UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Self-management strategies for maintaining weight loss Trentadue, Bonnie Lee 1978

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1978_A8 T75.pdf [ 3.24MB ]
Metadata
JSON: 831-1.0094453.json
JSON-LD: 831-1.0094453-ld.json
RDF/XML (Pretty): 831-1.0094453-rdf.xml
RDF/JSON: 831-1.0094453-rdf.json
Turtle: 831-1.0094453-turtle.txt
N-Triples: 831-1.0094453-rdf-ntriples.txt
Original Record: 831-1.0094453-source.json
Full Text
831-1.0094453-fulltext.txt
Citation
831-1.0094453.ris

Full Text

SELF-MANAGEMENT STRATEGIES FOR MAINTAINING WEIGHT LOSS by BONNIE LEE TRENTADUE B.A., York Un i v e r s i t y , 1974 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1978 (jc) Bonnie Lee Trentadue, 1978 In presenting th i s thes is in par t i a l fu l f i lment of the requirements an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree th the L ibrary shal l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying o f th is thesis for scho la r l y purposes may be granted by the Head of my Department o by his representat ives. It is understood that copying or pub l i ca t i o of th is thesis fo r f inanc ia l gain sha l l not be allowed without my wri t ten permission. Depa rtment The Univers i ty of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Date Oct. V /97<P 6 i i ABSTRACT The purpose of the present study was to assess the d i f f e r e n t i a l e f f e c t s of two s e l f - m o n i t o r i n g approaches i n a weight c o n t r o l c l i n i c . F o r t y - f i v e female subjects who responded to a newspaper advertisement of the programme were assigned to one of three groups: an approp-r i a t e s e l f - m o n i t o r i n g group, an i n a p p r o p r i a t e s e l f - m o n i t o r i n g group, and a minimal treatment c o n t r o l group. A l l s ubjects met i n groups of seven or eig h t f o r s i x weeks of treatment and attended two follow-up sessions (one at four-weeks and one at three-months). Several pre-measures i n c l u d i n g demographic data, i n i t i a l weight, and scores on two questionnaires were taken (an E a ting S i t u a t i o n s Questionnaire and Rotter's E x t e r n a l i t y Ques-t i o n n a i r e were c o l l e c t e d at the i n i t i a l s e s s i o n ) . I n a d d i t i o n , a l l subjects completed the Eating S i t u a t i o n s Questionnaire a f t e r treatment ended. Subjects' weights were taken at each s e s s i o n . The r e s u l t s of a repeated measures a n a l y s i s of s u b j e c t s ' raw weights at four time periods revealed no s i g n i f i c a n t d i f f e r e n c e s be-tween the groups. However, the analyses revealed s i g n i f i c a n t weight l o s s and maintenance of weight l o s s across a l l groups. No important p r e d i c t o r s of s u c c e s s f u l weight l o s s or weight maintenance were found on any of the analyses conducted to explore t h i s i s s u e . Park Davidson, Ph.D. i i i TABLE OF CONTENTS Page Ab s t r a c t i i L i s t of Tables v L i s t of Figures v i Acknowledgement v i i Chapter 1: I n t r o d u c t i o n 1 Experimental Findings 3 R a t i o n a l e f o r the R e a c t i v i t y of S e l f - M o n i t o r i n g 7 Ra t i o n a l e f o r Present I n v e s t i g a t i o n 9 Overview of Experiment 13 Chapter 2: Method 15 Subjects 1 15 P e r s o n a l i t y Measures 16 Demographic Data 16 P h y s i c a l Measures 17 Procedure 17 Treatment Group 1 18 Treatment Group 2 19 Minimal Treatment C o n t r o l Group 20 Follow-Up 20 Chapter 3: Results 21 Pre-Measures 21 Treatment Outcome 21 R e l a t i o n s h i p Between Pretreatment and Process Measures and Outcome 25 Chapter 4: D i s c u s s i o n 34 P r e d i c t o r s of Weight Loss 37 Footnotes 40 Reference Notes 41 References 42 i v TABLE OF CONTENTS continued Page Appendices 48 Appendix A: Newspaper Advertisement f o r Subjects 48 Appendix B: I n i t i a l P a r t i c i p a n t A p p l i c a t i o n Form 49 Appendix C: Experimental Consent Form 50 Appendix D: E x t e r n a l i t y Questionnaire 51 Appendix E: Eating S i t u a t i o n s Questionnaire 56 Appendix F: I n i t i a l Weight H i s t o r y Questionnaire 58 Appendix G: Data Deposit Agreement Form 61 Appendix H: B a s e l i n e S e l f - M o n i t o r i n g Form 62 Appendix I : S e l f - M o n i t o r i n g I n s t r u c t i o n s and Forms 63 Appendix J : S e l f - M o n i t o r i n g Appropriate Cognitions 70 Appendix K: S e l f - M o n i t o r i n g Inappropriate Cognitions 73 Appendix L: R a t i o n a l e f o r Increasing P h y s i c a l A c t i v i t y 76 V LIST OF TABLES Page Table 1 Means and Standard Deviations of Subject C h a r a c t e r i s t i c s by Group Table 2 Means and Standard Deviations of Subject C h a r a c t e r i s t i c s by Group Table 3 Summary Table f o r Analyses of Variance of Onset by Group Table 4 Summary Table f o r Repeated Measures A n a l y s i s of Variance (Raw Weights at Four Time Periods) Table 5 Means and Standard Deviations of Weight at Four Time Periods by Group Table 6 Means and Standard Deviations of Kg Lost at Four Time Periods by Group Table 7 Pearson C o r r e l a t i o n C o e f f i c i e n t s 22 23 24 26 27 30 33 v i LIST OF FIGURES Page Figure 1 Kg Lost at Four Time Periods f o r Each Group 28 Figure 2 Pounds Lost at Four Time Periods f o r Each Group 29 v i i ACKNOWLEDGEMENT I would l i k e to express my a p p r e c i a t i o n to my committee chairman, Dr. Park Davidson, f o r h i s advice and encouragement throughout t h i s i n v e s t i g a t i o n . I a l s o wish to thank Drs. Demetrios Papageorgis and Susan B u t t - F i n n f o r consenting to serve on my committee and f o r sugges-t i o n s concerning my research. A s s i s t a n c e w i t h the data a n a l y s i s was provided by Barbara Szandorowska, and my f e l l o w students, Jeremy Safran, Ken Prk a c h i n , and John Ta y l o r . I would a l s o l i k e to thank Dr., Malcolm Weinstein and the s t a f f of the C i t y of Vancouver's Health Department f o r t h e i r i n v a l u a b l e a s s i s t a n c e i n p r o v i d i n g space, c l e r i c a l a s s i s t a n c e , and t h e i r time throughout the p r o j e c t . A s p e c i a l thanks i s extended to Dr. Lynn B a r r e t t f o r her a s s i s t a n c e and support throughout a l l stages of the research. A s s i s t a n c e w i t h corrections, and a l l t y p i n g was completed by Judy Hawkins. To the subjects i n the p r o j e c t , I o f f e r my s i n c e r e s t a p p r e c i a t i o n f o r t h e i r co-operation and the enthusiasm they expressed concerning t h e i r p a r t i c i p a t i o n i n the c l i n i c . And f i n a l l y , I would l i k e to thank my daughters, Mary and J e n n i f e r Trentadue, and my f r i e n d s f o r t h e i r i n f i n i t e p atience and support w h i l e I completed t h i s work. 1 INTRODUCTION Obesity^" a f f e c t s over 50% of the Canadian adult population (20 years and over) and t h i s f i g u r e r e f l e c t s a s i g n i f i c a n t trend towards a large proportion of overweight persons i n i n d u s t r i a l i z e d countries (Nu t r i t i o n Canada, 1973). A recent a r t i c l e i n a journal devoted to t h i s major health problem reports that i n the United States, 25-45% of the adult population were found to be at l e a s t 20 percent overweight (Strata, Z u l i a n i , Caronna, Magnati, Pugnoli, & T i r e l l i , 1977), Re-cent surveys on the population of London have shown that at l e a s t 40% of the middle-aged are obese. In Sweden, 50%. of the men and .70% of women aged 50-60 years of age are at l e a s t 10 kg. overweight. The problem of overweight i s not simply one of aesthetics. Obesity has been implicated as a major contributing factor i n diabetes, athero-s c l e r o s i s , hypertension, a r t h r i t i s , and many other d i s a b l i n g diseases (Howard & Bray, 1977). In addition, being overweight often compli-cates otherwise simple medical problems and t h e i r treatment. As age increases, the prevalence of obesity increases, presumably because a reduction i n energy expenditure does not correspond to a reduced c a l o r i e intake (Strata et a l . , 1977). The problem of over-weight becomes even more serious when one considers that the post-war "babies" are approaching t h e i r 40's. U n t i l 1958-1959, the outcome of various treatment approaches to obesity was extremely depressing. The emphasis i n most treatment programmes was placed more on t r y i n g to understand why one became overweight, with l i t t l e or no time devoted to teaching c l i e n t s s k i l l s 2 which would show them how to lose weight (Stunkard, 1974). Stunkard (1974) summarizes the status of treatment for obesity at that time as follows: "... most obese people do not enter treatment for obesity ... of those who do enter treatment, most w i l l not remain ... of those who remain, most w i l l not lose much weight ... of those who do lose weight, most w i l l regain i t ... and many w i l l pay a high p r i c e f or t r y i n g " (p. 196). However, within the l a s t f i f t e e n years, the treatment for obesity has improved somewhat with the use of behaviour modification proce-dures. The f i r s t of many studies using a behavioural approach with an improvement i n the rates of weight loss over t r a d i t i o n a l treatments was c a r r i e d out by Ferster, Nuremberger, and L e v i t t i n 1962. They trained c l i e n t s i n self-management techniques which included teaching c l i e n t s to lengthen the chain of responses required before eating and thus weakening the desire to eat. Their ten subjects l o s t an average of ten pounds i n f i f t e e n weeks of treatment. Using some of the behavioural techniques f i r s t developed by Ferster et a l . , Stuart (1967) produced s i g n i f i c a n t losses with eight c l i e n t s during a 12-week treatment period, and c l i e n t s had maintained these losses at a one-year follow-up session. This study and a sub-sequent one which r e p l i c a t e d these r e s u l t s provided the basis f or a weight control programme which teaches s k i l l s to help i n d i v i d u a l s con-t r o l food intake and energy expenditure. The programme places the emphasis on co n t r o l over the antecedents and consequences of eating and energy expenditure. S e l f - c o n t r o l approaches to obesity have improved treatment e f f i c a c y somewhat. Howeverj c l i n i c a l l y s i g n i f i c a n t 3 losses which are maintained over a longer-term remain an unachieved goal for most treatments to date. Studies using behavioural s e l f -c o n t r o l approaches have been c a r r i e d out since these e a r l i e r attempts i n an e f f o r t to meet t h i s challenge and to discover which elements of the procedures make the difference, and under which treatment condi-tions. Long-term maintenance of weight loss continues to be a major concern to researchers i n the area. Experimental Eindings Several studies since Stuart's i n i t i a l success with overweight subjects have reported favourable r e s u l t s for behaviour modification techniques when compared to t r a d i t i o n a l therapy and no-treatment control groups. Harris (1969) reported success i n a c o n t r o l l e d study using a behavioural programme based on Stuart's work. Wollersheim (1970) compared a behavioural treatment with a nonspecific therapy (insight into the reasons for obesity), a s o c i a l pressure group, and with a no-treatment w a i t i n g - l i s t control group. The behavioural treatment achieved the most weight loss when compared to the no-treat-ment con t r o l group and to two placebo conditions. Several studies at t h i s time reported more weight loss f or behavioural techniques compared with t r a d i t i o n a l therapies (Penick, F i l i o n , Fox, & Stunkard, 1971; J e f f r e y & Christenson, 1972). These studies p r i m a r i l y emphasized the use of s e l f - c o n t r o l techniques for weight l o s s . Other behaviour modification techniques which have reported some success with overweight subjects are: aversive conditioning (Kennedy & Foreyt, 1968; Foreyt & Kennedy, 1971), covert s e n s i t i z a t i o n (Cautela, 1967; Meyner, 1970; Janda & Rimm, 1972), and experimenter-4 con t r o l l e d reinforcement (Ayllon, 1963; Harmetz &'. Lapue, 1968; H a l l , 1972). Tyler and Straugh (1970) instruc t e d subjects to hold t h e i r breath everytime they thought of fattening foods. S t o l l a c k (1967) shocked subjects for t a l k i n g about h i g h - c a l o r i e foods. Mann (1972) used contingency contracting which involved withholding subjects' valuables u n t i l they l o s t weight. Morganstern (1974) used punishment with a non-smoker i n the form of having to smoke a c i g a r e t t e each time she chewed on one of the forbidden foods. Sacks and Ingram (1972) compared backward conditioning and a standard covert s e n s i t i z a t i o n with overweight c l i e n t s . These techniques produce some weight loss during treatment but subjects i n these treatments do not maintain consistent weight loss as long as subjects who have been trained i n self-management techniques (Abramson, 1973). The next l o g i c a l step f o r researchers was to begin looking at the various components of the "self-management package" i n an e f f o r t to discover which components or combination thereof were e s s e n t i a l . Most behaviour modification programmes for obesity included a period of having the c l i e n t monitor h i s d a i l y food intake. These data would be used to develop an appropriate behavioural programme. However, i t was foud that monitoring one's food intake had a r e a c t i v e e f f e c t on the behaviour. Several researchers became interested i n self-monitoring as a therapeutic technique and an important aspect of the s e l f - c o n t r o l programmes they were t e s t i n g . Self-monitoring consists of a person observing some aspect of his/her behaviour and keeping a record of these events. Nelson (1977) 5 has reviewed the studies on self-monitoring and outlines i t s importance for both therapeutic and assessment value. Mahoney, Moura, and Wade (1973) and Mahoney (1974) reported that monitoring of eating urges or eating habits did not r e s u l t i n s i g n i f i c a n t weight l o s s . More p o s i t i v e r e s u l t s have been attained for the monitoring of food or c a l o r i c intake. S t o l l a k (1967) found self-monitoring to be more e f f e c t i v e than e i t h e r aversive conditionning or a no contact c o n t r o l condition. Romanczyk, Tracey, Wilson, and Thorpe (1973) and Romanczyk (1974) compared self-monitoring of c a l o r i c intake with self-monitoring of weight and with stimulus-control supplemented by a v a r i e t y of r e i n -forcement procedures. The self-monitoring group did not receive stimulus c o n t r o l i n s t r u c t i o n . Self-monitoring of weight was no more e f f e c t i v e than a no treatment co n t r o l condition, while self-monitoring of c a l o r i e s was as e f f e c t i v e as the stimulus c o n t r o l procedures. Stuart (1971) and Mahoney (1974) found self-monitoring to be e f f e c t i v e when f i r s t implemented but the e f f e c t decreased over time. Bellack, Rozensky, and Schwartz (1974) found that timing was important, that i s , a pre-eating monitoring group did best compared to post-eating monitoring and a stimulus-control therapy group. Kanfer (1970) has att r i b u t e d the rea c t i v e e f f e c t s of post-behaviour monitoring to covert s e l f - e v a l u a t i o n and s e l f - r e i n f o r c i n g operations that occur a f t e r the behaviour i s observed. Bellack (1975) has suggested assigning a l e t t e r grade to every instance of eating; thus reinforcement f o r "good" behaviour can be delivered immediately under a l l circumstances. The r e a c t i v i t y of self-monitoring i s affected by several v a r i a b l e s (Nelson, 1977). A person's motivation to a l t e r self-recorded behaviour 6 may determine whether or not s e l f - r e c o r d i n g produces behaviour change.(McFall & Hammen, 1971). P o s i t i v e l y evaluated behaviours tend to increase i n frequency during s e l f - r e c o r d i n g , while negatively evaluated behaviours tend to decrease (Brodin, H a l l , & M i t t s , 1971; Nelson, L i p i n s k i , & Black, 1976; Cavior & Marabetto, 1976; Kazdin, 1974; Sieck & McFall, 1976). R e a c t i v i t y can be affected by the choice of the s p e c i f i c behaviour monitored. Romancyzk (1974) reported greater weight los s i f both d a i l y weight and c a l o r i c intake were monitored than i f j u s t weight was self-recorded. McFall (1970) reported that i n s t r u c t i o n s to monitor r e s i s t e d urges to smoke decreased smoking rate, whereas i n s t r u c t i o n s to s e l f - r e c o r d the number of cigar e t t e s increased smoking rates. Gottman and McFall (1972) reported that s e l f - r e c o r d i n g p o s i t i v e behaviours increased the behaviour, while recording of negative behaviours decreased the behaviour. D i f f e r e n t i a l r e a c t i v i t y rates of s e l f - r e c o r d i n g depend on the s e t t i n g of performance goals and the a v a i l a b i l i t y of reinforcement and feedback on the self - r e c o r d e r ' s performance (Kazdin, 1974; Richards, McReynolds, Holt, & Sexton, 1974). Kolb, Winter, and Berlew (1968) reported more change when groups received s o c i a l reinforcement on t h e i r progress. Nelson et a l . (1976) found that reinforcement and s e l f -recording increased p o s i t i v e behaviours and decreased negative behaviours. In another study, reinforcement decreased negative behaviours ( L i p i n s k i , 1975). R e a c t i v i t y of s e l f - r e c o r d i n g increases when the act of recording i s obstrusive (Nelson, 1977; Malitzky, 1974; Nelson, L i p i n s k i , & Baykin, 19 ). Brodin et a l . (1971) reported that the 7 presence ;of s l i p s of paper without even using them to s e l f - r e c o r d caused p o s i t i v e behaviours to increase. Continuous recording pro-duces greater r e a c t i v i t y (Mahoney, Moore, Wade, & Mours, 1973; Frederiksen, Epstein, & Kosevesky, 1975). Rationale for the Re a c t i v i t y of Self-Monitoring Nelson (1977) states that the i n i t i a t i o n of self-monitoring pro-duces an a l t e r a t i o n i n the self-recorder's stimulus s i t u a t i o n and t h i s a l t e r a t i o n may produce the resultant and reac t i v e behaviour change. Kanfer (1976) suggests a r e c i p r o c a l r e l a t i o n s h i p between a per-son and the environment. He states that a person i s the product of the en-vironment and that behaviour of the person shapes the environment. Therefore, by changing one's behaviour, one can modify the conditions under which one l i v e s . I t i s t h i s l a t t e r d i r e c t i o n of behavioural e f f e c t s on which self-management focuses. The goal of s e l f - c o n t r o l methods i s to t r a i n i n d i v i d u a l s to become better problem solvers and behaviour analysts and to therefore become more independent of the immediate, environment. Kanfer describes three classes of variables which produce behaviour i n individuals: s i t u a t i o n a l (alpha) v a r i a b l e s , self-generated (beta) v a r i a b l e s , and b i o l o g i c a l (gamma) variables. These three variables are constantly changing i n t h e i r j o i n t impact on behaviour at any given time (Kanfer & Karoly, 1972). Gamma variables usually do not change; however, they never assume a zero value. Alpha and beta v a r i -ables may assume major or minor importance i n a f f e c t i n g a given be-haviour-in-a-situation. Operant approaches to treatment often employ alpha variables (environmentally based change programmes). S e l f -8 management methods concentrate on the use of beta v a r i a b l e s . However, he stresses the importance of understanding that (1) no event i s l i k e l y to be under t o t a l c o n t r o l of only one set of variables and (2) these influences constantly i n t e r a c t and moderate the f i n a l e f f e c t . According to Kanfer, s e l f - c o n t r o l should not be considered as a construct, a mechanism, or a psychological force, but rather ought to be used to designate an area of i n t e r e s t . S e l f - c o n t r o l i s a s p e c i a l case of s e l f - r e g u l a t i o n and i s defined as s e l f - d i r e c t e d behaviour sequences i n which a person i s exposed to c o n f l i c t and to the require-ment for taking actions which i n i t i a l l y a l t e r the l i k e l i h o o d of executing a previously highly probable response. The c r i t e r i o n f o r performance i n s e l f - c o n t r o l represents the.attainment of some complex goal that i s contrary to previous or concurrent behaviour standards and may have conflicting consequences. In the treatment f o r obesity, the c r i t e r i o n for performance i s a reduction of food intake. The s e l f - r e g u l a t i o n model, however, also includes s i t u a t i o n s such as new learning, complex problem-solving i n which the criterion-attachment i s generally neutral or favourable (p. 17ff ) . Kanfer's model outlines three r e l a t e d stages i n s e l f - r e g u l a t i o n — self-monitoring, s e l f - e v a l u a t i o n , and self-reinforcement. In order to make a change i n a behaviour, the person must f i r s t take note of h i s / her current a c t i v i t i e s which can be l a t e r evaluated i n terms of t h e i r appropriateness f o r reaching a desired goal. This self-observation makes a person aware of his/her actions. The second stage involves the actual comparison between the observed data and the c r i t e r i a for the desired behaviour. This stage i s c a l l e d the s e l f - e v a l u a t i v e 9 stage. If the data match the performance c r i t e r i o n , s a t i s f a c t i o n with oneself occurs. A large discrepancy y i e l d s d i s s a t i s f a c t i o n . F o l -lowing the s e l f - e v a l u a t i o n , self-reinforcement occurs, usually depen-ding on the degree to which the behaviour matches the performance c r i t e r i a . P o s i t i v e s e l f - e v a l u a t i o n leads to a continuation of the ob-served behaviours. Aversive consequences should lead the i n d i v i d u a l to try a new response that i s more appropriate (p. 22). Kanfer's model outlines a way of conceptualizing how s e l f - r e g u -l a t i o n occurs. I t i s not a statement of the exact sequence of events i n reality. Studies which have been c a r r i e d out to analyze the various com-ponents of s e l f - c o n t r o l methods have produced findings which provide sujport for the importance of self-monitoring (Mahoney, 1973; Romanczyk, Nelson, & McReynolds, 1971), of s e l f - e v a l u a t i o n (Weiner, Heckhauser, Meyer, & Cook, 1972; Rehm, 1975), and of self-reinforcement (Bellack, 1976) . Kanfer's model i s e s s e n t i a l l y a mediational model (Nelson, 1977) . Rachlin's (1974) non-mediational approach suggests that s e l f -monitoring reminds or cues the subject about the ultimate environmental consequences of the self-recorded behaviour. Kanfer's model emphasizes the immediate r e i n f o r c i n g p o s s i b i l i t i e s of the recorded behaviour ("that's good, I've done w e l l " ) , whereas Rachlin's model emphasizes the p o t e n t i a l gains to be made i n the future, and emanating out of the environment ("If I study, I w i l l get my degree"). Rationale for Present Investigation It i s clear from the above findings and t h e o r e t i c a l o utlines that 10 self-monitoring i s an important aspect of a s e l f - c o n t r o l approach to weight l o s s . I t has also been stated that t h i s e f f e c t i s most pro-nounced during the early stages of the treatment programme, but does not maintain a behaviour change f o r very long (Kazdin, 1974). Kanfer (1976) suggests that i t would be important to discover what r o l e s e l f -monitoring plays as a way of e s t a b l i s h i n g a c l i e n t ' s a c t i v e r o l e i n the treatment process, thus i n i t i a t i n g other b e n e f i c i a l processes such as s e l f - a t t r i b u t i o n of any generated change, or increasing awareness of the antecedents of target behaviours. Kanfer suggests that the re-quirement to attend to target behaviours r e s u l t s i n strong aversive consequences which may r e s u l t i n a learned avoidance of the monitoring a c t i v i t y . Studies on s e l e c t i v e attention to s e l f (Mischel & Ebbesen, 1973; Byrne, 1964; Horan, 1974; Horan & Johnson, 1971; Horan, Baher, Hoffman, & Shute, 1974; Horan, Myers, Dorfman, & Jenkins, 1975) re-port that obese subjects are le s s w i l l i n g to t o l e r a t e observations of t h e i r image than average weight persons. Subjects tend to r e s i s t or quit programmes that require focussing on aversive aspects of t h e i r person or behaviour (Kanfer, 1976). Kirsahenbaum (1975) suggests that the value of the monitored behaviour might be an important factor since self-monitoring of aversive events compared to self-monitoring of po s i t i v e l y - v a l u e d behaviours should r e s u l t i n an unfavourable s e l f -evaluation. As a r e s u l t , p o s i t i v e self-reinforcement should be re-duced and. a negative a f f e c t increased. Execution of such behaviour should be aversive and should eventually be stopped. To date, i t appears that c l i e n t s are capable of following i n s t r u c -tions using the newly acquired s k i l l s f o r managing t h e i r programme only 11 as long as the programme continues. However, maintaining the motiva-t i o n to continue t h e i r programme requires tremendous e f f o r t s on the part of the c l i e n t s , and i s a drain on therapeutic resources. This lack of long-term maintenance presents a serious health problem. And further, a f a i l u r e to achieve maintenance of weight loss post treatment has been a major problem i n weight co n t r o l studies to date. Many published studies have not even reported follow-up data for t h e i r subjects (Wildfogel, 1976). Medical personnel are increasingly be-coming concerned about obesity as a major contributing factor i n heart disease and other p h y s i c a l problems. A Public Health Service Report (1966) suggests that l o s i n g weight and then gaining i t back produces an a d d i t i o n a l stress factor since serum c h o l e s t e r o l l e v e l s are elevated during periods of weight gain and do not show evidence of decreasing once the weight goes down. Respondents to such reports (Stuart & Davis, 1972) have stated that weight reduction programmes should be aimed at obtaining a stable weight which can be maintained over time. It appears that the p o s i t i v e e f f e c t s of the loss of weight and success i n a weight programme are not enough to maintain the subjects' newly acquired behaviour. Wildfogel (1976) has noted that the c l i e n t s he treated "... often undermine t h e i r own weight reduction e f f o r t s by saying things to themselves that cue 'inappropriate' behaviour ... i . e . , the obese seldom praise t h e i r own weight reduction e f f o r t s or even consider t h e i r e f f o r t s worthy of praise ... they have u n r e a l i s t i c a l l y high self-expectations regarding future weight reduction behaviour which i n e v i t a b l y r e s u l t i n f a i l u r e experiences. ... they believe (1) they are not l o s i n g fast enough and (2) they w i l l never lose an 12 appreciable amount of weight and (3) i f they did they would gain i t a l l back." He summarizes his experiences with t r e a t i n g the obese: "The problem i s not i n teaching techniques that w i l l be e f f e c t i v e jLf_ used, i t i s teaching techniques that w i l l be used." Monitoring one's over-weight condition (prior to reaching i d e a l weight) and bad habits i s unpleasant, and many c l i e n t s drop out of programmes, or f a i l to continue t h e i r e f f o r t s to lose weight. The present i n v e s t i g a t i o n was concerned with the treatment e f f i -cacy of two d i f f e r e n t self-monitoring, approaches. As stated, s e l f -monitoring appears to have a f a i r l y r e l i a b l e r e a c t i v e e f f e c t on the behaviour under observation and self-monitoring of p o s i t i v e events tends to increase these events, whereas self-monitoring negative events decreases these events. In weight control programmes, often both events are being monitored. However, treatment often focusses on decreasing the undesirable behaviours. At f i r s t , t h i s causes the behaviours to decrease. However, i f the c l i e n t i s asked to become aware of a l l the inappropriate habits he engages i n , then he i s gathering evidence that he i s a person who has bad habits, and has l i t t l e s e l f - c o n t r o l . In other words, the c l i e n t may develop an image of himself as " f a t " or "weakr-willed." As long as the c l i e n t i s involved i n a weight c o n t r o l programme, the support and reinforcement he has access to outweighs the punishing e f f e c t s . However, once the programme is^over, the c l i e n t gradually goes back to h i s old patterns, where at l e a s t he has the powerful reinforcement of immediate g r a t i f i c a t i o n while overeating. If we could change the focus of self-monitoring from a negative approach to a p o s i t i v e one, and teach c l i e n t s to utter s e l f - r e i n f o r c i n g 13 statements for appropriate behaviour, perhaps they would f i n d main-tenance of weight loss less aversive and long-term maintenance would occur. Overview of Experiment The present i n v e s t i g a t i o n compared a p o s i t i v e self-monitoring approach with a negative self-monitoring approach and a minimal t r e a t -ment manual control group. The f o c a l treatment (p o s i t i v e s e l f -monitoring) group (Group 1 .. ) monitored only appropriate eating be-haviour, appropriate a c t i v i t y , and p o s i t i v e self-statements. The nega-t i v e self-monitoring group (Group 2) were trained to monitor inapprop-r i a t e eating, inappropriate a c t i v i t y , and negative self-statements. These subjects were given t r a i n i n g i n how to change t h e i r eating, a c t i v i t y l e v e l s , and t h e i r negative thinking patterns. The minimal treatment control group (Control group) were given Stuart and Davis' (1972) manual to read on t h e i r own, and treatment consisted of weekly discussion groups about t h e i r progress. On the basis of previous findings where s e l f - c o n t r o l methods are taught, i t was hypothesized that a l l subjects would lose weight during the course of the programme. However, the group using p o s i t i v e self-monitoring would lose more weight during treatment compared with the negative self-monitoring group and the minimal treatment group. And further, i t was hypothe-sized that at a three month follow-up session, i n d i v i d u a l s from Group 1 would have maintained t h e i r weight loss and/or continued to lose weight, when compared to e i t h e r of the other groups. A l l subjects completed the Eating Situations Questionnaire pre and post treatment. The difference scores on these questionnaires 14 provided another measure, of the d i f f e r e n t i a l e f f e c t s of the three treatments on s u b j e c t s ' s e l f - c o n t r o l s k i l l s w i t h regard to a number of problematic e a t i n g s i t u a t i o n s . F i n a l l y , analyses were c a r r i e d out on the usefulness as p r e d i c -t o r s of outcome of the f o l l o w i n g : demographic v a r i a b l e s (age, m a r i t a l s t a t u s , education); s e v e r i t y of the overweight problem (onset of o b e s i t y , c h r o n i c i t y , percent overweight); t e s t v a r i a b l e s ( e x t e r n a l i t y , s e l f - c o n t r o l i n problematic s i t u a t i o n s , p r e d i c t e d success), and operant measures (weight). 15 METHOD Subj ects Subjects were obtained through an advertisement i n a l o c a l Vancouver paper f o r a weight c o n t r o l programme, o f f e r e d f r e e of charge (see Appendix A ). F i f t y - n i n e women responsed to the advertisement, and 45 of these women were chosen f o r the programme. In order to i n -crease the g e n e r a l i z a b i l i t y of the r e s u l t s to a normal obese popu-t i o n , no r e s t r i c t i o n s were placed on sex or age. However, only women i n q u i r e d about the programme. Subjects chosen f o r the experiment were at l e a s t 15% overweight and were not attending any other programme f o r weight l o s s , nor ta k i n g medication f o r the purpose of weight re d u c t i o n . A l l c l i e n t s were asked to c l e a r t h e i r involvement i n the programme w i t h t h e i r f a m i l y doctor. Information gathered on the i n i t i a l telephone i n t e r v i e w was used to match subjects f o r age, m a r i t a l s t a t u s , and percent overweight. Percent overweight was determined by c a l c u l a t i n g the number of pounds over i d e a l weight (where i d e a l weight was a value taken from the middle ranges of what would be i d e a l given that person's sex and height) over i d e a l weight m u l t i p l i e d by 100. The ages ranged from 17 to 82 w i t h a mean age of 42 years. F i f t e e n subjects were randomly assigned to each of the three treatment groups. Where drop-outs occurred w i t h i n the f i r s t two sessions of the programme, an attempt was made to add another person to the group to balance the numbers. No attempt was made to replace 2 dropouts at l a t e r stages of the programme. Subjects were seen i n 16 groups of seven or eight throughout the programme. P e r s o n a l i t y Measures The I n t e r n a l / E x t e r n a l Locus of C o n t r o l Scale ( R o t t e r , 1966) was administered to a l l p a r t i c i p a n t s (see Appendix D ). The construct of e x t e r n a l i t y has been found to be r e l a t e d to o b e s i t y (Leon & Roth, 1977) and f o r t h i s reason the success of the p a r t i c i p a n t s was analyzed on the s c a l e . I n a d d i t i o n , a l l p a r t i c i p a n t s were administered an E a t i n g S i t u a -t i o n s Questionnaire (see Appendix E ). This form was developed to provide a behavioural s e l f - r e p o r t measure of the i n d i v i d u a l ' s perceived a b i l i t y to handle p o t e n t i a l l y problematic s i t u a t i o n s . There are 17 items on the s c a l e and each item o u t l i n e s a s i t u a t i o n which has the p o t e n t i a l f o r overeating to occur. I t a l s o provided i n f o r m a t i o n which allowed the programme to focus on t a r g e t problems of i n d i v i d u a l group members. Demographic Data A l l subjects were asked to complete a personal h i s t o r y i n f o r m a t i o n sheet (see Appendix F ). In a d d i t i o n to name, age, m a r i t a l s t a t u s , and educational l e v e l achieved, subjects were asked to complete items g i v i n g i n f o r m a t i o n r e l a t e d s p e c i f i c a l l y to t h e i r weight, a v a i l a b i l i t y of support from f a m i l y and/or f r i e n d s , previous d i e t attempts, age of onset of obesity, and the extent of previous successes or f a i l u r e s . Subjects were asked to give t h e i r reasons f o r wanting to l o s e weight and t h e i r perceived chances f o r success. The l a t t e r . . i n f o r m a t i o n was obtained i n the form of a p r o b a b i l i t y of success on a s c a l e of zero to 100. 17 P h y s i c a l Measures Weight and height were measured on a standard medical s c a l e . Weight i s r e p o r t e d . i n kgs. and subjects were weighed.in indoor c l o t h i n g without shoes. Groups met at the same time each week; thus f l u c -t u a t i o n i n weight over the course of the day was c o n t r o l l e d f o r . Procedure A l l c a l l e r s who responded to the advertisement were considered f o r the programme. Some were excluded because of. t h e i r involvement w i t h other weight c o n t r o l programmes. Subjects who met the c r i t e r i o n of being at l e a s t 15% overweight were given a b r i e f o u t l i n e of the programme and were asked to give t h e i r preference f o r time. Those who worked i n the daytime were placed i n evening groups and those who were a v a i l a b l e during the day were assigned to a daytime time s l o t . Each treatment group of 15 was subdivided i n t o two smaller groups of 6-8 members and treatment c o n d i t i o n s were balanced w i t h regard to the evening/daytime time s l o t s . These groups met f o r s i x treatment sessions and follow-up sessions were he l d at four weeks and at three months post-treatment. At the f i r s t s e s s i o n , a l l p a r t i c i p a n t s were asked to s i g n a data deposit agreement form (see Appendix G ). One of the problems w i t h research on weight r e d u c t i o n has been the problem of subject a t t r i t i o n due to non-;completion of the programme and non-attendance at f o l l o w -up sessions. Since the follow-up sessions were p a r t i c u l a r l y important f o r the present study, a data deposit agreement was signed by the subjects p r i o r to c o n t i n u a t i o n i n t o s e s s i o n 2. This agreement was i n the form of a contract made w i t h the subjects wherein subjects deposited 18 a cheque of $25.00 which was returned a f t e r the study p e r i o d ended and aited f o r attendance at a l l treatment sessions and follow-up sessions and the completion of re q u i r e d forms throughout the programme. Sub-j e c t s were asked to r e t u r n the cheque the f o l l o w i n g week. At t h i s f i r s t s e s s i o n , they a l s o completed a weight h i s t o r y , i n f o r m a t i o n ques-t i o n n a i r e , the Locus of C o n t r o l Scale, and an Eating S i t u a t i o n s Ques-t i o n n a i r e . The s u b j e c t s ' weights and heights were recorded at t h i s time. Subjects were given forms on which to monitor t h e i r e a t i n g f o r one week and were i n s t r u c t e d on how to monitor as a c c u r a t e l y as pos-s i b l e (see Appendix I ). A l l groups were a l s o given a copy of Stuart & Davis' (1972) Slim Chance i n a Fat World to read during the week. They were asked to r e t u r n the week's monitoring form at Session I I . Treatment Group 1 ( S e l f - M o n i t o r i n g Appropriate E a t i n g , A c t i v i t y L e v e l s , and P o s i t i v e Self-Statements). The treatment approach f o r Group 1 placed an emphasis on s e l f - m o n i t o r i n g of appropriate e a t i n g , appropriate a c t i v i t y l e v e l s , and appropriate c o g n i t i v e s e l f - s t a t e m e n t s . Each of these d i f f e r e n t aspects was introduced at s p e c i f i c stages of the programme. This focus was explained at Session I I , along w i t h the r a t i o n a l e f o r a behavioural s e l f - c o n t r o l approach to weight l o s s and the importance of s e l f - m o n i t o r i n g was explained from the p o i n t of view of increased awareness. In t h i s s e s s i o n , data deposits and the base-l i n e monitoring forms were c o l l e c t e d , weights were recorded, and sub-j e c t s were given i n s t r u c t i o n s f o r monitoring only t h e i r a ppropriate e a t i n g behaviours and given forms on which to do t h i s (see Appendix J ) . This form l i s t s s e v e r a l important behaviours which have been found to be r e l a t e d to overeating. The f i r s t week of t h i s monitoring d e a l t w i t h 19 only seven behaviours and new items were added i n subsequent weeks. These items were taken from Stuart and Davis' manual (1972) and from a manual by Ferguson (1976). Each week, the importance of each item on the l i s t was explained and subjects were asked to p r a c t i c e the new behaviours. In a d d i t i o n , behaviours r e l a t e d to i n c r e a s i n g . a c t i v i t y l e v e l s were added to the monitoring forms a f t e r the t h i r d week of the pro-gramme. During the l a s t two s e s s i o n s , c l i e n t s were given t r a i n i n g i n how to observe t h e i r p o s i t i v e c o g n i t i v e self-statements and were given a r a t i o n a l e on how t h i s t h i n k i n g r e l a t e d to t h e i r weight problem. They were asked to monitor these statements f o r two weeks and c l i e n t s were given i n s t r u c t i o n s and p r a c t i c e i n how to i n c r e a s e the number of p o s i t i v e self-statements.they made. Monitoring forms were c o l l e c t e d each week and feedback was given to the groups based on t h i s informa-t i o n . (See monitoring forms i n Appendix J.) Treatment Group 2 ( S e l f - M o n i t o r i n g of Inappropriate Behaviours — E a t i n g , A c t i v i t y , and Negative Self-Statements). The treatment approach f o r Group 2 places an emphasis on s e l f - m o n i t o r i n g of i n a p p r o p r i a t e e a t i n g , i n a p p r o p r i a t e a c t i v i t y l e v e l s , and negative s e l f - s t a t e m e n t s . Each of these d i f f e r e n t aspects were introduced at s p e c i f i c stages i n the programme (yoked w i t h Group 1). The focus on monitoring of inap-p r o p r i a t e behaviours was explained as being a way of i n c r e a s i n g one's awareness of s p e c i f i c problem behaviours and t h e r e f o r e being i n a b e t t e r p o s i t i o n to change them. The subjects i n t h i s group were taught how to develop a l t e r n a t i v e ways of d e a l i n g w i t h problematic s i t u a t i o n s and developing an understanding of how negative t h i n k i n g leads to f a i l u r e 20 at weight l o s s . As i n Group.1, data deposits and b a s e l i n e monitoring forms were c o l l e c t e d , weights were recorded and subjects were given i n s t r u c t i o n s f o r monitoring only t h e i r i n a p p r o p r i a t e e a t i n g behaviours, and were given forms on which to do t h i s (see Appendix I ). This form l i s t s the same behaviours as those given to Group 1. However, subjects would check o f f only those items which were problematic f o r them. As i n Group 1, the subjects i n Group 2 were given new monitoring forms each week w i t h new items added and subjects were given feedback on t h e i r monitoring and suggestions were made concerning t h e i r progress. Minimal Treatment C o n t r o l Group. At Session I I , data deposits and b a s e l i n e monitoring forms were c o l l e c t e d and subjects were t o l d that the meetings would be spent i n d i s c u s s i o n s based on Stuart and Davis' manual. They were i n s t r u c t e d to come i n each week w i t h problems and p o s s i b l e s o l u t i o n s were discussed.. Each week subjects were weighed and d i s c u s s i o n s o f t e n centered on s e l f - c o n t r o l , d i e t foods, and v a r i -ous a c t i v i t y programmes a v a i l a b l e i n the area. P a r t i c i p a n t s i n t h i s group o f t e n provided each other w i t h advice regarding the above. Follow-up. Follow-up sessions were held at four weeks and at the end of three months (post-treatment). At the four-week follow-up s e s s i o n , subjects were weighed and any problems they.were having were discussed. Subjects were asked about which aspects of the programme they were u s i n g , i . e . , monitoring s p e c i f i c behaviours, graphing t h e i r weights, using the manual, e t c . At the three-month follow-up s e s s i o n , subjects were weighed and they completed the Ea t i n g S i t u a t i o n s Ques-t i o n n a i r e f o r the second time. 21 RESULTS Pre Measures Analyses of variance were conducted on the pre-treatment measures to determine whether the matching of the groups on these variables p r i o r to treatment was successful. Pre-treatment variables included i n these analyses were age, m a r i t a l status, the number of years of education, age of onset of overweight, the subject's predicted chances for success on the programme, t o t a l score on an Eating Situa-tions Questionnaire (see Appendix E), and the subject's i d e a l weight. These measures were obtained from a Personal History Questionnaire and weight measures taken at the i n i t i a l treatment session. Means and standard deviations are reported i n Tables 1 and 2. In addition, a l l subjects completed Rotter's Locus of Control scale. The r e s u l t s of these analyses revealed no differences between the groups except on one of these measures, onset of obesity, F_(2,42) = 4.27, p_ < .05 (see Table 3). However, a multiple regression analysis of the pretreatment measures using weight reduction indices as a dependent v a r i a b l e suggested that onset of obesity was not an impor-tant predictor of weight change. Treatment Outcome A repeated measures analysis of variance was conducted to test for o v e r a l l treatment e f f e c t s using raw weight scores as the c r i -t e r i o n measure. No s i g n i f i c a n t differences were found i n Weight loss between the groups, F_(2,42) = 1.34, p_ < .26, and there were no Table 1 Means and Standard Deviations of Subject C h a r a c t e r i s t i c s by Group Weight 1 Ideal Weight Percent Predicted Group Kg Lb Kg Lb Overweight % Success Appropriate Self-Monitoring .'.75.31 165.67 54.51 119.93 38 61 Group (13.36) .(29.38) .(4.30) (9.45) (19) (16) Inappropriate Self-Monitoring 71.44 157.17 54.33 119.53 31 56 Group ;(8.48) (18.66) (3.96) (8.70) (13) (18) Minimal Treatment 78.85 173.47 56.21 123.67 40 57 Group (13.76) (30.27) (3.01) (6.63) (20) (17) Standard deviations i n parentheses (below weights). 23 Table 2 Means and Standard Deviations of Subject C h a r a c t e r i s t i c s ^ 3 by Group Group Mean Age Mean Education (years) M a r i t a l S t a t u s b Mean Eat i n g S i t u a t i o n s Questionnaire Time 1 Appropriate S e l f - M o n i t o r i n g 40.07 13.20 Group (12.84) (2.65) Inappropriate S e l f - M o n i t o r i n g 45.27 13.35 Group (14.96) (1.99) Minimal Treatment 42.33 12.33 Group (17..25) (1.95) 60/40 67/33 60/40 61.40 (9-98) 60.73 (8.10) 56.67 (8.12) a ' Standard d e v i a t i o n s i n parentheses. ^ M a r i t a l Status: p r o p o r t i o n married vs s i n g l e separated divorced widowed 24 Table 3 Summary Table f o r Analyses of Variance of Onset by Group Source df SS MS F Between Groups 2 ,.876.85 438.43 4.27 0.0205 Within Groups 42 4314.80 102.73 To t a l 44 5191.65 Means and Standard Deviations of Onset by Group Standard Group Means Deviations Appropriate Self-Monitoring Group 14.13 9.39 Inappropriate Self-Monitoring Group 22.47 13.69 Minimal Treatment Group 12.33 5.72 25 s i g n i f i c a n t i n t e r a c t i o n e f f e c t s . However, t h i s a n a l y s i s revealed a s i g n i f i c a n t treatment e f f e c t (see Table 4). According to these r e -s u l t s , a l l groups l o s t weight, F(3,176) = 41.59, p_ < .001. Table 5 presents mean weights f o r a l l groups at four time periods. Figures 1 and 2 p l o t weight l o s s i n kg. and l b s . Post-hoc comparisons were made using a Tukey range s t a t i s t i c to compare the means i n order to f i n d out the nature of these d i f f e r e n c e s . Four of the comparisons exceeded the required c r i t i c a l value (p_ < .05). These were: (1) i n i t i a l weight compared w i t h subject's weight at the end of the six-week, programme; (2) i n i t i a l weight compared w i t h the f i r s t follow-up; (3) i n i t i a l weight compared w i t h weight at the three-month follow-up; and (4) end of programme weight compared w i t h the f i n a l follow-up weight (maintenance p e r i o d ) . Thus, a l l groups l o s t , weight during the programme and continued to l o s e weight between the end of the programme and the three-month follow-up p e r i o d . A l l groups l o s t weight over the e n t i r e eighteen-week p e r i o d or p a r t i c i -p a t i o n i n the study and there was a s i g n i f i c a n t maintenance weight l o s s over a l l three groups. R e l a t i o n s h i p between Pretreatment and Process Measures and Outcome Spearman c o r r e l a t i o n c o e f f i c i e n t s were computed of pre-post scores on the Eating S i t u a t i o n s Questionnaire w i t h the subject's p r e d i c t e d success (expressed as a percentage), locus of c o n t r o l , and compliance on the programme. The c o r r e l a t i o n c o e f f i c i e n t s which r e s u l t e d were low and none was s i g n i f i c a n t . Table 4 Summary Table f o r Repeated Measures A n a l y s i s of Variance (Raw Weights at Four Time Periods) Source SS df MS F 2. A (Group) 7438.13 2 3719.06 1.345 0.27 B (Within) 116162.00 42 2765.76 B (Time) 703.13 3 234.38 41.593 0.001 AB (Group x Time) 32.81 6 5.47 0.971 0.448 B S-Within 710.00 126 5.64 Table 5 Means and Standard Deviations of Weight at Four Time Periods by Group End of Program One-Month Follow- Three-Month I n i t i a l Weight Weight Up Weight Follow-Up Weight Group Kg Lb Kg Lb Kg Lb Kg Lb Appropriate S e l f - 75, .31 . 165. 67 73. .27 161. 20 72. 96 160; .50 72. 35 159. 17 Monitoring Group (13. ,36) (29. ,38) (13, ,43) (29. 54) (13. 63) (29. ,98) (12. 98) (28. 55) Inappropriate S e l f - 71. ,44 157. .17 70. ,17 154. 37 69. 59 153. ,10 69. 68 153. 30 Monitoring Group (8. ,48). (18. .66) (8. 59) (18. 89) (8 ..43) (18. 54) (8. 43) (18. 55) Minimal Treatment 78. .85 173. ,47 77. ,01 169. 43 77. 00 169. ,40 76. 61 168. 53 Control Group (13. .76) (30. 27) (13. ,85) (30. 46) (13. 46) (29. ,61) (12. 73) (28. 01) Standard deviations i n parentheses. 0.0 + 1.0 2.0 3.0 4. 0 Figure 1 *. • * • * • Follow-Up F i n a l Follow-Up Time of Assessment 0 0 Lbs Figure 2 0.0 1.0 h 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 4- X X Pre Post 1st Follow-Up F i n a l Follow-Up Time of Assessment N2 Table 6 Means and Standard Deviations of Kg. Lost at Four Time Periods by Group I n i t i a l - I n i t i a l - 1 s t I n i t i a l - F i n a l End of Program-Post-treatment Follow-Up Follow-Up F i n a l Follow-Up Group Kg Lb Kg Lb Kg Lb Kg Lb Appropriate Self- 1 2. ;03 4. 47 2. ,35 5. 17 2. 96 6. 50 0. ,92 2. ,03 Monitoring Group (1. ,58) (3. 47) (1. .42) (3. 13) (2. 16) (4. 74) (1. ,73) (3. ,80) Inappropriate S e l f - 1. 27 2. 80 1. .80 4. 07 1. 76 3. 87 0. ,49 1. ,07 Monitoring Group (0. 82) (1. 80) (1. ,03) (2. 26) (1. 49) (3. 27) (1. ,41) (3. ,11) Minimal Treatment 1. 83 4. 03 1. ,85 4. 07 2. 24 4. 93 0. ,41 0. ,90 Control Group (1. 17) (2. 40). (1. ,42) (3. 12) (2. 57) (5. 66) (2. ,09) (4. • 59) Standard deviations i n parentheses. 31 Non-parametric correlation coefficients (Spearman's) were cal-culated to investigate the relationship between the support variable (whether the subject expected to receive support from spouse, family, or friends) and the number of kg. lost at four time periods. The correlations were: support with kg. lost at time one ( i n i t i a l weight/ end of programme weight) = .12; at time two ( i n i t i a l weight/first follow-up weight) = .21; at time three ( i n i t i a l weight/final follow-up weight) = .17; and with the maintenance period (end of programme weight/final follow-up weight) = .12. None of these correlations was significant. One-way analyses of variance were conducted for percent-overweight calculated at four time periods ( i n i t i a l weighing, end of programme, one-month follow-up, and three-month follow-up) by group. No s i g n i f i -cant differences occurred between groups on percent-overweight at any time period. A correlation matrix (Pearson) was produced which included the following variables: age, education, onset of obesity, chronicity, support, locus of control, and compliance with weight at four time periods and kg. lost at four time periods. Significant negative cor-relations occurred between onset and i n i t i a l weight (r_ = -.28), onset and post-treatment weight (r = -.28), onset and weight at f i r s t follow-up (r_ = -.28), and onset and weight at f i n a l follow-up (r_ = -.29). However, no significant correlations occurred between onset of obesity and weight loss at four time periods. Chronicity of obesity correlated significantly with i n i t i a l weight (r = .30). with post-treatment weight (r = .28), with f i r s t follow-up (r_ = .27), and with weight at f i n a l follow-up. Significant correlations were also found between 32 chronicity and weight at f i r s t follow-up (r = .25) and at f i n a l follow-up (r_ = .26) (see Table 7). Table 7 Pearson Correlation C o e f f i c i e n t s Weight 1 Weight 2 Weight 3 Weight 4 Lbs Lost 1 Lbs Lost 2 Lbs Lost 3 Maintenance Age 0.198 (0.096) 0.197 (0.098) 0.196 (0.098) 0.192 (0.103) 0.008 (0.480) 0.019 (0.451) 0.081 (0.298) 0.094 (0.270) Education 0.089 (0.282) 0.085 (0.288) 0.089 .(0.281) 0.095 (0.268) 0.029 (0.424) 0.000 (0.499) -0.011 (0.471) -0.034 (0.412) Onset -0.276 (0..033) -0.276 (0.030)' -0.277 * (0.033) -0.288 ^ (0.030) 0.001 (0.497) 0.001 (0.497) -0.009 (0.475) -0.013 (0.467) Chronicity 0.299 a (0.023) 0.283 A (0.030) 0.274 * (0.034) 0.266 ^ (0.039) 0.159 (0.148) 0.249 * (0.050) 0.263 ^ (0.040) 0.210 (0.083) Support 0.068 (0.329) 0.056 (0.358) 0.045 (0.380) 0.040 (0.39-7) 0.122 (0.210) 0.214 (0.080) 0.169 (0.132) 0.123 (0.211) Locus 0.020 (0.449) 0.029 (0.426) -0.033 (0.415) -0.049 (0.375) -0.087 (0.284) -0.124 (0.208) -0.155 (0.155) -0.128 (0.200) Compliance -0.006 (0.484) -0.022 (0.443) -0.031 (0.421) -0.035 (0.411) 0.158 (0.150) 0.231 (0.064) 0.155 (0.155) 0.078 (0.304) Sig n i f i c a n c e l e v e l i n parentheses. 'p_ < .05 34 DISCUSSION The results of the analyses of variance to test for treatment effects confirmed the f i r s t hypothesis of the study that a l l groups would lose weight. Although these weight losses were s t a t i s t i c a l l y significant, i t is important to point out that their c l i n i c a l signi-ficance is not as clear. These losses do not seem to be that impres-sive in terms of the overall kg. required to approach ideal weight. However, on a six-week treatment programme for weight loss, one would not expect nor would i t be medically acceptable to have sub-jects lose a large percentage of excess weight. In addition, a weight control programme designed to teach people how to lose weight and, more importantly, to maintain this weight change after the pro-gramme ends would have as i t s major goal, gradual weight change, where weight loss was a function of systematic habit change with regard to eating, an increase in physical activity, and an improvement in sub-jects' perceived and actual self-control. Weight loss during the weight control programme is important; however, the efficacy of treatment for the overweight must clearly be judged on a criterion which concerns the maintenance of i n i t i a l treat-ment and a continued loss of weight post-treatment unt i l some ideal weight is achieved. Studies to date on the treatment of obesity rarely report follow-up data on their subjects (Wilson, 1978). In those studies where f o l -low-up data are reported the evidence for maintenance of weight loss after the programme ends has overwhelmingly indicated failure 35 (Wildfogel, 1976). Although the present study was unable to show d i f f e r e n t i a l e f f e c t s due to treatment, the finding.of s i g n i f i c a n t post-treatment weight loss across a l l groups may be very important. A l l groups i n the present study received a treatment programme which included an emphasis on l i f e s t y l e change using s e l f - c o n t r o l methods. A l l subjects received Stuart and Davis' s e l f - h e l p manual for weight co n t r o l and were given i n s t r u c t i o n s on how to use the manual. A l l subjects were t o l d that t h e i r success i n the programme would depend on the degree to which they would be responsible for making the re-quired behavioural changes leading to weight l o s s . I t may be that a l i f e s t y l e change approach which stresses s e l f - h e l p methods c o n t r i -butes to weight loss maintenance and continued loss post-treatment. In the l i g h t of the fact that a l l conditions shared both non-specific and technique s i m i l a r i t i e s , the absence of s i g n i f i c a n t differences may not be s u r p r i s i n g . In order to make a more d e f i n i t e statement with regard to the strength of the trend of post-treatment weight loss which the r e s u l t s show,._it would be necessary to contact the subjects for a six-month follow-up. A reasonable statement could be made with regard to the present s i g n i f i c a n t change i n weight for a l l groups i f the changes approxi-mated, for example, an average weight loss of at l e a s t kg. (%-l lb.) per week over the e n t i r e period under study. This conservative expectation takes into account plateau periods which often occur during any long-term weight-loss programme. In the present study, the expected 36 weight loss would f a l l within a range of 4 kg - 7 kf (9-18 lbs) per subject. Comparing the groups on the number of subjects who achieved such a score produces the following result: five (33%) of the subjects achieved this goal in Group 1, one subject in Group 2, and two subjects in the Control group. This suggests that Group 1 may be a superior treatment for some individuals compared with both the inappropriate self-monitoring group and a control. The issue of experimental contamination in terms of experimenter bias should be considered here. A l l groups in the present study were led by a therapist who knew what the experimental hypotheses were and which subjects were in which group. Although an effort was made to treat a l l groups equally in terms of involvement and support, i t is not possible to completely dismiss the bias which may have been introduced. Given the results of a significant loss of weight across a l l groups, this criticism may not be that important. Another limitation of experimental studies of weight.loss is uncertainty about the possible effects of being observed or p a r t i c i -pation in any experiment. For most of the participants in the groups, a self-control treatment approach was novel. Several subjects (in-cluding the control group subjects) commented on the appeal which this had for them. In the absence of a no-treatment control group, i t is not possible to completely rule out this alternative explanation of the obtained results. Because i t is not clear how participants in a waiting l i s t control group w i l l respond to having to wait for treatment, and because of the ethical concerns about withholding treatment from subjects for a 37 p e r i o d of time, the present study used a minimal treatment c o n t r o l group r a t h e r than a no-treatment c o n t r o l or a w a i t i n g l i s t c o n t r o l . P r e d i c t o r s of Weight Loss The c o r r e l a t i o n c o e f f i c i e n t s reported f o r support c o r r e l a t e d w i t h the number of kg. l o s t at four time periods throughout the programme suggest that t h i s v a r i a b l e as measured i n the present i n v e s t i g a t i o n d i d not appear to be important. Stuart (1972) and others -have s t a t e d that support from f a m i l y and f r i e n d s are important f a c t o r s i n s u c c e s s f u l weight l o s s programmes. The present study d i d not show evidence f o r the importance of support. Although an i d e a l s i t u a t i o n might be one i n which the environment supported the i n d i v i d u a l ' s success i n weight r e d u c t i o n , i n terms of long-term maintenance i t would seem much more important f o r .the c l i e n t to have as much c o n t r o l over r e i n f o r c e r s of success f o r s m a l l steps made towards weight r e d u c t i o n r a t h e r than have them r e l y on an u n p r e d i c t a b l e reinforcement system over which they have l e s s c o n t r o l ( i . e . , other persons and how they might respond to the c l i e n t ' s e f f o r t s ) . The negative c o r r e l a t i o n s between age of onset and subject's weight suggest that age of onset i s r e l a t e d to the s e v e r i t y of the c o n d i t i o n of o b e s i t y . Age of onset d i d not c o r r e l a t e s i g n i f i c a n t l y w i t h post treatment (or maintenance of) weight l o s s . This suggests that s u b j e c t s ' age of onset of o b e s i t y was not an important f a c t o r i n t h e i r success or f a i l u r e i n the programme. C h r o n i c i t y was p o s i t i v e l y c o r r e l a t e d w i t h i n i t i a l weight, post-treatment weight, and weight at both follow-up periods. This i s not s u r p r i s i n g i n that we would expect subjects who have been overweight 38 for longer periods of time to be heavier. Chronicity was also p o s i -t i v e l y correlated with weight loss at both follow-up periods. This f i n d i n g may mean that subjects who had a longer h i s t o r y of overweight were more successful at l o s i n g weight and maintaining t h i s weight. An a l t e r n a t i v e explanation might be that subjects whose h i s t o r y of overweight i s longer are heavier, and weight loss expressed as the number of kg. (or lbs.) l o s t r e f l e c t s the case that heavier c l i e n t s have more to. .lose and i t i s easier f o r them to lose weight during the f i r s t few months of a weight loss programme. Given the s i z e of the c o r r e l a t i o n s , any statements which are made about the re l a t i o n s h i p s between onset and weight, and c h r o n i c i t y and (1) weight and (2) weight loss must be cautiously received. The most important f i n d i n g of the present study involved the s i g n i f i c a n t post-treatment weight losses across a l l groups. In order to further explore (I) post-treatment weight maintenance and weight change and (2) possible divergent trends f o r the three groups, a s i x -month follow-up on subjects w i l l be c a r r i e d out. I t seems that researchers involved i n obesity studies and r e -viewers of these studies often make the same mistake i n evaluating t h e i r findings that c l i e n t s make of t h e i r progress on a weight co n t r o l programme. Their expectations of what constitutes a c l i n i c a l l y s i g -n i f i c a n t weight loss i s often too high, and they are very e a s i l y d i s -couraged from further exploration of subjects' progress as suggested by t h e i r lack of long-term follow-up of subjects. I t seems that very l i t t l e i s known about the process of l o s i n g weight over a long-term period. Long-term follow-up of (1) subjects' weights, (2) patterns of 39 weight change which might include, f o r example, plateau periods, (3) changes i n a t t i t u d e s , and (4) changes i n the p h y s i c a l output of energy might be i l l u m i n a t i n g f o r the development of successful weight co n t r o l programmes. The fa c t that a l l groups l o s t weight during the programme and continued to lose weight a f t e r treatment ended may point to the r e l a -t i v e s u p e r i o r i t y of s e l f - c o n t r o l methods which stress l i f e s t y l e change i n weight reduction c l i n i c s . 40 FOOTNOTES For the purpose of t h i s study o b e s i t y i s defined as being at l e a s t f i f t e e n percent over the i d e a l weight suggested by the t a b l e s i n Stuart and Davis' (1972) s e l f - h e l p manual f o r weight l o s s (p. 6). Obesity and overweight w i l l be used interchangeably throughout the study. There are problems w i t h using a c u t - o f f p o i n t of 15% above i d e a l weight and there are problems w i t h d e f i n i n g an i d e a l weight f o r s u b j e c t s . Leon and Roth (1977) have o u t l i n e d some of these i n t h e i r review of o b e s i t y . In the present study subjects were accepted i f they met the 15% c u t - o f f c r i t e r i o n . Data f o r two subjects were ex t r a p o l a t e d by the author. One of these subjects was i n the Inappropriate S e l f - M o n i t o r i n g group (Group 2) and the other subject was i n the Minimal Treatment C o n t r o l group. These subjects were u n a v a i l a b l e f o r the f i n a l follow-up s e s s i o n and t h e i r f i n a l weights, .were estimated based on the average weight l o s t between one-month follow-up and three-month follow-up f o r t h e i r r e s p e c t i v e groups. 41 REFERENCE NOTES 1. Kanfer, F.H. S e l f - r e g u l a t i o n and s e l f - c o n t r o l . A chapter to appear i n H. Z e i e r (Ed.), The psychology of the 20th century. Volume 4: From c l a s s i c a l c o n d i t i o n i n g to b e h a v i o r a l therapy. Z u r i c h : K i n d l e r and V e r l a g , 1977(7). Published i n German. 2. Kirschenbaum, D.S. When s e l f - r e g u l a t i o n f a i l s : Tests of some  p r e l i m i n a r y hypotheses. Unpublished d o c t o r a l d i s s e r t a t i o n , U n i v e r s i t y of C i n c i n n a t i , 1975. 3. W i l d f o g e l , J . Treatment innovations: Where we have come from and  where we are going. Paper presented at the 56th annual meeting of the Western P s y c h o l o g i c a l A s s o c i a t i o n , Los Angeles, A p r i l , 1976. 42 REFERENCES Abramson, E.E. A review of behavioral approaches to weight c o n t r o l . Behavior Research and Therapy, 1973, 11_, 547-556. Ayllon, T. Intensive treatment of psychotic behavior by stimulus s a t i a t i o n and food reinforcement. Behavior Research and Therapy, 1963, 1_, 53-61. Bellack, A.S. Behavior therapy f o r weight reduction. Addictive Behaviors, 1975, 1_, 73-82. Bellack, A.S., Rozensky, R., & Schwartz, J. A comparison of two forms of self-monitoring i n a behavioral weight reduction program. Behavior Therapy, 1974, j>, 523-530. Brodin, M., H a l l , R.V., & M i t t s , B. The e f f e c t of s e l f - r e c o r d i n g on the classroom behavior of two eighth-grade students. Journal of Applied Behavior Analysis, 1971, 4-, 191-199. Byrne, D. Repression-sensitization as a dimension of personality. In B.A. Maher (Ed.), Progress i n experimental personality research. Volume 1. New York: Academic Press, 1964. Cuatela, J . Covert s e n s i t i z a t i o n . Psychological Reports, 1967, 20, 459-460. Cavior,N.& Marabatto, CM. Monitoring verbal behaviors i n a dyadic i n t e r a c t i o n : valence of target behaviors, type, timing, and r e a c t i v i t y of monitoring. Journal of Consulting and C l i n i c a l  Psychology, 1976, 44, 68-76. Ferster, C.B., Nurnberger, J . I . , & L e v i t t , E.B. The con t r o l of eating. Journal of Mathetics, 1962, 1_, 87-104. 43 Foreyt, J.P. & Kennedy, W.A. Treatment of overweight by a v e r s i o n therapy. Behavior Research and Therapy, 1971, _7_, 29-34. Freder i k s e n , L.W., E p s t e i n , L.H., & Kosevsky, B.P. R e l i a b i l i t y and c o n t r o l l i n g e f f e c t s of three procedures f o r s e l f - m o n i t o r i n g smoking. The P s y c h o l o g i c a l Record, 1975, 25, 255-264. Gottman, J.M. & M c F a l l , R.M. S e l f - m o n i t o r i n g e f f e c t s i n a program f o r p o t e n t i a l high school dropouts: a t i m e - s e r i e s a n a l y s i s . J o u r n a l  of C o n s u l t i n g and C l i n i c a l Psychology, 1972, 39, 273-281. H a l l , S.M. S e l f - c o n t r o l and t h e r a p i s t c o n t r o l i n the b e h a v i o r a l treatment of overweight women. Behavior Research and Therapy, 1972, 10, 59-68. Harmetz, M.G. & Lapue, P. Behavior m o d i f i c a t i o n of overeating i n a p s y c h i a t r i c p o p u l a t i o n . J o u r n a l of Consulting and C l i n i c a l  Psychology, 1968, 32, 583-587. H a r r i s , M.B. S e l f - d i r e c t e d program f o r weight c o n t r o l . A p i l o t study. J o u r n a l of Abnormal Psychology, 1969, 7_4, 263-270. Horan, J . J . Negative coverant p r o b a b i l i t y : an analogue study. Behavior Research and Therapy, 1974, 1_2, 265-266. Horan, J . J . , Baher, S., Hoffman, A.M., & Shute, R.E. Weight l o s s through v a r i a t i o n s i n the coverant c o n t r o l paradigm. J o u r n a l  of C o n s u l t i n g and C l i n i c a l Psychology, 1975, 4j3, 68-72. Horan, J J . & Johnson, R.G. Coverant c o n d i t i o n i n g through a s e l f -management a p p l i c a t i o n of the Primack p r i n c i p l e : i t s e f f e c t on weight r e d u c t i o n . J o u r n a l of Behavior Therapy and Experimental  P s y c h i a t r y , 1971, _2, 243-249. Horan, J . J . , Smyers, R.D., Dorfman, D.L., & J e n k i n s , W.W. Two analogue 44 attempts to harness the negative coverant e f f e c t . Behavioral Research and Therapy, 1975, i n press. Janda, L.H. & Rimm, D.C. Covert s e n s i t i z a t i o n i n the treatment of obesity. Journal of Abnormal Psychology, 1972, 80_, 37-42. J e f f r e y , D.B. & Christensen, E.R. E f f e c t of behavior therapy vs. " w i l l power" i n the management of obesity. Journal of Psychology, 1975, 90, 303-311. Kanfer, F.H. Se l f - r e g u l a t i o n : research issues and speculations. In C. Neuringer & J.L. Michael (Eds.), Behavior modification i n c l i n i c a l psychology. New York: Appelton-Century-Crofts, 1970, 178-220. Kanfer,F.H. & Karoly, P. S e l f - c o n t r o l : a b e h a v i o r i s t i c excursion into the l i o n ' s den. Behavior Therapy, 1972, 3_» 398-416. Kennedy, W.A. & Foreyt, J . Control of eating behavior i n an obese patient by avoidance conditioning. Psychological Reports, 1968, 22, 571-576. L i p i n s k i , D.P., Black, J.L., Nelson, R.O., & Ciminero, A.R. The influence of motivational variables on the r e a c t i v i t y and re-a l i b i l i t y of self - r e c o r d i n g . Journal of Consulting and C l i n i c a l  Psychology, 1975, 43, 637-646. McFall, R.M. E f f e c t s of self-monitoring on normal smoking behavior. Journal of Consulting and C l i n i c a l Psychology, 1970, 3_5, 135-142. McFall, R.M. & Hammen, C.L. Motivation, structure, and self-monitoring: r o l e of nonspecific factors i n smoking reduction. Journal of  Consulting and C l i n i c a l Psychology, 1971, _37, 80-86. Mahoney, M.J. Self-reward and self-monitoring techniques for weight 45 l o s s . Behavior Therapy, 1973, 76-83. Mahoney, M.J. C o g n i t i o n and behavior m o d i f i c a t i o n . Cambridge, Mass.: B a l l i n g e r , 1974. Mahoney, M.J. Fat f i c t i o n . Behavior Therapy, 1975, 6, 416-418. Mahoney, M.J., Moura, N.G.M., & Wade, T.C. R e l a t i v e e f f i c a c y of se l f - r e w a r d , self-punishment, and s e l f - m o n i t o r i n g techniques f o r weight l o s s . J o u r n a l of Consulting and C l i n i c a l Psychology, 1973, 40, 404-407. Maletzky, B.M. Behavior recording as treatment: a b r i e f note. Be- havior Therapy, 1974, 5_, 107-111. Mann, R.A. The behavior-therapeutic use of contingency c o n t r a c t i n g to c o n t r o l an a d u l t behavior problem: weight c o n t r o l . J o u r n a l  of A p p l i e d Behavior A n a l y s i s , 1972, _5, 99-109. Meynen, G.E. A comparative study of three treatment approaches w i t h the obese: r e l a x a t i o n , covert s e n s i t i z a t i o n , and modified systematic d e s e n s i t i x a t i o n . D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l , 1970, 31_, 2998. M i s c h e l , W. & Ebbesen, E.B. A t t e n t i o n i n delay of g r a t i f i c a t i o n . J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, 1970, JJ>, 329-337. Morganstern, C P . C i g a r e t t e smoke as a noxious stimulus i n s e l f -managed a v e r s i o n therapy f o r compulsive e a t i n g . Behavior Therapy, 1974, _5, 255-260. Nelson,R.O. Methodological issues i n assessment v i a s e l f - m o n i t o r i n g I n J.D. Cone & R.P. Hawkins (Eds.), Behavioral.assessment: new  d i r e c t i o n s i n c l i n i c a l psychology. Bruner/Mazel, 1977. Nelson, R.O., L i p i n s k y , D.P., & Black, J.L. The e f f e t c s of expectancy 46 on:the r e a c t i v i t y of se l f - r e c o r d i n g . Behavior Therapy, 1975a,^ 337-349. Nelson, R£>., L i p i n s k i , D.P. , & Black, J.L. The r e l a t i v e r e a c t i v i t y of external observations and self-monitoring. Behavior Therapy, 1976b, ]_, 314-321. N u t r i t i o n Canada. N u t r i t i o n : a na t i o n a l p r i o r i t y . Ottawa: Informa-t i o n Canada, 1973. Penick, S.B., F i l i o n , R., Fox, S., Stunkard, A. Behavior modification i n the treatment of obesity. Psychosomatic Medicine, 1971, 33, 49-55. Rachlin, H. S e l f - c o n t r o l . Behaviorism, 1974, 2, 94-107. Rehm, L.P. A s e l f - c o n t r o l model of depression. Unpublished manu-s c r i p t . U niversity of Pittsburgh, 1975. Romancyzk, R.G. Self-monitoring i n the treatment of obesity: para-meters of r e a c t i v i t y . Behavior Therapy,. 1974, J 5 , 531-540. Romancyzk, R.G., Tracey, D.A., Wilson, G.T., & Thorpe, G.L. Behvaioral techniques i n the treatment of obesity. Behavior Research and  Therapy, 1973, 11_, 629-640. Rotter, J.B. Generalized expectancies f or i n t e r n a l versus external c o n t r o l of reinforcement. Psychological. Monographs, 1966, 80(1). Sieck, W.A. & McFall, R.M. Some determinants of self-monitoring ef-f e c t s . Journal of Consulting and C l i n i c a l Psychology. Manu-s c r i p t submitted f or p u b l i c a t i o n , 1975. Stollack, C E . Weight loss obtained under d i f f e r e n t experimental procedures. Psychotherapy: Theory, Research, and P r a c t i c e , 1967, 4, 61-64. 47 Strata, A., Z u l i a n i , V., Caronna, S., Magnati, G., Pugnoli, C., & T i r e l l i , F. Epidemiological aspects and s o c i a l importance of obesity. The s i t u a t i o n i n I t a l y compared with other developed countries. International Journal of Obesity, 1977, JL_, 191-206. Stuart, R.B. Behavioral co n t r o l of overeating. Behavior Research and  Therapy, 1967, 5_, 357-365. Stuart, R.B. A three-dimensional program for the treatment of obesity. Behavior Research and Therapy, 1971, % 177-186. Stuart, R.B. & Davis, B. Slim chance i n a f a t world: Behavioral c o n t r o l of obesity. Champaign, I l l i n o i s : Research Press, 1972. Stunkard, A.J. P r e s i d e n t i a l Address — 1974: From explanation to action i n psychomatic medicine: The case of obesity. Psycho- somatic Medicine, 1975, _3_7, 195-236. Tyler, V.O. & Straughan, J.H. Coverant co n t r o l and breath-holding as techniques for the treatment of obesity. Psychological Record, 1970, 20, 473-478. Weiner, B., Heckhausen, H., Meyer, W.V., & Cook, R.E. Causal a s c r i p -tions and achievement behavior: a conceptual analysis of e f f o r t and reanalysis of locus of c o n t r o l . Journal of Personality and  S o c i a l Psychology, 1972, 21, 239-248. Wilson, G.T. Methodological considerations i n treatment outcome research on obesity. Journal of Consulting and C l i n i c a l  Psychology, 1978, 44(4), 687-702. 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, 7_6, 462-474. Leaf 48 omitted i n page numbering. APPENDIX B VANCOUVER HEALTH DEPARTMENT, WEST UNIT KEEP IT OFF This program w i l l be offered through the Vancouver Health Department to explore an alternative approach to weight control. It involves a behavioural approach with a special emphasis on training clients to appropriately self-monitor their eating, level of activity, and attitudes toward •> themselves and their progress i n the program. The program w i l l include 6 group sessions commencing each week throughout the spring. Both evening and daytime sessions w i l l be offered. During these sessions the procedures w i l l be presented and discussed. In addition, clients w i l l be asked to complete daily records of their progress and mail these to the unit i n pre-stamped envelopes. The program i s offered free-of-charge to residents of Vancouver as a service of the Health Department. To register, mail i n the application form attached below. Further information i s available from Lee Trentadue, at the West Health Unit (Kerrisdale). Call Yours sincerely, Lee Trentadue LTjeh . Mail to: Ms. Lee Trentadue APPLICATION FOR THE VANCOUVER HEALTH DEPARTMENT "Keep It Off" Name: Age: Address: Sex: M. F. Telephone No: Present weight Ideal weight How long have you been overweight? Are you presently under medication for weight loss? MEMBER OF THE METROPOLITAN HEALTH SERVICE OF GREATER VANCOUVER 50 APPENDIX C Experimental Consent Form Major I n v e s t i g a t o r : Lee Trentadue F a c u l t y Supervisor: Dr. P.O. Davidson Since t h i s i s a study designed to t e s t the treatment e f f i c a c y of self-management techniques f o r weight l o s s , we are unable to i n c l u d e i n d i v i d u a l s (1) who are i n v o l v e d i n any other program f o r weight l o s s , (2) who are l e s s than 15 percent over i d e a l weight, and (3) who are p r e s e n t l y t a k i n g drugs which might a f f e c t weight change throughout the program. I understand the above r e s t r i c t i o n s on experimental s u b j e c t s . I have been informed of the procedures i n v o l v e d i n the experiment and agree to p a r t i c i p a t e i n the sessions as they have been o u t l i n e d f o r me. I a l s o understand that I am f r e e to terminate my p a r t i c i p a t i o n i n the experiment at any time and f o r any reason. Signature: Date: APPENDIX D SOCIAL REACTION INVENTORY This is a questionnaire to find out the way In which certain important event8 in our society affect different people. Each item consists of a pair of alternatives lettered a or b_. Please select the one statement of each pair (and only one) which you more strongly believe to be the case as far as you're concerned. Be sure to select the one you actually believe to be more true rather than the one you think you should choose or the one you would like to be true. This is a measure of personal belief; obviously there are no right or wrong answers. Your answer, either si or b_, to each question on this Inventory is to be recorded cn page 6 (last pape). Please answer those items carefully but do not Spend too much time on any ©ne Item. Be sure to- find an aneuer for every choice. For each numbered question make an X on the line beside either the a or the b_, whichever you choose as the statement most true. In some instances you may discover that you believe both statements or neither one. In such cases, be sure to select the one you more strongly believe to be the case as far as you're concerned. Also try to respond to each item indpendently when making your choice: do not be influenced by your previous choices. Select that alternative which you personally believe to be more true. Write your nane on the top of page 6, and answer a l l questions on page 6. 52 APPENDIX D continued I more strongly believe that: 1. a. Children get into trouble because their parents punish them too much. b. The trouble with most children nowadays i s that their parents are too easy with them. 2. a. Many of the unhappy things in people's lives are partly due to bad luck. b. People's misfortunes result from the mistakes they make. 3 . a. One of the major reasons why we have wars i s because people don't take enough interest In 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 in this world. b. Unfortunately, an individual's worth often passes unrecognized no matter how hard he tries. 5 . a. The idea that teachers are unfair to students i s nonsense. b. ?iost students don't realize the extent to which their grades are influenced by accidental happenings. 6. a. Without the right breaks one cannot be an effective leader. b. Capable people who f a i l to become leaders have not taken advantage of their opportunities. 7. a. No matter bow hard you try, some people lust don't like you. b. People who can't Ret others to like them don't understand how to get along with others. 8 . a. Heredity plays the major role in determining one's personality. b. It is one's experiences in l i f e which determine what they're l i k e . 53 APPENDIX D continued I wore strongly believe that: 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 roe as making a decision to take a definite course of action. 10. a. In the case of the well prepared student there i s rarely, i f ever, such & thing as an unfair test. b. Many times exam questions tend to be so unrelated to course work, that studying i s really useless. 11. a. Becoming a success is a matter of hard work; luck has l i t t l e or nothing to do with It. b. Getting a good job depends mainly on being in the right place at the ripht time. 12. a. The average citizen can. have an influence in government decisions. b. This world is run by the few people in power, and there i s not much the l i t t l e guy can do about i t . 13. a. TThen I make plans, I am almost certain that I can make them work. b. It i s not always wise to plan too far ahead because many things turn out to be a matter of good or bad fortune anyhow. 14. a. There are certain people who are just no good, b. There is some good in everybody. 15. a. In my case petting what I want 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 flipping a coin. 16. a. Who gets to he the boss often depends on who was lucky enough to be in the riftht place f i r s t . b. Gettinft people to do the right thing depends upon abi l i t y ; luck has l i t t l e or nothing to do with i t . 17. a. As far as world affairs are concerned, most of us are the victims of forces we can neither understand, nor control. b. By taking an active part in p o l i t i c a l and social aff a i r s , the people can control world events. 54 APPENDIX D continued I more strongly believe that: 18. a. Most people can't realize the extent to which their lives are controlled by accidental happenings. b. There really i s no such thing as 'luck'". 19. a. One should always be willing to admit his mistakes, b. It i s usually best to cover up one's mistakes. 20. a. It is hard to know whether or not a person really likes you. b. r\avr wany 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. ?*ost misfortunes are the result of lack of a b i l i t y , ignorance, laziness, or a l l three. 22. a. With enough effort we can wipe out p o l i t i c a l corruption. b. It i s d i f f i c u l t for people to have much control over the things politicians do in office. 23. a. Sometimes I can't understand how teachers arrive at the grades they give. b. There is a direct connection between how hard I study and the grades I get. 24. a. A good leader expects people to decide for themselves what they should do. b. A good leader makes i t clear to everybody what their jobs are. 25. a. Many times T. feel that I have l i t t l e influence over the things that happen to me. b. It i s impossible for me to believe that chance or luck plays an important role in my l i f e . 55 APPENDIX D continued I more strongly believe that: 26. a. People are lonely because they don't try to be friendly. b. There's not much use in trying too hard to please people; i f they like you, they like you. 27. a. There i s too much emphasis on athletics in high school, b. Team sports are an excellent way to build character. 28. a. What happens to me is my own doing. b. Sometimes I feel that I don't have enough control over the direction my l i f e i s taking. 29. a. Most of the time I can't understand why politicians behave the way they do. b. In the long run the people are responsible for bad government on a national as well as on a local level. 56 APPENDIX E Ea t i n g S i t u a t i o n s Questionnaire Which of the f o l l o w i n g s i t u a t i o n s do you f i n d problematic w i t h regard to overeating? Often Sometimes Rarely I tend to overeat when I am alone. 2. I tend to overeat when I am w i t h com-pany and food i s r e a d i l y a v a i l a b l e . 3. I f i n d i t d i f f i c u l t to t u r n down food even when I am not hungry. 4. I overeat when making dinner (snacking w h i l e cooking). 5. I do not eat re g u l a r meals. 6. I s k i p meals. 7. I overeat (a) at breakfast (b) at lunch (c) at dinner (d) between meals 8. I go on food binges (a) l a t e at night (b) w h i l e on v a c a t i o n (c) s p e c i a l occasions (Christmas, b i r t h d a y s , etc.) (d) when problem foods are a v a i l a b l e (e) other ( s p e c i f y ) 9. I overeat when I am out at a r e s t a u r a n t . 10. I eat out. 11. I eat at f a s t food o u t l e t s . 12. One of my problems i s that I overeat foods high i n c a l o r i e s (cakes, cookies, candy) 13. I eat too q u i c k l y . 57 APPENDIX E continued Often Sometimes . Rarely 14. I eat w h i l e reading, watching T.V., or r i d i n g i n my car. 15. I eat when I am experiencing: (a) depression -(b) confusion (c) l o n e l i n e s s (d) tens i o n / a n x i e t y (e) sadness (f) f r u s t r a t i o n (g) anger (h) boredom ( i ) other f e e l i n g s 16. I use food as a reward. 17. For me eating i s a major s o c i a l a c t i -v i t y . 58 APPENDIX F Weight History and Medical Information Questionnaire 1. Name 2. Address 3. 4. 5. 6. Phone: Age: Home Business: Sex M a r i t a l Status Occupation Educational Level Attained: Public/Elementary Secondary/High School College/Specialized Training (Specify) University Post Graduate Work a. Present Weight c. Height e. What i s the l i g h t e s t you have ever been (as an adult —: 19 years.or over? f. Short term goal 4 weeks Number of Years Number of Years Number of Years Number of Years ...Number of Years Ideal Weight d. What i s the most you have ever weighed? 8 weeks 3 months Have you been overweight i n the past? During what periods? Childhood (1-8 years) Pre-teens (9-11 years) Adolescence (12-18 years) Adult (19 years or l a t e r ) Are there others i n your family who are overweight? Father Mother S i s t e r ( s ) Brother(s) Son(s) Daughter(s) Others? 59 APPENDIX F continued 10. How long have you been overweight? 11. Was t h i s a gradual process or d i d you s t a r t p u t t i n g on weight suddenly (e.g., i n response to some l i f e c r i s i s or change)? 12. How o f t e n have you t r i e d to l o s e weight before? a. I always seem to be on a d i e t b. On and o f f a l l my l i f e c. Several times i n the past 10 years d. Went on a d i e t ( s e r i o u s l y ) 1-5 times i n the past ten years e. O c c a s i o n a l l y t r i e d to cut out f a t t e n i n g foods f. Never d i e t e d before 13. Have you been su c c e s s f u l ? 14. Which methods d i d you use and which methods worked best f o r you? 15. How long were you able to maintain the weight l o s s ? 16. Were there any s p e c i f i c reasons/events which you t h i n k have made you overweight? Pr e s e n t l y ? In the Past? 17. Do you have any s p e c i a l preferences w i t h regard to a lowered i n t a k e of food and/or an increase i n a c t i v i t y or energy use? Lowered c a l o r i e d i e t Exchange d i e t (as o u t l i n e d ) Low carbohydrate d i e t J u s t c u t t i n g down q u a n t i t i e s of food One of the above plus adding a re g u l a r e x e r c i s e r o u t i n e 18. Are you p r e s e n t l y t a k i n g any form of medication? O r a l contraceptives D i e t p i l l s D i a r e t i c s Other 60 APPENDIX F continued 19. How much support do you expect to get from f a m i l y members and/ or f r i e n d s ? Please s p e c i f y who. 20. Do you pl a n to do the program on your own (that i s , not discuss w i t h others that you are t r y i n g to l o s e weight)? 21. Why do you want to l o s e weight? Health reasons? Want to look b e t t e r ? Other reasons? 22. What do you t h i n k your chances are f o r success? 0-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 90-100 'APPENDIX G -Deposit Agreement You and this weight c l i n i c both provide important services to each other. The c l i n i c operates as a public service to help you with your progress i n weight control. Ih return for this service, I am asking you to help me develop a more adequate treatment approach for weight problems. In order to make any significant changes i n your habits, f u l l co-operation and complete information about you and your habits are essential. People tend to be more conscientious when they have to make a commitment to a project. I am asking a l l clients to make a commitment to this program by providing a deposit of $25.00. The deposit guarantees your active co-operation with the program. I t i s returned at a three month follow-up of the c l i n i c i f you haves 1) Attended a l l scheduled sessions. 2) Submitted complete records of your progress i n weight control during and after the clixdc. 3) Completed and returned a l l questionnaires related to the program. Please realize that a great deal of effort goes into the program and I must be s t r i c t i n requiring this co-operation - keeping appointments, completing records and returning follow-ups. If you can't make this commitment, say so now. Note that the deposit i s not tie d i n any way to your weight loss, simply your co-operation. Your deposit w i l l be i n the form of a cheque for $25.00 made payable to the B.C. Cancer Society. It i s i n no way payment for the C l i n i c . The cheque w i l l be returned uncashed at the three month follow-up, providing you have met the conditions above. Forfeited deposits w i l l be donated to the B. C. Cancer Society. I . , agree to co-operate with the program requirements of the Weight C l i n i c . My deposit of $25.00 may be forfeited at the Clinic's discretion, and donated to the B.C. Cancer Society yin the event that I f a i l to attend sessions and (or provide necessary information. Date: Signature: Name APPENDIX H Se l f - M o n i t o r i n g Form Week One Day of Week Time No. Minutes Spent E a t i n g M/S H A c t i v i t y While Eating Location Of Eating Type of Food & Quantity Mood 6:00 AM 11:00 AM 4:00 PM 9:00 PM M/S = meal or snack CTN N3 H = hunger,! = extremely hungry, 3 = moderately hungry, 5 = not hungry at a l l 63 APPENDIX I I n s t r u c t i o n s f o r Monitoring Habit i s Habit and not to be f l u n g out the window by any man, but coaxed down-s t a i r s , a step at a time. Mark Twain Throughout the c l i n i c , you w i l l be asked to monitor d a i l y your food h a b i t s , your a c t i v i t y l e v e l s and your t h i n k i n g about your progress i n the c l i n i c . There are at l e a s t three important reasons why moni-t o r i n g of s e l f - o b s e r v a t i o n are e s s e n t i a l aspects of any program i f o r a change i n h a b i t s . 1) Before you can change a h a b i t , i t i s important to understand how your p a r t i c u l a r h a b i t s c o n t r i b u t e to your weight problem. 2) Monitoring your e a t i n g h a b i t s , your a c t i v i t y l e v e l s , and your a t t i -;:. fcudes about y o u r s e l f i n r e l a t i o n to e a t i n g and e x e r c i s e makes you aware of what you are doing. Before you can make a d e c i s i o n about whether you w i l l eat a p p r o p r i a t e l y or engage i n e x e r c i s e , you must be conscious of what you are doing. Often we eat without t h i n k i n g or make ourselves f e e l bad without r e a l i z i n g that we are saying things to ourselves to r e i n f o r c e our negative self-images. 3) Monitoring provides us w i t h a way of breaking down our h a b i t s i n t o manageable u n i t s . When most of us t h i n k of our "weight problem", our thoughts are o f t e n ones which overwhelm us, make us f e e l hope-l e s s . For example, o f t e n we are t o l d "you w i l l have to watch your d i e t f o r the r e s t of your l i f e . " Or we may say to ourselves — " I have 50 pounds to l o s e — how am I going to do that when I f i n d i t so hard j u s t to l o s e 1 or 2 pounds?" I f we could break down the h a b i t i n t o smaller u n i t s , see our i n d i v i d u a l p a t t e r n , and being working on changing various aspects of our h a b i t , one step at a time, we are much l e s s l i k e l y to give up so e a s i l y and w i l l being to experience a l i t t l e more f e e l i n g of s e l f - c o n t r o l . Over the next week I am asking you to keep t r a c k of your e a t i n g . Please use the form which w i l l be passed out. I b e l i e v e the forms are s e l f - e x p l a n a t o r y . There may be a tendency f o r you to change your, e a t i n g h a b i t s — to cut down when you are r e q u i r e d to w r i t e down what you are e a t i n g . Please make an e f f o r t not to do t h i s t h i s week,., s i n c e we do need to know where the problems areas l i e f o r you. 64 APPENDIX I continued Self-Monitoring Appropriate Eating Week II EATING 1. Eating i n one room at home (check each time during day) 2. Eating i n one place i n room (at home). 3. Eating i n one place at work. 4. No other a c t i v i t y while eating. 5. Turning down food (in excess of appropriate eating). 6. Did not exceed d a i l y allowance ( c a l o r i c or otherwise). 7. F i l l e d out monitoring forms. 8. 9. This f i r s t week of monitoring your appropriate eating w i l l help you focus on a few aspects of your eating which may be important areas f o r you to consider with regard to habit change. This method teaches you to break down your habits into manageable u n i t s , makes you aware of important aspects of eating, and gives you a f e e l i n g of s e l f - c o n t r o l . I have l e f t two places f o r you to add aspects of your eating which you f e e l are important (spaces 8 and 9). Please f e e l f ree to use these i f applicable. This form should be completed d a i l y for the next week. 65 APPENDIX I continued S e l f - M o n i t o r i n g Appropriate Eating Week I I I EATING 1. Eating i n one room at home. 2. E a t i n g i n one place i n room. 3. Eating i n one place at work. 4. No other a c t i v i t y w h i l e e a t i n g . 5. Turning down food ( i n excess of appropriate e a t i n g ) . 6. Did not exceed d a i l y food allowance. 7. F i l l e d out monitoring forms. 8. Did not buy or b r i n g home i n a p p r o p r i a t e foods. 9. Made an e f f o r t to remove food from s i g h t . 10. Avoided being i n c l o s e proximity to problem foods. 11. Avoided a tempting s i t u a t i o n . 12. 13. T o t a l This week I have added some other areas f o r you to consider w i t h regard to your e a t i n g h a b i t s . Items 8, 9, 10, and 11 have to do w i t h how often, you are i n a s i t u a t i o n i n which i t i s very easy f o r you to overeat. I want you to n o t i c e the times when you make an e f f o r t to avoid these s i t u a t i o n s , thereby e x e r t i n g more c o n t r o l over your e a t i n g w i t h very l i t t l e e f f o r t . Again I have l e f t two spaces f o r you to add items which may be more s p e c i f i c a l l y r e l e v a n t to you. 66 APPENDIX I continued S e l f - M o n i t o r i n g Week IV Appropriate E a t i n g / A c t i v i t y EATING AND ACTIVITY 1. Eating i n one room at home. 2. E a t i n g i n one place at home. 3. E a t i n g i n designated place at work. 4. No other a c t i v i t y w h i l e e a t i n g . 5. Turning down food ( i n excess of appropriate e a t i n g ) . 6. Did not exceed d a i l y food allowance. 7. F i l l e d out monitoring form. 8. Did not buy or b r i n g home i n a p p r o p r i a t e food. 9. Made an e f f o r t to remove food from s i g h t . LO. Avoided being i n c l o s e p r o x i m i t y to problem foods. LI. Avoided a tempting s i t u a t i o n . L2. Managed to delay an urge to eat an i n a p p r o p r i a t e food. L3. Engaged i n an a l t e r n a t i v e a c t i v i t y to e a t i n g . L4. Walked or rode a b i k e i n s t e a d of using the car or bus. L5. Did not tu r n down the opportunity to engage i n p h y s i c a l a c t i v i t y . L6. Chose a form of s o c i a l r e c r e a t i o n i n s t e a d of going out to dinner (e.g., a walk, a movie, swimming, t e n n i s , t h e a t r e , etc.) L7. Took a r e s t i n s t e a d of eating when t i r e d . .8. Engaged i n d e l i b e r a t e a c t i v i t y (e.g., gardening, walking, g o l f i n g , c a l i s t h e n i c s , running, moving f u r -n i t u r e , etc.) .9. Recorded energy use on chart. T o t a l 67 APPENDIX I continued S e l f - M o n i t o r i n g Form Week I I E a t i n g / A c t i v i t y / C o g n i t i v e Self-Statements Problem Areas EATING 1. Did not eat i n designated area at home. 2. Did not eat i n designated p l a c e at home. 3. Did not eat i n designated place at work. 4. Engaged i n a c t i v i t y w h i l e e a t i n g (reading, T.V.,etc.) 5. Did not t u r n down i n a p p r o p r i a t e food. 6. Exceeded d a i l y food allowance. 7. Did not complete monitoring forms. 8. 9. This f i r s t week of monitoring your problem areas w i l l focus s p e c i f i c a l l y on those h a b i t s we have chosen to work on. Habit change re q u i r e s d e l i b e r a t e focus on one or two h a b i t s . When these are under c o n t r o l we can go on to other areas of d i f f i c u l t y . I have..left a few which you may f e e l are more important to you. Please f e e l f r e e to add these to your l i s t . 68 APPENDIX I continued S e l f - M o n i t o r i n g Form Week I I I E a t i n g / A c t i v i t y Problem Areas EATING 1. Did not eat i n designated area at home. 2. Did not eat i n designated place at home. 3. Did not eat i n designated place at work. 4. Engaged i n a c t i v i t y v h i l e e ating (reading, etc.) 5. Did not t u r n down i n a p p r o p r i a t e food. 6. Exceeded d a i l y food allowance. 7. Did not complete monitoring forms. 8. Bought and/or brought home..inappropriate food. 9. Did not remove i n a p p r o p r i a t e food from s i g h t . 10. Did not avoid being i n c l o s e p r o x i m i t y to problem foods. 11. Did not avoid a 'tempting' s i t u a t i o n . 12. 13. T o t a l This week I have added some other areas f o r you to consider w i t h regard to your e a t i n g h a b i t s . Items 8, 9, 10, and 11 have to do w i t h e x p l o r i n g how o f t e n you are i n a s i t u a t i o n i n which i t i s very easy f o r you to overeat. I f you do f i n d that t h i s i s one of your problems, the s o l u t i o n i n v o l v e s removing e i t h e r y o u r s e l f or the food from your s i g h t or making the food l e s s l i k e l y to 'beckon' to you. Again I have l e f t two spaces f o r you to add items which may be problematic to you. APPENDIX I continued S e l f - M o n i t o r i n g Week IV E a t i n g / A c t i v i t y Problems Areas EATING AND ACTIVITY 1. Did not eat i n designated area at home. 2. Did not eat i n designated place at home. 3. Did not eat i n designated place at work. 4. Engaged i n a c t i v i t y w h i l e eating (reading, etc.) 5. Did not turn down in a p p r o p r i a t e food. 6. Exceeded d a i l y food allowance. 7. Did not complete monitoring forms. 8. Bought and/or brought home in a p p r o p r i a t e food. 9. Did not remove i n a p p r o p r i a t e food from s i g h t . 10. Did not avoid being i n c l o s e p r o x i m i t y to problem foods. 11. Did not avoid a 'tempting' s i t u a t i o n . 12. Did not delay the urge to eat. 13. Eating i n s t e a d of engaging i n a c t i v i t y . 14. Took a r i d e i n s t e a d of walking. 15. Turned down the opportunity to engage i n p h y s i c a l a c t i v i t y . 16^ Chose ea t i n g as a form of s o c i a l r e c r e a t i o n i n s t e a d of e.g., a walk, a movie, swimming, p l a y i n g t e n n i s , e t c . 17. Eating i n s t e a d of r e s t i n g . 18. Did not perform e x t r a energy expenditure ( d e l i b e r a t e p h y s i c a l a c t i v i t y , gardening, walking, running, moving f u r n i t u r e , swimming, g o l f i n g ) . 19. Did not record energy use on chart. 20. TOTAL 70 APPENDIX J Monitoring Your P o s i t i v e Thinking Patterns Often when we take on any program of self-improvement, our m o t i v a t i o n i s h i g h , we begin changing some of the things we do, keeping i n mind the g o a l , i n t h i s case — a slimmer you. However, a f t e r a few weeks of maintaining your d i e t , and t r y i n g out the various ways to l o s e weight, we may get bored, or we may be disappointed w i t h the slow progress, and we become discouraged. At t h i s p o i n t , i t i s very easy f o r the o l d patterns to return,, o f t e n the process by which we s l i p back i n t o our o l d h a b i t s begins w i t h our t a l k i n g ourselves out of the d i e t . We o f t e n do t h i s by u t t e r i n g s e l f - d e f e a t i n g statements to our-s e l v e s , we begin e v a l u a t i n g our e f f o r t s , and the weight l o s s program i n negative ways. This i s a c r u c i a l time to renew our e f f o r t s concer-ning the program. We w i l l continue i f we f e e l we are being success-f u l , i f we can continue to feelgood about ou r s e l v e s , and the progress we have made so f a r . This week I would l i k e you to begin i n an a c t i v e and p o s i t i v e way t r a i n i n g y o u r s e l f to make appropriate, and encouraging s e l f - s t a t e -ments. The statements you w i l l be l o o k i n g f o r w i l l i n c l u d e , f o r example: (1) thoughts about pounds l o s t (I've l o s t 5 pounds so f a r , I r e a l l y deserve a pat on the back; (2) thoughts about c a p a b i l i t i e s (I've maintained t h i s program longer.than I ever have i n the past, maybe I'm r e a l l y changing t h i s t i m e ) ; (3) not making excuses (Well, I overate t h i s evening, never mind, I ' l l continue my e f f o r t s anyway); (4) standard s e t t i n g (Well I blew i t w i t h that doughnut, however i n the past, I would have eaten three or the whole package); and (5) thoughts about a c t u a l food items. There are two major ways of e v a l u a t i n g our behaviour, as good or bad. Negative t h i n k i n g gets us nowhere, o f t e n leads us back to over-e a t i n g , and i n order to continue our e f f o r t s to l o s e weight, we r e a l l y must s t a r t g i v i n g ourselves more c r e d i t f o r our e f f o r t s . This week I would l i k e you to w r i t e down any appropriate or p o s i t i v e s e l f - s t a t e -ments you might make which would be r e l a t e d to your overeating. These do not n e c e s s a r i l y have to be about e a t i n g . They can be simply things you say to y o u r s e l f which make you f e e l good about y o u r s e l f , and the r e f o r e i n more c o n t r o l of how you cope w i t h e a t i n g . To give you a f l a v o u r of the d i f f e r e n c e s between negative and p o s i t i v e statements, consider the f o l l o w i n g chart: continued 71 APPENDIX J continued Problem Category Pounds l o s t C a p a b i l i t i e s Excuses Negative Self-Statements "I'm not l o s i n g f a s t enough." "I've s tarved myself and haven't l o s t a t h i n g . " "I've been more c o n s i s t e n t than Mary and she i s l o s i n g f a s t e r than I am — I t ' s not f a i r . " " I j u s t don't have the w i l l power." "I'm j u s t n a t u r a l l y f a t . " "Why should this, w o r k — n o t h i n g e l s e has." " I ' l l probably j u s t r e g a i n i t . ' "What the h e c k — I ' d r a t h e r be f a t than miserable; besides I'm not that heavy." P o s i t i v e Self-Statements "Pounds don't count. I f I continue my eat i n g h a b i t s the pounds w i l l be l o s t . " "Have patience — these pounds took a long time to get there. As long as they stay permanently, I ' l l s e t t l e f o r any pro-gress ." " I t takes a long time to break down f a t and absorb the e x t r a water produced. I'm not going to worry about i t . " "There's no such t h i n g as w i l l p o w e r — j u s t poor planning." " I make a few improve-ments here and there and take things one day at a time, I can be very s u c c e s s f u l . " " I f i t weren't f o r my job and the k i d s , I could l o s e weight." " I t ' s j u s t impossible to eat r i g h t w i t h a schedule l i k e mine." "I'm j u s t so nervous a l l the t i m e — I have to eat to s a t i s f y my p s y c h o l o g i c a l needs." "Maybe next t i m e — " "My schedule i s n ' t any worse than anyone e l s e ' s . What I need to do i s to be more c r e a t i v e i i i how to improve my e a t i n g . " " E a t i n g doesn't s a t i s f y p s y c h o l o g i c a l n e e d s — i t creates new problems." "Job, k i d s , or whatever, I'm the. one i n c o n t r o l . " 72 APPENDIX J continued S e l f - M o n i t o r i n g P o s i t i v e Self-Statements Week IV Time/Place or Mood or Self-Statements Response(What S i t u a t i o n F e e l i n g d i d you do?) 73 APPENDIX K Monitoring Your Negat i v e Thinking Patterns Often when we take on any program of self-improvement, our moti-v a t i o n i s h i g h , we begin changing some of the things we do, keeping i n mind the g o a l , i n t h i s case, a slimmer you. However, a f t e r a few weeks of maintaining your d i e t , and t r y i n g out the v a r i o u s ways to l o s e weight, we may get bored, or we may be disappointed w i t h the slow progress, and we become discouraged. At t h i s p o i n t , i t i s very easy f o r the o l d patterns to r e t u r n . ..It i s a l s o at t h i s p o i n t that we begii to u t t e r " s e l f - d e f e a t i n g " statements and to t h i n k n e g a t i v e l y about our progress. Such negative thoughts may i n c l u d e (1) thoughts about pounds l o s t ( f o r example, I've starved myself and haven't l o s t a t h i n g ! ) , (2) thoughts about c a p a b i l i t i e s (I j u s t don't: have the willpower.'), (3) excuses ( I f i t weren't f o r my busy schedule, I could l o s e weight.'), (4) standard s e t t i n g (Well, I blew i t w i t h that doughnut. My day i s s h o t ! ) , and (5) thoughts about a c t u a l food items. This negative t h i n k i n g and negative s e l f - e v a l u a t i n g o f t e n leads us back to overeating and i n order to continue our e f f o r t s to l o s e weight, we r e a l l y must s t a r t a t t a c k i n g t h i s t h i n k i n g i n an a c t i v e way. This week I would l i k e you to w r i t e down any i n a p p r o p r i a t e s e l f - s t a t e -ments you might make which might be r e l a t e d to your overeating. These do not n e c e s s a r i l y have to be about e a t i n g . They can be simply things you say to y o u r s e l f which make you f e e l bad and .therefore l e s s i n con-t r o l of how you cope w i t h e a t i n g . Here are some examples of negative and p o s i t i v e monilogs about ea t i n g . Problem Category Negative Self-Statements Appropriate or P o s i t i v e S e l f -Statements Pounds l o s t II I'm not l o s i n g f a s t enough. I've starved myself and haven't l o s t a t h i n g . " I've been more c o n s i s t e n t than Mary and she i s l o s i n g f a s t e r than I am. I t ' s not f a i r . " II i r 'Pounds don't count. I f I continue my e a t i n g h a b i t s the pounds w i l l be l o s t . " 'Have patience. Those pounds took a long time to get there. As long as they stay permanentle, I ' l l s e t t l e f o r any progress." 'It takes a long time to break down f a t and absorb the e x t r a water produced. I'm not going to worry about i t . " II II it it 74 APPENDIX K continued Problem Category Negative Self-Statements C a p a b i l i t i e s " I j u s t don't have the w i l l power." "I'm j u s t n a t u r a l l y f a t . " "Why should t h i s work — nothing e l s e has." " I ' l l probably j u s t r e g a i n i t . 1 "What the heck - I'd r a t h e r be f a t than miserable; besides I'm not that heavy." Appropriate or P o s i t i v e S e l f -Statements "There's no such t h i n g as w i l l power. Ju s t poor planning. I f I make a few improvements here and there and take things one day at a time, I can be very success-f u l . " Excuses " I f i t weren't f o r my job and the k i d s , I could l o s e weight " I t ' s j u s t impossible to eat r i g h t w i t h a schedule l i k e mine." "I'm j u s t so nervous a l l the time - I have to eat to s a t i s -f y my p s y c h o l o g i c a l needs." "Maybe next time " "My schedule i s n ' t any worse . ", .than anyone e l s e ' s . What I need to do i s be a b i t more c r e a t i v e i n how to im-prove my e a t i n g . " "Eating doesn't s a t i s f y psycho-l o g i c a l n e e d s — i t creates new peoblems." "Job, k i d s , or whatever. I'm the one i n c o n t r o l . " 75 APPENDIX K continued S e l f - M o n i t o r i n g Negative S e l f Statements Week IV Time/Place or Mood or Response (What S i t u a t i o n F e e l i n g Self-Statements . d i d you do?) 76 APPENDIX L Why Become More A c t i v e ? Common sense t e l l s us that i f we e x e r c i s e more we w i l l become more hungry. This i s "true w i t h i n a ' n a t u r a l ' range of a c t i v i t i e s f o r most animals, i n c l u d i n g humans. But i n a way we no longer l i v e i n a ' n a t u r a l ' s t a t e , or even 50 years ago i n our c i v i l i z e d s o c i e t y , peo-p l e got more e x e r c i s e than they do today. The average Canadian now spends much of h i s l i f e s i t t i n g , or i n e q u a l l y m i l d a c t i v i t y . We are the most e f f i c i e n t people i n the h i s t o r y of the world — and we show i t . (Ferguson, 1976). We are no longer operating i n our ' n a t u r a l ' a c t i v i t y range, and we are s u f f e r i n g from the same phenomenon that rangers e x p l o i t when they put c a t t l e i n a f e e d l o t . When penned up w i t h excess food a v a i l a b l e , a s t e e r eats more, becomes f a t and l e s s mobile, e x e r c i s e s l e s s , gains more, et c . I t i s a v i c i o u s c i r c l e . S everal s t u d i e s have shown that humans who adopt a sedentary l i f e i n c r e a s e t h e i r food i n t a k e . Con-v e r s e l y , when sedentary desk-bound people become more a c t i v e — f o r example, when they change to a more a c t i v e job — they eat l e s s , and they l o s e weight. SIX BONUSES CAN BE GAINED BY WORKING ON THE "ENERGY USED" SIDE OF THE ENERGY EQUATION. 1. If-you i n c o r p o r a t e e x e r c i s e i n t o your d a i l y r o u t i n e , a higher pro-p o r t i o n of the weight you l o s e w i l l come from f a t d e p o s i t s , the energy your.body has .stored as f a t . 2. Some form of e x e r t i o n or a c t i v i t y added to a d u l l r o u t i n e w i l l r e -l i e v e some of the boredom (or blues) that f r e q u e n t l y s t i m u l a t e e a t i n g . 3. Strenuous e x e r c i s e has a s p e c i f i c e f f e c t on a p p e t i t e , p a r t i c u l a r l y i f you e x e r c i s e hard before a meal. Frequently i t w i l l markedly decrease your a p p e t i t e . 4. As you l o s e weight, your body w i l l r e g a i n a t h i n a t h l e t i c shape. 5. Your body tone w i l l improve, and your c a r d i o v a s c u l a r system w i l l r e g a i n . i t s a b i l i t y to respond r a p i d l y to s t r e s s and e x e r c i s e . 6. You w i l l enjoy l i f e more. (Ferguson, 1976) 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0094453/manifest

Comment

Related Items