Dispositional and situational correlates of long-term weight reduction in obese children

Addictive Behaviors, Vol. 11, pp. 249-261, 1986 Printed in the USA. All rights reserved.

DISPOSITIONAL LONG-TERM

AND

WEIGHT

0306-4603/86 $3.00 + .00 Copyright ©1986 Pergamon Journals Ltd

SITUATIONAL REDUCTION

CORRELATES IN OBESE

OF

CHILDREN

R A N D A L L C. F L A N E R Y University of Wisconsin Hospital and Clinics D A N I E L S. K I R S C H E N B A U M Northwestern University Medical School Abstract-Two samples of obese children were studied in order to investigate the extent to which four classes of variables were associated with weight reduction outcomes: (a) use of selfcontrol techniques, (b) degree of social support, (c) attributional style, and (d) selfreinforcement style. One sample participated in a program in Wisconsin (n = 22) 1-2 years before assessment, whereas the second sample completed a similar program in Pittsburgh (n = 17) 3 months prior to assessment. Children and parents were individually interviewed using structured protocols, and children also completed a block design task. Children's selfreinforcement and attributional styles, motivation to change, problem-solving style, family environment, and intellectual skills were assessed. Regression analyses selected a subset of variables which were clearly associated with change in percent overweight and Feinstein indices, computed from pretreatment and from posttreatment to time of assessment. Substantial proportions of outcome variance were accounted for in the Wisconsin sample but not in the Pittsburgh sample. The results suggest that obese children who terminate ineffective problemsolving efforts quickly and who make more adaptive weight reduction attributions may be more likely to succeed in long-term weight reduction. The differential results in the two samples suggest that variables investigated in this study may play a greater role in maintenance than in initial behavior change.

T h e d i s a p p o i n t i n g results o f m o s t r e m e d i a l t r e a t m e n t s with obese a d u l t s have led s o m e i n v e s t i g a t o r s to focus u p o n p r e v e n t i v e i n t e r v e n t i o n s with c h i l d r e n at risk f o r life-long o b e s i t y (e.g., E p s t e i n , W i n g , K o e s k e , A n d r a s k i , & Ossip, 1981). U n f o r t u n a t e l y , the existing o u t c o m e studies o f child weight loss p r o g r a m s have also y i e l d e d m i x e d a n d g e n e r a l l y d i s a p p o i n t i n g results ( C o a t e s & T h o r e s e n , 1980). It is crucial to n o t e , h o w ever, t h a t a sizable m i n o r i t y o f p a r t i c i p a n t s in the m o r e intensive b e h a v i o r a l interventions lose clinically significant a m o u n t s o f weight while their u n t r e a t e d c o u n t e r p a r t s gain weight ( K i r s c h e n b a u m , H a r r i s , & T o m a r k e n , 1984). T h e p r e s e n t s t u d y is a n a t t e m p t investigate d i s p o s i t i o n a l a n d s i t u a t i o n a l v a r i a b l e s which m a y help e x p l a i n w h y s o m e c h i l d r e n succeed in l o n g - t e r m weight r e d u c t i o n while o t h e r s fail. A review o f the a d u l t a n d child o b e s i t y l i t e r a t u r e suggests f o u r classes o f v a r i a b l e s t h a t s h o w p r o m i s e as p r e d i c t o r s o f weight r e d u c t i o n o u t c o m e s : (a) selfr e g u l a t o r y techniques; (b) degree o f social s u p p o r t ; (c) a d a p t i v e n e s s o f a t t r i b u t i o n s ; a n d (d) g e n e r o s i t y o f s e l f - r e i n f o r c e m e n t (cf. K i r s c h e n b a u m & T o m a r k e n , 1982). T h e use o f s e l f - r e g u l a t o r y t e c h n i q u e s has b e e n a s s o c i a t e d with successful c h a n g e in p r o b l e m b e h a v i o r s b y adults. I n a r e t r o s p e c t i v e s t u d y , P e r r i a n d R i c h a r d s (1977) f o u n d t h a t a c r o s s f o u r p r o b l e m b e h a v i o r s , i n d i v i d u a l s w h o successfully m o d i f i e d their o w n b e h a v i o r used a g r e a t e r v a r i e t y o f s e l f - c o n t r o l t e c h n i q u e s , a n d u s e d the techniques m o r e o f t e n , m o r e c o n s i s t e n t l y a n d for a l o n g e r p e r i o d f o r t i m e t h a n t h o s e w h o failed to We gratefully acknowledge the assistance of Elizabeth Francis, Lisa Halberstadt, Edward Harris, Gerald Metalsky, Arnold Ordman, Andrew Tomarken and Alice Valoski for their varied contributions to this study. We owe special thanks to Leonard Epstein for his generous and numerous contributions to this work. Requests for reprints should be sent to Randall Flanery, who is now at Lutheran General Hospital, Medical Ecology Unit, 8 East, 1775 Dempster, Park Ridge, IL, 60068. 249

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change. Several studies also indicate that the continued use of self-regulatory techniques facilitates maintenance of initial behavior change. The continued use of behavioral techniques, especially self-monitoring, and life style changes, such as increased activity and mastery over moods, have been significantly associated with successful weight reduction (Gormally, Rardin, & Black, 1980; Stuart & Guire, 1978). In one of the few studies of the determinants of successful weight reduction by obese children, Cohen, Gelfand, Dodd, Jensen, and Turner (1980) found that children who maintained weight loss reported using more self-regulatory techniques than obese children who regained weight. Degree of social support is another important contributor to a variety of health outcomes (Schaefer, Coyne, & Lazarus, 1981). Increasing social support for the weight loss effort by encouraging the cooperation of significant others can improve weight reduction by the targeted individual (Brownell, Heckerman, Westlake, Hays & Monti, 1978). Unfortunately, these original findings have not been replicated (e.g. Brownell & Stunkard, 1981). Efforts to increase social support for child weight loss by formally including parents in weight loss programs, while appealing on rational grounds, have not demonstrated unequivocally outcomes superior to the standard behavioral package (see Epstein et al., 1981; Kirschenbaum et al., 1984). Attributional variables may also influence the implementation of self-control techniques which may, in turn, enhance weight control (Cooke & Meyers, 1980). Adults who evidenced high internal locus of control or who attributed weight loss to their own abilities or efforts, tended to lose more weight than those who believe that weight loss was due to other causes (Hartigan, Baker-Strauch, & Morris, 1982). It is also likely that attributional style may be particularly important for weight maintenance (Sonne & Janoff, 1979). While the influence of attributions on child weight loss has not yet been investigated, the achievement motivation literature suggests, for example, that tending to attribute failure to inadequate effort is an attributional style that may contribute to successful weight regulation (cf. Diener & Dweck, 1978). Self-reinforcement style is currently the best predictor of weight control success among adults. Bellack and his associates demonstrated that obese adults who positively reinforced themselves frequently and self-punished infrequently lost more weight than those who were more self-punishing and less positively reinforcing (Bellack, Glanz, & Simon, 1976; Rozensky & Bellack, 1974). Research with children in academic settings (see O'Leary & Dubey, 1979) suggests that a benign self-reinforcing style may likewise facilitate children's efforts at weight reduction in the context of self-control therapies. Since the present study was the first study of its kind with children and, therefore largely exploratory in purpose, a retrospective design was employed. We hypothesized that children who were relatively successful at losing weight and maintaining weight reduction would have: (a) used more self-regulatory techniques; (b) received strong support from their families for weight loss; (c) self-reinforced at high rates and selfpunished infrequently; and (d) attributed success to ability and failure to lack of effort. METHOD

Subjects Participants included obese children and their parents who had participated in a behavioral weight loss intervention at the University of Wisconsin (Kirschenbaum et al., 1984) and at the Western Psychiatric Institute and Clinic, University of Pittsburgh (Epstein et al., 1981). Families received $10 for participating. All children met the following criteria: (a) the child was between 8 and 13 years of age when the weight loss at-

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251

tempt was made; (b) at least one parent was 15% or more overweight and participated in the weight loss program; (c) the child was at least 20o/o overweight for his/her height, age, and sex (Edwards, 1978); (d) the child did not at the time of weight loss or at the time of the study have a serious physical or psychological impairment; and (e) child and parent had satisfactorily completed their programs by attending more than half of the scheduled treatment sessions, completing assignments and appearing for follow-up weigh ins. Both programs had the following treatment components in common: (a) selfmonitoring of eating behavior and weight; (b) nutrition education; (c) stimulus control of eating; (d) self-reward; (e) contingency managment; (f) increased activity, especially structured exercise; and (g) parental involvement in the child's weight loss attempt.

Wisconsin sample. Twenty-three children and their parents of the 33 eligible childparent dyads contacted from the Wisconsin program agreed to participate (70°7o). The data of one child, who denied ever being overweight and who fabricated answers were not included in any analyses. The present data was collected an average of 1 year, 8 months after the beginning of treatment. Table 1 summarizes relevant retreatment data about both samples. Long-term outcomes ranged from very successful weight loss to moderate weight gain. Pittsburgh sample. Eighteen children and their parents from the Pittsburgh sample who were eligible out of the 31 contacted agreed to participate (58°7o). One child from this sample did not understand some of the instructions and was not able to provide sufficient data to be included. Data was collected 3 months post-treatment and showed a wide range of outcomes (see Table 1). Procedure Each child was tested individually while the parent filled out questionnaires in another room. The child measures (described below) were administered in the following order: Block Design Task; Peabody Picture Vocabulary Test; Revised Child Weight Loss Interview; and the Survey of Child Weight Loss Situations. The parent was given the Parent Weight Loss Questionnaire and the Family Environment Scale. Measures Block design task. A modified version of the Block Design Task (Dweck & Repucci, 1973) was used to assess attributional and self-reinforcement styles of children (see Flanery, 1984, for details). It was administered first in order to minimize possible contamination by questions about success and failure in weight loss efforts. The basic task for the child was to use nine red and white blocks to reproduce a design presented by the experimenter. A total of 21 trials were administered: 6 training trials, 6 success trials, 6 (unsolvable) failure trials, and 3 (unsolvable) test trials. The task assessed selfreinforcement style, performance attributions, and problem-solving persistence. Selfreinforcement style was assessed following each success and failure trial. The child evaluated his or her performance by placing nickels in the child's bowl (self-reward) or in the interviewer's bowl (self-punishment). Expectancy of future performance was assessed after the success trials and after the failure trails using 9-point Likert scales. The child rated the degree to which outcome was due to four causal attributions using 9-point Likert scales. Following the terminology of Abramson, Garber, and Seligman (1980), attributions were chosen which may be located along three orthogonal dimensions: (a) internal-external; (b) stable-unstable;

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Table 1.

Age and weight data for the Wisconsin and Pittsburgh samples. Wisconsin

N Males Females Age at beginning of treatment Range Mean age of data collection Initial weight M SD Initial percent overweight M SD Posttreatment weight M SD Posttreatment percent overweight M SD

Three month follow-up change in percent overweight M SD Range One year follow-change in percent overweight M SD Range

22 7 15 10 yrs., 7 mos. 8 yrs., 11 mos.13 yrs., 1 mo. 12 yrs., 3 mos. 121.9 lbs. (55.4 kg.) 27.7 49.9 23.9 118.1 lbs. (53.7 kg.) 35.3 44.4070 31.6 -7.0 11.4 - 38.0 to + 9.1 -5.6 14.7 -42.5 to + 14.1

Pittsburgh 17 6 11 10 yrs., 4 mos. 8 yrs., 5 mos.12 yrs., 6 raps. 10 yrs., 10 mos. 132.7 lbs. (60.3 kg.) 28.8 63.1 23.0 125.5 ibs. (57.0 kg.) 29.1 53.0070 24.1 -10.1 10.5 - 3 1 . 4 to +7.1 B

R

and (c) global-specific. The four attributions were internal-stable-global (ISG), internal-stable-specific (IUS), external-stable-global (ESG), and external-unstable-specific (EUS). Two measures of problem-solving persistence were obtained on each of the three unsolvable test trials: time on task and model checks; and the number of times the child compared his blocks to the design card. The test trials of eight subjects were observed by a second person behind a one-way mirror. The high correlations for time on task (r = .96) and model checks (r = .98) indicate that interviewers made the observations reliably.

Peabody Picture Vocabulary Test (PPVT). The PPVT is a widely used, standardized intelligence test of adequate reliability and validity (Dunn & Dunn, 1981). Child weight loss interview. Following Perri & his associates (Perri & Richards, 1977) a structured interview was developed which inquired about the children's attempt to lose weight (Flanery, 1984). A series of ratings were derived from the interview pertaining to the child's perception of family support, readiness to change, and the use of selfcontrol techniques. (The variables are described in more detail below under "Classification of the Variables into Groups.") Survey of Child Weight Loss Situations (SCWLS). The SCWLS is a 12 item scale created to assess attributions by children for weight control behaviors. The development of the SCWLS, scoring procedures, and preliminary validity data are described in

Dispositional correlates

253

Flanery (1984). Each item consists of a one sentence description of a critical weight loss situation and a choice among four responses representing the causal attributions assessed during the block design task (ISG, IUS, ESG, EUS). The measure yields a total of eight scores, a score for each causal attribution for successful weight loss outcome and a score for each attribution for failure outcome.

Parent questionnaire. Parent Questionnaire items were suitably modified versions of those in the Child Weight Loss Interview (Flanery, 1984). Pronouns and sentence structure were altered to clarify that parents' perceptions of their child's behavior was desired. This questionnaire yielded a series of ratings corresponding to the Child Interview ratings pertaining to perceptions of family support, child and parent readiness to change, and the use of self-control techniques (for details, see below under "Classification of Variables into Groups"). Family Environment Scale (FES). The FES is a 90 item true-false questionnaire consisting of statements describing family characteristics (Moos & Moos, 1981). The measure of family support, the Family Relationship Index (FRI), consists of an average of the standardized scores of the three FES subscales, Cohesion, Expressiveness and Conflict (reversed scored). Classification o f variables into groups The variables were rationally sorted by the authors into four classes, corresponding to the four sets of predictors presumed to be most influential in determining weight control outcomes. A fifth class, designated "other," was added for two variables that did not belong to the four classes of outcome correlates but which were potentially im° portant (age, IQ-Peabody Score). As shown in Table 2, and described below, within each of the four primary classes, variables were further sorted into distinct groups or individual items. Use o f self-control techniques. Two groups of variables assessed the child's use of 11 self-control techniques for weight reduction and maintenance. The child provided the data in one group and the parent reported data for the other. The technique variables were "frequency of use in past month," "helpfulness," "number of different techniques used during treatment," and "number used in the last month." Social support. We translated "social support" to mean family support for child weight loss. Five groups of variables were identified: "child perception of support"; "parent perception of support"; "child readiness to change"; "parent readiness to change." They were composed of selected items from the Child Interview and the Parent Questionnaire (see Flanery, 1984 for the specific items). The fifth variable group was the Family Relationship Index from the FES. Attributions. Three groups of attributional variables were used, "attributions for weight loss behavior," "peformance attributions during the block design task," and "problem-solving persistence during the block design task." The weight loss and performance attribution variables, while differing in content, were each combined to reflect "adaptive attributions." Based on theoretical and empirical work relating attributional styles to efficacy of performance (e.g., Diener & Dweck, 1978), two individuals specializing in attributional research assigned consensual weights for each attribution which reflected its "adaptiveness." For attributions accounting for success, the weights were: ISG, 5; IUS, 4; ESG, 4; EUS, 1, and for failure attributions, ISG, 1; IUS, 5; ESG, 1; EUS, 3. The child's scores, multiplied by the appropriate weights and summed, produced

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RANDALL C. FLANERY and DANIEL S. KIRSCHENBAUM

an a d a p t i v e a t t r i b u t i o n score f o r " s u c c e s s f u l " a n d " u n s u c c e s s f u l weight loss b e h a v i o r " an d f o r "successful" and "unsuccessful b lo c k design p e r f o r m a n c e . " Similar logic guided the c o n s t r u c t i o n o f the e x p e c t a n c y scores, w h i c h were i n c l u d e d because o f their co n cep tual a f f i n i t y to a t t r i b u t i o n s (cf. A b r a m s o n , G a r b e r , & S e l i g m a n , 1980). T h e source o f the d a t a used to c o n s t r u c t these scores are detailed in T a b l e 2. T h e " p r o b l e m - s o l v i n g p e r s i s t e n c e " g r o u p consisted o f the " r a t e o f m o d e l ch eck s" an d " t i m e o n t a s k " f o r the t h ree b l o c k design test trials. Table 2.

Classification of variables into groups.

I. Use of self-control techniques A. Child weight loss techniques-child 1. Frequency of use 2. Helpfulness 3. Number used during treatment 4. Number used in last month B. Child weight loss techniques-parent 1. Frequency of use 2. Helpfulness 3. Number used during treatment 4. Number used in last month II. Social Support A. Child perception of family support 1. Family concern about weight problem 2. Frequency of support 3. Helpfulness of support 4. Frequency of punishment 5. Helpfulness of punishment B. Parent perception of family support 1. Family concern about weight problem 2. Frequency of support 3. Helpfulness of support 4. Frequency of punishment 5. Helpfulness of punishment C. Child readiness to change 1. Child motivation-child 2. Child motivation-parent 3. Weight problem for child-child 4. Weight problem for child-parent D. Parent readiness to change 1. Parent reaction to child weight 2. Child weight problem for parent 3. Parent motivation to help child E. Family relationships index III. Attributions A. Attributions for weight loss behavior 1. Expectancy of future weight loss 2. Attributions for successful behavior 3. Attributions for unsuccessful behavior of child B. Performance attributions 1. Expectancy after success 2. Expectancy after failure 3. Attribution for success 4. Attribution for failure C. Problem solving persistence 1. Rate of model checks (3 Test Trials) 2. Time on task (3 Test Trials) IV. Self-reinforcement style A. Mean number of nickels (6 Success and 6 Failure Trials) V. Other A. Age B. I.Q.

Child Child Child Child

interview interview interview interview

Parent Parent Parent Parent Child Child Child Child Child Child Parent Parent Parent Parent Parent

questionnaire questionnaire questionnaire questionnaire

interview interview interview interview interview interview questionnaire questionnaire questionnaire questionnaire questionnaire

Child interview Parent questionnaire Child interview Parent questionnaire Parent questionnaire Parent questionnaire Parent questionnaire Family environment scale Child interview Survey of child weight loss situations Survey of child weight loss situations Block design Block design Block design Block design Block design Block design Block design Child interview Peabody picture vocabulary test

Dispositional correlates

255

Self-reinforcement style. The "self-reinforcement style" score was the mean number of nickels the child took from the interviewer on the six success and six failure trials. Dependent variables Four indices of weight loss outcome were obtained by calculating the change in percent overweight and the weight reduction index (Feinstein, 1959) over two time periods, pretreatment to the time of testing and posttreatment to time of testing. Children's height and weight were obtained from a balance beam scale at pretreatment, posttreatment, and time of data collection. The child's percent overweight at pretreatment, posttreatment, and time of testing were based on age, sex, and height norms from Edwards (1978). Total change in percent overweight (percent overweight at time of testing minus pretreatment percent overweight) and the weight reduction index (calculated from pretreatment to time of testing) served as indices of the success of the long-term weight loss efforts. For measuring success in maintenance change in percent overweight (time of testing minus posttreatment) and the weight reduction index (based on posttreatment and time of testing weight data) were used. RESULTS

Generation of principal component factors A principal components analysts was performed on each group of variables in order to obtain a single score that maximized internal consistency (Lord, 1958). However, the results of Box's Mtest (Cooley & Lohnes, 1971) indicated that the Wisconsin and Pittsburgh sample's variance-covariance matrices were significantly different for six of the nine variables (p < .05). Therefore, the principal component factor analysis could not be conducted on the pooled scores for most variable groups, and all subsequent analyses were performed for each sample separately. Coefficient alpha for each principal component factor for both samples ranged from .54 to .97 (M = .76) and were comparable for the Wisconsin and Pittsburgh samples. These generally adequate estimates of internal consistency, despite relatively few variables per factor, suggests that variables within a group were measuring a common construct, thereby supporting the integrity of the rationally-based groupings.

Regression analyses The 13 scores, 9 principal components and 4 individual variables (See Table 2) were considered independent variables in regression analyses. Because of the relatively high ratio of independent variables to sample size, the "best subset" of three variables were identified using Mallows Cp statistic as the criterion for both samples on each of the four dependent variables (Gorman & Toman, 1966). The Cp statistic is an estimate of the total error (bias error plus random error) in an equation (Mallows, 1973). The equation with the lowest Cp value is the best estimate of the linear combination of independent variables value.

Wisconsin sample. Table 3 shows that each equation accounted for large proportions of variance in the dependent variables for the Wisconsin sample (45°7o-57% [adjusted R2]). Considering the predictors for all four equations, problem-solving persistence was most clearly associated with weight reduction since it appeared in all four equations. The next best candidates were attributions for weight loss behavior and child readiness to change, each of which appeared in two equations. In order to understand which variables were performing well most consistently, we also computed the 10 best (lowest Cp) two-variable and 10 best three-variable equations for each dependent

256

RANDALL C. FLANERY and D A N I E L S. KIRSCHENBAUM

Table 3.

Best regression equations for the Wisconsin sample.

A. Percent overweight

Total change: Cp Multiple R ~ Adjusted R 2 Regression F(3,18)

Standardized ~

t

.512 -.492 - .323

3.73** -2.14" - 1.88

.429 -.450 .332

2.54* -2.54* 1.93

- .666 .479 - .287

- 4.49** 2.71 * - 1.91

-.534 .434

-2.90** 2.80*

20.44 .628 .566 9.00**

Variables in equation: Problem-solving behavior Attributions for weight loss behavior Child readiness to change

Maintenance change: Cp Multiple R 2 Adjusted R 2 Regression F(3,18)

14.02 .529 .450 5.99**

Variables in Equation: Problem-solving behavior Attributions for weight loss behavior I.Q. B. Reduction index

Total weight: Cp Multiple R 2 Adjusted R 2 Regression F(3,18)

- 1.72 .613 .548 8.45**

Variables in equation: Problem-solving behavior Child readiness to change Child t e c h n i q u e s - child Reduction index

Maintenance Weight: Cp Multiple R 2 Adjusted R 2 Regression F(2,19)

- 1.43 .520 .470 10,30'*

Variables in Equation: Problem-solving behavior Parent readiness to change

*p < .05 **p < .01

variable. The best variables were considered those which appeared most frequently and were associated with the lowest Cp values for all four dependent variables. These resuits conformed to the analyses presented in Table 3. Taken together, these analyses indicated that children who persisted less on the unsolvable test trials of the block design task (i.e., the problem-solving persistence variable), made relatively more adaptive attributions for weight loss behavior and reported greater readiness to change, achieved greater weight loss and maintenance.

Pittsburgh sample. Unlike the Wisconsin sample, the same variables assessed in exactly the same fashion in the Pittsburgh sample did not account for significant amounts of outcome variance (variance accounted for was above 20% [adjusted R 2] in only one equation; see Table 4). Of four dependent variables, a statistically significant regression solution (F(3,12) = 4.53, p < .05) was found only for maintenance change in percent overweight. Individuals who persisted most at the unsolvable test trials of the

Dispositional correlates

Table 4.

257

Best regression equations for the Pittsburgh sample.

A. Percent overweight

Total change."

cp

Standardized/3

t

-.808 - .622 .408

-2.64 - 2.34 1.41

- .929 - .624 .471

- 3.53" - 2.73 2.04

- .409

- 1.74

- .461

- 2.01

40.03

Multiple R ~ Adjusted R 2 Regression F(3,13)

.353 .204 2.86

Variables in equation: Problem-solving behavior Performance attributions Child techniques - child

Maintenance change: Cp

- .95 .511 .398 4.53*

Multiple R 2 Adjusted R 2 Regression F(3,13)

Variables in Equation: Problem-solving behavior Performance attributions Age B. Reduction index

Total weight: Cp

.66 .168 .112 3.02

Multiple R 2 Adjusted R 2 Regression F(1,15)

Variables in equation: Child t e c h n i q u e s - child

Maintenance weight: Cp Multiple R 2 Adjusted R 2 Regression F(1,15)

-5.97 .213 .160 4.06

Variables in Equation: Child t e c h n i q u e s - child *p < .05

**p < .01

block design task, made adaptive attributions for block design performance and were older, reduced the most in percent overweight after treatment.

Self-control techniques The questionnaire data describing the frequency and usefulness of the 11 weight loss techniques were combined additively to obtain a single score in the previously reported analyses. This procedure mathematically equates the utility of each technique. To explore further the relationship between reported use of techniques and weight reduction, child and parent ratings of the frequency that children used the 11 techniques were correlated with the four outcome measures for the Wisconsin sample. Keeping a daily weight chart was the only technique that significantly correlated with outcome (the Bonferroni procedure to reduce Type I error was used, see Table 5). Greater use of this technique, as reported by both children and parents, was associated with improved weight loss. The low positive correlations of the other techniques with outcome suggests that they did not play a significant role in long-term maintenance. This contradicts our assumption that use of any of the techniques is useful and also explains why the child technique factors were not correlated with outcome in the regression analyses.

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Table 5. Correlations Between Frequency of Use of Self-Control Techniques and Weight Loss Outcome for the Wisconsin Sample Total Change in Percent Overweight

Total Weight Reduction Index

Maintenance Change in Percent Overweight

Maintenance Weight Reduction Index

Child Report Self-Monitoring Eating in Kitchen Problem Avoidance Incompatible Activities One Portion Only Pure Food Experience Chaining Self-reward Self-punishment Exercise Weight Chart

- . 135 .142 .231 .286 .262 .096 .069 .104 .245 .023 -.703*

.023 - . 157 - .306 -.300 - .215 -.225 - . 180 - . 173 -.245 - .002 .763*

- . 319 -.080 .229 -.336 .394 .295 - .288 - .050 .419 - .054 -.474

.045 - . 112 - .318 -.234 - . 171 -.070 - . 140 - .090 - . 122 - .012 .618'

Parent Report Self-Monitoring Eating in Kitchen Problem Avoidance Incompatible Activities One Portion Only Pure Food Experience Chaining Self-reward Self-punishment Exercise Weight Chart

- .681* -.022 -.359 .205 -.019 -.195 - . 424 - .252 .157 - . 118 - .791"

.456 -.059 .401 - .240 .002 .226 .318 .286 - .161 .085 .868*

- .397 -.214 -.360 - .054 .383 -.281 - . 305 .006 .007 .338 - .592*

.375 -.022 .571 - . 164 -.101 .313 .404 .194 - .076 .188 .781"

*p < .0045Alpha of .05 was dividedamongthe 11 correlationsof techniqueswith outcome.

DISCUSSION F o r the W i s c o n s i n sample, d i s p o s i t i o n a l variables a c c o u n t e d for a s u b s t a n t i a l prop o r t i o n o f the v a r i a n c e (multiple R 2 r a n g e d f r o m 52% to 63%) in the four measures o f weight c o n t r o l o u t c o m e s . C h i l d r e n who t e r m i n a t e d p r o b l e m - s o l v i n g efforts with u n solvable p r o b l e m s sooner, m a d e m o r e adaptive a t t r i b u t i o n s for weight loss, a n d rep o r t e d increased readiness to change achieved greater weight control. P a r e n t a l readiness to change, IQ, f r e q u e n c y o f self-control t e c h n i q u e s used a n d age m a d e smaller c o n t r i b u t i o n s . O n e t e c h n i q u e , keeping a weight chart, was clearly associated with outcome. By contrast, few variables assessed in this study were significantly correlated with weight loss o u t c o m e s in the P i t t s b u r g h sample. However, P i t t s b u r g h children who persisted longer at the u n s o l v a b l e block design p r o b l e m s a n d who m a d e a d a p t i v e perf o r m a n c e a t t r i b u t i o n s a n d were older, lost s o m e w h a t m o r e weight d u r i n g m a i n t e n a n c e . It is c o u n t e r i n t u i t i v e that the W i s c o n s i n children who relatively quickly t e r m i n a t e d p r o b l e m - s o l v i n g a t t e m p t s were m o r e successful in l o n g - t e r m weight r e d u c t i o n . B e h a v i o r a l weight loss p r o g r a m s e n c o u r a g e children a n d adults to persist in p r o b l e m solving efforts in o r d e r to lose a d d i t i o n a l weight a n d m a i n t a i n weight c o n t r o l (Coates & T h o r e s e n , 1980), a strategy with d e m o n s t r a b l e effectiveness (e.g., Black & Scherba, 1983). O u r f i n d i n g suggests that p r o b l e m - s o l v i n g activity, per se, m a y be less crucial t h a n the q u a l i t y o f p r o b l e m - s o l v i n g (cf. H o p p e r & K i r s c h e n b a u m , 1985). H i g h levels o f persistent p r o b l e m - s o l v i n g is w a r r a n t e d w h e n a successful o u t c o m e is possible, b u t

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such persistence is a poor strategy when success is unlikely with current methods, regardless of one's efforts. Our measure of persistent problem-solving was obtained from three unsolvable test trials which followed six similarly unsolvable problems. To persist in this context is clearly nonproductive, since previous experience would indicate that success is unlikely. Children who achieved good weight control behaved as if they made this determination before children who did not maintain weight loss. Making adaptive attributions for weight-relevant behavior was another major correlate of outcome. Wisconsin children who attributed their successful weight control to internal-stable-global reasons (e.g., ability) while blaming their unsuccessful weight control on internal-stable-global causes (e.g., lack of effort) controlled their weight better than those who endorsed other attributions. Diener and Dweck's (1978) analysis of achievement motivation suggests why these attributions are adaptive. Most people can lose some weight but sooner or later, even the most highly committed individual will fail by consuming "forbidden" quantities or types of food. Those individuals who construe this failure as a lack of willpower (an ISG attribution) may be more likely to abandon self-regulation efforts than those who believe that their failure was due to insufficient effort (an IUS attribution). Marlatt and Gordon (1980) made a similar point in their analysis of relapse in addictive disorders. They suggested that attributing abstinence violations to lack of willpower increased the probability of relapse. Our data suggest that attributing abstinence violations or other failures in behavior change to lack of effort (IUS) rather than lack of willpower (ISG) facilitates self-regulation. Taken together, the adaptive attribution and problem-solving persistence findings begin converging upon a common theme. The attribution data points to the value of accelerated effort following failure. The persistence results argue that continued application of obviously poor strategies is maladaptive. Thus, successful children may have recognized that minor eating relapses (failures) signal that further efforts are needed because current strategies are not working. Thus, they may have been "flexibily persistent." Black and Scherba (1983) trained individuals to be "flexibly persistent" by using problem-solving skills in conjunction with standard behavioral weight control techniques in order to cope with specific problematic weight situations; these individuals achieved greater weight loss than those educated only about standard behavioral techniques (Black & Scherba, 1983). A remarkably parallel finding (Gormally & Rardin, 1981) was that 8007o of obese adults who successfully maintained weight loss utilized effective problem-solving but none of those who relapsed performed any problem-solving behaviors to cope with difficulties. Perhaps all self-control techniques need not be applied by each person, but by actively problem-solving, the most effective technique for altering idiosyncratic problem behaviors in specific situations can be utilized (Coates & Thoresen, 1980). Regardless of techniques or strategies used, close monitoring of one's weight is critical. Our data show that many techniques were rarely and inconsistently used once active treatment ended and that frequency of use was uncorrelated with long-term success, with one exception. Consistent with other work (e.g., Stuart & Guire, 1978), in our study keeping a weight chart was strongly associated with long-term success. Selfmonitoring is essential because it indicates when failure (or success) has occurred (Kirschenbaum & Tomarken, 1982). Those who never self-monitored would not know when they had failed and thus when accelerated effort and a change of strategy was required. It is striking that variables accounting for large portions of variance in the Wisconsin sample were uncorrelated with outcome in the Pittsburgh sample. The primary dif-

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ference between the two groups was that the responsibility for weight control resided primarily with the participants o f the Wisconsin sample while the therapists continued to exert a significant influence on the weight loss efforts of the Pittsburgh sample. The differences in the a m o u n t o f variance accounted for in the two samples is consistent with studies demonstrating that attributional and self-control variables predict posttreatment weight maintenance but not weight loss during active treatment (Jeffrey, 1974; Sonne & Janoff, 1979). Different processes appear to govern weight loss and weight maintenance. The variables we examined seem to tap maintenance processes but their influence m a y not become apparent until the immediate effects o f active treatment have begun to diminish. Alternative explanations for Wisconsin-Pittsburgh differences must explain the presence o f significant correlates in one sample but not the other. It is possible the children in the two groups differed. The Pittsburgh sample was more obese initially than the Wisconsin group (63.1070 vs. 49.9070 overweight) and showed a greater change in percent overweight ( - 10.1 vs. - 5 . 6 ) . However, these differences are an unlikely explanation since initial obesity was unrelated to outcome, and the outcome measures were adjusted for initial obesity and growth. Furthermore, admission criteria were very restrictive and virtually identical. Both samples also included sufficiently varied outcomes, so a restricted range in the dependent variables of the Pittsburgh sample cannot account for the absence o f correlates. While no two programs can be considered identical, both treatments contained the same components and shared a c o m m o n behavioral philosophy. Subtle differences in presentation and emphasis would not be expected to eliminate significant results altogether. In sum, the hypothesis that seems most viable is that differential involvement in the programs at the point of assessment contributed to the discrepancies in the results. A vital caveat must be offered about these data. We recognize that the causal direction of the observed relationships cannot be assigned unequivocally since it is as likely, for example, that adaptive attributions lead to successful weight loss as it is possible that weight loss generates particular beliefs. In other words, a flexibly persistent problemsolving style m a y be a product rather than a cause o f successful weight reduction. The degree to which flexibly persistent problem-solving adaptive attributions, and other factors p r e d i c t or enhance obese children's self-regulation o f weight need to be explored in prospective and experimental studies. REFERENCES Abramson, L.Y., Garber, J., & Seligman, M.E. (1980). Learned helplessness in humans: An attributional analysis. In M.E.P. Seligman & J. Garber (Eds.), Human helplessness: Theory and application (pp. 3-34). New York: Academic Press. Bellack, A.S., Glanz, L.M., & Simon, R. (1976). Self-reinforcement style and covert imagery in the treatment of obesity. Journal of Consulting and Clinical Psychology, 44, 490-491. Black, D.R., & Scherba, D.S. (1983). Contracting to problem solve versus contracting to practice behavioral weight loss skills. Behavior Therapy, 14, 100-109. Brownell, K.D., & Stunkard, A.J. (1981). Couples training, pharmacotherapy, and behavior therapy in the treatment of obesity. Archives of General Psychiatry, 38, 1224-1229. Brownell, K.D., Heckerman, C.L., Westlake, R., Hayes, S.C., & Monti, P.M. (1978). The effect of couples training and partner co-operativeness in the behavioral treatment of obesity. Behavior Research and Therapy, 16, 323-333. Coates, T.J., & Thoresen, C.E. (1980). Obesity among children and adolescents. In B.B. Lahey & A.E. Kazdin (Eds.), Advances in clinical child psychology, Vol. 3 (pp. 215-264). New York: Plenum Press. Cohen, E.A., Gelfand, D.M., Dodd, D.K., Jensen, J., & Turner, C. (1980). Self-control practices associated with weight loss maintenance in children and adolescents. Behavior Therapy, 11, 26-37. Cooke, C.J., & Meyers, A. (1980). The role of predictor variables in the behavioral treatment of obesity. Behavioral Assessment, 2, 59-69. Cooley, W.W., & Lohnes, P.R. (1971). Multivariate data analysis. New York: Wiley.

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