Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change.

Results support the idea that daily weighing is valuable to individuals trying to lose weight or prevent weight gain. Daily self-weighing should be emphasized in clinical and public health messages about weight control. Experimental studies on the effects of weighing frequency in these contexts are recommended.

Objective-Evaluate the association between obesity and depression among middle-aged women.Methods-4641 female health plan enrollees aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, a brief measure of rate was 62%.Results-Prevalence of moderate or severe depression increased from 6.5% among those with body mass index (BMI) under 25 to 25.9% among those with BMI over 35. Prevalence of obesity increased from 25.4% among those with no depressive symptoms to 57.8% among those with moderate to severe depression. Independent of obesity, depression was associated with significant reductions in frequency of moderate (4.6 vs. 5.4 times per week) or vigorous (2.8 vs. 3.7 times per week) physical activity. Depression was associated with significantly higher daily caloric intake (1831 vs. 1543) among those with BMI over 30.Conclusions-Among middle-aged women, depression is strongly and consistently associated with obesity, lower physical activity, and (among the obese) higher caloric intake. Public health approaches to reducing the burden of obesity or depression must consider the strong association between these two common conditions. Obesity is a major public health concern. Among US adults, prevalence of obesity (defined as a Body Mass Index or BMI of 30 or more) increased from approximately 23% in 1990 to 31% in 2000 1 . Similar increases were seen for men and women, across all age groups, and across all racial/ethnic groups. 1 2 More recent data indicate no improvement in this trend between 2000 and 2002 2 . Adverse consequences of obesity, such as diabetes and cardiovascular disease, are predicted to cause an unprecedented decline in life expectancy in the United States 3 .Beginning in the 1970s, numerous epidemiologic studies have examined the association between obesity and depression or other psychiatric disorders. Early research in the UK 4 5 suggested a negative association between obesity and symptoms of depression or anxiety. Subsequent studies had variable results, with some 6 7 finding no significant association Author address: Gregory Simon Center for Health Studies 1730 Minor Ave. Seattle, WA 98101 Phone: 206-287-2979 Fax: 206-287-2871. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The present paper uses data from a large sample of middle-aged women enrolled in a prepaid health plan to: 1) Assess the association between various levels of obesity and various levels of depression severity; 2) Examine potential confounders of the association includin...

ObjectiveEating at "fast food" restaurants has increased and is linked to obesity. This study examined whether living or working near "fast food" restaurants is associated with body weight.MethodsA telephone survey of 1033 Minnesota residents assessed body height and weight, frequency of eating at restaurants, and work and home addresses. Proximity of home and work to restaurants was assessed by Global Index System (GIS) methodology.ResultsEating at "fast food" restaurants was positively associated with having children, a high fat diet and Body Mass Index (BMI). It was negatively associated with vegetable consumption and physical activity. Proximity of "fast food" restaurants to home or work was not associated with eating at "fast food" restaurants or with BMI. Proximity of "non-fast food" restaurants was not associated with BMI, but was associated with frequency of eating at those restaurants.ConclusionFailure to find relationships between proximity to "fast food" restaurants and obesity may be due to methodological weaknesses, e.g. the operational definition of "fast food" or "proximity", or homogeneity of restaurant proximity. Alternatively, the proliferation of "fast food" restaurants may not be a strong unique cause of obesity.

OBJECTIVE:To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. DESIGN: Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. SUBJECTS: A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/ m 2 ) were recruited from a large Midwestern US managed care organization. MEASUREMENTS: Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. RESULTS: Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. CONCLUSION: Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.

Objective Examine whether (1) childhood maltreatment is associated with subsequent obesity and depression in middle-age; (2) maltreatment explains the associations between obesity and depression; and (3) binge eating or body dissatisfaction mediate associations between childhood maltreatment and subsequent obesity. Methods Data were obtained through a population-based survey of 4,641 women (mean age = 52 years) enrolled in a large health plan in the Pacific Northwest. A telephone survey assessed child sexual and physical abuse, obesity (BMI ≥ 30), depressive symptoms, binge eating, and body dissatisfaction. Data were analyzed using logistic regression models incorporating sampling weights. Results Both child sexual and physical abuse were associated with a doubling of the odds of both obesity and depression, although child physical abuse was not associated with depression for the African American/Hispanic/American Indian subgroup. The association between obesity and depression (unadjusted OR = 2.82; 95% CI = 2.20 – 3.62) was reduced somewhat after controlling for sexual abuse (adjusted OR = 2.54; 1.96 – 3.29) and for physical abuse (adjusted OR = 2.63; 2.03 – 3.42). Controlling for potential mediators failed to substantially attenuate associations between childhood maltreatment and obesity. Conclusions This study is the first to our knowledge that compares associations of child abuse with both depression and obesity in adults. Although the study is limited by its cross-sectional design and brief assessments, the fact that child abuse predicted two debilitating conditions in middle-aged women indicates the potential long-term consequences of these experiences.

ROTHMAN. Are unrealistic weight loss goals associated with outcomes for overweight women? Obes Res. 2004;12:569-576. Objective: To examine cross-sectional correlates of current, goal, and dream weight and their prospective associations with weight loss in treatment. Research Methods and Procedures: Goal and dream weights, demographic characteristics, and psychosocial factors were assessed by self-report questionnaire in 302 adult women enrolled in a weight loss trial. Height and weight were assessed at baseline, after 8 weeks of active treatment, and at 6-and 18-month follow-up. Regression techniques examined associations among baseline, goal, and dream weights, psychosocial factors, and treatment outcomes. Results: On average, goal and dream weight losses were unrealistically high (Ϫ24% and Ϫ30%, respectively). High goals were associated with greater expected effort and greater expected reward but were not associated with psychological distress. Goal and dream weight losses were only weakly associated with behavioral or weight outcomes. An association between higher dream weight losses and greater weight loss at 18 months was the only outcome result to reach statistical significance. Discussion: Results suggest that lack of realism in weight loss goals is not important enough to justify counseling people to accept lower weight loss goals when trying to lose weight.