clinical obesity
doi: 10.1111/cob.12093
Lower weight loss expectations and healthier eating attitudes in older overweight and obese women attempting weight loss E. H. Evans1, L. G. Boothroyd2, E. Muscariello3, B. C. M. Stephan1, G. Nasti3, A. Colantuoni3 and M. Siervo4 What is already known about this subject
What this study adds
• The prevalence of obesity in older subjects is growing.
• First study to compare different categories of WLEs in young and older
• Evidence on efficacy, safety and compliance to weight loss treatments in older subjects is lacking. • Weight loss expectations (WLEs) are directly associated with BMI and typically exceed clinical recommendations.
obese women. • Young and older obese women reported different WLEs, which varied depending on their perceived origin in personal, lifestyle and social factors. • Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss.
1
Institute for Health and Society, Newcastle
University, Newcastle upon Tyne, UK; 2
Department of Psychology, Durham
University, Durham, UK; 3Human Nutrition and Physiology, Department of Neuroscience, University of Naples, Naples, Italy; 4Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, UK
Received 20 December 2014; revised 18 February 2015; accepted 9 March 2015
Correspondence: Dr M Siervo, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK. E-mail: [email protected]
The material presented in this manuscript is original and it has not been submitted for
Summary Weight loss outcomes in overweight and obese individuals may be influenced by individual weight loss expectations (WLEs). Research on these phenomena in older women is lacking. This cross-sectional study compared groups of younger and older women on their WLEs and related attitudes (body dissatisfaction and disordered eating). Twenty-six younger (18–38 years) and 33 older (60–78 years) overweight and obese women were recruited from a weight loss clinic, prior to treatment. Disordered eating attitudes and body dissatisfaction were assessed using validated questionnaires and a pictorial figure-choice scale. Participants reported 10 WLEs categorized according to personal, lifestyle and social factors. Overall, women with a higher body mass index had greater WLEs. Older women reported lower WLEs than younger women (−14.5 kg vs. −22.4 kg) in all categories except past weight. Older women perceived that career success would necessitate the greatest level of weight loss (−18.5 kg), whereas younger women derived their greatest WLEs from mass media (−28.5 kg). Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss (−8.4 and −17.6 kg, respectively). The groups did not differ on body dissatisfaction, but younger women’s disordered eating attitudes were significantly higher (p < .001). Older overweight and obese women have lower WLEs than younger women but experience similar levels of body dissatisfaction and healthier eating attitudes. The attitudinal constructs underlying these differences may be useful in clinical practice to tailor age-specific weight loss interventions.
publication elsewhere while under consideration for Clinical Obesity.
136
Keywords: Ageing, body image, obesity, weight loss.
© 2015 World Obesity. clinical obesity 5, 136–144
clinical obesity
Introduction In Europe and the USA, obesity in older women (aged ≥60 years) is increasingly prevalent (>20%) and presents a considerable public health challenge (1). However, little is known about the psychological characteristics of older women attempting behavioural weight loss and the variables that may influence success. The development of effective weight loss interventions, sensitive to older women’s goals and attitudes, requires a greater understanding of these characteristics. There is a clear need to enhance extant interventions, which presently yield modest but highly variable weight losses (2). Weight loss expectations (WLEs) are calculated by subtracting an individual’s current weight from their goal weight. Typical WLEs in overweight and obese individuals involve losses of 20% to 30% of total body weight (3,4), greatly exceeding recommendations of 5–10% (5). Individuals with higher body mass index (BMIs) tend to report higher WLEs (6). Unsurprisingly, few patients attempting weight loss attain their ambitious goals: mean weight loss following behavioural weight loss programmes is 3–5% (7). It is unclear how, and to what extent, the mismatch between expected and actual loss affects weight management (6). Most prior research (6) and clinical guidance (5) assumes that unrealistically high WLEs are detrimental to weight loss (8,9) because the individual is highly likely to miss their goal, resulting in disappointment, low motivation and treatment discontinuation (3). Indeed, Foster and colleagues (8) intervened to artificially lower patients’ WLEs in the (unfulfilled) hope of enhancing weight loss. In contrast to this, however, is a growing body of evidence suggesting that weight loss is enhanced by ambitious WLEs (10–13). These findings are consistent with self-regulation theory (14), in which individuals with ambitious goals exhibit increased motivation and persistence, resulting in more effortful goal striving and progress. To reconcile this mixed picture of evidence, it has been suggested that the relationship between weight loss and WLEs is mediated by other variables (6); these may include age (15), the perceived origin of the WLEs (16), body dissatisfaction (17) and disordered eating (18). Prior research indicates that younger women’s WLEs are greater than middle-aged women’s (3,12,15,19,20). Middle-aged women’s weight histories may include greater numbers of prior failed weight loss attempts than younger women’s, giving rise to less optimistic WLEs (21). Alternatively, or in addition, age differences in WLEs may originate with middle-aged women’s lower reported levels of thin-ideal internalization and perceived pressure to be thin (22). Unfortunately, there are no data to indicate whether women aged >60 years express similarly low WLEs, or whether – as the process of ageing takes them further from the youthful body ideal – the trend reverses. There is, © 2015 World Obesity. clinical obesity 5, 136–144
Weight loss expectations & age in women
E. H. Evans et al.
137
therefore, an explicit need for research on the WLEs of older women. Research into older women’s WLEs should also examine the perceived origins of their WLEs. Siervo and colleagues (23) asked young women seeking weight loss treatment to report a number of different WLEs according to their origin with personal, lifestyle or social factors (see Appendix A for questions in full). They found that WLE magnitude varied with the apparent source of the expectation: young women perceived that their most ambitious WLEs originated with the mass media, and they felt that their family and friends would accept the lowest amount of weight loss (23). There is cause to hypothesize that older women’s WLEs would show different patterns of variation by perceived origin. Mediatransmitted appearance ideals become less salient with age, whereas the role of weight and appearance as a signifier of physical function and social status increases (24). However, such patterns have not been previously examined in samples that specifically include overweight and obese older women. The current study examined whether two groups of weight loss treatment-seeking overweight and obese women, one younger and one older, differed in their WLEs and related attitudinal variables (body dissatisfaction and disordered eating). We defined younger women as being at least 18 but no more than 40 years of age (25,26), and older women as being at least 60 years of age (27). We expected that participants with higher BMIs, regardless of age, would report higher WLEs. We expected participants to report WLEs that exceeded recommended losses of 5–10%. We also aimed to explore, for the first time, age differences in WLEs and we expected younger women’s highest WLEs to relate to appearance standards promoted by the mass media. Finally, we predicted in both age groups that WLEs perceived as acceptable to family and friends would be the least ambitious.
Methods Participants Participants were 26 non-smoking, younger (age range = 18–38 years; BMI = 29.0–44.0 kg m−2) and 33 older (age range = 60–78 years; BMI = 30.0–41.0 kg m−2) overweight and obese Italian women. All sought, but had not yet commenced, behavioural weight loss treatment at a university hospital weight loss clinic in Naples, Italy, between January and December 2010. The study received a favourable ethical opinion from the hospital ethics committee, and participants provided written consent. Subjects were weight stable (weight change
doi: 10.1111/cob.12093
Lower weight loss expectations and healthier eating attitudes in older overweight and obese women attempting weight loss E. H. Evans1, L. G. Boothroyd2, E. Muscariello3, B. C. M. Stephan1, G. Nasti3, A. Colantuoni3 and M. Siervo4 What is already known about this subject
What this study adds
• The prevalence of obesity in older subjects is growing.
• First study to compare different categories of WLEs in young and older
• Evidence on efficacy, safety and compliance to weight loss treatments in older subjects is lacking. • Weight loss expectations (WLEs) are directly associated with BMI and typically exceed clinical recommendations.
obese women. • Young and older obese women reported different WLEs, which varied depending on their perceived origin in personal, lifestyle and social factors. • Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss.
1
Institute for Health and Society, Newcastle
University, Newcastle upon Tyne, UK; 2
Department of Psychology, Durham
University, Durham, UK; 3Human Nutrition and Physiology, Department of Neuroscience, University of Naples, Naples, Italy; 4Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, UK
Received 20 December 2014; revised 18 February 2015; accepted 9 March 2015
Correspondence: Dr M Siervo, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne NE4 5PL, UK. E-mail: [email protected]
The material presented in this manuscript is original and it has not been submitted for
Summary Weight loss outcomes in overweight and obese individuals may be influenced by individual weight loss expectations (WLEs). Research on these phenomena in older women is lacking. This cross-sectional study compared groups of younger and older women on their WLEs and related attitudes (body dissatisfaction and disordered eating). Twenty-six younger (18–38 years) and 33 older (60–78 years) overweight and obese women were recruited from a weight loss clinic, prior to treatment. Disordered eating attitudes and body dissatisfaction were assessed using validated questionnaires and a pictorial figure-choice scale. Participants reported 10 WLEs categorized according to personal, lifestyle and social factors. Overall, women with a higher body mass index had greater WLEs. Older women reported lower WLEs than younger women (−14.5 kg vs. −22.4 kg) in all categories except past weight. Older women perceived that career success would necessitate the greatest level of weight loss (−18.5 kg), whereas younger women derived their greatest WLEs from mass media (−28.5 kg). Both older and younger groups perceived that their families would be supportive of the smallest amount of weight loss (−8.4 and −17.6 kg, respectively). The groups did not differ on body dissatisfaction, but younger women’s disordered eating attitudes were significantly higher (p < .001). Older overweight and obese women have lower WLEs than younger women but experience similar levels of body dissatisfaction and healthier eating attitudes. The attitudinal constructs underlying these differences may be useful in clinical practice to tailor age-specific weight loss interventions.
publication elsewhere while under consideration for Clinical Obesity.
136
Keywords: Ageing, body image, obesity, weight loss.
© 2015 World Obesity. clinical obesity 5, 136–144
clinical obesity
Introduction In Europe and the USA, obesity in older women (aged ≥60 years) is increasingly prevalent (>20%) and presents a considerable public health challenge (1). However, little is known about the psychological characteristics of older women attempting behavioural weight loss and the variables that may influence success. The development of effective weight loss interventions, sensitive to older women’s goals and attitudes, requires a greater understanding of these characteristics. There is a clear need to enhance extant interventions, which presently yield modest but highly variable weight losses (2). Weight loss expectations (WLEs) are calculated by subtracting an individual’s current weight from their goal weight. Typical WLEs in overweight and obese individuals involve losses of 20% to 30% of total body weight (3,4), greatly exceeding recommendations of 5–10% (5). Individuals with higher body mass index (BMIs) tend to report higher WLEs (6). Unsurprisingly, few patients attempting weight loss attain their ambitious goals: mean weight loss following behavioural weight loss programmes is 3–5% (7). It is unclear how, and to what extent, the mismatch between expected and actual loss affects weight management (6). Most prior research (6) and clinical guidance (5) assumes that unrealistically high WLEs are detrimental to weight loss (8,9) because the individual is highly likely to miss their goal, resulting in disappointment, low motivation and treatment discontinuation (3). Indeed, Foster and colleagues (8) intervened to artificially lower patients’ WLEs in the (unfulfilled) hope of enhancing weight loss. In contrast to this, however, is a growing body of evidence suggesting that weight loss is enhanced by ambitious WLEs (10–13). These findings are consistent with self-regulation theory (14), in which individuals with ambitious goals exhibit increased motivation and persistence, resulting in more effortful goal striving and progress. To reconcile this mixed picture of evidence, it has been suggested that the relationship between weight loss and WLEs is mediated by other variables (6); these may include age (15), the perceived origin of the WLEs (16), body dissatisfaction (17) and disordered eating (18). Prior research indicates that younger women’s WLEs are greater than middle-aged women’s (3,12,15,19,20). Middle-aged women’s weight histories may include greater numbers of prior failed weight loss attempts than younger women’s, giving rise to less optimistic WLEs (21). Alternatively, or in addition, age differences in WLEs may originate with middle-aged women’s lower reported levels of thin-ideal internalization and perceived pressure to be thin (22). Unfortunately, there are no data to indicate whether women aged >60 years express similarly low WLEs, or whether – as the process of ageing takes them further from the youthful body ideal – the trend reverses. There is, © 2015 World Obesity. clinical obesity 5, 136–144
Weight loss expectations & age in women
E. H. Evans et al.
137
therefore, an explicit need for research on the WLEs of older women. Research into older women’s WLEs should also examine the perceived origins of their WLEs. Siervo and colleagues (23) asked young women seeking weight loss treatment to report a number of different WLEs according to their origin with personal, lifestyle or social factors (see Appendix A for questions in full). They found that WLE magnitude varied with the apparent source of the expectation: young women perceived that their most ambitious WLEs originated with the mass media, and they felt that their family and friends would accept the lowest amount of weight loss (23). There is cause to hypothesize that older women’s WLEs would show different patterns of variation by perceived origin. Mediatransmitted appearance ideals become less salient with age, whereas the role of weight and appearance as a signifier of physical function and social status increases (24). However, such patterns have not been previously examined in samples that specifically include overweight and obese older women. The current study examined whether two groups of weight loss treatment-seeking overweight and obese women, one younger and one older, differed in their WLEs and related attitudinal variables (body dissatisfaction and disordered eating). We defined younger women as being at least 18 but no more than 40 years of age (25,26), and older women as being at least 60 years of age (27). We expected that participants with higher BMIs, regardless of age, would report higher WLEs. We expected participants to report WLEs that exceeded recommended losses of 5–10%. We also aimed to explore, for the first time, age differences in WLEs and we expected younger women’s highest WLEs to relate to appearance standards promoted by the mass media. Finally, we predicted in both age groups that WLEs perceived as acceptable to family and friends would be the least ambitious.
Methods Participants Participants were 26 non-smoking, younger (age range = 18–38 years; BMI = 29.0–44.0 kg m−2) and 33 older (age range = 60–78 years; BMI = 30.0–41.0 kg m−2) overweight and obese Italian women. All sought, but had not yet commenced, behavioural weight loss treatment at a university hospital weight loss clinic in Naples, Italy, between January and December 2010. The study received a favourable ethical opinion from the hospital ethics committee, and participants provided written consent. Subjects were weight stable (weight change
