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Bandura (1998) highlighting the overarching nature and strengths of SCT in comparison to other psychosocial theories

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Explained by Bandura (1998) to be either distal (e.g. long-term goals) or proximal (e.g. attainable intentions). It is important that this intervention focuses on both of these goal-setting types in order to sustain long-term change.

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For example, the self-observation and judgement behaviours surrounding an expected outcome.

For an outcome of weight-loss, this can be expressed through the self-regulation of weight-loss behaviour (activity/diet tracking).

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(Please refer to the previous information surrounding social support)

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Determinants in Social Cognitive Theory (Mansori, 2018)

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Explained by Bandura (1998) to come in three types:
1. Mastery experiences (ones own belief of their capabilities)
2. Vicarious experiences (seeing relatable individuals similar to ones self succeed)
3. Social persuasion (encouragement from other people, verbally)

In this paper, Bandura (1998) discusses how self-efficacy can be mediated by a persons psychological state. For example, a bad mood or increased stress would make them feel increased signs of inefficacy.

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(Bandura, 1986, 1998)

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The importance of theory based interventions

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The importance of theory based interventions

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Webb et al. (2010) highlighted that theory based weight loss interventions are more effective than those not using theory. They also found that the use of more behaviour change techniques predicted better intervention success.

This is also supported by the NICE (2014) guidelines of behaviour change for eating behaviour and physical activity improvements such as: setting goals, planning, feedback and monitoring progress and receiving social support.

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The uncertainty surrounding long-term weight-loss management is expressed by Simpson et al. (2011).

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Determinants of weight loss maintenance: a systematic review

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Determinants of weight loss maintenance: a systematic review

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This systematic review by Varkevisser et al. (2018) analysed 49 unique studies. Including the Look AHEAD programme discussed above. This review found that the self-monitoring of progress, self-efficacy for exercise and self-efficacy for weight loss were strong determinants (predictors) of long-term weight management.

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Self-determination theory (SDT) (Ryan & Deci, 2000) has been used by Silva et al. (2010) to significantly reduce the weight of women through increasing physical activity. SDT was adopted in this intervention through the promotion of autonomous exercise regulation and intrinsic motivation.

This study eliminated extrinstic motivators (like rewards) from the study which could induce short-term change. Instead, opting for ways to increase the participants desire to fulfil the goals for themselves (intrinsic motivation).

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Group sharing of self-regulation practices

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Group sharing of self-regulation practices

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Within the allocated support groups, members would be encouraged to share their progress through (optional):
- Meal photos
- Exercise routines
- Physique updates
- Life updates
- Support for others in the group

Enabling community updates within the app is aimed to increase self-efficacy through the viewing of others loose weight in the community ("if they can do it, so can I" attitude).

Secondly, being encouraged to give regular updates should make the individual feel accountable to the journey and other members of their support group. Helping to reduce attrition rate and encourage long-term participation.

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Research has shown that adults are most affected by obesity. It is hoped that by targeting adults, long-term results of this intervention will be an increased awareness and education that will be passed onto future generations; breaking the cycle of childhood-adult family obesity through biopsychosocial factors (please see section 1).

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Although research has shown obesity is more common amongst the male population, as all genders can be equally affected by obesity associated comorbidities, this intervention will include no gender restrictions.

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Enabling professional guidance will give individuals the correct tools they need to have a successful weight-loss journey. It will also prevent incorrect advice being shared through the online app community.

Following the health belief model (Rosenstock, 1974), professional guidance can help to educate the individuals on the benefits of change, increasing the likelihood for them to want to maintain change long-term.

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Small groups will be matched by similar demographics after filling out a lifestyle questionnaire (e.g. parents, mums, middle-aged men, diabetics). The aim of matching via similar communities is so that the clients inspire one another, building self-efficacy and determination they can achieve weight-loss if others like them can as well (the participant's vicarious experience). Pairing people in similar groups also enables a support system with people who are able to relate to the personal challenges of obesity.

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Basing obesity interventions online have been praised as beneficial when trying to target hard to reach populations such as those who are socioeconomically deprived; important as deprived populations have been found to have highest rates of obesity (see section 1).

Online interventions are low-cost and quick to deliver.

Use of a downloadable app can bring the individual autonomy over their own journey as they are the ones deciding to download it and begin their personal weight-loss journey.

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Based on analysis of interventions in section 3, this intervention also aims to:

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Based on analysis of interventions in section 3, this intervention also aims to:

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1. Involve social support

2. Educate participants about their chronic illness

3. Encourage active participation within the intervention

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How this intervention will be delivered?

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How this intervention will be delivered?

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Psychological factors this intervention aims to encourage:

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Psychological factors this intervention aims to encourage:

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1.  Self-efficacy (derived from social cognitive theory)

2. Autonomous motivation (derived from self-determination theory)

3. Self-regulation (e.g. self-monitoring)

Based on the systematic review by Teixeira et al. (2015).

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(Teixeira et al., 2015)

A systematic review analysing 35 unique obesity interventions for psychological and self-regulation mediators/predictors of change in body weight or BMI, physical activity, and dietary intake.

When measuring intervention length, only 1 study lasted 24 months or more. With only a third of studies (n=11) including a follow-up assessment period. Highlighting the lack of research in long-term obesity treatment.

Theories of behaviour change were the most common intervention: social cognitive theory (n=23), the trans theoretical model (n=5), and self-determination theory (n=3). Other theories included: group dynamics theory, the problem solving model, theory of planned behaviour,
health belief model and self-regulation theory.

Results

Weight control predictors
Short term: self-regulation skills, high self-efficacy, low perceived barriers and positive body image
Long term: positive body image, self-regulation skills and self-efficacy. Autonomous motivation and flexible eating restraint were only tested once but in this instance acted as long-term mediators of weight control.

Physical activity predictors
Short term: body image and self-efficacy
Long term: autonomous motivation and self-efficacy

Healthy diet predictors:
Short term: self-efficacy, lower perceived barriers and self-regulation skills
Long term: / not measured

Overall most effective predictors of obesity management
Autonomous motivation, self-efficacy and self-regulation skill use were found to be the best obesity mediators. "For long-term weight control, promoting a positive body image and flexible eating control may also
be important".

By dividing studies by length of measurement period, this review was able to determine the predictors of long-term weight management.

Refining the search from after the year 2000 enabled modern and relevant research to be reviewed.

The majority of interventions analysed were RCT's (n=28), followed by National clinical trials (n=6) and non-rct's (n=1). Indicating that the studies analysed were conducted with high-standards regarding validity of data collection and the interpretation of findings.

Personal factors such as social support, QoL & well-being were not monitored for in this review, despite these factors also being found to have an influence over long-term weight-loss success.

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A systematic review of successful behaviour change in adult obesity interventions

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A systematic review of successful behaviour change in adult obesity interventions

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(Sanford, 2010)
This article compliments blogging as a tool for weight loss as it: (a) allows for empathy; (b) ensures accountability to others; (c) provides venting and advice seeking; and (d) shares validation of the weight loss experience.

This research identified that women use online services more than men.

Blogging enabled support from others who knew what it was like that they were going through.

However, data collection was only taken from members of a weight loss blog who wanted their journey to be recorded. Perhaps these individuals already had levels of intrinsic motivation to loose weight irrespective of the social support.

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An evidence based intervention for weight-loss to reduce obesity associated co-morbidity and promote optimum wellbeing.

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Please click to enlarge. This reasoning (both on a group and individual level) highlights the essential nature of group support to encourage motivation. It also highlights the need for an intervention to be easy, convenient and implies the need of having knowledge to make the right decisions (Clark et al., 2020).

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An app-, web- and social support-based weight loss
intervention for adults with obesity: the HelpMeDoIt!
feasibility RCT
(Simpson et al, 2020)

Based on social cognitive theory and control theory

Encourages: goal setting, self-monitoring and social support

Enables 'helpers' to reach the app user and support them in weight-loss

Positive effects of the app trial were found. However, 'helper' support engagement was reported low. Highlighting the need for social support to be encouraged in this intervention through other methods than relying on healthy individuals to engage on a friends journey and to not just rely on the individuals belief in themselves by discounting their vicarious experience of seeing other people engage in the weight-loss journey.

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Quantitative analysis of participants in an online facebook Weight Watchers group showed that not everyone has the same level of participation (Ballantine & Stephenson, 2011).

This indicates the need for an intervention to encourage active participation and discourage passive engagement.
This could be achieved through the self-monitoring of behaviour.

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Social support in an Internet weight loss community

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Social support in an Internet weight loss community

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(Hwang et al., 2010)

A qualitative analysis of use of internet communities for weight-loss showed that they gave: encouragement, motivation, information and enabled shared experiences to occur. Sub-themes demonstrated: testimonies, recognition for success, accountability, friendly competition, and humour. Members valued the: convenience, anonymity, and the non-judgemental interactions as unique factors of computer-mediated-communication.

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Commercial weight loss programmes -   a systematic review

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Commercial weight loss programmes -   a systematic review

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(Gudzune et al., 2015)

This systematic review measured the success of 13 RCT weight-loss research programmes (e.g. Weight Watchers, Nutrisystem & Jenny Craig).

Weight Watchers was found to have the largest long-term sustained success when measuring weight-loss. The key features of Weight Watchers include: controlled diet plans, social support in group weigh ins, self-accountability when tracking food 'points' and goal setting for weight-loss targets.

13 weight-loss studies were analysed which met the RCT criteria of trying to loose weight. However, studies with goals of improving the well-being of obese individuals were excluded from this analysis, despite prior research in this portfolio highlighting the benefits of a positive mental well-being and mental health when attempting a weight-loss journey.
Results after 1 year were considered 'long-term'. Although this is not considered enough time to measure whether weight-regain and habit relapse occurs.

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(Dalen et al., 2010)

This intervention focused on the teaching of skills to participants to help them increase awareness of their eating behaviour. This was achieved in group sessions through adopting mindful eating and meditation.

After 12 weeks, all participants (n=10) achieved weight loss and had a decrease in psychological distress. However, as this study was only a pilot study the sample size is too low to apply to a large population.  It is be cost effective to teach and give participants intangible skills like mindfulness over expensive weight loss equipment and so could be applied on a large-scale. However, 12 weeks did not asses long-term life results so further evidence is required to support the benefits of mindfulness in weight loss.

The benefits of using stress-relieving techniques like mindfulness and meditation on behaviour change has been discussed in section 1.

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(Baktash & Naji, 2019) In a RCT, use of the HBM was found to significantly improve overweight participants beliefs about the risk of having a stroke, understanding that weight-loss could be used to reduce the risk.

However, as this study was only a small sample size (n=63), post-hoc analysis showed that differences between control and HBM group understandings could be attributed to participant differences. Long term weight-loss after participation was not measured. Thus, this highlights that HBM knowledge may not transmit to actual behaviour and suggests the importance of educating and also finding a way to monitor that knowledge applies into actual weight-loss behaviour.

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Daddario (2007)

Educating a person about the threats of an illness can be effective in inducing fear and a want to change. However, people with obesity related co-morbidities frequently still do not want to change their behaviour.

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Controversial meal replacements used in Look Ahead

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Controversial meal replacements used in Look Ahead

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In a RCT no significant difference was observed by Annunziato (2009) in weight loss between people on a meal replacement plan and a control condition not consuming meal replacements. Attrition occurred in both conditions.

A systematic review of weight loss programmes (Gudzune et al., 2015) has shown that short-term benefits of using meal replacements (e.g. Optifast/Medifast) can arise in comparison to other weight-loss methods like counselling. However, in the long-term this weight-loss difference is not maintained. Negative consequences were found to occur for well-being like constipation and the potential risk of gallstones.

This limited success reflects the short-term want which some obese people have to change. Meal replacements can be expensive and can be difficult to maintain for a long time period due to the strict schedules. The meal replacement plans can also coach patterns of food restriction and result in negative food-associations. This review has suggested that although meal replacements can help to seek short-term results, they will not be used for this intervention as the aim is instead focused on long-term weight-loss and improvements in well-being.

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ILI Look AHEAD (Action for Health in Diabetes) 

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ILI Look AHEAD (Action for Health in Diabetes) 

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(Look AHEAD Research Group, 2013) A randomised control rial comparing ILI to diabeties support and education (DSE). This research was positive because it followed up long-term results after 8 years and involved a large sample size (5145 people).

Results:

Participants in ILI lost significantly more weight than DSE at all points within weight check ups (1, 4 and 8 years).

Comparable weight loss in ILI was noted across genders.

ILI involved:

Both group and one-on-one professional support

Calorie restriction

Structured meal plans

Meal replacements

Activity plans

Behaviour counselling using: Cognitive behavioural therapy (CBT), problem solving methods, motivational interviewing & cultural tailoring

DSE involved:

Group meetings, less frequent than ILI (initially only 3 per year)

Discussions on: diet, physical activity and social support

Information, not behavioural strategies

Highlights the importance of actually offering behavioural strategies of change, not just informing the person of weight loss information. Note that even in the ILI condition, weight loss was not achieved for all participants.

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Principle components in treating of ILI:

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Principle components in treating of ILI:

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(Web & Wadden, 2017)

1. Diet

2. Physical activity

3. Behaviour therapy

= weight loss

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(Rosenstock, 1974)

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Current obesity intervention analysis to achieve weight-loss

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Weight loss intervention adherence and factors promoting adherence: a meta-analysis

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Weight loss intervention adherence and factors promoting adherence: a meta-analysis

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Lemstra et al. (2016) Overview:

Adherence rates of 27 weight loss studies were compared.

Interventions that included social support improved adherence rates by 29% compared to those interventions that did not include social support.

Participation in weight loss interventions that allow friends or family to participate may have important implications for weight loss and weight loss maintenance.

Analysis determined that programs supervising and monitoring attendance improved adherence rates by 65% compared to self-monitoring programs and had the highest adherence rates overall.

Increasing knowledge may improve self-efficacy.

Accountability is used as a factor determining adherence, through supervision from either social support of professionals.

There was better adherence to dietary interventions alone than exercise interventions alone however both in combination produce best weight loss results.

Interventions analysed lasting less than 12 months had the highest adherence rate (69.9% vs 53% for over or equal to 12 months), however less than a year does not indicate long term weight loss adherence.Which is crucial for comorbidity reduction and overall health improvement.

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The Thoughts Feelings Behaviours (TFB) Cycle

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The Thoughts Feelings Behaviours (TFB) Cycle

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The behavior of being physically active can help to improve mood and reduce states of depression which are correlated with obesity, improving overall mental health (SilverCloud, n.d.).

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Weight loss should be the primary goal of this intervention as it is the key to improving physical health by reducing obesity associated comorbidities.

Weight loss can be achieved through physical activity and a healthy diet. However, with most interventions showing only short-term weight loss, behaviour change maintenance should be a goal of this intervention to encourage long term change.

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Many physical activity and diet plans already exist. Attrition and nonadherence to these plans is the issue for many individuals in achieving long-term weight loss.

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SPA predicts a negative correlation to physical activity (Sicilia et al., 2013) and enrolment in exercise programmes has been found to reduce SPA (Berger et al., 2019; McAuley et al., 2002; Bartlewski 1996) and body image concerns (Gammage et al., 2016).

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Although being overweight/obese can result in SPA through self-consciousness, this research depicts that increasing physical activity can also decrease SPA and body esteem.
Therefore, increasing physical activity acts as a method to reduce SPA and the associsted negative body image concerns - an alternate way to increase body positivity from those discussed (e.g. the fatosphere, see below), whilst also improving health and reducing comorbidities at the same time.

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McAuley et al. (2002)

In a RCT, involvement in exercise programmes were correlated with improvements in self-efficacy and fitness.

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People living with obesity move in together to explore what it means to be larger bodied.

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Bacon et al. (2002)

Approach inspired by the high relapse rate of calorie restrictive diets.

Move from a weight-centred approach to a health-centred one

Improving health behaviours irrespective of weight outcome as it has been suggested you can still be healthy and overweight

Idea that targeting weight as the issue does not target comorbidities directly like targeting health behaviour does

Weight-loss dieting failure can be damaging to self-esteem so this approach would try to avoid that

Energy expenditure increased in long term measures

Improves body dissatisfaction long term

Improvement in body image avoidance behaviours

This non-diet approach minimised attrition rate and attribution of blame to self as a 'failure'

non-diet approach saw metabolic fitness improvements however saw no weight loss.

Weight loss was not a goal of the programme however would have been beneficial. If neither diet or non-diet approaches produce long term weight loss achievements then the improved metabolic health in the non-diet approach is a suitable alternative.

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BBC (2020) Documentary: Who are you calling fat?

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BBC (2020) Documentary: Who are you calling fat?

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This documentary discusses the 'body positive' community, highlighting views of acceptance and giving voice to certain 'toxic' viewpoints which decide size of body is not an indicator of health. Actually stating against scientific evidence that certain comorbidities like Type II diabetes are not caused by being overweight.

This raises problems for interventions as the community are discouraging healthy lifestyle changes. This body positivity movement is particularly strong for young females online, meaning social media may not contribute positively to a healthy lifestyle change for obese patients.

Conversation also discusses the  glorifying of obesity and it's impact on modern culture. In particular, the famously controversial Cosmopolitan magazine cover boasting Tess Holiday, a plus sized obese model. On one hand this cover has been praised for encouraging body positivity, though on the other, shamed for promoting obesity.

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Puhl and Brownell's (2003) route 1: Behaviour change and weight loss

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Puhl and Brownell's (2003) route 1: Behaviour change and weight loss

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Can be achieved through increased physical activity and diet change (see above).

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Puhl and Brownell's (2003) route 2: Body positivity and preservation of self-image can be explored here

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Puhl and Brownell's (2003) route 2: Body positivity and preservation of self-image can be explored here

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Individuals with mental health struggles are more at risk of obesity (please refer to section 1.)

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Statistics on obesity prevalence by gender, age and deprivation

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Statistics on obesity prevalence by gender, age and deprivation

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Baker (2019)

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6% of cancer cases in the UK are caused by overweight and obesity, making it the UK's biggest cause of cancer after smoking (Cancer Research UK, 2019)

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More than 6 in 10 adults are overweight or obese (Cancer Research UK, 2019)

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Overweight and obesity in adults is associated with higher deprivation (Cancer Research UK, 2019)

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Factors healthy diet change is impacted by:

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Factors healthy diet change is impacted by:

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Social factors - habits of family/friends (there is a need to surround an obese individual with other motivated individuals).

Emotional factors - Reasons for current diet change may be emotional and highlight the need for behavioural therapies like cognitive behavioural therapy (e.g. binge eating disorder, please see section 1).

Cultural factors - Some diets may be embedded in particular cultures, making diet change more difficult.

Cognitive factors - Knowledge on how to actually change, how easy do the obese adults think this will be? (Health Belief Model, section 3, Rosenstock, 1974).

Perceived symptoms - Many adults who are yet to experience comorbidities of obesity may be more likely to not notice a problem and continue their current lifestyle. Evident from the BBC documentary 'Who are you calling fat?' (2020), many people do not believe the correlation between weight and health.

Accessibility to medical services - Although British adults have access to the NHS, stigma of being overweight may prevent them from seeking help for their comorbidities. Highlighting the need to reduce this stigma and the associated stress.

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Factors increased physical are impacted by:

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Factors increased physical are impacted by:

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Social factors - Time schedule, family commitments making it more difficult to have personal time to exercise.

Emotional factors - physical activity could be channelled as an output of emotion.
On the other hand, sensitive emotions in body stigma may prevent physical activity.

Cultural factors - Certain cultures may stigmatise exercise of certain groups - e.g. women.

Cognitive factors - Knowledge about types of exercise and their success on weight loss and body transformations (refer to the Health Belief model in section 3, Rosenstock, 1974).

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Coping with stigma - body image and poor mental health 

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Coping with stigma - body image and poor mental health 

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Ways of coping with obesity stigma: review and conceptual analysis

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Ways of coping with obesity stigma: review and conceptual analysis

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Puhl and Brownell (2003) discuss two ways of coping with obesity related stigma.
1. Changing behaviour to avoid the stigma via weight loss
2. Take pride in large weight to change attitudes and prevent discrimination.

This intervention aims to encourage the first method of coping, as this is what will improve physical health in the long-term by reducing risk of co-morbidities.

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Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self- esteem

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Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self- esteem

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Myers and Rosen (1999) report the negative comments people with obesity face in stigmatising situations, with the most common being comments from children.

This review also reports that common self-coping mechanisms include positive self-talk.

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What are the primary self-management challenges associated with obesity?

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Heavier individuals are at often at an increased risk of discrimination in: employment, health care, education, the media and in interpersonal relationships (Puhl & Brownell, 2003). Respectively, reducing quality of life for the individual.

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‘Just Bloody Fat!’: A Qualitative Study of Body Image, Self-Esteem and Coping in Obese Adults

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‘Just Bloody Fat!’: A Qualitative Study of Body Image, Self-Esteem and Coping in Obese Adults

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(Thomas et al., 2012)

This interpretative phenomenological analysis marks the negative factors obese males and females face when adapting to obesity. Particularly focusing on issues of poor self-esteem and body image. It also explores the coping strategies of this, commonly being self-isolation and alternatively, finding humour in their situation.

It was noted that females put more blame on themselves while males often attribute weight gain to external explanations such as providing for their families (working long hours).

Highlighting that females may have a more damaging perspective of who is at fault for their weight-gain, which could drive them to negative states of mental health. Alternatively, this mindset could also drive the female to take autonomous control of their own behaviour. A factor which can be correlated with long-term change (Teixeira et al., 2015). Therefore, this intervention aims to make participants aware of their comorbidities in order to install the idea to all participants that they have personal control over their own situations.

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The Role of the Fatosphere in Fat Adults’ Responses to Obesity Stigma: A Model of Empowerment Without a Focus on Weight Loss

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The Role of the Fatosphere in Fat Adults’ Responses to Obesity Stigma: A Model of Empowerment Without a Focus on Weight Loss

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Dickens et al. (2011) explore the fat-acceptance movement.

The 'fatosphere' refers to an online-fat acceptance community, which aims to proactively prevent from stigma before it occurs.

Fatosphere entry may be positive for mental health - acting as a coping mechanism to stigma - but this intervention aims to avoid fat acceptance as this can prevent the want to change and improve physical health by not reducing weight.

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This figure by Wizman (n.d.) demonstrates the comorbidities which obesity can bring to an individual.

This can be challenging for individuals living with obesity as they are left the fear and anxiety of developing these conditions.

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Effect of T'ai Chi Exercise on Biochemical Profiles and Oxidative Stress Indicators in Obese Patients with Type 2 Diabetes

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Effect of T'ai Chi Exercise on Biochemical Profiles and Oxidative Stress Indicators in Obese Patients with Type 2 Diabetes

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Chen et al. (2010).

Practising T'ai Chi had benefits in reducing the BMI of obese patients with Type 2 diabetes, whilst conventional exercise had no effect.

Highlighting that practices which involve the mind can sometimes increase the success of weight-loss interventions.

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Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study

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Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study

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(Daubenmier et al., 2011).

A mindfulness for stress eating programme saw improvements in anxiety, and external-based eating compared to control participants.

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Obesity, Oxidative Stress, Adipose Tissue Dysfunction, and the Associated Health Risks: Causes and Therapeutic Strategies

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Obesity, Oxidative Stress, Adipose Tissue Dysfunction, and the Associated Health Risks: Causes and Therapeutic Strategies

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(Manna & Jain, 2015).

Oxidative stress seems to be the linking factor between obesity and its associated chronic conditions.

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Understanding the complexity of biopsychosocial factors in the public health epidemic of overweight and obesity

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Understanding the complexity of biopsychosocial factors in the public health epidemic of overweight and obesity

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As cited in Rosenbaum & White (2016).

Marks’ (2015) Homeostatic Theory of Obesity helps understand the condition. Features of the theory include: social complexities (food production/distribution), behavioural factors (physical activity/consumption) and psychological factors (attachment, sense of cohesion, eudaimonic wellbeing, income, and negative affect).

This is known as a “Circle of Discontent".

This article critiques Marks (2015) research, suggesting other explanations for obesity are also required like socioeconomic factors.

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Relationship between stress, eating behavior, and obesity

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Relationship between stress, eating behavior, and obesity

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(Torres & Nowson, 2007).

This study correlated weight gain and higher BMI's with chronic life stress.

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Scott, Melhor & Sakai (2012)

Stress is an environmental stressor and can be chronic.

Chronic social stress can then change: diet preference, food consumption (e.g. high fat comfort food cravings) and body composition changes  = cause and affect of obesity and stress as triggers for one another

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Effects of Chronic Social Stress on Obesity

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Effects of Chronic Social Stress on Obesity

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Scott et al., (2012) initially discuss a hypothesis about why obesity is rising. This explains that maladaptive 'obesity genes' have increased over time due to genetic drift, occurring in modern society as humans are less vulnerable to predators.

*This refers back to for a detailed biological explanation for the stress pathway and how this effects metabolic dysfunction.

Conclusions drawn are that obesity is increased due to:
1. Modern environment - Modern lifestyle being sedentary and having easy access to nutrient-dense foods
2. PsychoSocial relations - Chronic social stress i.e. from unemployment stress associated with obesity and chronic illnesses due to the biological stress pathway overactivation.
3. BioPsychological - Chronic stress altering food preference and dietary intake. Different for individuals however some stressors encourage 'comfort-food' intake which activates the brain's reward pathway similar to that observed in drug-addiction.

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Stress in obesity: Cause or consequence?

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Stress in obesity: Cause or consequence?

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(Foss & Dyrsrad, 2011).

This paper explores the positive feedback interaction between weight gain and stress, as a result of the increased cortisol levels. Suggesting that stress is both a consequence and a cause of obesity.

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(Rasheed, 2017)

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How chronic stress can increase obesity (MacLaughlin et al., 2011)

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Binge eating disorder (BED) symptoms and connections with obesity 

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Binge eating disorder (BED) symptoms and connections with obesity 

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(Zwaan, 2001)
BED is:

Categorised in the DSM IV

65% Female

More common in women seeking weight loss treatment

Positively correlated with depression

Maintained by CBT and interpersonal psychotherapy (IPT) in the short term but these are expensive and difficult to maintain

Effectively treated with self-help strategies (e.g. group video sessions or one-to-one telephone help) in the long term

Overall analysis of BED by Zwaan (2001) showed that the eating disorder should be treated first (before targeting weight loss) to more effectively reduce overweight and obesity.
Again, highlighting the significance of behavioural therapies when treating obesity.

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Cognitive‐behavioral treatment (CBT) of obese binge eaters

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Cognitive‐behavioral treatment (CBT) of obese binge eaters

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(Smith et al., 1992)

CBT in obese binge eaters was found to reduce bulimic episodes and concern surrounding body shape/weight.

However it is not evident if results of this study reported actual weight loss/change in obesity status.There seems to be a disconnect between mental health and physical health surrounding obesity.

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Depression could induce tiredness within an individual or unwillingness to partake in activities, meaning energy expenditure is lower

Anxiety disorders could induce fear and worry within an individual meaning they do not socialise or partake in activities as much, reducing energy expenditure

Depression and anxiety is associated with obesity (Strine et al., 2008), showing that higher rates of depression equate to increased rates of obesity.

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Twin and adoption studies consistently found a genetic link in obesity (Silventoinen et al., 2010).

Also learned behaviour from parents (e.g. poor eating habits) is not only genetic (as it can be environmental).

Genes encouraging obesity can be inherited, but obesity can also result from the environmental factors on an individual encouraging obesity behaviours (interactions coined the 'obesogenic environment'), creating epigenetic changes in obesity gene expression (Herrera et al., 2011).

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Education for health in schools

Unhealthy school lunches?

Policy changes for consumerism

Overweight parent and child correlation

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Who's Responsible For Childhood Obesity? | This Morning

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Parents education levels - could teach poor health habits to children