Association Determination Motivation

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Interestingly, Carels et al. Unfortunately, motivation was not assessed in this study. One study found an advantage only for high attenders receiving a high intensity MI intervention [ 69 ].

Pollak and colleagues [ 75 ] found that physicians' use of MI-consistent techniques with overweight and obese patients predicted weight loss at three months whereas patients of physicians who used MI-inconsistent techniques gained or maintained weight. Other studies have failed to show significant additional weight loss benefits for supplementing behavioral treatments with MI or in comparisons of MI with other interventions or control conditions [ 9 , 70 , 76 — 79 ]. However, in these studies the number of MI sessions was generally fewer than those with more positive outcomes.

Furthermore, a number of studies have found advantages for MI in terms of weight-related outcomes other than weight loss, including physical activity [ 72 , 73 ], dietary behaviors [ 77 ], eating concerns and unrestrained eating [ 74 ], program adherence and glycemic control among type II diabetics [ 71 , 76 ], and a reduction in CHD risk factors [ 72 ].

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Overall the evidence is at least suggestive that MI can be useful in weight control interventions but it remains unclear just how effective it is, and the extent to which it is effective in different populations [ 80 ]. Relatively few MI studies in weight control have included measures of motivation or considered motivation per se, and autonomous motivation in particular, as a desirable outcome to target or as a predictor or mediator of change.

Self-Determination Theory

It is understandable that researchers should in the first instance be primarily interested in establishing treatment efficacy. Nevertheless, given the aforementioned explicit acknowledgement in many of the studies that the facilitation of internally-generated motivation for change is important for successful weight control, such studies offer an excellent opportunity to examine the motivational mechanisms underpinning successful, or indeed unsuccessful outcomes.

A number of well-validated instruments are available for assessing self-determination theory constructs which are suitable or adaptable for weight control contexts, including measures of perceived support for autonomy and the other psychological needs, satisfaction of psychological needs, and measures of autonomous and controlled regulation of behavior. Incorporating such measures in weight control interventions, and not just MI interventions, could help determine whether in comparison to control conditions a the intervention is perceived by participants as autonomy-supportive rather than controlling; b the intervention does lead to more autonomous motivation for engaging in adaptive weight control behaviors; and c enhancing autonomous motivation leads to greater adherence to adaptive behaviors and ultimately greater weight loss and maintenance.

Adopting such measures could also help elucidate situations where interventions are found to be non-optimal or ineffective in producing desirable weight loss outcomes, for example by showing that the intervention led to more controlled rather than more autonomous motivation for change. For MI researchers in particular, even if they are not interested in self-determination theory per se, the use of such measures could provide support for the contention that MI is effective insofar as it promotes internal motivation for change and avoids externally coerced motivation.

Four studies so far have assessed autonomous motivation in MI interventions for weight loss discussed below. All four used the Treatment Self-regulation Questionnaire TRSQ: [ 52 ] and they illustrate the usefulness of tassessing autonomous motivation in understanding intervention outcomes.

In an intervention for weight loss among obese African American women, Befort et al. Weight, dietary intake, physical activity, program adherence, and self-efficacy for diet and exercise were assessed, along with autonomous motivation.

Self-Determination Theory

There was significant weight loss and improvements in diet in both groups but no differences between the two conditions, neither in autonomous motivation, self-efficacy, or program adherence. Furthermore and unexpectedly, autonomous motivation and exercise self-efficacy were significantly reduced in both groups, although post hoc analyses showed that higher motivation and self-efficacy at baseline were associated with greater decreases in motivation and self-efficacy.

The authors proposed that the latter finding suggests that participants may have had unrealistic efficacy expectations and motivation at baseline. Webber et al. Results showed a significant decrease in weight but no difference between groups.

Autonomous motivation increased in both groups and, importantly, higher autonomous motivation at follow-up was associated with greater weight loss. Furthermore, the average number of self-motivating statements change talk , expressed by participants during MI was correlated with an increase in autonomous motivation.

An increase in change talk is considered the key 'active ingredient' in MI [ 64 , 81 ].

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Thus, this study provides some evidence that MI can impact upon behavior change and weight outcomes by promoting autonomy. Although there was significant weight loss over 16 weeks, there was no difference between groups. However, examination of predictors of weight loss showed that treatment condition moderated the effect of baseline controlled motivation on weight loss.

While low baseline controlled motivation was negatively associated with weight loss, moderation analysis revealed that individuals with high baseline controlled motivation lost less than 1 kg of body weight if they were assigned to the standard treatment group or 4. Therefore, the MI-based intervention appeared to have buffered the negative effects of initial controlled motivation.

This was confirmed by the similar weight loss results obtained among the individuals in the treatment group, whether they presented with high or low baseline controlled motivation. A different report from the same intervention has shown that motivational changes obtained during the first 4 weeks of treatment were associated with week weight loss [ 67 ].

An increase in motivation, both autonomous and controlled, was observed during the 4 weeks. The authors reported that the maintenance of autonomous motivation level was a possible mechanism by which the intervention might have affected adherence measured by self-monitoring and weight reduction. West et al. All participants underwent a six-month behavioral treatment program before being randomized to treatment conditions and followed for a further twelve months.

The treatment conditions produced comparable sustained weight losses and both groups lost significantly more weight than controls. Participants in the motivational intervention group had significantly greater autonomous motivation for weight control than the skills-based group at the mid-point of the maintenance period, although the effect size was small. The authors suggested that motivational-based interventions are an effective alternative to available skill-based programs, and that future studies should investigate whether some women prefer one approach over the other [ 68 ].

A notable positive feature of the research on MI in weight control is that in most studies those delivering the interventions have been formally trained in MI and in the majority treatment fidelity checks have been conducted. On the other hand, the studies have tended to adopt or adapt selected discrete strategies from MI, combining them with alternative behavioral treatments, and the reports are often vague as to exactly how the interventions were implemented. In some studies, MI has been used principally to facilitate adherence to the behavioral treatments they have accompanied, or to enhance the efficacy of those treatments, rather than to promote autonomous motivation for engaging in a healthier lifestyle [ 9 , 74 ].

The potential problems with combining MI with other treatment approaches are lucidly discussed elsewhere [ 63 ] and we will not dwell on them here. Suffice it to say that reducing MI to a set of clinical techniques that are merely adjunctive to other treatments, or incorporating them into behavioral treatments that primarily emphasize outcomes e. In this article, we aimed to explore the topics of motivation and self-regulation from the viewpoint of self-determination theory, in the context of weight management and related behaviors. By doing so, we have offered a somewhat different perspective in the ongoing discussion around promoting sustained behavior changes in the broader literature, which represents one of the most difficult challenges facing health care professionals, behavioral scientists, and the individuals who struggle to make lifestyle change and manage their weight.

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It was our premise that a consideration of qualitative dimensions of motivation is essential in helping individuals to be more successful in their efforts to achieve their goals, such as adopting physical activity or losing weight. In weight control, as in other areas of behavioral medicine, we suggest that only to the degree to which individuals fully endorse behavioral goals and to the extent that the goals facilitate satisfaction of the needs for autonomy, competence, and relatedness will their efforts be more likely to result in behavioral change that is effectively maintained.

Most interventions have thus far focused mainly on the "skills" or more functional aspects of behavior change e. In doing so, interventions may have commonly ignored important elements associated with the process involved in adopting new behaviors e. That is, the "whats" and "whys" of losing weight have been limited to extrinsic and mostly superficial aspects such as compliance with prescriptions, weight-contingent improvements in self-esteem, physical attractiveness, or the immediate gratification of a changing number on the scale. Moreover, goals have often been set out by health professionals, or indirectly promoted by society, but perhaps never entirely "validated" by i.

Generally, these studies have been supportive of the role of perceived autonomy and autonomous regulation in long-term behavior change.

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As to MI, the rationale for using it has often been that it has been shown to be effective in other behavioral domains. However, most researchers conducting these studies have also explicitly or implicitly acknowledged that motivation for change must come from within the individual [ 84 ]. Unfortunately, few of the studies have attempted to elucidate the mechanisms by which MI might exert its effects, or determine whether their interventions have actually promoted self-motivation. Future research in this area would benefit from drawing on self-determination theory to explore the motivational processes that mediate the effects of MI on successful treatment outcomes, including autonomous motivation and satisfaction of psychological needs [ 65 ].

A sounder understanding of these processes could allow us to refine and maximise the impact of MI interventions for weight control. In conclusion, the current evidence is compatible with the notion that autonomous regulation is among the key predictors of successful weight outcomes. However, intervention research with obese individuals is still in the early stages. Aust New Zealand Health Policy. Am J Clin Nutr. N Engl J Med. Int J Obes Lond. Int J Circumpolar Health. Diabetes Educ. J Behav Med. Elfhag K, Rossner S: Who succeeds in maintaining weight loss?

A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. American Psychologist. Obesity Silver Spring. Behav Res Ther. Rothman AJ: Toward a theory-based analysis of behavioral maintenance. Health Psychol. Obesity prevention: The role of the brain and society on individual behavior. Deci E, Ryan R: Intrinsic motivation and self-determination in human behavior. Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.

Am Psychol. Canadian Psychology. Ryan R, Deci E: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Personality and Social Psychology Bulletin.

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Applied Psychology: Health and well-Being. Psychological Inquiry. J Pers.