lose weight. Stuart and Davis (1972) discuss the importance of getting help from loved ones. Mahoney (1973) instructed subjects to ask family and friends not to c r i t i c i z e them about t h e i r weight loss program. Mahoney and Mahoney (1975) trained p a r t i c i p a n t s ' f a m i l i e s i n s o c i a l reinforcement. Family support cor-re l a t e d strongly with success i n weight l o s s . However, i t i s very d i f f i c u l t to c o n t r o l the responses of s i g n i f i c a n t others i n the natural environment. More work i s necessary to help the person re-program h i s immediate s o c i a l environment so as to reinfor c e behaviors leading to weight loss and main-tenance of weight l o s s . Self-reinforcement i s the other strategy of consequent c o n t r o l . Some research projects report that addition of self-reinforcement improved be-havior change programs (Jackson & Van Zoose, 1972; Mahoney, Moira & Wade, 1973). Mahoney (1974) found self-reinforcement for weight loss more e f f e c -t i v e than e i t h e r self-monitoring alone or no treatment. He also found self-reinforcement for s p e c i f i c habit improvement more e f f e c t i v e than s e l f -reinforcement for weight l o s s . He found better maintenance at one year follow-up for those people who had used self-reinforcement for improvement of d a i l y eating habits. J e f f r y (1973) r e p l i c a t e d these fin d i n g s . Aversive Control Aversive control i s used to eliminate a response. However, the goal i n obesity control i s not elimination of eating but reduction of the c a l -25. o r i c intake. Procedures to increase appropriate eating and exercise be-haviors rather than punishment should be stressed. Complications i n the use of aversive c o n t r o l a r i s e as the p a r t i c i p a n t may have d i f f i c u l t y i n applying procedures c o n s i s t e n t l y . Aversive control may heighten anxiety and inappropriate eating may increase as a r e s u l t . Abramson reviewed pun-ishment or avoidance conditioning techniques used to eliminate inappropri-ate eating . He wrote, " I t appears safe to conclude that despite some early enthusiasm, there i s l i t t l e evidence to i n d i c a t e that aversive pro-cedures are an e f f e c t i v e treatment for obesity" (1973, p. 548) . Self-Monitoring Self-monitoring i s another behavior management technique used exten-s i v e l y i n weight co n t r o l studies. Self-monitoring has been used to c o l l e c t data on weight changes, eating habits and p h y s i c a l a c t i v i t y . I t may be im-portant that self-monitoring i s directed towards s p e c i f i c goals but goal s e t t i n g has not received much experimental attention. Bandura (1969) showed i t i s important to ensure that terminal goals are r e a l i s t i c and broken down int o smaller goals so progress can be measured and reinforced. Self-monitoring may help the learner be more aware of h i s eating and exercise habits. I t may act as a reminder that progress i s not being made and may also r e i n f o r c e any progress that i s occurring. Kanfer and Goldstein describe self-monitoring as a " t o o l that i s not s u f f i c i e n t l y powerful f o r use as a primary v e h i c l e for l a s t i n g behavior change but which can be used su c c e s s f u l l y to increase the c l i e n t ' s motivation for change" (1975, p. 328) . Simply recording a behavior may influence i t s occurrence (Kazdi'n, ' 1974) . However, t h i s reactive e f f e c t i s v a r i a b l e and transient (Thorensen & Mahoney, 26. 1974). Stuart (1971) found self-monitoring useful f or i n i t i a l loss only, a f i n d i n g r e p l i c a t e d by Mahoney (1974) and Mahoney, Moura and Wade (1973). In summary the major f i n d i n g about self-monitoring i s that i t needs to be used i n combination with other techniques. Effectiveness of Behavioral Programs Versus Other Programs Reviews of obesity treatment (Stuart & Davis, 1972; Stunkard, 1972; Stunkard & Mahoney, 1976) conclude that behavior modification techniques are e f f e c t i v e . Stuart's r e s u l t s (1967) were f a r better than any reported (80 percent l o s t 20 pounds or more, 30 percent l o s t 40 pounds or more). Previous research reviews (Stunkard & McLaren-Hume, 1959) reported 25 per-cent of subjects l o s i n g 20 or more pounds and 5 percent l o s i n g 40 or more pounds. Furthermore, high a t t r i t i o n occurred i n p s y c h o l o g i c a l l y based pro-grams with 20 to 80 percent of patients abandoning programs before comple-t i o n (Stunkard, 1959). L e v i t z and Stunkard (1974) compared four groups over a three month treatment program. Behavior modification produced s i g -n i f i c a n t l y lower a t t r i t i o n rates and greater weight losses than did the other treatment methods. A f t e r nine months, differences among treatments were even greater. Wollersheim (1970) reported s i g n i f i c a n t differences between groups of college students who were taught self-management techniques and those who served as no contact control subjects or who received other treatments. Bellack et. a l . (1974) also found the behavioral management contact group more e f f e c t i v e than a no contact group. Two other studies (Harmatz & Lapuc, 1968; Harris, 1969) point to the p o t e n t i a l effectiveness of using l e a r n -ing p r i n c i p l e s i n the treatment of obesity. A study by Penick et. a l . (1971) adds support to the view that behavior management techniques rep-resent a s i g n i f i c a n t advance i n the treatment of obesity. His findings are for only three months compared to Stuart's (1967) success on a year long program. However, the weight losses reported by Penick et. a l . are even greater than those reported by Stuart a f t e r only three months. A l -though the exact u t i l i t y of various techniques have yet to be i d e n t i f i e d , there can be l i t t l e doubt that eating and exercise habits can be viewed as behavior amenable to change through a p p l i c a t i o n of strategies based on p r i n c i p l e s of learning. Problems Remaining i n Behavioral Management Programs Even though weight control has been achieved through behavioral man-agement, problems with maintenance of weight loss s t i l l e x i s t . Treated groups usually show weight increases a f t e r the program i s completed (Hagen, 1974; Wollersheim, 1970; Harris & Bruner, 1971). Behavior management success has so f a r occurred l a r g e l y during short periods of time. There i s a need for research with follow-up measurement at possibly s i x months and one year a f t e r the i n i t i a l program. I n s t r u c t i o n a l programs need to be designed to help p a r t i c i p a n t s maintain the weight loss a f t e r the program. Continued follow-up contact may be necessary to help i n d i v i d u a l s maintain weight loss over time. A second problem i s the wide i n d i v i d u a l v a r i a t i o n i n responsiveness to behavioral treatment programs. Individual differences are reported by Penick et. a l . (1971), Horan and Johnson (1971) and Mahoney (1974(a)). Re-search on obesity has i n many cases been with l i m i t e d populations such as college students (Harris & Bruner, 1971; H a r r i s , 1969; Wollersheim, 1970) 28. rather than with the middle-age;.adult i n whom the overweight problem i s prevalent. L i t t l e study has been done on p r e d i c t i n g which subjects w i l l be successful i n behavior management programs or on matching learners to s p e c i f i c behavior management str a t e g i e s or i n s t r u c t i o n a l programs. A t t r i t i o n i s the t h i r d major problem. Dropouts have been a problem for t r a d i t i o n a l programs i n weight co n t r o l and for those based on learning p r i n c i p l e s (Harris & Bruner, 1971). There i s a need for research on f a c -tors that cause p a r t i c i p a n t s to abandon the program. Research has i n d i -cated that subjects i n programs were more successful than subjects i n no program control groups (Wollersheim, 1970; Hagen, 1974; Ha r r i s , 1969; Harris & Bruner, 1971; Penick et. a l . , 1971; Stunkard & Mahoney, 1976). One of the f i r s t concerns i n program design i s getting the i n d i v i d u a l s to con s i s t e n t l y attend the program sessions. Research has been conducted to compare the effectiveness of behavioral management programs with no-program con t r o l groups and with programs based on other treatments. Behavioral programs have shown increased success over other treatments. Research on behavioral management of weight includes comparisons of d i f f e r e n t techniques including stimulus c o n t r o l , r e i n f o r c e -ment, aversion therapy and self-monitoring. There has been no clear e v i -dence supporting any one technique as superior on i t s own. Behavioral management has been found to be successful when the tech-niques are applied. Both the problem of i n d i v i d u a l v a r i a t i o n within groups and maintenance of the weight loss a f t e r the program may r e l a t e to the ex-tent that i n d i v i d u a l s apply behavior management techniques. A p p l i c a t i o n r e f l e c t s the extent to which they a c t u a l l y learn self-management theory and s k i l l s . Research should now focus on i n s t r u c t i o n a l components i n weight 29. cont r o l programs. E f f e c t i v e t r a i n i n g i n self-management may r e s u l t i n low-er a t t r i t i o n rates, decreased v a r i a b i l i t y i n success within groups and high-er success i n weight loss maintenance a f t e r program completion. Research i s needed to i d e n t i f y variables which predict success i n self-management weight control programs. The problems outlined i n weight control research suggest that further study i s needed i n the area of i n s t r u c t i o n i n s e l f -management s k i l l s so :that each p a r t i c i p a n t w i l l be able to su c c e s s f u l l y man-age weight control during and a f t e r a program. B. WEIGHT CONTROL INSTRUCTIONAL PROGRAM Curriculum Content L i t t l e information about curriculum content for behavioral-based weight control programs i s ava i l a b l e i n adult education or behavioral research l i t e r a t u r e . Thus t h i s study began with the design of an i n s t r u c t i o n a l pro-gram to teach p r i n c i p l e s of self-management as applied to changes i n eat-ing and exercise patterns. The objectives and a c t i v i t i e s designed f o r t h i s study are described i n Appendix A. One general d e s c r i p t i o n of curriculum content i s presented by Mahoney and Mahoney (1976). They recommend the following components for a maxi-mally e f f e c t i v e program. 1. A simple and portable self-monitoring system which emphasizes actual behaviors rather than weight (for example, eating habits, exercise, food relevant thoughts). 2. Basic information on n u t r i t i o n with an emphasis on the development of sound long-term eating patterns which permit weight co n t r o l without jeopardizing e s s e n t i a l nutrient intake (no crash d i e t i n g , no to-t a l l y r e s t r i c t e d foods). 30. 3. Instruction i n exercise management o u t l i n i n g the ph y s i o l o g i c a l assets of exercise and encouraging increases i n d a i l y energy output ( a c t i v i t y pat-terns) which are more l i k e l y to be maintained than c a l i s t h e n i c s . 4. Guided i n s t r u c t i o n i n the many facets of stimulus c o n t r o l as a means of regulating food intake. 5. I n i t i a l provision of therapist or group support with the magnitude and frequency of t h e i r r e i n -forcement gradually withdrawn as the i n d i v i d u a l continues progressing. 6. Training of spouses and other family members i n s o c i a l reinforcement strategies i n order to main-t a i n program-induced improvements. 7. Training i n modification of s e l f - d e f e a t i n g thought patterns and u n r e a l i s t i c performance standards. 8. Training i n development of broad problem-solving s k i l l s and the establishment of se l f - r e g u l a t e d incentive systems (tangible, self-reward, s e l f -praise) to enhance maintenance. The program designed f o r th i s study attempted to incorporate these guide-l i n e s and the behavioral approach described by Stuart and Davis (1972). Instructor/Helper Variables I n i t i a l t r a i n i n g i n self-management seems to require i n s t r u c t o r sup-port to help the i n d i v i d u a l b u i l d eating and exercise management s k i l l s . Kanfer and Goldstein describe the helper's r o l e as follows: 1. "Helping the i n d i v i d u a l e s t a b l i s h favorable condi-tions f o r carrying out a s e l f - c o n t r o l program and providing i n i t i a l reinforcement to a l t e r balance i n favor of changing the undesirable behavior (mo-t i v a t i o n ) . 2. Helping the i n d i v i d u a l acquire s p e c i f i c behavior change techniques that ease the process of change ( t r a i n i n g ) . 3. Reinforcing the c l i e n t ' s e f f o r t s and successes i n carrying out a self-management program (support and maintenance)" (1975, p. 317). 31. There has been l i t t l e systematic research into i n s t r u c t o r ' s e f f e c t i v e -ness i n behavioral programs for weight c o n t r o l . However, psychotherapy l i t e r a t u r e suggests there i s need for therapeutic and interpersonal s k i l l s i n conducting behavior change programs (Feske, Hunt, Luborsky, Orme, P a r l o f f et. a l . , 1970; Kanfer & Goldstein, 1975). The following i s a des-c r i p t i o n of s k i l l s needed by the helper or i n s t r u c t o r (Craighead, Kazdin & Mahoney). The helper needs to: be competent i n behavior management p r i n c i p l e s and knowledgeable about basic p r i n c i p l e s of n u t r i t i o n and exercise; have basic interviewing and interpersonal s k i l l s ; care about the c l i e n t and be s e n s i t i v e to the c l i e n t ' s needs at a l l times (1976, p. 413). Bellack et. a l . (1974) give support for the view that external control at some l e v e l i s necessary for the maintenance of s e l f - c o n t r o l . Their pro-gram emphasized r e l i a n c e on s e l f - c o n t r o l for behavior change with external control added to help maintain the use of self-management as opposed to pro-grams such as f i n a n c i a l contracting where external consequences are a p r i -mary aspect of the program. Kanfer and Karoly (1972) suggest that external control i s c r i t i c a l to maintenance of self-management. These r e s u l t s sug-gest that when self-management i s the primary focus, the presence or ab-sence of external control i s more important than the degree of external con-t r o l . P a r t i c i p a n t Variables Behavioral management procedures for weight control have been e f f e c -t i v e but a high degree of intra-group v a r i a b i l i t y has been evident (Penick et. a l . , 1971). L i t t l e attempt has been made to match subjects to t r e a t -32. merits or to design treatments f o r i n d i v i d u a l subjects. Abramson (1973), Bellack (1976), and H a l l and H a l l (1974) recommend e f f o r t s be directed to-wards i d e n t i f y i n g i n d i v i d u a l predictor variables to f a c i l i t a t e more e f f e c -t i v e subject-treatment match. K e i s l e r (1966) c r i t i c i z e d the use of post hoc c o r r e l a t i o n a l analysis of r e s u l t s involving variables such as age, sex, marital status, h i s t o r y of weight problem and d i e t i n g success. Instead he suggested the following procedure be used: 1. Identify s k i l l s or c h a r a c t e r i s t i c s necessary for a s p e c i f i c treatment procedure. 2. Select i n d i v i d u a l s independently assessed as d i f -f e r i n g on those c h a r a c t e r i s t i c s . 3. Compare the performance of the groups on the target program. Comparisons should include treatment by subject i n t e r a c t i o n s and a study of the o v e r a l l treatment and subject differences. C. LOCUS OF CONTROL Locus of Control as a Generalized Expectancy One possible predictor of success i s a generalized b e l i e f i n Internal Locus of Control. Most subjects successful in: s e l f - m o d i f i c a t i o n of diverse behaviors were s i g n i f i c a n t l y more i n t e r n a l than were l e a s t successful sub-j e c t s (Schallow, 1975). Also, Internals were more successful i n l o s i n g weight than Externals (Balch & Ross, 1975; Manno & Marston, 1972). Lefcourt (1972) observed that the Internal i n d i v i d u a l i s l e s s subject to external sources of influence than i s the externally oriented i n d i v i d u a l . Best and Steffy (1975) explored t h i s suggestion i n a study on smoking be-havior. They suggest that programs i n smoking habit reduction should match 33. i n t e r n a l and external focused treatment to the respective i n t e r n a l and ex-t e r n a l o r i e n t a t i o n of the p a r t i c i p a n t s . I f a r e l a t i o n s h i p between Internal Locus of Control and weight loss during and a f t e r a night school program on self-management weight co n t r o l i s found, then i n s t r u c t o r s might attempt to modify i n s t r u c t i o n to match the i n d i v i d u a l ' s locus of control o r i e n t a t i o n . Reinforcement or reward i s c r u c i a l to the a c q u i s i t i o n and performance of s k i l l s and knowledge. However, an event regarded by some persons as a reward or reinforcement may be perceived d i f f e r e n t l y by others. One of the determinants of t h i s reaction i s the degree to which the i n d i v i d u a l per-ceives that the reward follows from and i s contingent upon his own behavior. Rotter (1966) hypothesized that Locus of Control i s of major s i g n i f i c a n c e i n understanding the nature of learning processes i n d i f f e r e n t kinds of learning s i t u a t i o n s . In Rotter's (1954) theory, the p o t e n t i a l f o r any be-havior to occur i n a given s i t u a t i o n i s a function of the person's expec-tancy that the behavior w i l l secure the a v a i l a b l e r e i n f o r c e r and depends also on the value of the a v a i l a b l e reinforcements for that person. This construct was developed as a generalized expectancy that r e l a t e s to wheth-er the i n d i v i d u a l believes that he possesses or lacks power over what hap-pens to him. Rotter, Seeman and Liverant define Internal-External Locus of Control as follows: "As a general p r i n c i p l e , then, i n t e r n a l control re-fers to the perception of p o s i t i v e and/or negative events as being a consequence of one's own actions and thereby under personal c o n t r o l . Whereas ex-t e r n a l control r e f e r s to the perception of p o s i t i v e and/or negative events as being unrelated to one's own behaviors i n c e r t a i n s i t u a t i o n s and therefore beyond personal c o n t r o l " (1962, p. 499). In Rotter's (1954, 1955, 1960) theory, a reinforcement acts to strength-34. en an expectancy that a p a r t i c u l a r behavior or event w i l l be followed by that reinforcement i n the future. Once an expectancy for such a behavior-reinforcement sequence i s b u i l t up, the f a i l u r e of the reinforcement to occur w i l l reduce or extinguish the expectancy. Expectancies generalize from a s p e c i f i c s i t u a t i o n to s i t u a t i o n s perceived as. re l a t e d or s i m i l a r . A generalized a t t i t u d e , b e l i e f or expectancy regarding the nature of the causal r e l a t i o n s h i p between one's own behavior and i t s consequences might a f f e c t a v a r i e t y of behavioral choices i n a broad range of l i f e s i t u a t i o n s . Such generalized expectancies i n combination with s p e c i f i c expectancies and the value of the p o t e n t i a l reinforcements act to determine an i n d i v i d u a l ' s choice of behaviors. Development of Tests to Measure Internal-External Locus of Control Phares (1957) used a L i k e r t format test with 13 external and 13 i n -t e r n a l a t t i t u d e statements. James (1957) revised Phares' test s t i l l using 26 items plus f i l l e r items based on the most successful items from Phares' t e s t . This James-Phares' test correlated s i g n i f i c a n t l y with the Incom-plete Sentences Blank personal adjustment score (Rotter, 1950) - extreme externals and i n t e r n a l s appearing le s s adjusted. In addition, the James-Phares' scale was found to c o r r e l a t e (r=.51, n=101) with the C a l i f o r n i a F scale. Both scales measure the degree to which i n d i v i d u a l s see the world as containing powerful forces they cannot influence. Liverant i n associa-t i o n with Rotter and Seaman (1962). undertook to broaden the t e s t , develop subscales and control for s o c i a l d e s i r a b i l i t y by construction of a new forced-choice questionnaire. The scale was item and factor analyzed and reduced from a 100 to a 60 item scale by Liverant on the basis of i n t e r n a l 35. consistency c r i t e r i a . Through item a n a l y s i s , they found that the subscales were not generating separate predictions; items to measure more s p e c i f i c sub-areas of Internal-External control were abandoned. This scale was eventually modified to a 29 item forced-choice test including s i x f i l l e r items. The items deal with the subject's b e l i e f about the nature of the world and h i s expectations about how reinforcement i s con-t r o l l e d . Thus the test i s considered as a measure of generalized expectan-cy. None of the items i s d i r e c t l y r e l a t e d to a preference for Internal ver-sus External c o n t r o l . Two further questions about the Internal-External scale have not been investigated i n any depth. These concern the o r i g i n s and.sources of Locus of Control o r i e n t a t i o n and operations for a l t e r i n g such orientations. A v a r i e t y of techniques (forced choice, Likert-type scales, t r u e - f a l s e scales, interview assessment, p r o j e c t i v e devices and performance measures drawn from Level of A s p i r a t i o n tasks) have been used to measure locus of c o n t r o l . Considerable research on diverse populations has demonstrated construct v a l i d i t y i n experimental and f i e l d s i t u a t i o n s (Lefcourt, 1966; Rotter, 1966). The most s i g n i f i c a n t evidence of the construct v a l i d i t y _. ... comes from predicted differences i n behavior for i n d i v i d u a l s above and be-low the median of the scale (Rotter, 1966). Internal consistency estimates are r e l a t i v e l y stable though.only moderately high. Test-retest r e l i a b i l -i t y f o r a one month period i s quite consistent i n two d i f f e r e n t samples. Rotter (1966) concludes that a generalized expectancy that one can a f f e c t the environment through one's behavior i s present and that i t can be re-l i a b l y measured. Although there has been much evidence supporting the v a l i d i t y of the 36. Rotter t e s t , there has also been c r i t i c i s m . Most research with Rotter's I-E scale has proceeded from the assumption that the scale measures are a unidimensional t r a i t . However, Mi r e l s (1970) i d e n t i f i e d two f a c t o r s : 1. Fatalism-belief that luck, fate or fortune versus hard work, a b i l i t y and personal re-s p o n s i b i l i t y determine one's outcomes. 2. S o c i a l System Control - b e l i e f concerning the extent to which the i n d i v i d u a l c i t i z e n can or cannot a f f e c t change within the socio-p o l i t i c a l realms of t h e i r society. Mirels suggests that predictions i n v o l v i n g the I-E scale might be sharpened by separate consideration of these two f a c t o r s . Reid and Ware (1973) also suggest I-E i s a multirdimensional construct. Mirels (1970) and Reid and Ware (1973) ask whether s e l f - c o n t r o l of impulses, desires and emotional behaviors i s part of the present two factor structure determined by Rotter's I-E construct. Or i s i t a t h i r d dimension of I-E? Reid and Ware (1973) suggest that the three dimensions are reasonably independent of one another. B e l i e f i n s e l f - c o n t r o l appears to d i f f e r from both b e l i e f i n chance determinants of one's outcomes and expectations of control by socio-p o l i t i c a l forces i n society. Rotter's scale might be measuring more d i r e c t l y the dimensions of f a t a l i s m and s o c i a l system control rather than s e l f - c o n t r o l . In the study conducted by Balch and Ross (1975) no s i g n i f i c a n t c o r r e l a t i o n s between I-E scores and either program 37. completion or weight loss success were found on e i t h e r of M i r e l ' s f a c t o r s . There i s no f i n a l r e s o l u t i o n of the question of whether the I-E scale meas ures: a unidimensional." t r a i t :-"generalized expectancy of reinforcement"-, or not. However, the research described i n t h i s paper considers the Rotter scale as measuring a unidimensional Internal-External locus of control construct. Internal-External Locus of Control and Weight Control Programs Behavioral weight reduction programs d i r e c t attention to the i n d i v i -dual 's a b i l i t y to modify external antecedents and consequences that a f f e c t eating and exercise patterns. Locus of Control has some p o s s i b i l i t y as a predictor of success i n a.-self-management weight co n t r o l program. .. The i n -t e r n a l l y oriented i n d i v i d u a l who believes he can c o n t r o l important aspects of h i s l i f e would be expected to be more successful than the e x t e r n a l l y oriented i n d i v i d u a l who believes that luck or fate are important determi-nants of h i s l i f e (Rotter, 1966). Balch and Ross (1975) found s i g n i f i c a n t c o r r e l a t i o n s between locus of c o n t r o l scores and both completion (measured as at least 75% attendance at the nine weekly meetings) and success (meas-ured as weight loss greater than eight pounds). Their findings suggest that the Locus of Control dimension as measured by Rotter's scale i s r e l e -vant and could be used to predict success i n a weight co n t r o l program base on t r a i n i n g the i n d i v i d u a l i n self-management s k i l l s r e l a t e d to eating and exercise patterns. The research described i n t h i s study was designed to further i n v e s t i -gate whether the Rotter I-E scale i s useful i n p r e d i c t i n g weight loss suc-cess for p a r t i c i p a n t s i n a p a r t i c u l a r self-management s k i l l s t r a i n i n g pro-38. gram and the r e l a t i o n s h i p between I-E score, two d i f f e r e n t i n s t r u c t o r f o l -low-up contact schedules and subsequent weight loss success of the p a r t i c -ipants i n the program. 39. CHAPTER III DESIGN AND METHODOLOGY OF THE STUDY A. INSTRUCTIONAL PROGRAM Program P a r t i c i p a n t s The program p a r t i c i p a n t s were 24 adult women (ages 19-65, mean 38.8 years), who registered for a Weight Control class i n a Vancouver School Board night school program i n the f a l l term of 1977. The course was ad-ve r t i s e d once i n the Vancouver Sun Newspaper, (August, 1977) as part .of the regular f a l l advertisement of Vancouver night school programs. Only women volunteered to p a r t i c i p a t e i n t h i s weight co n t r o l c l a s s . None were referred to the program for medical or other reasons, nor were people i n -d i v i d u a l l y r e c r u i t e d to the program, but responded only to the newspaper advertisement. This group may be more representative of the weight con-t r o l problem i n the adult community than are many weight control research groups of subjects r e c r u i t e d l a r g e l y from u n i v e r s i t y s e t t i n g s . When reg-i s t e r i n g for the c l a s s , p a r t i c i p a n t s were not aware they were p a r t i c i p a t i n g i n an experiment. No pre-requisites were required except p a r t i c i p a n t s were not to r e g i s t e r i f they knew they were pregnant. The weight co n t r o l i n s t r u c t i o n a l program was an eight week sequence of two hour group classes given one evening a week. The study included two classes running concurrently. The course was designed as an adult educa-t i o n a c t i v i t y and not as therapy. The night school centre provided a com-munity based s e t t i n g and a means of reaching a cross section of adults. However, t h i s d e l i v e r y format also constrained the study. The i n s t r u c t i o n -40. a l design had to f i t into a two hour weekly session. No external demands (such as refundable deposits for attendance) could be placed on p a r t i c i -pants. Nor could p a r t i c i p a n t s be assigned into a no-program c o n t r o l . A l l i n d i v i d u a l s registered f or the course paying the standard night course.fee of sixteen d o l l a r s . The i n s t r u c t o r was the experimenter, a female grad-uate student i n adult education who, together with a community n u t r i t i o n -i s t , had previously taught two other weight co n t r o l programs''" based on b a l -anced, nutritional^.planning and use of :behavioral management' techniques. Intake Session On the evening of the f i r s t c l a s s , the i n s t r u c t o r introduced the course objectives describing the behavioral management approach to weight control and the types of a c t i v i t i e s that would be used during the class (short l e c t u r e s , question and discussion periods, group a c t i v i t i e s , f i l m discussions, and homework assignments). The i n s t r u c t o r described her own personal i n t e r e s t and d i f f i c u l t i e s with weight c o n t r o l . The class was t o l d that perfect attendance was expected. The group was informed that, unlike most night school programs, t h i s course would include follow-up contact by the i n s t r u c t o r to determine the success each i n d i v i d u a l was having with weight loss goals. No e x p l i c i t information was given as to the nature and extent that t h i s follow-up contact would take. Af t e r i n i t i a l rapport was established between p a r t i c i p a n t s and the i n s t r u c t o r , each i n d i v i d u a l completed the Rotter and James I-E tests and a weight h i s t o r y questionnaire (see Appendix C). P a r t i c i p a n t s were i n -1. One at Simon Fraser Health Unit, Coquitlam, the second at the Coquitlam Recreation Centre. 41. formed that these "opinionnaires" would be used by the i n s t r u c t o r to de-termine differences between i n d i v i d u a l s i n the group. The i n s t r u c t o r would then use t h i s information i n planning learning a c t i v i t i e s f or t h i s p a r t i c -u l a r c l a s s . A f t e r these questionnaires were completed, each p a r t i c i p a n t was weighed and t h e i r weight recorded. The remainder of the f i r s t class was devoted to a lecture/discussion on the r e l a t i o n s h i p between eating and exercise balance and the importance of each i n d i v i d u a l assessing her own s p e c i f i c eating and exercise habits. The f i l m , Weight Control a Step  Away"*" was used to r e i n f o r c e ideas presented i n t h i s f i r s t c l a s s . The i n d i v i d u a l s were t o l d that overweight i s a r e s u l t of a prolonged p o s i t i v e energy balance r e s u l t i n g from inappropriate eating and exercise habits. The goal of the program was to teach new eating and exercise hab-i t s - so they could lose weight and maintain the l o s s . The intent of the course was to teach a systematic way to approach eating and exercise b a l -ance based on learning p r i n c i p l e s . This overview was presented during the f i r s t class and re^emphasized throughout the whole program. Program Continuation Classes two through eight followed a s i m i l a r format. As p a r t i c i p a n t s a r r i v e d for each session, they checked into the scale room where they were weighed by the i n s t r u c t o r i n t h e i r street clothing but without shoes, heavy sweaters or jackets. The i n s t r u c t o r recorded the weight and t o l d the i n d i -v i d u a l the net change from the previous weigh-in. Af t e r a l l p a r t i c i p a n t s 1. Informedia Production Ltd., Vancouver, B r i t i s h Columbia. 42. had been weighed, the i n s t r u c t o r went back to the classroom. Each class began with a b r i e f review of the weight control techniques introduced i n the previous session followed by questions and discussion on the homework assignment (see Appendix A) and d i f f i c u l t i e s encountered the previous week. Problems were analyzed on the basis of information provided from food-record d i a r i e s . The group was introduced to behavior management tech-niques of 1) stimulus c o n t r o l , 2) slowing down eating behavior, 3) s e l f -monitoring and 4) self-reinforcement. Each technique and the learning p r i n c i p l e s upon which i t was based was explained by the i n s t r u c t o r . Throughout the sessions, p a r t i c i p a n t s worked eit h e r alone or i n small groups on a c t i v i t i e s designed to have them analyze problems and suggest solutions. Problems employed were those raised by group members. In addition to t r a i n i n g p a r t i c i p a n t s to use behavior management tech-niques, a major emphasis was placed on n u t r i t i o n education. The program used the d a i l y food exchange system described by Stuart and Davis (1972). This food exchange system was introduced by a lecture followed by exercises where p a r t i c i p a n t s used t h e i r own food and a c t i v i t y records to determine actual and i d e a l d a i l y food exchange plans. The food exchange system was continually reviewed throughout the course. Self-monitoring charts were introduced during week two. P a r t i c i p a n t s used these charts and t h e i r own d a i l y food exchange goals as the d a i l y c r i t e r i a f o r measurement of success. Exercise and p h y s i c a l a c t i v i t y were also emphasized. Lectures and discus-sions were held on applying behavior management techniques to increase phy-s i c a l a c t i v i t y as well as to decrease food intake. However, no actual phy-s i c a l a c t i v i t y was included during the night school class i t s e l f . The pro-43. gram was oriented towards slow steady loss by making small d a i l y changes i n eating and exercise habits - changes that the i n d i v i d u a l would be able to maintain over time. Interaction was a major feature of the program as the group worked together throughout the classes while attempting to sug-gest behavior management techniques to solve s p e c i f i c problems encountered by the people i n the c l a s s . Follow-Up Contact A f t e r I n s t r u c t i o n a l Program The i n s t r u c t o r made telephone c a l l s to the i n d i v i d u a l s i n the four c a l l follow-up group at weeks three, eight, fourteen and twenty-one a f t e r the l a s t c l a s s . The second group received one i n s t r u c t o r follow-up t e l e -phone c a l l at week fourteen. Telephone contact was made i n the evening and included a b r i e f discussion about t h e i r present weight, weight loss success to date, and included encouragement and suggestions about s p e c i f i c d i f f i c u l t i e s encountered. A l l p a r t i c i p a n t s were i n v i t e d by mail to a follow-up session at the night school centre. This meeting was held s i x months a f t e r the f i n a l c l a s s . One person had dropped out of the program during the classes. One person was i n the h o s p i t a l and two people indicated they did not wish to attend. The three i n d i v i d u a l s who could not attend the follow-up session indicated that t h e i r weight was exactly the same as when they had started the program. The other people attended and t h e i r f i n a l weight score was recorded at that time. Eight people were interested i n meeting again. F o l -low-up meetings were held with these people for three more months. However, these sessions were outside the boundaries of the present study. 44. B. EXPERIMENTAL PROCEDURES Administration and Scoring of Internal-External Locus of Control Tests The Rotter and the James Internal-External Locus of Control tests were group administered by the researcher. The two night school classes were each tested separately during the second half-hour period of the f i r s t c l a s s . Testing was done i n the classroom. A l l scoring was done by an assistant who marked the t e s t s , recorded the scores and coded the groups. Throughout the study, the researcher remained b l i n d to the In-ternal-External scores of the p a r t i c i p a n t s . These two paper and p e n c i l tests were used to assess each p a r t i c i p a n t ' s r e l a t i v e score on an I n t e r n a l -External Locus of Control continuum. Assignment of . P a r t i c i p a n t s : t o Groups On the basis of t h e i r score on the Rotter scale, the 24 p a r t i c i p a n t s were divided into three equal groups of low, medium and high External Lo-cus of Control o r i e n t a t i o n . The scores on the James scale'were used to separate p a r t i c i p a n t s who had i d e n t i c a l scores on the Rotter scale. An equal number of p a r t i c i p a n t s from each locus of co n t r o l group was then randomly assigned by a coin toss into: e i t h e r the one telephone c a l l or four telephone c a l l follow-up group. A l i s t i n g of p a r t i c i p a n t s , t h e i r Rotter and James scores, and t h e i r assignment into Locus of Control and follow-up groups appear i n Appendix D. Record of Weight Control Success Weight scores were c o l l e c t e d at four d i f f e r e n t times: i n i t i a l c l a s s , f i n a l class at week eight, at a period fourteen weeks l a t e r , and 26 weeks 45. after, program completion. Weight measurements for the f i r s t c l a s s , f i n a l c l a s s , and follow-up meeting at week 26 were taken by the experimenter on the balance beam scale at the night school centre. The t h i r d weight meas-ure at fourteen weeks was self-reported by. the i n d i v i d u a l during the i n s t r u c t o r follow-up telephone c a l l . During the i n s t r u c t i o n a l program, each p a r t i c i p a n t had checked t h e i r own scale with t h e i r weight measured on the balance beam scale. This s e l f - r e p o r t measure was given i n terms of the equivalent weight score on the night school centre balance beam scale. Trust had been established between the i n s t r u c t o r and the p a r t i c i p a n t s , but one must assume that the s e l f - r e p o r t measures were given t r u t h f u l l y . Weight control was measured as the change i n the number of pounds and as change i n the percentage of body weight. Analysis of Weight Control Success 2x3 F a c t o r i a l Design on Weight Control Success Weight Loss: , LOW I-E , MED I-E HIGH I-E . Four C a l l Follow-up Single C a l l Follow-up : ; Percentage of Body Weight Lost: LOW I-E MED I-E HIGH I-E Four C a l l Follow-up Single C a l l Follow-up 46. A 2x3 analysis of variance design was used to analyze the differences between the mean weight loss of each group. The function of t h i s f a c t o r -i a l design was to explore the r e l a t i o n s h i p between Internal-External Loc-us of Control and success i n a weight control program, the r e l a t i o n s h i p between four c a l l follow-up and one c a l l follow-up schedules and subsequent success i n weight co n t r o l , and the i n t e r a c t i o n between Internal-External Locus of Control, i n s t r u c t o r follow-up and success i n weight co n t r o l . CHAPTER IV PRESENTATION OF THE DATA A. DESCRIPTION OF THE RESULTS OBTAINED FROM THE ANALYSIS OF VARIANCE The experimental phase of t h i s study was designed to test the r e l a -tionship between Locus of Control (low, medium, and high l e v e l s of ex-t e r n a l i t y ) , i n s t r u c t o r follow-up schedule (one telephone c a l l and four telephone c a l l s ) and success i n weight loss (pounds l o s t and percentage of body weight change) at four d i f f e r e n t times. In order to investigate these r e l a t i o n s h i p s , a 2x3 analysis of variance design with four repeated measures was employed. The r e s u l t s of the s t a t i s t i c a l analysis f or change of body weight (in pounds) are presented i n the following two tables. Table 1 presents mean weights for each group over the eight months l i f e of the study. Table 2 shows the r e s u l t s of s i g n i f i c a n c e tests among these means. F-values were calculated f or differences between the weight change means of each of the s i x c e l l s i n the 2 x 3 design. No s t a t i s t i c a l l y s i g n i f i c a n t differences i n weight change for the three I-E groups or for the two follow-up groups were found for any time period. Thus the data obtained does not .support the hypotheses about increased weight loss success for e i t h e r the low external locus of control group or for the four c a l l i n s t r u c t o r follow-up group. 48. TABLE 1 MEAN WEIGHTS IN POUNDS OVER .EIGHT MONTHS LOCUS High High Medium Medium Low Low OF External External External External External External CONTROL Marginal FOLLOW-UP One C a l l Four C a l l s One C a l l Four C a l l s One C a l l Four C a l l s September November March June Marginal 153.17 145.83 150.33 151.00 150.08 161.50 154.13 151.25 152.63 154.88 151.88 148.88 148.75 149.50 149.75 162.50 160.88 160.75 158.50 160.66 154.63 149.88 152.25 149.38 151.53 139.38 132.88 134.25 137.88 136.09 153.87 148.87 149.57 149.76 150.52 STANDARD DEVIATIONS September 25.47 19.97 22.91 24.14 15.10 17.52 November 24.02 16.65 22.24 27.22 12.48 19.10 March 19.14 18.68 22.01 26.06 12.53 19.50 June 25.06 23.77 20.57 27.91 13.34 20.90 49. TABLE 2 EFFECTS OF LOCUS OF CONTROL AND FOLLOW-UP SCHEDULES ON POUNDS CHANGE IN BODY WEIGHT (Analysis of Variance Summary Table) SOURCE S.S. df, MEAN SQUARE F. PROBABILITY (One T a i l ) Locus of Control 2245.44 1122.72 0.65 0.532 Follow-Up Schedule 0.17 0.17 0.00 0.992 Locus & Follow-Up 3015.01 1507.50 0.88 0.433 Error 20146.18 17 1714.48 Weight Change Over Time 353.15 117.72 7.40 0.000 Weight Change & Locus 65.13 10.86 0.68 0.665 Weight Change & Follow-Up 32.16 10.72 0.67 0.572 Weight Change, Locus & Follow-Up 119.81 19.97 1.25 0.295 Error 811.63 51 15.91 50. The r e s u l t s of the s t a t i s t i c a l analysis f o r change of body weight (in percentage of body weight change) are presented i n the next.:two tables. Table 3 presents mean percentage of body weight for each group over the 8 months of the study. Table 4 shows the r e s u l t s of the s i g n i f i c a n c e tests among these means. F-values were calculated f o r diffe r e n c e between the percentage of body weight means of each of the 6 c e l l s . No s t a t i s t i c a l l y s i g n i f i c a n t differences i n percentage body weight change were found for the two follow-up groups at any time period. The data about the percent-age of body weight change does not support the hypotheses that weight loss success w i l l be greater for ei t h e r the low external group or the four c a l l i n s t r u c t o r follow-up group. Thus the n u l l hypotheses were confirmed as follows: H Q There were no s t a t i s t i c a l l y s i g n i f i c a n t differences i n the average weight loss by the low external group as compared to the medium or high external group at any of the time periods. H Q There were no s t a t i s t i c a l l y s i g n i f i c a n t differences i n the average weight loss by the p a r t i c i p a n t s i n the four c a l l follow-up group as compared to those i n the one c a l l follow-up group. H Q When the average weight loss of low externals was compared to the average weight loss of ei t h e r of the other two I-E groups i n ei t h e r the one c a l l or four c a l l follow-up group, no s t a t i s t i c a l l y s i g n i f i c a n t differences were found. However, weight did d i f f e r s i g n i f i c a n t l y over the four repeated meas-ures; both for actual pounds l o s t (F=7.40, df=3, p ^.01) and for percent-age of body weight change (F=6.50, df=3, p<.01). The average weight loss at the end of the eight classes was 5.0.pounds or 3.2-percent of" body.' weight change. By the end of the 6 month follow-up period t h i s average weight loss dropped s l i g h t l y to 4.1 pounds or 2.64 percent of body weight 51. TABLE 3 MEAN PERCENTAGE OF BODY WEIGHT OVER EIGHT MONTHS LOCUS High High Medium Medium Low Low OF External External External External External External CONTROL Marginal FOLLOW-UP One C a l l Four C a l l s One C a l l Four C a l l s One C a l l Four C a l l s September November March June Marginal 100.00 95.30 98.73 98.70 98.18 100.00 95.60 93.68 94.28 95.89 100.00 98.03 98.00 98.67 98.66 100.00 98.78 98.78 97.30 98.71 100.00 97.13 98.63 96.73 98.12 100.00 95.23 96.33 98.93 97.62 100.00 196.73 97.30 97.37 97.85 STANDARD DEVIATIONS September .00 .00 .00 .00 .00 .00 November .17 2.02 1.58 2.35 4.42 4.22 March 4.00 3.30 2.61 2.51 3.91 7.62 June 1.04 5.43 2.75 4.53 3.75 9.36 52. TABLE 4 EFFECTS OF LOCUS OF CONTROL AND FOLLOW-UP SCHEDULES ON PERCENT OF CHANGE IN BODY WEIGHT (Analysis of Variance Summary Table) SOURCE S.S. •df. MEAN SQUARE PROBABILITY (One T a i l ) Locus of Control 4037.64 2018.82 0.60 0.559 Follow-Up Schedule 1904.73 1904.74 0.57 0.461 Locus & Follow-Up 2179.40 1089.70 0.32 0.727 Error 57010.74 17 3353.57 Weight Change Over Time 14613.84 4871.28 6.50 0.001 Weight Change & Locus 2284.84 380.81 0.51 0.800 Weight Change & Follow-Up 1674.11 558.04 0.74 0.531 Weight Change, Locus & Follow-Up 5854.54 975.76 1.30 0.274 Error 38244.86 51 749.90 53. change. Thus the weight loss program was successful but the losses were not d i f f e r e n t i a l l y predicted by locus of con t r o l scores or by i n s t r u c t o r follow-up contact schedules. B. DESCRIPTION OF THE RESULTS OBTAINED FROM THE MULTIPLE REGRESSION ANALYSIS Several variables have been suggested by other researchers as factors that may be important for successful weight l o s s . This study included an examination of the r e l a t i o n s h i p between a number of such factors and pre-d i c t i o n of weight loss success at the end of the i n s t r u c t i o n a l period and at the end of the s i x month follow-up period. The e f f e c t s of these s i t u a -t i o n a l and biographical variables on amount of weight loss were examined by means of multiple regression. The independent variables considered were Locus of Control score, follow-up contact group, number of sessions attended, i n i t i a l weight, night of class attended, age, whether overweight as a c h i l d , whether overweight as a teen, whether one parent was overweight, whether both parents were overweight, and height. Table 5 presents a summary of t h i s data at the end of the eight week i n s t r u c t i o n a l program. Only attendance rate was s t a t i s t i c a l l y s i g n i f i c a n t i n p r e d i c t i n g weight loss (F=4.5, d f = l l , p ^ . 0 1 ) . The Beta score for attendance indicates that each session attended resulted i n a .52 pound weight l o s s . Table 6 outlines a s i m i l a r summary, but at the end of the s i x month follow-up period. At the end of that period, none of the variables c o r r e l a t e d with f i n a l weight beyond a chance l e v e l of .05. When a l l eleven variables were forced into the equation to predict weight 2 loss at the completion of the eight week course, they yielded an R of .49. By the end of the eight month follow-up, t h e i r p r e d i c t i v e power had 2 dropped to an R of .38. 54. TABLE 5 PREDICTION OF WEIGHT LOSS SUCCESS BY END OF ".THE EIGHT .WEEK INSTRUCTIONAL PROGRAM (Multiple Regression Summary Table) Cumulative R2 Simple r Beta F. to enter Locus of Control .02 Follow-Up Schedule .02 Attendance Rate .20 I n i t i a l Weight .20 Night of Class .22 Age .22 Overweight as a Child .23 Overweight as a Teenager .25 One Parent Overweight ,41 Both Parents Overweight .41 Height ,49 ,14 ,04 ,40 ,07 ,18 ,07 .12 .04 .41 .24 .23 ,19 ,18 ,52 .31 .26 ,07 ,02 .16 .49 .12 .39 .573 .439 4.564 1.108 .647 .040 .184 .134 2.704^ .172 1.750 S i g n i f i c a n t at .01 Level. 55. TABLE 6 PREDICTION OF WEIGHT LOSS SUCCESS AT END OF SIX MONTH FOLLOW-UP .PERIOD (Multiple Regression Summary Table) Cumulative R2 Simple r Beta F. to enter Locus of Control .02 Follow-Up Schedule .03 Attendance Rate .16 I n i t i a l Weight .16 Night of Class .17 Age .17 Overweight as a Chi l d .18 Overweight as a Teenager .21 One Parent Overweight ,32 Both Parents Overweight .35 Height .38 .15 .10 .35 .10 .07 .04 .11 .06 .36 .38 .05 .16 .08 .29 .04 .14 .29 .16 .05 .40 .25 .21 .324 .070 1.169 .017 .157 .591 .091 .012 1.464 .582 .403 Figure 1. WEIGHT LOSS SUCCESS IN POUNDS LOST AT THREE TIME PERIODS -CD. cn CD CO CO CO CD CD rH rH rH rH CO rH rH rH rH CD rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH H •H CO n) rH rH cO cd cd crj rH rH CO CO CO CO cO cO a o a CJ cO cd a O a a cO CO O CJ CJ CJ O CJ O u o CJ rH <r rH <r rH <r rH <r rH <r rH <r rH 1 i 1 1 rH 1 1 1 1 rH <T 1 1 | 1 1 1 • • • • 1 1 • • • • | 1 • . • • • • 4J 4-1 4J • 4J 4J 4-1 4-1 • 4-1 4-) 4-1 4-1 4-1 4J X X X X 4-1 4-1 . X X X X 4-1 4-1 X X X X X w w w w X X w w w w ' X X w w W" w w w w w w W • • x: • • rC ^ * '• rC & :s XI X) 0 0 6 0 6 0 6 0 & IS X) XI 6 0 6 0 o o QJ •H -H o o cu. a; •H -H o o cu CU •H •H g g tc in rJ rJ g g EC EC • J g g EC EC Figure 2. WEIGHT LOSS SUCCESS IN POUNDS AND PERCENT BODY WEIGHT CHANGE OVER FOUR REPEATED MEASURES' 8 Weeks 22 Weeks 34 Weeks M.E. L.E. H.E. Medium Externals Low Externals High Externals 58. C. SUMMARY OF THE RESULTS Figure 1 presents a summary of weight loss success i n pounds l o s t by each of the s i x groups at three time periods. These three time periods are: 1) at the end of the 8 week i n s t r u c t i o n a l program, 2) 22 weeks a f t e r the beginning of the program, 3) 34 weeks a f t e r the beginning of the program. Figure 2 gives a v i s u a l presentation of the weight loss success i n both pounds l o s t and percent body weight change over the 4 repeated meas-ures of the 8 month l i f e of the study. Twenty-three p a r t i c i p a n t s (one i n d i v i d u a l l e f t town a f t e r the second class) were divided on the basis of I-E scores into low, medium, or high external groups. One-half of each of these I-E groups was randomly assigne into e i t h e r one c a l l or four c a l l follow-up groups. While the high externals i n the four c a l l follow-up condition were the most successful weight l o s e r s , t h e i r weight losses were not s i g n i f i c a n t l y d i f f e r e n t from weight losses of the other f i v e treatment conditions (each I-E group compared i n both follow-up conditions). None of the d i f f e r ences proved s t a t i s t i c a l l y s i g n i f i c a n t at the .05 l e v e l and none of the three n u l l hypotheses could be rejected. When eleven variables were forced into a multiple regression equation attendance rate was the one sin g l e v a r i a b l e found to be s t a t i s t i c a l l y s i g -n i f i c a n t i n p r e d i c t i n g success i n weight loss and then only at the end of the 8 week i n s t r u c t i o n a l program. By the end of the follow-up period, none of the i n d i v i d u a l v a r i a b l e s correlated with f i n a l weight beyond a chance 59. l e v e l . C o l l e c t i v e l y these eleven v a r i a b l e s accounted f o r 49 percent of the variance. This dropped to 38 percent by the end of the 6 month f o l -low-up period. The o v e r a l l change of weight was s t a t i s t i c a l l y s i g n i f i c a n t both at the end of the eight week i n s t r u c t i o n a l program and at the end of the s i x month follow-up period as shown by a repeated measures analysis of variance . te s t . P a r t i c i p a n t s did a l t e r t h e i r weight score s i g n i f i c a n t l y , but i t was not possible to predict success on the basis of Locus of Control score or follow-up contact schedules. The average subject l o s t 5.0 pounds at the end of the 8 week program which amounted to a 3.27 percent reduction of body weight. The average subject managed to maintain a loss of 4.1 pounds by the end of the s i x month follow-up period or 2.64 percent reduction of body weight. 60. CHAPTER V CONCLUSIONS, DISCUSSION, AND RECOMMENDATIONS FOR FUTURE RESEARCH A. CONCLUSIONS The following conclusions were derived from the r e s u l t s of the present study: 1. It was not possible to predict weight loss on the basis of Locus of Control scores, number of telephone c a l l s received a f t e r the classes, or from i n t e r a c t i o n e f f e c t s of Locus of Control scores and follow-up c a l l s . 2. P a r t i c i p a n t s were s i g n i f i c a n t l y l i g h t e r both at the end of the eight week i n s t r u c t i o n a l program (down 5.0 pounds or 3.27 percent reduction of body weight) and at the end of the s i x month follow-up period (down 4.1 pounds or 2.64 percent reduction of body weight). This weight loss was s t a t i s t i c a l l y s i g n i f i c a n t at the .01 l e v e l both f or pounds l o s t (F=7.40, df=3, p <.01) and for percent weight change (F=6.5, df=3, P <01). 3. Par t i c i p a n t s who attended more i n s t r u c t i o n a l sessions l o s t more weight by the end of the eight week classes than did p a r t i c i p a n t s who attended fewer sessions. This difference was s t a t i s t i c a l l y s i g n i f i c a n t (F=4.5, d f = l l , p <^.01). Each session attended resulted i n an average weight loss of .52 pounds. However, by the end of the s i x month follow-up period, attendance rate at the classes was no longer a s i g n i f i c a n t pre-d i c t o r of weight loss. 61. B. DISCUSSION Even though p a r t i c i p a n t s did lose a s i g n i f i c a n t amount of weight and maintained the loss over s i x months, the three hypotheses of t h i s study were a l l refuted. The f i r s t hypothesis that: there i s a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the average weight loss by the low external group as compared to the medium or high external group at any of the time periods could not be tested because of no o v e r a l l s i g n i f i c a n c e due to Locus of Control and thus, the n u l l hypothesis (of no e f f e c t ) remains i n force. As t h i s program was designed to i n s t r u c t each i n d i v i d u a l i n the use of behav-i o r management techniques, each person was-expected to set up and main- •  ' t a i n her own weight control program. The study attempted to explore wheth-er a low External score on the Rotter Internal-External Locus of Control test disposed i n d i v i d u a l s attending t h i s adult education course towards greater weight loss success both during the program and a f t e r the classes were completed. The i n d i v i d u a l s with low external locus of co n t r o l scores did lose a s i g n i f i c a n t amount of weight over the four repeated measures. Most of the weight loss occurred during the 8 week i n s t r u c t i o n a l period. However, i n -dividuals i n the other.groups also l o s t a s i g n i f i c a n t amount of weight dur-ing the program and managed to maintain the weight loss achieved. Three possible reasons why low External Locus of Control score was not able to predict success at a s t a t i s t i c a l l y s i g n i f i c a n t l e v e l when the weight loss of low Externals was compared to that of ei t h e r medium or high Externals are presented below: 62. 1. The sample of 23 people divided into three groups may have been too small f or a s i g n i f i c a n t difference of weight loss to be discerned between the low, medium, and high external Locus of Control groups. 2. Generalized Locus of Control may be a construct useful i n p r e d i c t i n g weight loss success, but the Rotter I-E test may not be an adequate instrument to measure Locus of Control including b e l i e f about person-a l s e l f - c o n t r o l and the a b i l i t y to make l i f e s t y l e changes. Instru-ments such as the Self-Control P o t e n t i a l Scale (Stuart, 1978, p. 58) may be more e f f e c t i v e i n p r e d i c t i n g success i n weight loss than was the Rotter I-E test used i n t h i s study. 3. Generalized Locus of Control may not be a construct useful i n p r e d i c t -ing weight loss success. The second n u l l hypotheses was retained as follows: there was no s t a t i s t i c a l l y s i g n i f i c a n t difference i n the average weight loss by p a r t i c i p a n t s i n the four c a l l follow-up group as compared to those i n the one c a l l follow-up group. This study was conducted as part of a night school program and constrained by the type of on-going attendance beyond regular classes that could be ex-pected from a l l p a r t i c i p a n t s . The experimenter decided to test the e f f e c t -iveness of two telephone follow-up contact schedules on on-going success i n weight co n t r o l . The o v e r a l l weight change for a l l groups both at the end of the program and at the end of the s i x month follow-up period was found to be s t a t i s t i c a l l y s i g n i f i c a n t , but i t was not possible to d i f f e r e n t i a l l y predict weight loss on the basis of the d i f f e r e n t telephone follow-up schedules. Four possible reasons why i t was not possible to predict weight loss 63. success on the basis of the four c a l l contact schedule are outlined below: 1. A l l p a r t i c i p a n t s knew that the i n s t r u c t o r would contact them at a l a t e r date and that they would be i n v i t e d to a follow-up meeting of the whole group. Expectation of follow-up contact may have been im-portant f o r some i n d i v i d u a l s i n both groups regardless of number or timing of telephone c a l l s received. 2. Some of the learners may have had success because of t h e i r own high commitment to weight l o s s . Some of these highly motivated i n d i v i d -uals may have been present i n each group thus moderating any d i f -ference i n success between the one c a l l and four c a l l follow-up groups. 3. It could be that the two telephone contact schedules were not d i f -ferent enough to r e s u l t i n a s i g n i f i c a n t difference i n maintenance of weight loss success between the two groups. 4. Perhaps follow-up contact schedules need to be much more regular and sustained i n order for continued weight loss to occur. The t h i r d n u l l hypothesis was also confirmed: when the average weight loss of low externals was compared to the average weight loss of eit h e r of the other two I-E groups i n eit h e r the one c a l l or four c a l l follow-up group, no s t a t i s t i c a l l y s i g -n i f i c a n t difference was found. As the i n s t r u c t i o n a l program focused on teaching self-management s k i l l s r e l a t e d to eating and exercise c o n t r o l , i t was suggested that those i n d i -viduals with high Internal Locus of Control b e l i e f would be more success-64. f u l i n developing and using these self-management s k i l l s to lose weight than would groups with low or medium Internal Locus of Control scores. However, i t was the high Externals i n the four c a l l follow-up group that l o s t a greater number of pounds when compared to any of the other groups i n e i t h e r follow-up condition. They were the only group that continued to lose weight a f t e r the i n s t r u c t i o n a l sessions, but the difference was not found to be at a s t a t i s t i c a l l y s i g n i f i c a n t l e v e l . If further inves-t i g a t i o n were conducted using a more sustained and regular i n s t r u c t o r con-tact schedule, then i t would be worthwhile to test again for the i n t e r -action e f f e c t between Internal-External Locus of Control score, follow-up contact schedule and weight loss success. C. SUMMARY OF PROGRAM FINDINGS Even though weight loss was not predicted by locus of control scores, i n s t r u c t o r follow-up schedules, or i n t e r a c t i o n of locus of control and f o l -low-up contact, p a r t i c i p a n t s i n the program did lose weight at a s i g n i f i c a n t l e v e l and maintained the lo s s . Furthermore, those p a r t i c i p a n t s who attended more sessions l o s t s i g n i f i c a n t l y more weight during the eight week program than did people who attended fewer sessions. The average weight loss was 0.5 pound for each session attended. Most of the weight loss by p a r t i c i -pants was achieved during the 8 week i n s t r u c t i o n a l session period. It seems that the i n s t r u c t i o n a l program was e f f e c t i v e f or p a r t i c i p a n t s regardless of t h e i r generalized Internal-External Locus of Control score or follow-up contact schedule. No cl e a r conclusions can be drawn from t h i s study about why pa r t i c i p a n t s l o s t weight nor why those who attended more sessions l o s t s i g n i f i c a n t l y more weight than did p a r t i c i p a n t s who at-65. tended fewer sessions as the study did not d i r e c t l y test for the e f f e c t i v e -ness of t h i s p a r t i c u l a r i n s t r u c t i o n a l program. It may be that i n s t r u c t i o n i n self-management was e f f e c t i v e i n t r a i n i n g some i n d i v i d u a l s i n the s k i l l s of applying self-management techniques to eating and exercise habits. For other i n d i v i d u a l s , the important aspect may have been the external sup-port provided by the i n s t r u c t o r and group members during the program. A program that provides regular weigh-ins, i n s t r u c t i o n a l a c t i v i t i e s , and i n -structor and group support may lead to s i g n i f i c a n t weight loss f o r most p a r t i c i p a n t s . The r e s u l t s attained during t h i s program may be at t r i b u t e d to the effectiveness of the program or they may be the r e s u l t of p a r t i c i -pation i n a program regardless of i t s i n s t r u c t i o n a l effectiveness. Some ind i v i d u a l s may have been more highly motivated or committed to weight loss and demonstrated t h i s motivation by attendance and weight loss success, whatever the reasons, program attendance was associated with weight l o s s . As p a r t i c i p a n t s attending t h i s p a r t i c u l a r weight control program did a-chieve and maintain s i g n i f i c a n t success, further development and te s t i n g of the program seems warranted. D. RECOMMENDATIONS FOR FUTURE RESEARCH 1. The eight class i n s t r u c t i o n a l program used i n t h i s study should now be revised and tested again with a larger sample of p a r t i c i p a n t s and with evaluation of the i n s t r u c t i o n by pa r t i c i p a n t s and by outside e v a l -uators. 2. Regular and sustained follow-up contact schedules by eit h e r i n s t r u c -tor or group members should be designed and tested f o r effectiveness both during and a f t e r an i n s t r u c t i o n a l program. 66. 3. The program should be tested using d i f f e r e n t i n s t r u c t o r s . 4. Incentive plans to encourage attendance at classes (such as refundable deposits) should be tested. 5. Stuart's P o t e n t i a l f o r Self-Control test should be given along with the Rotter I-E Locus of Control t e s t . These tests should be assessed for t h e i r a b i l i t y to predict weight loss when p a r t i c i p a n t s are assigned to d i f f e r e n t conditions of follow-up contact and refundable deposit plan. Revision of the Eight Session I n s t r u c t i o n a l Program The eight i n s t r u c t i o n a l sessions should be evaluated by p a r t i c i p a n t s and by an external evaluator on the basis of the objectives and the e f f e c -tiveness of the i n s t r u c t i o n a l a c t i v i t i e s used to reach the objectives. This study did not include any formal evaluation of the effectiveness of each of the i n s t r u c t i o n a l sessions. However, now that the class has been used with two groups of learners, some improvements could be suggested. Certain areas of the program appeared to the instructor-researcher to have strength. These included: question and answer techniques based on p a r t i c i p a n t s ' experiences related to eating and exercise habits - regular check with each i n d i v i d u a l on problems she encountered the previous week group p a r t i c i p a t i o n i n presenting possible solutions to the problems ra i s e d by members of the class i n d i v i d u a l and group exercises on the di a b e t i c food exchange system f i l m presentations and discussions regular weigh-ins and charting of weight changes 67. continual review of behavior management p r i n c i p l e s with examples rel a t e d to i n d i v i d u a l s ' problems raised i n the cl a s s techniques for charting p o s i t i v e feedback for suc-cess including food d i a r i e s , food exchange charts, graphs. Areas that seemed weak to the instructor-researcher included i n s t r u c -t i o n i n how to: - v i s u a l i z e success change one's own s e l f - t a l k set up one's own support and reward system - change one's response to family and work pressures. Three a d d i t i o n a l questions should be addressed i n any r e v i s i o n : 1. What techniques would help i n d i v i d u a l s learn to i d e n t i f y and change p a r t i c u l a r l y d i f f i c u l t behav-i o r chains including eating binges and problem eating during times of emotional upset such as fear, anxiety, fatigue, boredom, anger? 2. How can an i n s t r u c t o r help people maintain i n t e r -est and motivation during f a i l u r e i n changing eating and exercise habits? 3. How can an i n s t r u c t o r help an i n d i v i d u a l choose what behavior management str a t e g i e s to use at d i f f e r e n t phases of her behavior management pro-gram? One assumption made i n the design of t h i s i n s t r u c t i o n a l program should be re-examined. It was assumed that people attending a night school class could not be expected to p a r t i c i p a t e i n a program past the i n i t i a l eight week sessions f o r which they registered. However, i t has been suggested i n weight co n t r o l research that programs of s i x months to one year are needed for weight loss programs to be e f f e c t i v e . The l o g i s t i c s of any study over t h i s extended time period pose problems i n research design, as 68. some p a r t i c i p a n t s w i l l l i k e l y leave the program. This, study used a mini-mal contact procedure assuming that a l l p a r t i c i p a n t s assigned to the four c a l l follow-up schedule would be w i l l i n g to p a r t i c i p a t e to that extent and therefore data could be gathered on a l l subjects. Even with t h i s l i m i t e d contact, two of the 23 people indicated that they had not l o s t weight and that they r e a l l y were not interested i n r e c e i v i n g any further telephone c a l l s . However, many people attending a night school program may be w i l l -ing to p a r t i c i p a t e i n follow-up sessions. The follow-up schedule should now be revised and should include more regular sustained contact for as long as the p a r t i c i p a n t i s i n t e r e s t e d i n p a r t i c i p a t i n g i n the weight con-t r o l program. In addition to t e s t i n g the program i n a night school centre, i t could be tested i n other settings as w e l l . The i n s t r u c t i o n a l program might be successful i f used with groups that are already established and operating such as TOPS or C a l o r i e Counters. Such groups are often looking for out-side resource assistance. It may be that group leaders could be trained to o f f e r the program themselves. In addition, groups might be organized through public health u n i t s , r e c r e a t i o n a l centres, community schools, med-i c a l c l i n i c s and h o s p i t a l s . Further r e v i s i o n could also be conducted to i n d i d u a l i z e portions of the program for self-study. Individuals using such packages could then attend seminars and receive support through t e l e -phone link-up. The obesity problem i s extensive i n our society. Behavior management approaches o f f e r the most optimism to date. This study included the de-sign of an i n s t r u c t i o n a l program i n weight control and showed that p a r t i -cipants l o s t weight and maintained t h e i r weight l o s s . Further r e v i s i o n s 69. and t e s t i n g of the program i n d i f f e r e n t settings with a larger sample seems j u s t i f i e d . D i f f e r e n t d e l i v e r y mechanisms could be used once the basic core i n s t r u c t i o n a l program i s refined and re-tested. Design and Testing of Follow-Up Contact Schedules A d i f f i c u l t y i s presented to anyone who wants to study follow-up con-tact schedules and that d i f f i c u l t y i s a t t r i t i o n . Some i n d i v i d u a l s w i l l not remain i n the program over a length of time. However, the major ques-t i o n i n weight co n t r o l research i s not whether to use follow-up contact but rather what type of follow-up to use and when. Questions that could be explored i n further research are outlined below: What Type of Contact? Is telephone contact adequate or i s personal con-tact necessary? If personal contact i s recommended should i t be with the i n s t r u c t o r or with group mem-bers? What Schedule of Contact? Should extra contact be av a i l a b l e between the week-l y class sessions during the i n i t i a l i n s t r u c t i o n a l sessions as w e l l as a f t e r the classes are completed? Should contact be d a i l y , two or three times a week, weekly or less often? Over what length of time should contact continue? What Should Be the Nature of the Contact? Should the focus be support, information, advice or reward for success? Who Should I n i t i a t e Contact? Should the i n s t r u c t o r i n i t i a t e a l l contact? Should the learner contact the instructor? Should group members share contact r e s p o n s i b i l i t i e s ? Should a pa r t i c i p a n t be encouraged to set up her own con-tact/support system with family or friends or other hopeful weight losers? 70. Testing of'Program with D i f f e r e n t Instructors The program should be tested using d i f f e r e n t i n s t r u c t o r s to determine i f the design can be e f f e c t i v e l y used by a v a r i e t y of i n s t r u c t o r s . The program design should be of use to i n s t r u c t o r s i n Public Health, Recreation Centres, Hospitals, Medical C l i n i c s and to i n s t r u c t o r s i n voluntary weight loss support groups. There may be a need for i n s t r u c t o r s to have c r e d i b i -l i t y as someone who has or s t i l l i s struggling with a weight control prob-lem. However, most people i n North America meet th i s c r i t e r i o n to some ex-tent. In order to test the program with various i n s t r u c t o r s i n d i f f e r e n t s e t tings, an i n s t r u c t o r o r i e n t a t i o n program to t r a i n p o t e n t i a l i n s t r u c t o r s would have to be designed and evaluated. Incentive Plan to Encourage Attendance For the purpose of t h i s study, i t was decided not to use refundable deposit schemes that have been found of some value i n other programs (Kingsley and Wilson, 1977). The only plan that would be considered by t h i s researcher would be a plan that included the c o l l e c t i o n of deposits from the p a r t i c i p a n t s which were then refundable on a weekly basis for at-tendance at the weekly i n s t r u c t i o n a l session. There are d i f f i c u l t i e s i n the administration of a refundable deposit scheme i n an adult education s e t t i n g . However, as such plans have been related to weight loss success i n other studies, i t does seem to be a program v a r i a b l e that deserves f u r -ther attention. If refundable deposits seem to be a c r i t i c a l v a r i a b l e leading to success i n weight l o s s , perhaps programs could o f f e r a deposit scheme as an option to p a r t i c i p a n t s . It has been suggested that deposit schemes work only for some i n d i v i d u a l s . Further i n v e s t i g a t i o n of the i n -71. t e r a c t i o n between locus of control and refundable deposit for attendance i s an area recommended' for further study. Internal-External Locus of Control and P o t e n t i a l for Self-Control Tests  and Weight Loss Success This study looked at the effectiveness of the Rotter I-E Locus of Control test as a predictor of weight loss i n t h i s program. The I-E test was not s t a t i s t i c a l l y s i g n i f i c a n t i n p r e d i c t i n g success e i t h e r at the end of the eight classes or at the end of the s i x month follow-up period. Further research should examine the i n t e r a c t i o n e f f e c t between Locus of Control tests and sustained i n s t r u c t o r contact and refundable deposit f o r attendance. If a s i g n i f i c a n t i n t e r a c t i o n i s found, then i n s t r u c t o r s could use these tests at the beginning of the program. The i n s t r u c t o r could then discuss the r e s u l t s with the learner and attempt to design an i n d i v i d u a l program which has enough support to help each i n d i v i d u a l increase the l i k e -lihood of achieving and maintaining weight loss success. E. RESEARCH DESIGN FOR FURTHER STUDY Ins t r u c t i o n a l Program as Part of Future Study The present research was conducted as a f i e l d study. This researcher recommends that any future research on weight control i n s t r u c t i o n a l pro-grams should a c t u a l l y include the presentation of an adult education course. Research could be conducted to investigate what s p e c i f i c condi-tions lead to improved performance for p a r t i c i p a n t s registered i n the course. In designing f i e l d experiments, c e r t a i n constraints must be con-sidered including the on-going v i a b i l i t y of the program as an adult educa-72. t i o n a c t i v i t y as well as the requirements of experimental design. Three problems described e a r l i e r should also be addressed i n any weight con-t r o l program design: 1. Individuals have shown v a r i a b l e success i n weight loss during programs. 2. A t t r i t i o n i s a major problem a f f e c t i n g weight loss success. 3. P a r t i c i p a n t s do not usually continue to lose weight once the i n s t r u c t i o n a l sessions are completed. As these factors suggest that p a r t i c i p a n t s should be given an oppor-tunity to p a r t i c i p a t e i n a program as long as the person chooses, the pro-gram design proposed for further research includes weekly sessions a v a i l -able on a continuous basis. D i f f e r e n t i n d i v i d u a l s w i l l lose weight at d i f -ferent rates and w i l l require d i f f e r e n t lengths of time to reach t h e i r goals. The i n i t i a l i n s t r u c t i o n a l program could s t i l l be eight sessions followed by further reinforcement sessions a v a i l a b l e on a weekly basis. Learners would decide whether to r e g i s t e r f or the next two months at the end of each eight week session. However, p a r t i c i p a n t s would also be allowed to attend on an occasional basis paying a weekly fee for each class attended. Programs would be offered year round. The i n s t r u c t i o n a l sessions would be two hours; the reinforcement sessions would be one hour i n length. A fee schedule would be calculated to cover i n s t r u c t i o n a l costs of the i n i t i a l two hour sessions, the one hour reinforcement session and telephone contact time. Groups would pay the same fee for each two month session regardless of t h e i r assignment into d i f f e r e n t i n s t r u c t o r contact conditions. Experimental Conditions If t h i s program were i n place, research could be conducted with the adult education classes on weight c o n t r o l . P a r t i c i p a n t s would s e l f - s e l e c t into a class on the basis of preferred class time and place. Each cl a s s would be randomly assigned into various conditions including: class with on-going mid-week i n s t r u c t o r telephone c a l l s or no telephone contact refundable deposit f o r attendance or no deposit plan d i f f e r e n t i n s t r u c t o r s . Each p a r t i c i p a n t would be given the Rotter I-E Locus of Control and the P o t e n t i a l f o r Self-Control tests at the f i r s t session. Each p a r t i c i p a n t assigned to the i n s t r u c t o r telephone contact condi-t i o n would receive two mid-week c a l l s by the i n s t r u c t o r . C a l l s would be approximately ten'minutes duration. C a l l s would commence during the f i r s t week of i n s t r u c t i o n and continue throughout each session f o r which the par-t i c i p a n t registered. The i n s t r u c t o r would continue telephone contact for one session (two months) past the l a s t session of r e g i s t r a t i o n but on a.once a week basis rather than twice a week. Pa r t i c i p a n t s i n the telephone con-tact group would receive a d e s c r i p t i o n of the contact schedule during the i n i t i a l i n s t r u c t i o n a l session. The refundable deposit f o r attendance scheme would be s i m i l a r to that described i n Kingsley and Wilson (1977). Each p a r t i c i p a n t would be asked to sign a contingency contract that s p e c i f i e d that attendance at seven of the eight i n s t r u c t i o n a l sessions would r e s u l t i n the refund of a set amount, with a d d i t i o n a l amounts refunded two months and s i x months a f t e r t h e i r f i -n a l r egistered session. A suggested amount would be $20 for attendance at i n i t i a l classes with $10 returned for each of the other weigh-in sessions. The same deposit plan could then be offered to these p a r t i c i p a n t s each time 74. they registered for the next two month period of weekly reinforcement sessions. However, a f t e r the f i r s t two months of classes, p a r t i c i p a t i o n i n the deposit plan would be a matter of choice for those i n d i v i d u a l s assigned to that p a r t i c u l a r group. Measurement would include weight loss and attendance rate taken each week of the program. Weight scores would also be recorded two months and s i x months a f t e r the p a r t i c i p a n t s ' l a s t r egistered session. P a r t i c i p a n t s would be t o l d i n advance that they would be contacted at these times to determine the extent to which they had been able to main-t a i n weight loss a f t e r the completion of the program. A summary of the weight loss r e s u l t s that might be expected from t h i s research design are outlined i n Appendix E. If future research finds d i f f e r e n t i a l r e s u l t s with either i n s t r u c t o r telephone contact on a regular basis or with a refundable deposit plan, then such components should be integrated into the design of weight con-t r o l i n s t r u c t i o n a l programs. Furthermore, i f d i f f e r e n t i a l r e s u l t s can be predicted on the basis of i n t e r a c t i o n of I-E Locus of Control or P o t e n t i a l for Self-Control test scores and either regular i n s t r u c t o r t e l e -phone contact or refundable deposit plan then these tests may be useful for i n s t r u c t o r s and p a r t i c i p a n t s . The tests could be used to suggest the extent of external support needed by d i f f e r e n t i n d i v i d u a l s so that pro-gram p a r t i c i p a t i o n helps each i n d i v i d u a l achieve su b s t a n t i a l r e s u l t s . F. SUMMARY The conclusions-from research designed'for-this study suggest that 75. attendance i n an i n s t r u c t i o n a l program on self-management s k i l l s f o r weight control can a s s i s t some i n d i v i d u a l s lose weight and maintain the loss over a s i x month period. As i n other research studies there was a v a r i a b l e amount of success by the p a r t i c i p a n t s . The study at-tempted to predict success on the basis of locus of control scores and on the extent of i n s t r u c t o r follow-up contact a f t e r the classes. A l -though p a r t i c i p a n t s did a l t e r t h e i r weight score s i g n i f i c a n t l y both at the end of the eight week i n s t r u c t i o n a l program and at the end of the s i x month follow-up period, i t was not possible to p r e d i c t success on the basis of either Locus of Control score or follow-up contact sched-ules . The program designed for the purpose of the study showed some i n i -t i a l promise as an e f f e c t i v e i n s t r u c t i o n a l program. However, the goal of i n s t r u c t i o n i s to help each p a r t i c i p a n t who r e g i s t e r s i n a weight con-t r o l c l a s s a c t u a l l y achieve and maintain his weight goal. 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Behavioral S e l f - C o n t r o l . New York: Holt, 1974. Throop, W.F. & MacDonald, A.P. "Internal-External Locus of Control: A Bibliography." Psychological Reports, Monograph Supplement, 1971, 1, 28, 175-190. Ullmann, L.P. & Krasner, L. (Eds.) Case Studies i n Behavior Mo d i f i c a t i o n . New York: Holt, 1965. Withers, R.F.L. "Problems i n the Genetics of Human Obesity." Eugenico  Review, 1964, 56, 81-90. Wollersheim, J.P. "The Effectiveness of Group Therapy Based Upon Learning P r i n c i p l e s i n the Treatment of Overweight Women." Journal of  Abnormal Psychology, 1970, 76, 3, 462-474. 83. APPENDIX A DESCRIPTION OF THE INSTRUCTIONAL PROGRAM Objectives of the Program 1. In a period of eight months, eight weeks during the i n s t r u c t i o n a l program and s i x months a f t e r , p a r t i c i -pants w i l l lose weight slowly and s t e a d i l y at the rate of 0.5 to 1 pound a week. 2. Once p a r t i c i p a n t s have reached t h e i r desired weight, they w i l l maintain t h i s weight f o r the duration of the s i x month follow-up period. •84. Week One Objectives: 1. In a group discussion, p a r t i c i p a n t s w i l l describe i n one sentence the rel a t i o n s h i p of food intake and a c t i v i t y i n successful weight c o n t r o l . 2. In a group discussion, p a r t i c i p a n t s w i l l l i s t four steps of Habit Con-t r o l including: describe present habits; set r e a l i s t i c goals; make s p e c i f i c plans to reach these goals; check up to>.see how you have done and rei n f o r c e on the basis of the success. 3. Given a sample weight record form, p a r t i c i p a n t s w i l l f i l l out a food r e -cord diary for each of the next seven days. 4. In a group discussion, p a r t i c i p a n t s w i l l describe the kind of weight loss they can expect i n t h i s weight control program based on gradual change of eating and exercise habits. Week One A c t i v i t i e s : 1. Introduce the course: - describe the objectives describe program a c t i v i t i e s describe i n s t r u c t o r ' s expectations of p a r t i c i p a n t s describe follow-up component discuss p a r t i c i p a n t ' s expectations of course. 2. Introduce the i n s t r u c t o r : background i n weight co n t r o l i n s t r u c t i o n previous experience i n weight c o n t r o l . 3. Introduce the questionnaires: James and Rotter questionnaires personal weight h i s t o r y questionnaire. 4. Record height and weight. 5. Introduce f i l m : Weight Control a Step Away-*-. 6. Conduct small group discussion on the f i l m . Reinforce how changes i n eat-ing and exercise habits are necessary i n order for weight loss to occur. 7. Introduce self-monitoring procedures: - discuss keeping records show how food diary record can be kept. 8. Review and check with p a r t i c i p a n t s on: - i n s t r u c t o r ' s expectations of p a r t i c i p a n t s - objectives and a c t i v i t i e s of i n s t r u c t i o n a l program p a r t i c i p a n t ' s expectations of course balance of eating and exercise for weight loss success importance of self-monitoring as f i r s t step. Informedia Productions Ltd., Vancouver, B.C. Canada 85. Week Two Objectives: 1. In a group discussion, p a r t i c i p a n t s w i l l describe the four major steps i n habit control as presented by the i n s t r u c t o r . 2. In a group discussion, p a r t i c i p a n t s w i l l describe two key factors i n weight control as emphasized i n the f i l m : Weight Control A Step Away. 3. In a group discussion, p a r t i c i p a n t s w i l l describe three major advantages of keeping a food record. 4. Given the Menu Planning Guide, Food.Exchange Charts and t h e i r own week's Personal Food Record Diary, p a r t i c i p a n t s w i l l t r a n s l a t e t h e i r own food records to the food exchange charts. 5. Given a food exchange guide and chart, p a r t i c i p a n t s w i l l keep a d a i l y record of the number of food exchange units they eat i n each of the food groupings for the next seven days. Week Two A c t i v i t i e s : 1. Record weight. 2. Review i n discussion format: two key factors i n f i l m : Weight Control a Step Away, four major steps i n habit, control advantages of keeping a food diary. 3. Lecture/discussion on the Food Exchange System. 4. Individual a c t i v i t y : t r a n s l a t e food records to exchange u n i t s . 5. Review and answer questions on: eating/exercise d i r e c t i o n s i n c l u d i n g : slow down eating, walk d a i l y , reduce fats and sugars, record everything that i s eaten use of Food Exchange units recording form. 86. Week Three Objeetives: 1. Given t h e i r own food exchange record charts for a week, a copy of the menu planning guide and a l i s t of d a i l y food exchange plans from Styart and Davis "Slim Chance i n a Fat World", p a r t i c i p a n t s w i l l set up t h e i r own sample d a i l y meal planning guide based on a.1200 or 1350 c a l o r i e ex-change system. Their sample guide w i l l i n d i c a t e the times of meals and snacks each day with the number of food exchanges to be eated at each time. 2. Given t h e i r own d a i l y meal planning guide and the menu planning guide, par-t i c i p a n t s will.>set up a sample menu for one day with s p e c i f i c foods (types and- quantities)>fch-at might; be'-eateri "at "each meal'and- snack."- • 3. In a group discussion, p a r t i c i p a n t s w i l l discuss recommended preparation methods f o r foods i n each of the food groups. 4. In a group discussion, p a r t i c i p a n t s w i l l describe three advantages of sche-duling meals and snacks on a regular b a s i s . 5. In a group discussion, p a r t i c i p a n t s w i l l discuss three advantages of using the food exchange chart and menu planning system for planning food intake. 6. Given a food exchange chart and menu planning guide materials, p a r t i c i p a n t s w i l l record the number of units i n each food group and the times they were eaten each day f o r each.of the next seven days. Week Three A c t i v i t i e s : 1. Record weight. 2. Question and answer period on the food exchange system. 3. Lecture/discussion on the importance of planning ahead times of meals and snacks food exchange units for each meal and snack. 4. As an i n d i v i d u a l exercise, i n d i v i d u a l s work out sample menu plans f o r e i t h e r the 1200 or 1350 food exchange plan. 5. Introduce f i l m : Man Was Made to Move. ^ 6. Discuss f i l m and the l i n k between phy s i c a l a c t i v i t y and weight c o n t r o l . 7. Review and answer questions.on: timing of meals and snacks planning food exchange units i n advance importance of recording exchange units weight control goals f o r t h i s week including: d a i l y exercise, slow down eating, reduce fats and sugars, record food exchange and j o t down notes on any trouble spots. 1. C a r i l l o n Audio-Visual Media, Amsterdam, Holland. 87. Week Four Objectives: 1. In a group discussion,.participants w i l l describe at least s i x benefits of regular physical a c t i v i t y . 2. In a group discussion, p a r t i c i p a n t s w i l l be able to describe at least, ten p h y s i c a l a c t i v i t y options they have. From a set of handouts, they w i l l describe how many c a l o r i e s would be burned i n ten minutes of each a c t i v i t y . 3. During the next week, pa r t i c i p a n t s w i l l record t h e i r d a i l y exercise ac-t i v i t i e s . 4. In a group discussion, p a r t i c i p a n t s w i l l describe the d a i l y food plan and how to choose food options within each food group/ 5. In a group discussion, p a r t i c i p a n t s w i l l l i s t at least three benefits of slowing down eating and describe three ways to help them slow down t h e i r eating. 6. Given information on c a l o r i e s eaten during one week, p a r t i c i p a n t s w i l l c a l c u late how one inappropriate "binge" can mean weight gain. 7. In a group discussion, p a r t i c i p a n t s w i l l describe how f a t change.can.be affected by menstrual cycle, water retention and change of fat to muscle t i s s u e . 8. In a group discussion, p a r t i c i p a n t s w i l l describe three reasons f o r advance scheduling of meals and snacks within the allowable food exchange u n i t s . Week Four A c t i v i t i e s : 1. Record weight. 2. Questions and answers from previous week. 3. Review food exchange plans and.food preparation h i n t s . 4. As a group exercise, p a r t i c i p a n t s w i l l l i s t advantages of phys i c a l a c t i v i t y and options for physical a c t i v i t y i n t h e i r own l i f e . 5. Introduce, view and discuss f i l m : Physical Fitness a New Perspective. 1 6. Discuss e f f e c t of ph y s i c a l a c t i v i t y on c a l o r i e balance by using the "Fitness Wheel" from the B.C. Heart Foundation. 7. Review and answer questions on: home assignments goal s e t t i n g (both eating and exercise) using food recording forms analyzing trouble s i t u a t i o n s i n more depth. 1. Informedia Productions Ltd., Vancouver, B.C. Canada 88. Week Five Ob j ectives: 1. In a group discussion, p a r t i c i p a n t s w i l l describe-basics of weight control including: eating and exercise balance, steps to changing habits, use of food exchange system to set goals, use of recording sheets to check up on success of these goals. 2. In a group discussion, p a r t i c i p a n t s w i l l l i s t at least ten si t u a t i o n s i n which eating problems often occur. 3. In a group discussion, p a r t i c i p a n t s w i l l outline p o s s i b l e solutions to problem eating i n at least three of these s i t u a t i o n s . 4. Using a food recording sheet, p a r t i c i p a n t s w i l l keep d e t a i l e d notes on any s i t u a t i o n s which t r i g g e r problem eating during the next seven days. Week Five A c t i v i t i e s : 1. Record weight. 2. Review basics of weight_control through lecture and discussion including: eating and exercise balance goals using food'exchange system recording success on these goals and noting trouble spots slowing down eating increasing physical a c t i v i t y using four steps to changing habits (record habits, set small goals, plan to reach these goals, check up on success and reward f or t h i s success). 3. Conduct a group exercise on s i t u a t i o n a l eating problems: brainstorm a t l i s t . o f s i t u a t i o n s i n which eating problems often occur discuss at least three of these s i t u a t i o n s i n d e t a i l : describe three factors causing the problem have group outline.-possible ways to handle such s i t u a t i o n s i n a d i f f e r e n t way so that problem eating does not occur describe ways to reduce exposure to food i n these sit u a t i o n s describe ways to increase awareness while eating describe possible a l t e r n a t i v e s to eating i n these s i t u a t i o n s . 4. Review and answer questions on: s i t u a t i o n a l control of eating "assignment"to'record .in more d e t a i l the actual s i t u a t i o n s i n which they have problems over the next seven days. 89. Week Six Objectives: 1. In a group discussion, p a r t i c i p a n t s w i l l analyze and suggest solutions f o r at l e a s t three s i t u a t i o n s that t r i g g e r problem.'eating. 2. In a group•discussion,"participants w i l l describe strategies-that might be used to'avoid problem eating i n a-rarige-pf s i t u a t i o n s . 3. Given a graph and personal weight record, p a r t i c i p a n t s w i l l p l o t t h e i r own weight graph since the beginning o f the program. 4. In a group discussion, p a r t i c i p a n t s w i l l describe the importance of v i s u a l feedback on both eating and exercise success and on weight loss success. 5. Participants w i l l describe at least three advantages of v i s u a l i z i n g success i n weight control rather than v i s u a l i z i n g f a i l u r e . Week Six A c t i v i t i e s : 1. Record weight. 2. Review s i t u a t i o n a l control of eating i n a lecture/discussion. 3. Do group a c t i v i t y working through three more examples of problem s i t u a t i o n s that t r i g g e r eating. 4. Discuss questions on other d i f f i c u l t s i t u a t i o n s : ask f o r suggestions from the group on handling s p e c i f i c d i f -f i c u l t s i t u a t i o n s review Strategies that-might bet-useful to help avoid problem eating. 5. Have each p a r t i c i p a n t p l o t her own weight graph from her own weight record sheet. 6. Discuss the importance of v i s u a l i z i n g success not f a i l u r e . 7. Review and answer questions on: s i t u a t i o n a l control and problem-solving approach use of v i s u a l feedback such as charts and graphs v i s u a l i z i n g success steps they might take t h i s week. 90. Week Seven Objectives: 1. In a group discussion, p a r t i c i p a n t s w i l l describe at least ten si t u a t i o n s which cause stress and consequently problem eating. 2. In a group discussion, p a r t i c i p a n t s w i l l analyze at least three of these s i t u a t i o n s and suggest s p e c i f i c steps to keep problem eating from occur-r i n g . 3. Participants w i l l describe i n w r i t i n g one problem s i t u a t i o n of t h e i r own and l i s t steps they plan to follow to improve that s i t u a t i o n during the next seven days. Week Seven A c t i v i t i e s : 1. Record weight. 2. Discuss questions from p a r t i c i p a n t s . 3. Conduct a lecture/discussion on stress and time management i n re l a t i o n s h i p to weight control success. 4. Have p a r t i c i p a n t s brainstorm and l i s t s i t u a t i o n s where stress and problem eating are connected for them. 5. Introduce and view the f i l m : Stress. 1 6. In a group discussion, use the problem-solving approach on at least three s p e c i f i c s i t u a t i o n s r e l a t e d to d i f f i c u l t i e s i n stress/time management and weight co n t r o l . 7. Have pa r t i c i p a n t s take one s i t u a t i o n of t h e i r own and l i s t i n w r i t i n g the steps they plan to take t h i s week to improve that p a r t i c u l a r s i t u a t i o n . 8. Review and answer questions on: problem-solving approach to stress management s p e c i f i c s i t u a t i o n s that t r i g g e r problem eating s p e c i f i c steps they w i l l take this week. 1. Informedia Productions Ltd., Vancouver, B.C. Canada 91. Week Eight Objectives: 1. In a group, discussion, p a r t i c i p a n t s w i l l describe a four step problem-so l v i n g approach to weight control i n c l u d i n g : describing s p e c i f i c eating and exercise goals on a.daily basis s e t t i n g s p e c i f i c eating and exercise goals on a d a i l y basis having plans to deal with d i f f i c u l t s i t u a t i o n s using recording sheets, graphs, and d i a r i e s to show s p e c i f i c success and f a i l u r e f or r e s e t t i n g of s p e c i f i c eating and exercise goals. 2. In a group discussion, p a r t i c i p a n t s w i l l brainstorm techniques they might use i f problem eating s t a r t s to accelerate during the next few weeks. Week Eight A c t i v i t i e s : 1. Record weight and up-date graph. 2. Review questions and discussions on: two key factors i n weight control (eating and exercise) four steps i n problem-solving approach to habit change. 3. Introduce and discuss f i l m : Fad Diet Circus. 4. Review any questions about weight c o n t r o l . 5. Have group brainstorm techniques they could use on t h e i r own i f problem s i t u a t i o n s occur during the next few weeks. 6. Remind group about follow-up contact" by i n s t r u c t o r during the next s i x months. 1. Informedia Productions Ltd., Vancouver, B.C. Canada 92. APPENDIX B INTERNAL-EXTERNAL LOCUS OF CONTROL TESTS Directions Read to the Group for Rotter Test This i s a questionnaire to f i n d out the way i n which c e r t a i n im-portant events i n our society a f f e c t d i f f e r e n t people. Each item consists of a: p a i r of a l t e r n a t i v e s l e t t e r e d a or b. Please se l e c t the one statement of each p a i r (and only one) which you more strongly believe to be the case as f a r as you are concerned. Be sure to se l e c t the one you a c t u a l l y believe to be more true rather than the one you think;.you should choose or the one you would l i k e to be true. This i s a measure of personal b e l i e f ; obviously there are no r i g h t or wrong answers. Please' answer these items c a r e f u l l y but do not spend too much time on any one item. In some instances you may discover that you believe both statements or ne i t h e r one. In such cases, be sure to s e l e c t the one you more strongly believe to be the case as f a r as you are concerned. Directions Read to the Group for James Test These are a number of statements about various t o p i c s . They have been c o l l e c t e d from d i f f e r e n t groups of people and represent a v a r i e t y of opinions. There are no r i g h t or wrong answers. For every statement there are large numbers of people who agree and disagree. Please i n d i c a t e the response that most c l o s e l y corresponds to the way that you personally f e e l . C i r c l e SA for strongly agree, A i f you agree, D i f you disagree, SD i f you strongly disagree. 93. ROTTER INTERNAL-EXTERNAL TEST 1. a. Children get i n t o trouble because t h e i r parents punish them too much, b. The trouble with most children nowadays i s that t h e i r parents are too easy with them. 2. a. Many of the unhappy things i n people's l i v e s are p a r t l y due to bad luck. b. People's misfortunes r e s u l t from the mistakes they make. 3 . a. One of the major reasons why we have wars i s because people don't take enough i n t e r e s t i n p o l i t i c s , b. There w i l l always be wars, no matter how hard people try to prevent them. 4. a. In the long run people get the respect they deserve i n t h i s world, b. Unfortunately, an i n d i v i d u a l ' s worth often passes unrecognized no matter how hard he t r i e s . 5. a. The idea that teachers are unfair, to students i s nonsense. b. Most students don't r e a l i z e the extent to which t h e i r grades are influenced by accidental happenings. 6. a. Without the r i g h t breaks one cannot be an e f f e c t i v e leader. b. Capable people who f a i l to become leaders have "not taken advantage of t h e i r opportunities. 7. a. No matter how hard you t r y some people just don't l i k e you. b. People who can't get others to l i k e them don't understand how to get along with others. 8. a. Heredity plays the major role i n determining one's pe r s o n a l i t y . b. It i s one's experiences i n l i f e which determine what they're l i k e . 9. a. I have often found that what i s going to happen w i l l happen. b. Trusting to fate has never turned out as well for me as making a decision to take a d e f i n i t e course of action. 10. a. In the case of the well prepared student there i s r a r e l y i f ever such a thing as an u n f a i r t e s t , b. Many times exam questions tend to be so unrelated to course work that studying i s r e a l l y useless. 11. a. Becoming a success i s a matter of hard work, luck has l i t t l e or nothing to do with i t . b. Getting a good job depends mainly on being i n the r i g h t place at the r i g h t time. 94. 12. a. The average c i t i z e n can have an influence i n government decisions, b. This world i s run by the few people i n power, and there i s not much the l i t t l e guy can do about i t . 13. a. When I make plans, I am almost ce r t a i n that I can make them work, b. It i s not always wise to plan too f a r ahead because many things turn out to be a matter of good or bad fortune anyhow. 14. a. There are ce r t a i n people who are just no good, b. There i s some good i n everyone. 15. a. In my case getting what I want has l i t t l e or nothing to do with luck. b. Many times we might just as well decide what to do by f l i p p i n g a coin. 16. a. Who gets to be the boss depends on who was lucky enoughcto be i n the r i g h t place f i r s t , b. Getting people to do the r i g h t thing depends upon a b i l i t y , luck has l i t t l e or nothing to do with i t . 17. a. As f a r as world a f f a i r s are concerned, most of us are the victims of forces we can neit h e r understand, nor control, b. By taking an active part i n p o l i t i c a l and s o c i a l a f f a i r s the.people can control world events. 18. a. Most people don't r e a l i z e the extent to which t h e i r l i v e s are con-t r o l l e d by accidental happenings, b. There r e a l l y i s no such thing as "luck". 19. a. One should always be w i l l i n g to admit mistakes, b. I t i s usually best to cover up one's mistakes. 20. a. I t i s hard to know whether or not a person r e a l l y l i k e s you. b. How many friends you have depends upon,how nice a person you are. 21. a. In the long run the bad things that happen to us are balanced by the good ones. b. Most misfortunes are the r e s u l t of lack of a b i l i t y , ignorance, laziness, or a l l three. 22. a. With enough e f f o r t we can wipe out p o l i t i c a l corruption. b. I t i s d i f f i c u l t f o r people to have much control over the things p o l i t i c i a n s do i n o f f i c e . 23. a. Sometimes I can't understand how teachers arr i v e at the grades they give. b. There i s a d i r e c t connection between how hard I study and the grades I get. 95. A good leader expects people to decide for themselves what they should do. A good leader makes i t cl e a r to everybody what t h e i r jobs are. Many times I f e e l that I have l i t t l e influence over the things that happen to me. It i s impossible f o r me to believe that chance or luck plays an important r o l e i n my l i f e . People are lonely because they don't t r y to be f r i e n d l y . There's not much use i n t r y i n g too hard to please people, i f they l i k e you, they l i k e you. There i s too much emphasis on a t h l e t i c s i n high school. Team sports are an excellent way to b u i l d character. What happens to me i s my own doing. Sometimes I f e e l that I don't have enough control over the d i r e c t i o n my l i f e i s taking. Most of the time I can't understand why p o l i t i c i a n s behave the way they do. In the long run the people are responsible f o r bad government on a nationa l as well as on a l o c a l l e v e l . 96. SA A D SD 7 SA A D SD 8 SA A D SD 9 JAMES INTERNAL-EXTERNAL TEST SA A D SD 1. I l i k e to read newspaper e d i t o r i a l s whether I agree with them or not. SA A D SD 2. Wars between countries seem i n e v i t a b l e despite e f f o r t s to prevent them. SA A D SD 3. I believe the government should encourage more young people to make science a career. SA A D SD 4. It i s usually true of successful people that t h e i r good breaks far outweighed'their bad -breaks. SA A D SD. 5. I believe that moderation i n a l l things i s the key to happiness. SA A D SD 6. Many times I f e e l that we might just as well make many of our decisions by f l i p p i n g a coin. I disapprove of g i r l s who smoke cigarettes i n p u b l i c places. The actions of other people toward me many times have me b a f f l e d . I believe i t i s more important for a person to l i k e h i s work than to make money at i t . SA A D SD 10. Getting a good job seems to be l a r g e l y a matter of being lucky enough to be i n the r i g h t place at the righ t time. SA A D SD 11. It's not what you know but who you know that r e a l l y counts i n getting ahead. SA A D SD 12. A great deal that happens to me i s probably just a matter of chance. SA A D SD 13. I don't believe that the presidents of our country should serve for more than two terms. SA A D SD 14. I f e e l that I have l i t t l e influence over the way people behave. SA A D SD 15. I t i s d i f f i c u l t f o r me to keep well-informed about foreign af-f a i r s . SA A D SD 16. Much of the time the future seems uncertain to me. SA A D SD 17. I think the world i s much more unsettled now than i t was i n our grandfathers;', times. SA A D SD 18. Some people seem born to f a i l while others seem born f o r suc-cess no matter what they do. 97. SA A D SD 19. I believe there should be less emphasis on spectator sports and more on a t h l e t i c p a r t i c i p a t i o n . SA A D SD 20. It i s d i f f i c u l t f o r ordinary people to have much control over what p o l i t i c i a n s do i n o f f i c e . SA A D SD 21. I enjoy reading a good book more than watching t e l e v i s i o n . SA A D SD 22. I f e e l that many people could be described as victims of c i r -cumstances beyond t h e i r c o n t r o l . SA A D SD 23. Hollywood movies do not seem as good as they used to be. SA A D SD 24. I t seems many times that the grades one gets i n school are more dependent on the teachers' whims than on what the student can r e a l l y do. SA A D SD 25. Money shouldn't be a person's main consideration i n choosing a job. SA A D SD 26. I t i s n ' t wise to plan too f a r ahead because most.things turn out to be a matter of good or bad fortune anyhow. SA A D SD 27. At one time I wanted to become a newspaper reporter. SA A D SD 28. I can't understand how i t i s possible to p r e d i c t other people's behavior/ SA A D SD 29. I believe that the U.S. needs a more conservative foreign p o l i c y . SA A D SD 30. When things are going well f or me I consider i t due to a run of good luck. SA A D SD 31. I believe the government has been taking over too many of the a f f a i r s of pr i v a t e i n d u s t r i a l management. SA A D SD 32. There's not much use i n t r y i n g to p r e d i c t which questions a teacher i s going to ask on an examination. SA A D SD 33. I get more ideas from t a l k i n g about things than reading about them. SA A D SD 34. Most people don't r e a l i z e the extent to which t h e i r l i v e s are con t r o l l e d by accidental happenings. SA A D SD 35. At one time I wanted to be an actor (or ac t r e s s ) . SA A D SD 36. I have usually found that what i s going to happen w i l l happen, regardless of my actions. 98. SA A D SD 40. SA A D SD 41. SA A D SD 42. SA A D SD 43. SA A D SD 37. L i f e i n a small town offers more r e a l s a t i s f a c t i o n s than l i f e i n a large c i t y . SA A D SD 38. Most of the disappointing things i n my l i f e have contained a large element of chance. SA A D SD 39. I would rather be a successful teacher than a successful busiu; ness-man. I don!t believe that a person can r e a l l y be master of his f a t e . I f i n d mathematics easier to study than l i t e r a t u r e . Success i s mostly a matter of getting good breaks. I think i t i s more important to be respected by people than to be l i k e d by them. SA A D SD 44. Events i n the world seem to be beyond the control of most people. SA A D SD 45. I think that states should be allowed to handle r a c i a l problems without federal interference. SA A D SD 46. I f e e l that most people can't r e a l l y be held responsible f or themselves since no one has much choice about where he was born or r a i sed. SA A D SD 47. I l i k e to figure out problems and puzzles that other people have trouble with. Many times the reactions of people seem haphazard to me. I.r a r e l y lose when playing card games. There's not much use i n worrying about things...what w i l l be w i l l be. SA A D SD 51. I think that everyone should belong.to some kind of church. SA A D SD 52. Success i n dealing with people seems to be more a matter of the other person's moods and feelings at the time rather than one's own actions. One should not place too much f a i t h i n newspaper reports; I think that l i f e i s mostly a gamble. I am very stubborn when my mind i s made up about something. Many times I f e e l that I have l i t t l e influence over the things that happen to me. SA A D SD 48. SA A D SD 49. SA A D SD 50. SA A D SD 53. SA A D SD 54. SA A D SD 55. SA A D SD 56. 99. SA A D SD 57. I l i k e popular music be t t e r than c l a s s i c a l music. SA A D SD 58. Sometimes I f e e l that I don't have enough control over the di r e c t i o n my l i f e i s taking. SA A D SD 59. I sometimes s t i c k to d i f f i c u l t things too long even when I know they are hopeless. SA A D SD 60. L i f e i s too f u l l of unce r t a i n t i e s . 100. APPENDIX C PERSONAL WEIGHT HISTORY QUESTIONNAIRE Date What i s your name? What i s your address? What i s your telephone number? (At home) (At work) What i s your birthdate? What i s your height? What i s your weight today? Were you overweight as a child? (Describe i f so) Were you overweight as a teenager? (Describe i f so) Was there a p a r t i c u l a r time as an adult that you began to be overweight? (Describe i f so) Are or were e i t h e r or both of your parents overweight? 101. During the l a s t year, have you had a major change of weight? Have you recently gained or l o s t a s i g n i f i c a n t amount of weight? Have you r e -cently attempted to diet or somehow change your weight? Please add any other d e t a i l s that you think are p a r t i c u l a r l y relevant about your weight control success and f a i l u r e over the l a s t year. 102. APPENDIX D DESCRIPTION OF PARTICIPANTS Code Age I n i t i a l F i n a l Rotter James Assigned Random Number Weight Weight Score Score Group Assignment on Basis of to I-E Score Follow-up Group 15 50 166 153 3 53 Low External one c a l l 24 29 123 136 4 61 Low External four c a l l "4 55 133. 5 133 5 69 Low External one c a l l 9 55 156 154 6 63 Low External four c a l l 7 55 165 165 6 66 Low External one c a l l 22 28 154 146.5 6 65 Low External one c a l l 19 32 153 152.5 6 75 Low External four c a l l 18 34 125 109 7 66 Low External four c a l l 23 74 144 140 7 67 Medium External four c a l l 12 22 197. 5 197 7 69 Medium External four c a l l 5 58 151 151 7 70 Medium External one c a l l 11 38 165 165 8 64 Medium External one c a l l 14 32 149. 5 136 8 64 Medium External four c a l l 6 53 171. 5 162 8 68 Medium External one c a l l 21 25 159 161 9 56 Medium External four c a l l 1 49 120 120 9 70 Medium External one c a l l 10 29 132 120 9 77 High External four c a l l 2 30 175. 5 163 9 79 High External four c a l l 3 26 167 152 9 87 High External four c a l l 8 23 157 153 10 80 High External one c a l l 16 39 176. 5 175 10 80 High External one c a l l 13 29 126 125 11 68 High External one c a l l 20 19 162 - 11 73 High External dropped out 17 27 171. 5 175.5 13 80 High External four c a l l 103. APPENDIX E PREDICTED RESULTS FOR PROPOSED RESEARCH DESIGN Individuals would be assigned to one of four conditions: 1. No telephone contact, no deposit plan. 2. Telephone contact, no deposit plan. 3. No telephone contact, deposit plan. 4. Telephone contact, deposit plan. No Deposit Deposit No Telephone Contact Telephone ^ ^ Contact It i s suggested that the following r e s u l t s would be achieved: 1. Regardless of Locus of Control score, those i n d i v i d u a l s r e c e i v i n g i n -structor telephone contact would lose more weight at a s t a t i s t i c a l l y s i g n i f i c a n t l e v e l than would those i n d i v i d u a l s not receiving contact both during the i n s t r u c t i o n a l session and at the end of 6 months a f t e r the l a s t r e gistered session. 2. Regardless of Locus of Control score, those i n d i v i d u a l s i n the deposit plan and no telephone contact (group 3) w i l l lose more weight than w i l l those i n d i v i d u a l s i n the no deposit, no telephone contact group (group 1) during the i n s t r u c t i o n a l session. However, there may not be any s i g n i f i c a n t difference between groups 6 months a f t e r the l a s t ses-sion. 104. Those i n d i v i d u a l s with high Internal Locus of Control and/or high po-t e n t i a l f o r s e l f - c o n t r o l scores w i l l lose a s t a t i s t i c a l l y s i g n i f i c a n t amount of weight i n each condition but w i l l do considerably better i n condition 2 than i n the other groups both during classes and 6 months l a t e r . (There may be some reactance to the deposit plan by high In-ternals which may lead to reduced success by high Internals i n con-d i t i o n 4) . Those i n d i v i d u a l s with high External Locus of Control scores and/or low p o t e n t i a l for s e l f - c o n t r o l scores w i l l lose a s t a t i s t i c a l l y s i g -n i f i c a n t amount of weight i n each group during the classes. However, those i n group 4 w i l l do considerably better during the classes than w i l l Externals i n other groups. By the end of the 6 month period, high Externals i n groups 2 and 4 w i l l have greater success than w i l l high Externals i n groups 1 and 3. There w i l l be no s t a t i s t i c a l l y s i g n i f i c a n t difference i n the weight loss success of low Internals as compared to medium or high Externals. There w i l l be no s t a t i s t i c a l l y s i g n i f i c a n t difference i n weight loss between groups with d i f f e r e n t i n s t r u c t o r s . Those i n d i v i d u a l s who attend more sessions w i l l lose s i g n i f i c a n t l y more weight than w i l l those who attend fewer sessions. 

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