Weighing the Options Criteria for Evaluating Weight-Management Programs (1995) / Chapter Skim
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Appendix A: Assessment Instruments of Relevance to Obesity Treatment
Appendix A: Assessment Instruments of Relevance to Obesity Treatment
Pages 171-197
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From page 171... ...
Our third policy recommendation is that there be developed a more aggressive policy of informing the public and health-care providers about the nature of obesity, the difficulties inherent in treating this disease, and the need for susceptible individuals to take steps to prevent its occurrence or minimize its development. The techniques to be utilized are those suggested for informing the public of methods to be used in the evaluation of obesity treatment (Chapter 8~.
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From page 172... ...
170 WEIGHING THE OPTIONS pants. As this country debates health-care reform, attention should be paid to reimbursement mechanisms for nutrition services generally and for obesity treatment programs-certainly the clinical programs and some of the appropriate nonclinical programs as well.
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From page 173... ...
ASSESSING PSYCHOSOCIAL AND BEHAV1012AL ASPECTS OF OBESITY AND WEIGHT LOSS Regardless of the genetic and environmental factors that cause obesity, the psychological significance of this disease is important. Obese individuals who join comprehensive weight-loss programs experience major physiological changes, undertake major changes in lifestyle, and attempt to curtail a strongly appetitive behavior.
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From page 174... ...
This social stigmatization and discrimination experienced by obese individuals often leads to negative self-esteem and an unfavorable body image. Although enhanced selfesteem and a more positive body image may result from weight loss, these same factors may keep some people from entering treatment in the first place.
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From page 175... ...
ASSESSING PSYCHOSOCIAL AND BEHAV1012AL ASPECTS OF OBESITY AND WEIGHT LOSS Regardless of the genetic and environmental factors that cause obesity, the psychological significance of this disease is important. Obese individuals who join comprehensive weight-loss programs experience major physiological changes, undertake major changes in lifestyle, and attempt to curtail a strongly appetitive behavior.
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From page 176... ...
Body image represents the cognitive perception of one's body size and appearance along with the emotional response to these perceptions. Four measures of body image include the Body-Cathexis and Self-Cathexis Scale, Body Satisfaction Scale, Body Shape Questionnaire, and the Body Parts Satisfaction Scale.
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From page 177... ...
We describe seven different measures of disordered eating (Eating Disorders Inventory, Eating Inventory/Three-Factor Eating Questionnaire, Eating Attitudes Test, Eating Disorder Examination, Questionnaire on Eating and Weight Patterns, and the Stanford Eating Behavior Questionnaire) , including one designed specifically to assess binge eating (Binge Eating Scale)
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From page 178... ...
Body image represents the cognitive perception of one's body size and appearance along with the emotional response to these perceptions. Four measures of body image include the Body-Cathexis and Self-Cathexis Scale, Body Satisfaction Scale, Body Shape Questionnaire, and the Body Parts Satisfaction Scale.
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From page 179... ...
The scale is useful in distinguishing levels of binge-eating severity and appears to have high internal consistency. It also correlates well with clinical interviews for diagnosing disordered eating behaviors.
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From page 180... ...
Five measures of self-efficacy for eating behaviors and exercise are the Dieter's Inventory of Eating Temptations, Self-Efficacy for Eating Behaviors Scale, Self-Efficacy for Exercise Behaviors Scale, Physical Self-Efficacy Scale, and the Exercise Specific Self-Efficacy Scale. Dieting Readiness Scale This scale assesses whether a person is prepared to undertake a diet at the point when they decide to begin a new attempt at weight loss (Brownell, 1990~.
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From page 181... ...
The scale is useful in distinguishing levels of binge-eating severity and appears to have high internal consistency. It also correlates well with clinical interviews for diagnosing disordered eating behaviors.
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From page 182... ...
Five measures of self-efficacy for eating behaviors and exercise are the Dieter's Inventory of Eating Temptations, Self-Efficacy for Eating Behaviors Scale, Self-Efficacy for Exercise Behaviors Scale, Physical Self-Efficacy Scale, and the Exercise Specific Self-Efficacy Scale. Dieting Readiness Scale This scale assesses whether a person is prepared to undertake a diet at the point when they decide to begin a new attempt at weight loss (Brownell, 1990~.
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From page 183... ...
evolved from the Social Readjustment Rating Scale but offers two new features. It allows for separate positive and negative stress scores and requires the subject to rate the degree of impact of any relevant event on a 4-point scale from "no impact" to "extremely negative or positive." The survey includes 57 items: 47 specific events for all respondents and 10 items designed primarily for students.
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From page 184... ...
Adult and Child Behavior Knowledge Scales These scales measure knowledge of health behaviors related to cardiovascular disease (Vega et al., 1987~. They focus on behavioral capability rather than on the link between behavior and disease.
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From page 185... ...
Recently, computerized programs have been developed to greatly expedite data analysis and provide immediate feedback. In general, dietary assessment methods can be differentiated between those needed for research purposes to survey a population and those used in clinical settings for assessing usual intake and adequacy, choosing interventions, and measuring compliance and/or desired change.
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From page 186... ...
The recall takes about 15-30 minutes to administer but considerably more time to analyze. It is a more objective assessment tool than a dietary questionnaire, providing a quantitative assessment of energy and nutrient intakes on one day as well as qualitative insight into the foods eaten and timing of food intake.
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From page 187... ...
Existing methods, while relatively crude, nonetheless provide valid and reliable estimates of participation in physical activity and total energy expenditure. The most valid methods of physical activity assessment (doubly-labeled water, direct calorimetry, individual observation, and electronic monitoring)
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From page 188... ...
To be useful for weight-management programs, questionnaires need to provide estimates of total energy expenditure. In themselves, the frequency of exercise sessions and the intensity of the activity are relatively un~mportant for weight loss.
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From page 189... ...
Most individuals entering obesity treatment are already quite familiar with the caloric value of food, and teaching them about the caloric value of physical activity is not difficult. The multiples of resting energy expenditure method (the MET approach)
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From page 190... ...
The gold standard for physical activity measurement is by the doubly-labeled water method. This technique provides a reliable estimate of total energy expenditure, but cost and complexity limit its usefulness.
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From page 191... ...
The MLTPA, used extensively in epidemiological studies, yields an estimate of energy expenditure, typically in kilocalories expended per week. Folsom and colleagues administered the MLTPA two times over a five-week interval to 140 adults from the general population and two times over a two-week interval to 150 men who were participating in the Multiple Risk Factor Intervention Trial.
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From page 192... ...
These associations and reliability coefficients are comparable to data reported for more complicated and labor intensive questionnaire procedures. Bouchard et al., l 983 Energy expenditure estimates are derived from a three-day activity record.
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From page 193... ...
Heart rate monitors overestimated group energy expenditure by 2 to 9 percent. Activity diaries underestimated energy expenditure by 2 to 6 percent.
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From page 194... ...
Validity has been shown by monitoring changes in exercise groups in controlled studies. Objective data from both heart rate and bodily movement presumably provide more precise estimates of energy expenditure than for either used alone.
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From page 195... ...
Review Papers Caspersen, 1989; Lamb and Brodie, 1990; Saris, 1986; Tremblay and Bouchard, 1987; Wilson et al., 1986 These five review papers present information on most of the commonly used methods for the assessment of physical activity and physical fitness in population based studies. Methods applicable across the age range are presented.
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From page 196... ...
The doubly-labeled water method is considered by many to be the "gold standard" for energy expenditure. Unfortunately, the method is quite complex and very expensive, and it is not suited for epidemiological studies.
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From page 197... ...
The mean and standard deviation for blood pressure responses during an exercise load ranging from 100 to 600 watts are presented by sex, age, and resting blood pressure status. Wolthuis et al., 1 977 Systolic and diastolic blood pressures were measured using the Korotkoff method in 704 healthy asymptomatic aircrewmen at rest and at each stage of a maximal treadmill exercise test using a Balk-c-Ware protocol.
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