the clinical utility of the lifestyle questionnaire— weight management presentation by chris...

THE CLINICAL UTILITY OF THE LIFESTYLE QUESTIONNAIRE—WEIGHT MANAGEMENTPresentation by Chris Anderson, PhD

Background

In the U.S. more than 2/3rd of adults are overweight or obese and 6.5% are considered extremely obese (Ogden et al., 2014)

Weight regain following weight loss has become the norm (wing et al., 2006)

Interventions to improve multiple long-term behavior changes are needed (Johnson et al., 2008 & Wing et al., 2001)

Counseling and Obesity

Despite the recommendation to “offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults (U.S. Preventive Services Task Force, 2004)”, fewer than ½ of obese patients receive weight loss counseling from primary care providers (Kraschnewski et al., 2013).

Primary Care Physicians cite time-restraints, discomfort with counseling, and pessimism that people can change habits, as reasons for reduced counseling (Yarnall et al., 2003 & Foster, 2003)

Behaviors associated with Weight Status

• Physical activity levels (Jakicic, Wing, & Winters-Hart, 2002)

• Fast food consumption (Phelan et al., 2006)

• Finding opportunities to increase physical activity (taking the stairs; Andersen et al., 1999)

• Higher levels of depression (McGuire et al., 1999)

• Emotional eating (McGuire et al., 1999)

• Binge eating (McGuire et al., 1999)

• daily self-weighing (Wing et al., 2006)

Goals of The Original Lifestyle Questionnaire—Weight Management

Produce a questionnaire helpful for patients and clinicians to quickly identify behavioral patterns and to create weight management plans likely to result in success.

Create a “Lifestyle score” to track patient’s emotional/behavior changes from week-to-week.

Include questions related to body image, eating disordered behavior, and motivation for change.

The Lifestyle Questionnaire—Weight Management

Instructions: This questionnaire will assist your provider to create a weight management plan that is right for you. Please be open and respond based upon your lifestyle in the last week. Please see the scoring instructions and interpretation when you are finished.

Scores of People Trying to Lose W

Table 1.

Last week, how many days did I… 0-7 Days

1. Keep a calorie goal 2. Do moderate exercise for at least

30 minutes or take at least 10,000 steps

3. Find small opportunities to be physically active (e.g. take the stairs)

4. Modify meals in a healthy way (e.g. taken a smaller portion size)

5. Drink 4+cups of water 6. Check my weight

7. Plan meals Sum of

items 1-7= 8. “Binge” (eating a meal above

2,000 calories) or “Purge” (trying to get rid of recently eaten food via throwing up or using laxatives.)

9. Spend 2+ hours watching T.V. or playing video/computer games

10. Feel significant guilt or shame about eating

11. Feel significant sadness or negative emotions

12. Eat while watching T.V. 13. Drink soda or other sweetened

drinks

14. Eat fast food 15. Eat as a response to stress or

boredom

Sum of items 8-15=

16. From 0-100 (0=no motivation; 100=very high motivation), please rate your current motivation level to engage in: Increased physical activity____70___

Modification of your diet__50_____ Other behaviors (e.g. calorie tracking etc.) __10______

17. On a scale from 0-100, how comfortable are you with the shape or size of your body? (0=I am extremely uncomfortable with the shape or size of my body; 100=I am extremely comfortable and confident with my body). ____40_______ 18. On a scale from 0-100, how confident do you feel with your ability to manage your weight? (0=I feel I have no control over my weight; 100=I feel totally in control of my weight). _____80________

To calculate the Lifestyle Score add items 1-7 and then subtract the total of items 8-15. Note that items 4-7 and 11-15 are double weighted. Lifestyle Score________________

16. From 0-100 (0=no motivation; 100=very high motivation), please rate your current motivation level to engage in: Increased physical activity_____ Modification of your diet ______ Other behaviors (e.g. calorie tracking) _______ 17. On a scale from 0-100, how comfortable are you with the shape or size of your body? (0=I am extremely uncomfortable with the shape or size of my body; 100=I am extremely comfortable and confident with my body). ___________ 18. On a scale from 0-100, how confident do you feel with your ability to manage your weight? (0=I feel I have no control over my weight; 100=I feel totally in control of my weight). _____________

Case Study: Mr. W. Mr. W. was a 55 y.o. married Caucasian male who had been

denied placement on an organ transplant list due to his obesity status and inability to lose weight in past attempts—needed to lose 25 lbs. for placement.

Mr. W. completed the Lifestyle Questionnaire at intake and identified several behaviors he would be willing to work on changing.

Both Mr. W. and his wife presented as friendly and insightful and his wife commented,“this is the first time that anybody has actually showed us how to lose weight.”

Mr. W. was seen for two 30-minute appointments over two months with this writer (who had finished the rotation) and was well on his way to being placed on the transplant list (had lost 20lbs).

Mr. W.



Scores of People Trying to Lose W

Table 1.


1. Keep a calorie goal 0 2. Do moderate exercise for at least


2


1


3

5. Drink 4+cups of water 2 6. Check my weight 1 7. Plan meals 4 Sum of items 1-7= 13 8. “Binge” (eating a meal above


0


7


0


0

12. Eat while watching T.V. 7 13. Drink soda or other sweetened

drinks 7

14. Eat fast food 5 15. Eat as a response to stress or

boredom

7

Sum of items 8-15= 33




To calculate the Lifestyle Score add items 1-7 and then subtract the total of items 8-15. Note that items 4-7 and 11-15 are double weighted. Lifestyle Score____-20________

16. From 0-100 (0=no motivation; 100=very high motivation), please rate your current motivation level to engage in: Increased physical activity__90___ Modification of your diet __70____ Other behaviors (e.g. calorie tracking) __90_____ 17. On a scale from 0-100, how comfortable are you with the shape or size of your body? (0=I am extremely uncomfortable with the shape or size of my body; 100=I am extremely comfortable and confident with my body). _____90______ 18. On a scale from 0-100, how confident do you feel with your ability to manage your weight? (0=I feel I have no control over my weight; 100=I feel totally in control of my weight). _____50________

Case Study: Mr. S. 50 y.o. single, Caucasian Male referred for weight management on

the recommendation of his PCP that he lose weight due to his progression towards diabetes.

Mr. S. experienced obsessive compulsive disorder (OCD) Secondary symptoms of his OCD included: Body dysmorphia,

Caffeine addiction & h/o exercise addiction.

Completed the Weight Management Questionnaire at intake and was seen for 4 sessions of psychotherapy

Since his lifestyle appeared adequate for weight loss, session time was devoted towards his psychological health and body dissatisfaction.

Mr. S.



Scores of People Tryi

Table 1.


1. Keep a calorie goal 7 2. Do moderate exercise for at least


7


6


7

5. Drink 4+cups of water 2 6. Check my weight 7 7. Plan meals 5 Sum of items 1-7= 41 8. “Binge” (eating a meal above


0


3


7


7

12. Eat while watching T.V. 2 13. Drink soda or other sweetened

drinks 2

14. Eat fast food 0 15. Eat as a response to stress or

boredom

2

Sum of items 8-15= 23




To calculate the Lifestyle Score add items 1-7 and then subtract the total of items 8-15. Note that items 4-7 and 11-15 are double weighted. Lifestyle Score____18________

16. From 0-100 (0=no motivation; 100=very high motivation), please rate your current motivation level to engage in: Increased physical activity__100___ Modification of your diet __100____ Other behaviors (e.g. calorie tracking) _100_____ 17. On a scale from 0-100, how comfortable are you with the shape or size of your body? (0=I am extremely uncomfortable with the shape or size of my body; 100=I am extremely comfortable and confident with my body). ____0_______ 18. On a scale from 0-100, how confident do you feel with your ability to manage your weight? (0=I feel I have no control over my weight; 100=I feel totally in control of my weight). _______70______

Statistical Properties: Method• A sample of 277 college students completed the Lifestyle

Questionnaire as well as a questionnaire regarding their weight history. • Participants were asked if they had been gaining, maintaining, or losing

weight recently and if they were trying to lose weight. • Items were dropped that did not show associations with weight loss or

where there was significant overlap with other items.

Research questions: 1.Will significant behavioral/emotional differences from the Lifestyle Questionnaire exist between individuals gaining, maintaining, or losing weight?

2. Will the Lifestyle Score discriminate between people gaining, maintaining, or losing weight?

Unweighted Scores by Group

Total Sample Trying to lose Not trying to lose

0

5

10

15

20

25

30

35

40

45

Weight LosersWeight MaintainersWeight Gainers

***

***

*

* p<.05*** p < .001

N=273 n=57 n=177

Differences Between Successful and Unsuccessful Groups—Healthy Behaviors

Keep a

Calo

rie G

oal

Exerci

se

Small O

pport

unitie

s

Modify

mea

lsW

ater

Check

weig

ht

Plan m

eals

0

1

2

3

4

5

6

7

Sucessful n=16Unsuccessful n=41

***

*

***

* p < .05 *** p < .001

Days per Week *

Differences Between Successful and Unsuccessful Groups II—Unhealthy Behaviors

Binge

Guilt/S

hame

Sadne

ss

Eat whil

e watc

hing T

.V.

Drink s

oda

Eat fas

t food

Eat whe

n bore

d/stre

ssed

00.5

11.5

22.5

33.5

4

Successful n=16Unsuccessful n=41

*

****

**

**

* p < .05** p < .01*** p < .001

Days per week

Differences Between Groups with Weighted Items

Total Sample Trying to Lose Not Trying to Lose

-10

-5

0

5

10

15

20

25

30

35

40

Weight LosersWeight MaintainersWeight Gainers

***

*

* p < .05** p < .01*** p < .001

N=273 n=57 n=177

Mean LifestyleScore

Weight Trajectories by Score Groupsof Those Trying to Lose Weight

Weight Trajectory by Score Groups % of people losing weight.

% of people maintaining their weight.

% of people gaining weight.

Scores lower than zero n=24 0% 63% 37%

Scores between 0-29 n=19 22% 56% 22%

Scores above 30 n=14 86% 7% 7%

Those Not Trying to Lose Weight

Weight Trajectories by Score Groups % of people losing weight.

% of people maintaining their weight.

% of people gaining weight.

Scores lower than zero n=18 5% 68% 27%

Scores between 0-29 n=129 13% 69% 18%

Scores above 30 n=29 44% 54% 2%

Case Example



Last week, how many days did I… 0-7 Days Sum of scores

1. Keep a calorie goal 0 0 2. Do moderate exercise for at least


4 4


2 2


0 (x2) 0

5. Drink 4+cups of water 5 (x2) 10 6. Check my weight 0 (x2) 0 7. Plan meals 0 (x2) 0 Sum of

items 1-7= 16

8. “Binge” (eating a meal above 2,000 calories) or “Purge” (trying to get rid of recently eaten food via throwing up or using laxatives.)

0 0


7 7


0 0


1 (x2) 2

12. Eat while watching T.V. 2 (x2) 4 13. Drink soda or other sweetened

drinks 5 (x2) 10

14. Eat fast food 3 (x2) 6 15. Eat as a response to stress or

boredom

3 (x2) 6

Sum of items 8-15=

35




To calculate the Lifestyle Score add items 1-7 and then subtract the total of items 8-15. Note that items 4-7 and 11-15 are double weighted. Lifestyle Score__-19__________

A purpose of the Lifestyle Score is to allow you to see how your current lifestyle compares to the lifestyles of other individuals. In general, the higher your score the more likely you are to lose weight. The tables on the back compare scores of people trying to lose weight and those not currently trying to lose weight as well as their weight loss patterns.

16. From 0-100 (0=no motivation; 100=very high motivation), please rate your current motivation level to engage in: Increased physical activity__70___ Modification of your diet ___50___ Other behaviors (e.g. calorie tracking) ___10____ 17. On a scale from 0-100, how comfortable are you with the shape or size of your body? (0=I am extremely uncomfortable with the shape or size of my body; 100=I am extremely comfortable and confident with my body). _____40______ 18. On a scale from 0-100, how confident do you feel with your ability to manage your weight? (0=I feel I have no control over my weight; 100=I feel totally in control of my weight). _____80________


Scores of People Trying to Lose Weight

Table 1.

Table 2.

Average Lifestyle Scores amongst People Trying to Lose Weight Sample size=57

Average Lifestyle Score

Those that are losing weight. 36 Those whose weight is staying about the same. -1 Those actually gaining weight. -7

Weight Trajectory Likelihood by Score Groups

Sample size=57

% of people

losing

weight.

% of people

maintaining

their weight.

% of people

gaining weight.

Scores lower than zero 0% 63% 37%

Scores between 0-29 22% 56% 22%

Scores above 30 86% 7% 7%

Discussion• The Lifestyle Questionnaire—Weight Management can be

a helpful tool to create productive counseling sessions with patients.

• The Lifestyle score may be useful to raise patients’ awareness of their likelihood to lose or gain weight.

• The score can also be tracked weekly to promote multiple long-term behavior changes.

Discussion (Continued)• Future research designs on the Lifestyle Questionnaire

will:• expand the sample size. • sampling different populations.• employing causal research models.• use more sophisticated weight trajectory tracking.

• The Questionnaire will also be available in an app soon to help outpatients with self-monitoring of behaviors.

• Contact info to receive more information: [email protected]; or [email protected]

mailto:[email protected]

ReferencesAndersen, R. E., Wadden, T. A., Bartlett, S. J., Zemel, B., Verde, T. J., & Franckowiak, S. C. (1999). Effects of lifestyle

activity vs structured aerobic exercise in obese women: a randomized trial. Jama, 281(4), 335-340.Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., & Kessler, A. (2003). Primary

care physicians’ attitudes about obesity and its treatment. Obesity research, 11(10), 1168-1177.Gunn, W. B., & Blount, A. (2009). Primary care mental health: A new frontier for psychology. Journal of clinical

psychology, 65(3), 235-252.Hill, J. O., Wyatt, H., Phelan, S., & Wing, R. (2005). The National Weight Control Registry: is it useful in helping deal

with our obesity epidemic?. Journal of Nutrition Education and Behavior, 37(4), 206-210.Jakicic, J. M., Wing, R. R., & Winters-Hart, C. (2002). Relationship of physical activity to eating behaviors and weight

loss in women. Medicine & Science in Sports & Exercise.Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., ... & Sherman, K. (2008).

Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Preventive medicine, 46(3), 238-246.Kraschnewski, J. L., Sciamanna, C. N., Stuckey, H. L., Chuang, C. H., Lehman, E. B., Hwang, K. O., ... & Nembhard, H. B. (2013). A silent response to the obesity epidemic: decline in US physician weight counseling. Medical care, 51(2), 186-192.Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United

States, 2011-2012. Jama, 311(8), 806-814.Phelan, S., Wyatt, H. R., Hill, J. O., & Wing, R. R. (2006). Are the eating and exercise habits of successful weight losers

changing?. Obesity, 14(4), 710-716.U.S. Preventive Services Task Force. USPSTF Recommendations. Available at: http://www.uspreventiveservicestaskforce.org/uspstopics.htm.Accessed February 22, 2015.Wing, R. R., Goldstein, M. G., Acton, K. J., Birch, L. L., Jakicic, J. M., Sallis, J. F., ... & Surwit, R. S. (2001). Behavioral

science research in diabetes lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes care, 24(1), 117-123.Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. The American journal of clinical nutrition, 82(1),

222S-225S.

References IIWing, R. R., Papandonatos, G., Fava, J. L., Gorin, A. A., Phelan, S., McCaffery, J., & Tate, D. F. (2008). Maintaining

large weight losses: the role of behavioral and psychological factors. Journal of Consulting and Clinical Psychology, 76(6), 1015.

Wing, R. R., Tate, D. F., Gorin, A. A., Raynor, H. A., & Fava, J. L. (2006). A self-regulation program for maintenance of weight loss. New England Journal of Medicine, 355(15), 1563-1571.

Yarnall, K. S., Pollak, K. I., Østbye, T., Krause, K. M., & Michener, J. L. (2003). Primary care: is there enough time for prevention?. American journal of public health, 93(4), 635-641.

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