Abstract
Background/Objectives: Obesity has a high prevalence and is associated with many health risks. Minimal effects from behavioral obesity treatments might be linked to their atheoretical dependence on simply educating participants on healthy eating and increased physical activity/exercise, rather than evolving behavior-change methods through theory-based research. The use of pharmacologic interventions has recently overtaken bariatric surgery in medically based efforts to obtain greater weight losses than through behavioral means. Methods: The present longitudinal observational study aimed to extend earlier treatment-associated findings concerned with the order of emphasizing 3-, 6-, and 9-month changes in the theory-driven psychosocial constructs of self-regulation, self-efficacy, and mood associated with 12-month improvements in weight-loss behaviors. The "parent study" of women with obesity (N = 106) found significant paths through changes in self-regulation → mood → self-efficacy and mood → self-regulation → self-efficacy. In the present extension of that investigation, only those participants who did not already complete recommended physical activity amounts and consume recommended portions of fruits/vegetables at baseline were included (N = 73). Results: Only paths from changes in mood → self-regulation → self-efficacy were significantly associated with 12-month improvements in both physical activity and dietary behaviors. A mean weight change of -5.2 kg, or -5.5% from baseline weight, was found. Baseline scores in emotional eating and anxiety significantly moderated the mood-self-regulation change relationships within the significant paths. Conclusions: Findings suggested that future treatment contents focus on early physical activity-associated improvement in mood because of its association with increased usage of treatment-developed self-regulatory skills. Those skills should then be leveraged because of their association with feelings of ability (i.e., self-efficacy) to overcome lifestyle barriers to weight-loss behavior changes. Further improvements in behavioral obesity treatments should be reconsidered as either stand-alone modalities or, after appropriate testing, as an adjunct to medical means.