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James J Annesi¹

¹Kinesiology Department, School of Health Sciences and Human Services, California State University, Monterey Bay, Seaside, CA 93955, USA.

Behavioral Sciences (Basel, Switzerland)

|December 30, 2025

Abstract:

For behavioral obesity treatments to improve their typically minimal effects and reduce an increasing reliance on surgical and pharmacologic interventions, an enhanced understanding of theory-driven psychosocial factors is needed. Recent applied research successfully targeted the social cognitive theory-related variables of self-efficacy (SE), self-regulation (SR), and mood (e.g., total mood disturbance; TMD) to increase participants' exercise outputs and improve their dietary behaviors to sustain weight losses. However, an improved understanding of interactions of changes in those psychosocial factors, especially within paths toward longer-term behavioral changes, is required to increase both the reliability and effectiveness of obesity interventions. Women (N = 106) participated in a 12-month, community-based cognitive-behavioral obesity intervention. Consistent with tenets of social cognitive theory, most of the treatment time was focused on building SR and SE related to both exercise and controlled eating, and improving mood (i.e., TMD), primarily through increased exercise. Improvements in SR, SE, and TMD were significant (ps < 0.001) from baseline to Months 3, 6, and 9 (except in SE over 9 months). These effect sizes were large (ds = 0.82-1.53). In line with the prediction of both exercise and dietary improvements over 12 months, paths from 3-month, to 6-month, to 9-month changes in SR → TMD → SE (B = 0.93, SE_B = 0.59, 95% CI [0.034, 2.274], and B = 0.46, SE_B = 0.25, 95% CI [0.035, 1.025], respectively) and TMD → SR → SE (B = -0.08, SE_B = 0.03, 95% CI [-0.145, -0.020], and B = -0.04, SE_B = 0.01, 95% CI [-0.070, -0.015], respectively) were significant, whereas the other possible paths incorporating changes in SR, SE, and TMD were not. Consistent with social cognitive theory and the mood-behavior model, findings supported the value of early treatment foci on interactions of TMD and SR changes in pursuit of longer-term advancements in SE and weight-loss behaviors.

Insights

This study shows that improving self-regulation (SR) and mood (TMD) early in obesity treatment helps build self-efficacy (SE) for long-term weight management. These psychosocial factors are key to successful behavioral obesity interventions.

Area of Science:

Behavioral Psychology
Obesity Treatment
Health Psychology

Background:

Behavioral obesity treatments often have minimal effects, increasing reliance on surgery and medication.
Understanding theory-driven psychosocial factors like self-efficacy (SE), self-regulation (SR), and mood (total mood disturbance; TMD) is crucial for enhancing treatment effectiveness.
Interactions between these psychosocial factors are important for sustained behavioral changes in obesity interventions.

Purpose of the Study:

To investigate the interactions between changes in self-regulation (SR), self-efficacy (SE), and total mood disturbance (TMD) over 12 months in a cognitive-behavioral obesity intervention.
To determine the pathways through which improvements in SR, SE, and TMD contribute to longer-term weight-loss behaviors.
To support the development of more effective and reliable obesity interventions based on social cognitive theory.

Main Methods:

A 12-month community-based cognitive-behavioral obesity intervention involving 106 women.
Treatment focused on enhancing SR and SE for exercise and controlled eating, and improving TMD, primarily through increased exercise.
Statistical analysis of changes in SR, SE, and TMD from baseline to 3, 6, and 9 months, examining path analyses for longer-term behavioral changes.

Main Results:

Significant improvements in SR, SE, and TMD were observed from baseline to Months 3, 6, and 9 (p < 0.001), with large effect sizes (d = 0.82–1.53).
Path analyses revealed significant pathways from 3-month to 6-month and 9-month changes: SR → TMD → SE and TMD → SR → SE.
These findings indicate that early improvements in mood and self-regulation predict later gains in self-efficacy and sustained weight-loss behaviors.

Conclusions:

Early intervention focusing on the interplay between mood (TMD) and self-regulation (SR) is valuable for enhancing self-efficacy (SE) in obesity treatment.
The results support the integration of social cognitive theory and mood-behavior models for improving long-term adherence to weight-loss behaviors.
Targeting psychosocial factors and their interactions can increase the reliability and effectiveness of behavioral obesity interventions.

Read full analysis

Keywords:

behavioral eating exercise mood obesity physical activity self-efficacy self-regulation treatment

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