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48 M. Craeynest et al. / Eating Behaviors 9 (2008) 41–51 Table 5 Regression analyses predicting AMBI change at follow up from implicit attitudinal change towards PA and food during treatment Adj. R 2 Significant correlates Standard coefficient beta 3.4.4. Self-reported attitudes towards food In a fourth model, ABMI change during treatment was the dependent variable, and the change in attitude towards unhealthy food, towards healthy food, baseline ABMI, age and sex were entered as independent variables. The model accounted for 61% of the variance, F(5, 18)=6.73, pb.01. Only baseline ABMI and sex were significant predictors, respectively β=−.72; t(18) =4.44, pb.01 and β=.53; t(18) =3.35, pb.01 (see Table 4). 3.5. Prediction of ABMI change at follow up by attitudinal change during treatment To investigate whether attitudinal changes could explain the variance in ABMI change at follow up, we conducted standard multiple regression analyses in again four separate models. ABMI change at follow up was calculated by subtracting the ABMI at T2 from the ABMI at T3; attitudinal changes during treatment were calculated by subtracting the attitudinal scores at T1 from the attitudinal scores at T2. 3.5.1. Implicit attitudes towards physical activity In a first model, ABMI change at follow up was the dependent variable, and the change in attitude towards sedentary activity (RT), towards moderate intense PA (RT), towards high intense PA (RT), towards sedentary activity (PE), towards moderate intense PA (PE), towards high intense PA (PE), ABMI at the end of the treatment, age and sex were entered as independent variables. The model accounted for 40% of the variance, but was not significant, F(9, 18)= 2.32 ns. Only the change in implicit attitude towards moderate PA (RT) was a significant predictor, β=.89;t(18) =2.78, pb.05, indicating that decrease in overweight at follow up is related to a change towards a negative implicit attitude towards moderate intense physical activity at the end of the treatment, adjusted for age, sex and ABMI (see Table 5). Adj. R 2 Significant correlates PA Food Total model: .40 Total model .08 F(9, 18)=2.32 F(7, 18)=1.22 Sex −.34 Sex .29 Age .37 Age .42 Baseline ABMI .13 Baseline ABMI −.37 Sedentary activity (RT) −.03 Unhealthy food (RT) .48 Mod. intense PA (RT) .89⁎ Healthy food (RT) .02 High intense PA (RT) .12 Sedentary activity (PE) .15 Unhealthy food (PE) .23 Mod. intense PA (PE) −.33 Healthy food (PE) .05 High intense PA (PE) −.05 ⁎pb.05. Table 6 Regression analyses predicting AMBI change at follow up from self-reported attitudinal change towards PA and food during treatment Adj. R 2 Significant correlates Standard coefficient beta Adj. R 2 Significant correlates PA Food Total model: .03 Total model: .14 F(6, 18)=1.10 F(5, 18)=0.57 Sex .08 Sex .20 Age .53 Age .43 Baseline ABMI −.30 Baseline ABMI −.31 Sedentary activity −.59 Unhealthy food −.13 Mod. intense PA .53 Healthy food .28 High intense PA .20 Standard coefficient beta Standard coefficient beta
3.5.2. Implicit attitudes towards food In a second model, ABMI change at follow up was the dependent variable, and the change in attitude towards unhealthy food (RT), towards healthy food (RT), towards unhealthy food (PE), towards healthy food (PE), ABMI at the end of the treatment, age and sex were entered as independent variables. The model accounted for only 8% of the variance, and was not significant, F(7, 18)=1.22 ns (see Table 5). 3.5.3. Self-reported attitudes towards physical activity In a third model, ABMI change at follow up was the dependent variable, and the change in attitude towards sedentary activity, towards moderate intense PA, towards high intense PA, ABMI at the end of the treatment, age and sex were entered as independent variables. The model accounted for only 3% of the variance, and was not significant, F (6, 18)=1.10 ns. (see Table 6). 3.5.4. Self-reported attitudes towards food In a fourth model, ABMI change at follow up was the dependent variable, and the change in attitude towards unhealthy food, towards healthy food, ABMI at the end of the treatment, age and sex were entered as independent variables. The model accounted for 14% of the variance, and was not significant, F(5, 18)b1 (see Table 6). 4. Discussion M. Craeynest et al. / Eating Behaviors 9 (2008) 41–51 This manuscript presented a longitudinal study, investigating whether implicit and self-reported food and exercise attitudes changed during a six month inpatient treatment for youth obesity and at a one year follow up. Further, it was examined whether this change explained the variance in overweight change during treatment and at follow up. A first finding was that the youngsters lost weight during the treatment, that seemed not to be regained at follow up. This lack of weight regain is in contrast with what is often found (e.g., Braet et al., 2003, 2004). However, the finding of the present study should be interpreted with caution, as it is based on a very restricted and selective sample. As the dropout youngsters reported at baseline that they liked more unhealthy food and liked less healthy food than the remaining group, it can be assumed that especially the youngsters that regained weight after treatment, dropped out or could not be contacted at follow up. Another possibility may be that the participants further lost weight after the six months of treatment that was regained at follow up. The self-reports revealed more favourable attitudes towards healthy food and physical activity than towards unhealthy food and sedentary activities. This pattern was quite stable over time. Further, a change in self-reported attitudes was not related to decrease in overweight during treatment and at follow up. Possibly, demand characteristics leading to self-presentation strategies may have played a role (see Schwarz, 1999), but this pattern can also reflect a gap between a positive attitude towards health practices and the intention to effectively perform health behaviour. Moreover, it should be noted that the attitudes were assessed when the treatment had already started. Of particular interest was the change in implicit food and physical activity attitudes during treatment, and the relation with decrease in overweight. At baseline, the participants had positive attitudes towards both healthy and unhealthyfood,whichwasalsofoundinthetotalgroupsampleasdescribedinCraeynest et al. (2005).However,this mean effect disappeared in a longitudinal study design. Nevertheless, some specific changes in implicit attitude towards food and physical activity seemed to be related to the decrease in overweight during treatment and at follow up. More specifically, it was found that the decrease in overweight at the end of the treatment was related to becoming more positive towards healthy food during therapy. This pattern seems in line with studies that applied the Transtheoretical Model of behavioural change (Prochaska & DiClimente, 1983) on fruit and vegetable consumption, which found that increasing the perception of the benefits of the consumption of fruit and vegetables is a crucial factor for the move towards a higher behavioural stage (e.g., Cullen, Bartholomew, Parcel, & Koehly, 1998; Greene et al., 2004). Therefore, it may be assumed that emphasizing the benefits of healthyfoodiselementaryinthe treatment of childhood obesity. Further, a more negative attitude towards high intense physical activity and towards moderate intense physical activity seemed to be predictive for respectively decrease in overweight at the end of the treatment and at follow up. At first sight, these effects are not in line with the expectations. Nevertheless, they can also indicate that the youngsters who lost much weight are fed up with being intensively physical active. However, 49
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