Appetite 44 (2005) 283–288 www.elsevier.com/locate/appet

Research Report Self-set dieting rules: Adherence and prediction of success

Ba¨rbel Kna¨uper*, Surkhraj Cheema, Marjorie Rabiau, Odelia Borten

Department of Psychology, McGill University, Montreal, Que., Canada

Received 21 September 2004; revised 15 November 2004; accepted 25 January 2005

Abstract

The low achievement rates among dieters could be partially due to ineffective dieting strategies, or an inability to adhere to them in the long term. The present research examines the effectiveness of self-set dieting rules for achieving dieting goals. Specifically, it investigates how the types of dieting rules and the extent to which dieters adhere to them predict dieting success. A prospective study with reassessment after two months was conducted and analyzed in 2003. Participants were 132 currently dieting females recruited on a university campus. They completed measures assessing self-set dieting rules, dieting goal, and height and weight at Time 1 and Time 2. Data were analyzed using c2 tests and multiple linear regression. Overall, adherence to self-set dieting rules was markedly low. Reduction of caloric intake and increase of predicted weight loss success. Sustained adherence to the dieting rules ‘reducing calories’ and ‘increasing exercise’ was found to be effective for achieving self-set dieting goals. The findings suggest that encouraging long-term adherence to effective rules could help increase the number of successful self-controlled dieting efforts. q 2005 Elsevier Ltd. All rights reserved.

Keywords: Dieting rules; Self-controlled; Weight loss; Adherence; Self-regulation

Introduction a formal weight loss program (Kruger et al., 2004; Paeratakul et al., 2002). For example, a recent survey It is currently estimated that one in three adults in the found that only 4.5% of dieters in a US representative United States is trying to lose weight (Jeffery, Adlis, & sample attempted to lose weight by joining an organized Forster, 1991; Kruger, Galuska, Serdula, & Jones, 2004; weight-loss program (Kruger et al., 2004). Paeratakul, York-Crowe, Williamson, Ryan, & Bray, 2002; Rules followed as part of a self-controlled weight loss Serdula, Mokdad, Williamson, Galuska, Mendlein, & effort are far ranging (French, Jeffery, & Murray, 1999; Heath, 1999). Dieting attempts, however, frequently remain Kruger et al., 2004), and can include strategies such as unsuccessful. Within five years the majority of dieters will taking laxatives, pills or vomiting (French et al., 1999). regain the weight they originally lost and after five years Nonetheless, the vast majority of dieters have been found to they often exceed their initial weight (Crawford, Jeffery, & engage mostly in healthful dieting strategies such as French, 2000; National Task Force on the Prevention and reducing or increasing exercise (French et al., 1999; Treatment of , 1993). The low achievement rates Kruger et al., 2004). Little is known, however, about the among dieters could be partially due to ineffective dieting effectiveness of such self-set dieting rules for losing weight. strategies and partially to an inability to adhere long-term to Knowing which rules are effective in a self-controlled effective strategies (Dean, 2000). weight loss effort may help in understanding the factors that Survey results show that most people attempt to lose hinder individuals in successfully achieving a healthier weight by following self-set dieting rules rather than joining body weight. The present study uses a prospective design to examine the effectiveness of self-set dieting rules for achieving * Corresponding author. weight loss goals. Specifically, it investigates how the types E-mail address: [email protected] (B. Kna¨uper). of dieting rules people set for themselves, and the extent to 0195-6663/$ - see front matter q 2005 Elsevier Ltd. All rights reserved. which people adhere to these dieting rules, are related to doi:10.1016/j.appet.2005.01.008 dieting success. 284 B. Kna¨uper et al. / Appetite 44 (2005) 283–288

Past research The present study

Past studies have used cross-sectional retrospective The present research examines self-set dieting rules in a research designs or asked only general questions about sample of dieting women who were asked to list, in an open and exercise behaviors or assessed dieting strategies response format, up to eight dieting rules they follow in in samples not currently dieting to lose weight (Ball, Brown, order to lose weight. The study examines the type of dieting & Crawford, 2002; Blair, Booth, Lewis, & Wainwright, rules that dieters set for themselves, how well dieters adhere 1989; Boutelle, Neumark-Sztainer, Story, & Resnick, 2002; to their self-set dieting rules over the course of their diet, to French et al., 1999; Klesges, Klesges, Haddock, & Eck, which degree their self-set rules are effective for losing 1992; Kruger et al., 2004; Levy & Heaton, 1993; Paeratakul weight, and how the degree of adherence to self-set dieting et al., 2002; Rissanen, Heliovaara, Kneckt, Reunanen, & rules is related to dieting success. We also examine how Aromaa, 1991; Serdula et al., 1999). These studies do not successful a combination of reduced caloric intake and allow inferring which specific dieting strategies are related increased exercise is for losing weight. This combination of to weight loss over the course of a specific dieting episode. strategies is currently recommended by the National A number of prospective studies have examined the Institutes of Health, National Heart, Lung and Blood effectiveness of intervention and commercial weight loss Institute (1998). programs (Bautista-Castano, Molina, Cabrillana, Montoya- Alonso, & Serra-Majem, 2004; Grodstein, Levine, Troy, Spencer, Colditz, & Stampfer, 1996; Riebe et al., 2003; Method Skender et al., 1996; Tsai, Sandretto, & Chung, 2003; Westenhoefer, von Falck, Stellfeldt, & Fintelmann, 2004), Participants but did not study the effectiveness of dieting rules in self- controlled dieting efforts. Other studies compare the Overall, 169 women participated in the study. They were effectiveness of self-set regimens with commercial pro- recruited by flyers posted on a university campus searching for females who were currently on a weight loss diet and grams, but did not assess how more precise strategies used were between the ages of 18–30 years. Of the 169 women by self-dieters predict weight loss success (Heshka et al., recruited, 132 completed both Time 1 (T1) and Time 2 (T2) 2003). measures and were included in the present analyses. These A recent study used a prospective design to examine women were on average 21.45 years old (SDZ2.96, weight loss success of dieting strategies in a sample of 15 range: 18–32) and had a (BMI) of 23.05 males and 90 females (18–55 years old) who were (SDZ3.66, range: 17.67–41.73). They were 56.8% Cauca- planning to go on a diet (Dean, 2000). Participants were sian, 21.2% Asian, 5.3% African–American, 5.3% Arab, interviewed by phone about the dieting strategies they and 4.5% Latin/Hispanic. The remainder (6.8%) classified planned to use and contacted one month later to assess themselves as ‘other.’ their weight loss and the dieting strategies actually used. It was found that reducing sweets was predictive of Procedure percent of goal weight achieved. Furthermore, reducing ‘other and beverages’ and ‘following one’s exercise Ethics approval for the present study was received from routine’ were predictive of weight loss. The author did not the McGill Institutional Review Board. Participants filled report results concerning the relationship between adher- out a questionnaire as part of a larger study. Only questions ence to dieting rules and dieting success, presumably pertinent to the present study are described here. On an because the rules participants used when they began their average of two months later, participants were sent a diet had not been assessed. Furthermore, participants were questionnaire by email to assess dieting success, as presented with a list of strategies that the researcher had described below. The comparably short 2-months follow- compiled, and thus important dieting strategies may have up period was chosen because it minimizes the chances of been missed. any lost weight already being regained in participants who In sum, little is known about the specific rules that are no longer dieting. The data were collected and analyzed dieters use in self-controlled dieting efforts, to which in 2003. extent they adhere to their self-set rules and how the degree of adherence to self-set dieting rules predict Measures dieting success. We therefore conducted a prospective study that uses dieters’ own descriptions of the dieting Dieting rules rules that they intend to follow in their attempt to lose At T1, and again at T2, participants were asked to ‘write weight and assess weight loss achievement after two down up to eight rules you try to follow during your present months in order to establish which types of self-set dieting diet.’ They were provided with examples (e.g. ‘I will not eat rules are most effective. any junk during my diet.’) and given space for listing B. Kna¨uper et al. / Appetite 44 (2005) 283–288 285 up to eight dieting rules. At T2 they were asked to list up to Adherence to dieting rules eight rules they followed ‘during the past seven days,’ or in case they were no longer dieting, the rules they had followed The extent to which dieters adhered to the rules over the during the last seven days of their diet. course of their diet was examined by comparing the degree to which they reported the same rules at T1 and T2. On Body mass index (BMI) average, dieters were re-interviewed 8.23 weeks Z At T1, participants were asked to report their weight (in (SD 0.37) after the T1 assessment. They listed signifi- kilograms or pounds) and height (in inches or centimeters). cantly fewer rules at T2 than at T1 (765 vs. 895, c2 Z p! Reports were converted to kilograms and meters and used to (1) 5.57, 02, see Table 1). Overall, adherence to calculate participants’ BMI (weight (kg)/height (m)2). dieting rules was low. On average, only 27.6% (364) of the sample reported the same dieting rule at both times. The single most consistently reported category of dieting rules Dieting success was to increase exercising (see Table 1). Of the remaining Because dieters’ initial weight as well as the amount of categories, calorie reduction rules were relatively consist- weight they want to lose varies substantially, dieting success ently reported. Consistency of reporting was low for the was measured, consistent with a previous study (Dean, other three categories. 2000), as weight loss achieved relative to the intended weight loss, rather than as the absolute amount of weight Prediction of dieting success lost. At T1, participants were asked how much weight (in pounds or kilograms) they intended to lose. They reported Three participants did not report their weight at T2 and their weight again at T2. Reports in pounds were converted could therefore not be included in the analyses. On average, to kilograms. Dieting success was then calculated by participants lost 1.01 kg (SDZ2.30, rangeZ8.00–6.82) dividing the weight participants lost by the weight they over the interval of eight weeks. This indicates a modest intended to lose and multiplying it by 100. For example, a average weight reduction in this sample of dieters. Of the person who intended to lose 10 kg, but only lost 8 kg participants, 59.7% lost weight, 24.8% gained weight and achieved an 80% dieting success. A person who intended to 15.5% remained stable. The average weight loss goal that lose 10 kg, but lost 12, achieved a 120% dieting success. dieters set for themselves was 6.36 kg (SDZ4.66), with a range from 1.81 to 30 kg. The average dieting success (i.e. percentage weight loss achieved in relation to dieting goal) was a modest 18.85%. Total amount of weight lost was Results highly correlated with percent weight loss achieved, r(129)Z0.85, p!0.0001. Results reported below are Types of weight loss rules similar for total amount of weight lost, and are therefore not reported separately. Because the weight loss goal that Altogether, the 132 dieters listed 895 rules. On average, dieters set for themselves was associated with their BMI participants listed 6.78 rules (SDZ1.47). A rater (SC) coded (rZ0.59, p!0.0001), with a higher BMI being associated (each rule and grouped the listed rules into five categories with the intention to lose more weight, BMI was controlled (see Table 1): (1) reducing calories, (2) changing what one for in all regression analyses. eats, (3) increasing exercise, (4) changing attitudes and making plans, and (5) changing eating habits. Eighteen of Type of rule the cited rules could not be sorted into one of these Multiple regression was used to test which weight loss categories. Table 1 lists the different rules within each rules predict dieting success. For the first model a score was category and gives examples as well as the proportion of created for each category that summarizes how many rules dieters listing them at T1 and at T2. An independent rater an individual had reported within each category. The (MR) then coded all dieting rules of 20 randomly selected interaction between exercising (Category III) and reduction participants. Interrater agreement between raters was 90.3% of calories (Category I) was also included in the model to on the level of category and 84.3% on the level of rule. test how well engaging in both type of rules. In this sample, Focusing first on the overall composition of the total 79.5% of dieters reported using both type of rules at T1. As dieting rule pool (not reported in Table 1), rules about can be seen in Table 2, the more individuals reported rules reducing caloric intake were most common (31%). The relating to exercising or to reducing calories the more likely remaining rules were distributed quite equally across the they were to reach their weight loss goal. other four categories (15.2–19%). At the level of dieters Interestingly, dieters who used both rules in combination (see Table 1), dieters most frequently listed rules related to were less likely to reach their dieting goal than those who reducing calories, increasing exercise and changing what only used one of them. Follow-up analyses showed one eats. Rules from the other two categories were less specifically that dieters who just used caloric reduction as prevalent. a rule for losing weight were more successful in losing 286 B. Kna¨uper et al. / Appetite 44 (2005) 283–288

Table 1 Weight loss rules: Rule categories, content and consistency in reporting at T1 and T2

Rule categories Rules % dieters Average consistency Rule content % of total at % reporting T1–T2 T1 same rule at T2 I. Reducing calories 90.9% 40.7% 1. Decrease overall daily food intake (e.g. minimizing snacking; 66.7 47.0 smaller portions) 2. Decrease sugar intake 31.8 30.4 3. Decrease fat intake 29.5 43.2 4. Decrease carbohydrate intake 28.8 60.0 5. Decrease alcohol intake 9.8 23.1 II. Changing what one eats 76.5% 27.3% 1. Increase fresh fruits, and 46.2 39.4 2. Increase water/fluid 36.4 47.9 3. Replace particular items with alternatives (e.g. regular soft 12.1 16.7 drinks with diet) 4. Eat ‘healthy’ 9.1 25.0 5. Eat more fresh, non-processed foods 4.5 12.5 – Other 12.9 22.2 III. Increasing exercise 88.6% 81.2% 1. Increasing exercise 88.6 81.2 IV. Changing attitudes and making plans 59.1% 16.5% 1. Careful self-monitoring (e.g. write down everything eaten) 20.5 12.5 2. Give oneself allowances (e.g. can have one dessert a week) 17.4 13.0 3. General lifestyle changes (e.g. reduce stress; sleep more; 9.8 31.3 watch less TV) 4. Do not obsess over diet; do not let diet change life (e.g. do not 8.3 33.3 weigh self constantly) 5. No binging; purging; skipping 8.3 18.2 6. Avoid tempting situations (e.g. do not bring tempting foods 6.8 0.0 into house) 7. Plans for compensation (e.g. compensate eating something 6.1 11.1 fatty by going to the gym) – Other 15.9 12.4 V. Changing eating habits 63.6% 22.7% 1. Eat only at certain times a day (e.g. not after 7 pm; not 3 hours 28.8 47.6 before bed) 2. Low-fat snacks (vegetables, fruits, crackers) 10.6 20.0 3. Vary sizes of particular meals (e.g. moderate lunch, small 9.1 8.3 dinner) 4. Eat at home more often 8.3 18.2 5. Reduce certain foods at certain times of day (e.g. no carbs or 6.8 20.0 sweets after 6 pm) 6. Eat breakfast; eat big breakfast 6.8 22.2 7. Eat regularly (e.g. regular meals; regular intervals) 6.1 25.0 – Other 24.2 20.4

*NZ132, Total number of strategies reported at T1: 895; total number of strategies reported at T2: 765.

weight than dieters who used both rules. They came more Table 2 Results of multiple regression analysis predicting dieting success by type of than twice as close to reaching their dieting goal than dieters rules used who used both rules (MZ39.7%, SDZ68.6%, vs. MZ 14.5%, SDZ51.7%). Expressed in absolute amount of Dieting Rule Categories B S.E. t Sig. weight loss, those who just used caloric reduction as a rule Reducing calories 19.59 7.25 2.70 .008 Changing what one eats K4.43 5.06 K0.88 .38 lost 1.51 kg while those who used both rules lost 0.81 kg. Increasing exercise 26.78 12.39 2.16 .03 This difference is not statistically significant (t(115)Z1.67, Changing attitudes 0.06 4.38 0.01 .99 p!0.095, for amount weight loss achieved), but the Changing eating habits 7.06 5.72 1.23 .22 difference in mean values warrants further analysis, which Combination reducing K13.79 5.19 K2.66 .009 will be reported in the next paragraph. calories/exercise B. Kna¨uper et al. / Appetite 44 (2005) 283–288 287

Table 3 compensatory behaviors such as vomiting, purging or Results of multiple regression analysis predicting dieting success by degree using medication. Consistent with results from nationally of adherence to rules representative surveys (Kruger et al., 2004), the most Dieting rule categories B S.E. T Sig. common rules were reducing calories and increasing Reducing calories 14.66 6.69 2.19 .03 exercise. However, and again consistent with previous Changing what one eats K4.57 5.20 K0.88 .38 research (French et al., 1999), the majority of reported Increasing exercise 31.27 17.09 1.83 .07 dieting rules were found not to be effective for losing weight K K Changing attitudes 1.85 10.23 0.18 .86 and overall adherence to the rules, effective or not, over the Changing eating habits K1.82 10.85 K0.17 .87 Combination reducing K40.52 15.86 K2.55 .01 course of the diet was low. The only two types of dieting calories/exercise rules that predicted dieting success were a reduction of caloric intake and increasing exercise. Therefore, the present results corroborate findings from retrospective Adherence to dieting rules studies (Kruger et al., 2004; Riebe et al., 2003; Wing & It was tested how adherence to dieting rules predicts Hill, 2001). dieting success. Following the same structure of analyses as It was further found that the more dieters had adhered to for the type of rules, a score was created for each category rules relating to exercising or to caloric reduction over the that summarizes how many rules an individual had reported course of the diet, the closer they came to their weight loss within each category at both T1 and T2. The interaction goal. Apparently, persistence is particularly important for between the consistency of reporting reduction of calorie reaching self-set dieting goals and the dieters in the present rules (Category I) and consistency of reporting exercise study failed in the majority to be persistent. Public health rules (Category III) was also included in the model. Table 3 messages may thus not only want to educate the public reports the results of this analysis. As can be seen, the about effective dieting strategies (reducing calories and consistency of reporting caloric reduction and the consist- exercising), but also stress the importance of long-term ency of reporting exercising predicted weight loss success adherence to these rules as noted in prior research (French (with exercising approaching significance). The more et al., 1999; Kruger et al., 2004). consistently individuals reported rules relating to exercising Unexpectedly, a combination of exercise and caloric or to calorie reduction the closer they came to their weight reduction was found to result in lesser dieting success. loss goal. Dieters were more effective when focusing on caloric Similarly to the prediction of dieting success by type of reduction as they came almost twice as close to reaching rule, adhering to both exercising and reducing calories their dieting goal than dieters who used both type of rules. resulted in lower dieting success than adhering to only one One can speculate that this result, in part, is due to the higher of the strategies (see Table 3). One could speculate that initial weight and BMI in the group who used caloric dieters who solely relied on caloric reduction were more reduction rules only. Evidence shows initial weight loss is successful because they had more weight to lose: Specifi- easier the higher the excess weight, particularly when cally, these dieters weighed more at T1 than those who used previous caloric intake was high (McInnis, 2000). Con- both rules (MZ68.90 kg, SDZ16.30, vs. MZ62.52, versely, those reporting that they used both type of rules SDZ10.44, t(118)Z2.05, p!0.04) and had a higher BMI were actually, with their BMI of 22.67, quite normal weight (MZ25.04, SDZ5.92, vs. MZ22.67, SDZ3.26, t(117)Z according to current standards (Kuczmarski & Flegal, 2000) 2.33, p!02). Participants who used just exercising as a and it might have been quite difficult for them to lower their weight loss rule did not differ from those who used both weight even further. Finally, a higher BMI is associated rules in terms of their dieting success, initial weight, and with lower levels of cardio-respiratory fitness (McInnis, BMI (all O0.05). 2000), and this could have posed as a barrier to attempting physical activity in the heavier caloric reduction only group. Strengths of the present study include the employment of Discussion a prospective design with current dieters and the reliance on dieters’ own descriptions of the dieting rules they follow. The present study investigated self-set dieting rules in a Furthermore, the study focused on dieting success in terms sample of dieting women. The research examined the types of the extent to which dieters reached their self-set goal of dieting rules the women set for themselves, how well they rather than in terms of the absolute amount of weight they adhered to the rules over the course of their diet, to what lost. Finally, subjects listed dieting rules in an open response degree the rules were effective in reaching their weight loss format instead of checking off rules on a pre-prepared list goal, and how the degree of adherence to self-set dieting that may not reflect all the rules dieters use in self-controlled rules was related to dieting success. weight loss efforts. Overall, and consistent with previous research (French Limitations include that weight was self-reported. Diet- et al., 1999; Kruger et al., 2004), dieters reported mainly ers could have misreported their weight, particularly at healthful dieting rules rather than more extreme follow-up, and this might have led to an overestimation of 288 B. Kna¨uper et al. / Appetite 44 (2005) 283–288 dieting success. Furthermore, more specific information Heshka, S., Anderson, J. W., Atkinson, R. L., Greenway, F. L., Hill, J. O., about level and frequency of engaging in the different rules Phinney, S. D., et al. (2003). Weight loss with self-help compared with a was not attained. Finally, the sample is not representative of structured commercial program: A randomized trial. Journal of the American Medical Association, 289(14), 1792–1798. dieters and future research has to show how the findings Jeffery, R. W., Adlis, S. A., & Forster, J. L. (1991). Prevalence of dieting generalize to broader samples, the male population, and among working men and women: The health worker project. Health longer follow-up periods. Psychology, 10(4), 274–281. Implications include that health care professionals and Klesges, R. C., Klesges, L. M., Haddock, C. K., & Eck, L. H. (1992). A others who assist individuals in reaching dieting goals longitudinal analysis of the impact of dietary intake and physical should be aware that dieters may use ineffective rules. activity on weight change in adults. The American Journal of Clinical , 55, 818–822. 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