The Pennsylvania State University The Graduate School School of Behavioral Sciences and Education BRINGING THE ADULT LEARNING EXPERIENCE OF SUCCESSFUL WEIGHT LOSS MAINTENANCE INTO FOCUS: A NARRATIVE ANALYSIS WITH IMPLICATIONS FOR EDUCATORS AND CLINICIANS A Dissertation in Adult Education by Rebecca A. Stametz © 2013 Rebecca A. Stametz Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education December 2013 ii The dissertation of Rebecca A. Stametz was reviewed and approved* by the following: Robin Redmon Wright Assistant Professor of Adult Education Dissertation Advisor Chair of Committee Elizabeth J. Tisdell Professor of Adult Education Program Chair Kesha Baptiste-Roberts Assistant Professor of Nursing Rebecca M. LaFountain Assistant Professor of Psychology Fred M. Schied Associate Professor of Learning and Performance Systems Graduate Officer *Signatures are on file in the Graduate School. iii ABSTRACT In light of the many social, medical, and political viewpoints on obesity, little is known of the weight loss maintenance experience and the impact on learning processes and outcomes among adults. The purpose of this study was two-fold: a) to explore the experience and meaning-making processes of individuals who have maintained a weight loss and b) to explore how this learning manifested in successful weight maintenance and improved self-identity despite cultural stressors. This study was grounded in three intersecting theoretical frameworks relating to adult education: Transtheorectical Model of Behavior Change Transformational Learning Theory and Critical Media Literacy as informed by Critical Public Pedagogy. Narrative inquiry was chosen to study the nine stories of adult participants who successfully maintained a weight loss that bring meaning to the weight loss maintenance experience. The collective analysis resulted in two categories and five themes. The first category centered on adult learning. The first theme was related to triggers that were grounded by health and life events. Secondly, learning processes were evident in the narratives and were either self-directed, largely instrumental knowledge and occurred in a non-formal environment. Thirdly, weight loss was seen primarily as a physical transformation motivated by increased self-concept and helping relationships. The second category centered on hegemony and resistance. The fourth theme focused on cultural stressors including the fashion and entertainment industries. The fifth theme focused on changes in obesity discourse post weight loss. The study ends with a consideration of the findings in light of the theory for adult learning and practical implications for strengthening subsequent intervention design. iv TABLE OF CONTENTS List of Tables…………………………………………………………………...…………x List of Figures………………………………………………………………...…………..xi CHAPTER 1. INTRODUCTION .......................................................................................1 Background of the Study ..................................................................................................1 The War with Obesity .....................................................................................................2 Weight Loss Strategies ....................................................................................................4 Commercial weight loss programs ...........................................................................6 Integrated health approaches ....................................................................................6 Medical treatments: surgery and pharmacotherapy .................................................7 Successful Weight Loss Experience ................................................................................8 Problem Statement .........................................................................................................12 Purpose of Research .......................................................................................................13 Research Questions ........................................................................................................13 Theoretical Frameworks .................................................................................................14 Transtheorectical Model ........................................................................................15 Transformative Learning Theory ...........................................................................17 Critical Media Literacy and Critical Public Pedagogy ..........................................19 Overview of Methodology .............................................................................................19 Significance of Study .....................................................................................................22 Assumptions ...................................................................................................................25 Limitations .....................................................................................................................26 Definition of Terms ........................................................................................................27 CHAPTER 2. LITERATURE REVIEW ...........................................................................30 Problem Statement ........................................................................................................31 Purpose of the Study ......................................................................................................32 Research Questions ........................................................................................................33 Approach to Literature Review ......................................................................................33 v Theoretical Frameworks ................................................................................................34 Transtheorectical Model .......................................................................................34 Stages of change ........................................................................................35 Processes of change ...................................................................................36 Decisional balance and self-efficacy .........................................................37 Transformative Leaning Theory ...........................................................................38 Cultural-spiritual orientation ......................................................................44 Critical Media Literacy and Critical Public Pedagogy ...........................................45 Theoretical Assumptions .......................................................................................49 Adult education orientation ........................................................................50 Humanism ......................................................................................52 Constructivism ...............................................................................52 Critical orientation .........................................................................53 Theoretical Intersection .........................................................................................55 Weight Loss and Weight Loss Maintenance Experience ...............................................59 Experience of Chronic Disease ..............................................................................60 Experience of Weight Loss ....................................................................................63 Experience of weight loss surgery .............................................................67 Experience of Weight Loss Maintenance ..............................................................69 Weight Experience Summary ................................................................................75 Impact of Obesity ..........................................................................................................77 Medical Impact…………………………………………………………………. 78 Economic Impact ...................................................................................................79 Social and Psychological Impact ...........................................................................80 Negative impact of mass media ................................................................83 A deeper exploration of “Fattertainment” .................................................84 Impact of Obesity Summary ..................................................................................86 Weight Loss Treatments .................................................................................................87 Industry ..................................................................................................................87 Medical Interventions ............................................................................................89 Introduction of surgical options .................................................................92 vi Introduction of pharmacotherapy ...............................................................92 Weight Loss Treatment Summary .............................................................94 Summary .........................................................................................................................95 CHAPTER 3. METHODOLOGY ..................................................................................101 Qualitative Research