Challenging Weight Loss: The Effectiveness of a 12 Week Weight Loss Challenge on Weight Loss, Physical Activity and Motivation. Louise T. Blais, BSc. Submitted in partial fulfillment of the requirements for the degree of Master of Arts in Applied Health Sciences
 (Physical Health and Education) Under the supervision of Diane E. Mack, PhD. Faculty of Applied Health Sciences, Brock University St. Catharines, Ontario Louise Blais © 2013 Dedication To my parents. You always believed in me more than I believed in myself. I hope you are watching from heaven. I miss you and love you both. Abstract The objective of this study was to examine the effectiveness of a 12 week weight loss intervention in a commercial fitness centre on body mass index (BMI), moderate to vigorous physical activity (MVPA) and behavioural regulations consistent with Organismic Integration Theory (OIT, Deci & Ryan, 2002). The intervention group received weekly coaching sessions and bi-weekly seminars designed to increase MVPA and improve dietary intake. The results of the mixed model analyses of variance showed a significant within-subjects main effect for BMI (F = 3.57, p = .04). Changes in MVPA were not observed over time or between conditions. Changes in behavioural regulations congruent with OIT (Deci & Ryan, 2002) favoured the intervention condition. Study results indicate that 12 week weight loss challenges in commercial fitness centres may be effective to support the internalization process of exercise behavioural regulations but ineffective at producing sustainable weight loss or behavioural changes. Keywords: weight loss challenge, commercial fitness centre, Organismic Integration Theory, BMI, moderate-to-vigorous physical activity Acknowledgements After having spent the last two years fully immersed in this project, I feel I can truly say “It  takes  a  village  to  write  a  thesis”.  Without the knowledge, patience, assistance and support of so many people, I could not have completed this thesis (or at least not in one piece). Firstly, I want to thank my Supervisor Diane Mack. Diane, your patience with me (and my chaos) has been extraordinary. Moving to another province half way through the writing of this document provided challenges I am sure you could have done without. Regardless of the time difference between us, you always answered my questions thoroughly and returned my work promptly. You pushed me to develop both my writing and research skills and for that I am grateful. Secondly, thank you Phil Wilson. Together with Diane you provided me the opportunity to participate and attend many conferences. The experiences were invaluable and your relentless pursuit of excellence has pushed me to grow as a student. And lastly, I would like to thank Cristina Caperchione and Deb O’Leary  for your support and assistance with this research. This Masters degree would not have been possible without my wonderful husband Andre. Thank you Blaiso. From the day we met your unwavering belief, support and love have given me wings. You removed every obstacle that stood in my path and for that, I am grateful. I also want to thank my daughters, Jenna, Jessica  and  Kristen.  Your  ‘lust  for   life’  and  sense  of  adventure  have  inspired  me  to  keep  striving  for  excellence. And of course, I have to thank my boys Cooper and Jake for the endless distractions. Cooper, you are arguably the best thesis dog that was ever born. You spent every minute of this thesis curled up at my side, anticipating the closing of the laptop for a well-deserved walk/break. You are my beating heart with hair and legs. I also need to thank Ameer and Michael Wakil at The Club at White Oaks. You not only allowed me the space and freedom to conduct my research at The Club but you also gave me the flexibility to attend school during working hours. Your core values of respect and excellence are unwavering and I thank you for supporting mine. I also want to thank all of my co-workers at The Club who assisted with the measuring, training and overall success of the research and Challenge. You exemplify professionalism and passion in fitness every day. Thank you as well to the members and staff who endured the measurements and questionnaires with dignity and honesty as both the intervention group as well as the control  group.  I  truly  couldn’t  have  done  this  without  you. And lastly, I want to thank my lab mates Lindsay and Jenna. Thank you for allowing me to distract you with online shopping and my crazy life. Thank you for the runs and company  at  the  Conferenes  as  well  as  the  fun  nights  out.  Although  I  didn’t  get  to  work   with you much Matt, thanks for keeping Lindsay sane in the lab. And of course, thank you Carrie for letting me talk you into completing our Masters together. It was great not to be the only old person in class (although, I was the oldest). Table of Contents Dedication Abstract Acknowledgements CHAPTER 1: INTRODUCTION….……...……………………………………..………..1 The Role of Physical Activity…………………..………………….……….……..1 Lifestyle Interventions To Facilitate  Weight  Loss……………….……….…….…3 Length  of  Intervention…....……………………………………………….4 The Exercise  Prescription....………………………………………………5 The Dietary  Prescription…………………………………………………..6 Participant  Support………………………………………………………..7 Financial Incentives To Effect Weight Loss and Physical Activity  Behaviour…...8 Motivation…………………………………………….………………………..….9 Self-Determination  Theory……………………………………………...……….10 Organismic Integration  Theory…………………………………………………..11 Research Questions  and  Hypotheses………………………………………….….12 Significance  of  the  Study………….……………………………………………..13 CHAPTER 2: METHODS……………...…………………………………………...…..17 Study Design  and  Procedures……………………………………………………17 Measures…………………………………………………………………………18 Demographic and Lifestyle  Information…………………………………18 Height and  Body  Weight…………………………………………………18 Self-reported  Physical  Activity…………………………………………..19 Reliability and validity of the LTEQ.…………………....……….19 Motivational Regulation  for  Exercise……………………………………20 The Weight Loss Challenge: The Intervention Condition……………………….21 The Weight Loss Challenge:  The  Control  Condition……………………………21 Data  Analysis…………………………………………………………………….22 CHAPTER 3: THE RESULTS………………………………………………………..24 Participants………………………………………………………………………24 Participant  Attrition……………………………………………………………...25 Preliminary Analysis, Descriptive Statistics and Estimates of Consistency……………………………………………………….……………...25 Bivariate Correlations between Study Variables Across Conditions……………26 Cross-Sectional…………………………………………………………..26 Change Over Time……………………………………………………….28 Main Findings…………………………………………………..……………..…30 Changes in BMI Within  Conditions  Over  Time…………………………31 Changes in LTEQ MVPA Within  Conditions  Over  Time……………….32 Changes in Behavioural Regulations for Exercise Within Conditions Over  Time……………….………………………………...……………...32 CHAPTER  4:    DISCUSSION….…..………………………………………..………....34 Comparison of Study Participants to  Those  of  Previous  Research………………35 The Effect of PA and Dietary Interventions  on  Weight  Loss……………..…..…36 The Effect of PA Interventions  on  PA……………………….…………..…..…..39 The Effect of the Challenge on Behavioural Regulations for Exercise…..……...41 The Effect of Financial Incentives on  Weight  Loss  and  Motivation…………….46 Consideration of the Fitness Centre Setting………………………………..….....48 The Inability to  Sustain  Change……………………………………...…….…….49 Limitations………………………………………………………………………..51 Future Directions...……………………………………………..………………...54 Conclusion…………………………………………………………….………….55 Endnotes.…………………………………………………………………………………56 References………………………………………………………………………………..58 Tables Table 1. Baseline Demographic and Lifestyle  Descriptive  Statistics………...…..77 Table 2. Mean Difference in Study Variables Between Intervention and Control Conditions at Baseline……………………………………………………………81 Table 3. Cronbach’s   Reliability Statistics for each BREQ-2R Subscale at each Time Point………………………………………………………………………..82 Table 4. Pearson Bivariate Correlations between Study Variables by Condition at Baseline……………………………………………………………………..……83 Table 5. Pearson Bivariate Correlations between Study Variables by Condition at Time  1…...…………………………………………………………………….….84 Table 6. Pearson Bivariate Correlations between Study Variables by Condition at Time 2….…………………………………………………………………………85 Table 7. Pearson Bivariate Correlations between Standardized Residuals of Study Variables by Condition Baseline-Time 1……………………………………...…86 Table 8. Pearson Bivariate Correlations between Standardized Residuals of Study Variables by Condition Time 1 – Time  2…………………………………..……87 Table 9. Pearson Bivariate Correlations between Standardized Residuals of Study Variables by Condition Baseline-Time  2…………………………………….….88 Table 10. Analysis of Variance, Means and Standard Deviation for Study Variables……………………………………………………………………….…89 Appendices Appendix A: Research Ethics Clearance  Board  Letter……………………..……92 Appendix B: Recruitment Flyer  for  Study…………………………………….…94 Appendix C: Letter of Invitation…………………………………………………96 Appendix D: Informed  Consent………………………………………..…..…….99 Appendix E: Physical Activity Readiness Questionnaire (PAR-Q)………….....102 Appendix F: Questionnaire  Package……………………………………………104 Appendix  G:  Study  Flowchart……………………………………….………….123 1 CHAPTER ONE: INTRODUCTION According to recent measured height and weight data, over one in four Canadian adults are obese (defined as having a measured Body Mass Index (BMI) of over 30 kg/m2; Public Health Agency of Canada, (PHAC), 2011). With the inclusion of measured values within the overweight range (i.e., BMI = 25.00 – 29.99 kg/m2) this figure increased to 62.10% of Canadians in 2008 (PHAC, 2011). Obesity has been linked with numerous chronic health conditions including hypertension, coronary arteriosclerosis, elevated cholesterol, type 2 diabetes, joint problems, stroke and many types of cancers (Blissmer, Riebe, Dye, Ruggiero, Greene, & Caldwell, 2006). Direct and indirect costs attributed to obesity range between $4.6 billion – 7.1 billion (CAD$) per annum based on 2008 estimates (PHAC, 2011). Collectively, the increased prevalence rates of overweight and obesity, combined with the increased risk of chronic health conditions and the associated costs highlight the importance of public health initiatives targeting both prevention and treatment of overweight and obesity in Canada (PHAC, 2011). The Role of Physical Activity Risk factors associated with body weight regulation are well known and include uncontrollable factors such as metabolic susceptibility, age and gender (Bouchard, Blair, & Haskell, 2007) and controllable factors such as energy intake and expenditure (Hill, Wyatt, & Peters, 2012). Extensive research has shown that the effect of increased physical activity on energy expenditure makes it effective for preventing weight gain and reducing body weight in overweight and obese populations and therefore, can be a 2 predictor of success in weight control (Hill et al., 2012; Jakicic, 2009; Shaw, Gennat, O’Rourke,  &  Del  Mar,  2006). Physical activity (PA) is defined as any body movement that increases overall energy expenditure above resting values (Bouchard et al., 2007). Total daily physical activity is comprised of several domains, including leisure time physical activity (LTPA; e.g., exercise, sport), occupational activity, commuting and household chores (van Tuyckom & Scheerder, 2010). LTPA does not include lifestyle embedded activities (e.g. incidental walking, household chores or personal care), commuting or active transport or activity performed in occupational settings (Bryan & Katzmarzyk, 2009). As a result of its effect on energy expenditure, LTPA is commonly prescribed as a means of weight regulation for both overweight and obese individuals and has been identified as one of the best predictors of long-term weight loss (Jakicic, Marcus, Gallagher, Napolitano, & Lang, 2003). Lower levels of LTPA are associated with higher levels of obesity in both Canadian  men  and  women  (PHAC,  2011).    To  derive  health  benefits,  Canada’s  PA   guidelines recommend that Canadians perform at least 150 minutes of moderate to vigorous intensity PA (MVPA) per week which may be accumulated in bouts of 10 minutes or more (Colley et al., 2011). MVPA for adults is defined as working at a minimum intensity of 3 times the intensity of rest (CSEP, 2011) or at a minimum of 3 metabolic equivalents (METS; WHO, 2013). Despite public health recommendations, self-report data from the Canadian Community Health Survey shows that just more than half (53.80%) of Canadians over the age of 12 were reported to meet physical activity guidelines in 2011 (Statistics Canada, 2012). Research by Colley et al. (2011) showed that when using accelerometers to measure PA, the number of Canadian adults (>20 years) meeting the recommended