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1. Description of the EUROBIS program: a combination of an Epode community-based and a clinical care intervention to improve the lifestyles of children and adolescents with overweight or obesity.

Author

Mazzeschi C, Pazzagli C, Laghezza L, Battistini D, Reginato E, Perrone C, Ranucci C, Fatone C, Pippi R, Giaimo MD, Verrotti A, De Giorgi G, and De Feo P

Subjects
Adolescent, Child, Counseling, Exercise, Humans, Italy, Life Style, Obesity psychology, Overweight psychology, Parents psychology, Residence Characteristics, Obesity epidemiology, Overweight epidemiology
Abstract

The present paper describes the Epode Umbria Region Obesity Prevention Study (EUROBIS) and aims to implement the C.U.R.I.A.MO. model through the EPODE methodology. The main goal of the EUROBIS is to change the pendency of slope of the actual trend towards the increase in the yearly rates of childhood overweight and obesity in Umbria and to improve healthy lifestyles of children and their parents. The project is the first EPODE program to be performed in Italy. The aims of the Italian EUROBIS study are: (1) a community-based intervention program (CBP) carrying out activities in all primary schools of the Umbria Region and family settings as first step, to reverse the current obesity trend on a long-term basis, and (2) a clinical care program for childhood and adolescent by C.U.R.I.A.MO. model. C.U.R.I.A.MO. model is a multidisciplinary approach to improve three key aspects of healthy lifestyles: nutrition, exercise, and psychological aspects with the strategy of a family-based approach. The community-based intervention and clinical trial provide an innovative valuable model to address the childhood obesity prevention and treatment in Italy.

Published
2014
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2. The impact of strenuous group physical activity on mood states, personal views, body composition, and markers of myocardial damage in overweight/obese adults: the "Step-by-step Italy's coast to coast" trek.

Author

Mazzeschi C, Piana N, Capezzali D, Mommi A, Aiello C, Gatti M, Romani G, Buratta L, Battistini D, Nasini G, Reginato E, Urbani L, Pazzagli C, Ferri C, Ambrosio G, and De Feo P

Subjects
Adult, Humans, Italy, Qualitative Research, Affect, Body Composition, Motor Activity, Myocardium pathology, Obesity physiopathology
Abstract

It is clinically relevant to understand whether it is safe to recommend to trained overweight/obese people long-distance treks and whether these experiences could have a negative psychological impact or become even dangerous exposing the trekkers to the risk of clinically silent myocardial damage. To answer these questions we have performed a quantitative/qualitative study comparing the changes in mood profiles, personal views, body composition, and plasma troponin levels of 40 overweight/obese subjects with those of 36 healthy normal weight subjects after the participation in a trek of 388 km from the Adriatic to the Tyrrhenian seas trek: the "Step by step…Italy's coast to coast". The results of this study demonstrate that long-distance treks are a safe activity for trained overweight/obese people which should be recommended because they improve mood, health status, and the relationship of participants with themselves and with the regular practice of exercise with effects similar to those obtained by healthy normal weight subjects.

Published
2014
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3. Multidisciplinary lifestyle intervention in the obese: its impact on patients' perception of the disease, food and physical exercise.

Author

Piana N, Battistini D, Urbani L, Romani G, Fatone C, Pazzagli C, Laghezza L, Mazzeschi C, and De Feo P

Subjects
Adult, Combined Modality Therapy, Fear, Female, Focus Groups, Food, Humans, Interpersonal Relations, Italy, Male, Middle Aged, Motivation, Obesity diagnosis, Obesity physiopathology, Obesity psychology, Patient Compliance, Patient Education as Topic, Self Efficacy, Time Factors, Treatment Outcome, Diet psychology, Exercise Therapy psychology, Health Behavior, Health Knowledge, Attitudes, Practice, Obesity therapy, Perception, Risk Reduction Behavior
Abstract

Background and Aims: To be successful, lifestyle intervention in obesity must take into account patients' views. The aim of the present study, conducted using a narrative-autobiographical approach, was to report on the perception of disease, food and physical exercise in a group of 80 obese patients during a structured multidisciplinary lifestyle intervention., Methods and Results: Patients underwent lifestyle intervention, of three months' duration, structured in the following steps: 1) an initial medical examination; 2) an interview by a psychologist; 3) an assessment by a dietician, 4) a physical examination by a specialist in sports medicine; 5) an individualized program consisting of 24 sessions (two per week) of structured indoor exercise 6) eight sessions of group therapeutic education; 7) Nordic walking activity combined with walking excursions during weekends. All the narrative autobiographic texts obtained during the lifestyle intervention were submitted for content analysis; data were analysed according to the ''grounded theory'' method. According to patients' descriptions at the end of the intervention, lifestyle intervention resulted in enhanced self-efficacy and a reduction in their dependency on food and people; their fear of change was also diminished because, by undergoing intervention, they had experienced change., Conclusion: The findings made in the present qualitative analysis suggest that whenever multidisciplinary lifestyle intervention is planned for patients with obesity, it is of the utmost importance to tailor the approach while taking the following key aspects into account: motivation, barriers and/or facilitators in lifestyle change, patients' perceptions of obesity and relationship with food, diet and exercise., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Published
2013
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4. Effects of a multidisciplinary lifestyle intervention for obesity on mental and physical components of quality of life: the mediatory role of depression.

Author

Pazzagli C, Mazzeschi C, Laghezza L, Reboldi GP, and De Feo P

Subjects
Body Mass Index, Depression physiopathology, Exercise Therapy methods, Humans, Male, Middle Aged, Obesity physiopathology, Obesity psychology, Psychiatric Status Rating Scales, Surveys and Questionnaires, Counseling methods, Depression psychology, Life Style, Obesity therapy, Quality of Life
Abstract

The current study investigates the effects of a multidisciplinary lifestyle intervention for obesity on Health Related Quality of Life (HRQoL). In this study, 92 adults with obesity were weighed and completed the Short Form Health Survey (SF-36) and the Center for Epidemiologic Studies Depression Scale (CES-D) at the baseline and at the end of a 3-month intervention. Repeated measures analysis of variance (ANOVA), a series of hierarchical regressions, and the statistical mediation analysis of Baron and Kenny were conducted. (a) Over 3 months, changes in weight and the mental and physical scales of the SF-36 and depression were all significant. (b) The results indicate a significant mediation of changes in depression scores for the association between weight loss and enhancement on the General Health scale of the SF-36. Improvements to HRQoL from a multidisciplinary lifestyle intervention seem to affect both the physical and mental components of the SF-36 score and to reduce depression, contributing to enhanced self-perceptions of well-being.

Published
2013
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5. Mutual interactions between depression/quality of life and adherence to a multidisciplinary lifestyle intervention in obesity.

Author

Mazzeschi C, Pazzagli C, Buratta L, Reboldi GP, Battistini D, Piana N, Pippi R, Fatone C, and De Feo P

Subjects
Adult, Aged, Behavior Therapy methods, Combined Modality Therapy, Exercise Therapy, Female, Humans, Interdisciplinary Communication, Male, Middle Aged, Obesity complications, Obesity psychology, Patient Education as Topic, Risk Reduction Behavior, Depression epidemiology, Depression etiology, Life Style, Obesity epidemiology, Obesity therapy, Patient Compliance statistics & numerical data, Quality of Life psychology
Abstract

Context: There is scarce knowledge of the interaction between depression/health-related quality of life (HRQOL) and lifestyle intervention in obesity., Objective: The aim of the study was to establish whether baseline mood status or HRQOL affects attendance to educational or exercise sessions and whether attendance to these two components of the intervention affects mood and/or HRQOL in obesity., Design: A total of 282 overweight/obese subjects (body mass index, 33.4 ± 5.9 kg/m(2); 103 males, 179 females; age, 53.8 ± 13.0 yr, mean ± sd) were consecutively enrolled in a multidisciplinary lifestyle intervention program. During the intensive phase of the intervention (3 months) patients were invited to attend eight educational sessions and 26 exercise group sessions., Results: Poor adherence to exercise sessions is predicted by baseline depressive mood (P =0.006) and by low levels of HRQOL (domains of Vitality, Physical Role Functioning, Social Functioning, Mental Composite, Physical Composite Scores) (P < 0.05). Attendance to the educational sessions is associated with beneficial effects of the lifestyle intervention on depressive symptoms (P < 0.013) and on several mental domains of HRQOL (P < 0.041); attendance to the exercise sessions predicted the beneficial effects on perceived general health (P < 0.021) and body mass index (P < 0.011). Attendance to both educational and exercise components is associated (P < 0.05) with the reductions in waist circumference, fat mass, and blood pressure observed after the intensive phase of the intervention., Conclusions: Measurement of depressive mood and HRQOL before lifestyle intervention allows identification of patients at increased risk of attrition with exercise and educational sessions. Both the exercise and the educational sessions are essential for gaining the full spectrum of psychological and clinical benefits from multidisciplinary lifestyle intervention in obesity.

Published
2012
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6. An innovative model for changing the lifestyles of persons with obesity and/or Type 2 diabetes mellitus.

Author

De Feo P, Fatone C, Burani P, Piana N, Pazzagli C, Battistini D, Capezzali D, Pippi R, Chipi B, and Mazzeschi C

Subjects
Adult, Cost-Benefit Analysis, Directive Counseling, Exercise, Female, Follow-Up Studies, Humans, Italy, Male, Middle Aged, Weight Loss, Diabetes Mellitus, Type 2 therapy, Life Style, Obesity therapy, Patient Care Team
Abstract

Aim: To describe the multidisciplinary lifestyle intervention model used in an experimental CURIAMO (Centro Universitario Ricerca Interdipartimentale Attività Motoria) project designed to validate the short- and long-term efficacy of the model in obesity and Type 2 diabetes., Research Design and Methods: Over a 3-yr period, about 1000 adults (70% diabetes-free and overweight or obese; 30% with Type 2 diabetes and overweight or obese)., Inclusion Criteria: Age range 18-80 yr, body mass index >27 kg/m2 with or without Type 2 diabetes mellitus; participants will be divided into three age groups (18-45, 45-65, 65-80 yr). The study duration will be from 5 to 6 yr: 1 yr of intervention followed by a mean follow-up period of 4 yr. In the first years, after a 4- month intensive lifestyle intervention, subjects will follow a maintenance programme. The intervention, which includes seven steps, involves the following experts: endocrinologists, sport medicine doctors or cardiologists, psychologists, dietitians, educators, nurses, exercise physiologists, and promoters of outdoor activities., Results: The main endpoint of the study is to measure the efficacy of the lifestyle improvement intervention, defined as a loss of at least 7% of body weight combined with an increase of at least 10 MET/h-1·week-1 of energy expenditure by physical activity, after 1 yr and during the follow-up. A cost/utility analysis of the model will be made in participants with diabetes., Conclusions: We expect that the CURIAMO model will be highly effective, and that the aim of the intervention will be achieved in more than 70% of cases.

Published
2011
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7. A Time-Lagged, Actor–Partner Interdependence Analysis of Alliance to the Group as a Whole and Group Member Outcome in Overweight and Obesity Treatment Groups

Author

Gullo, S, LO COCO, Gianluca, Pazzagli, C, Piana, N, De Feo, P, Mazzeschi, C, Kivlighan Jr, Dennis, M., Gullo, S, Lo Coco, G, Pazzagli, C, Piana, N, De Feo, P, Mazzeschi, C, Kivlighan Jr, and Dennis, M

Subjects
Male, Social Psychology, Treatment outcome, group therapy, alliance to the group, obesity, actor-partner interdependence model, Overweight, Outcome (game theory), Treatment and control groups, Group (periodic table), Surveys and Questionnaires, medicine, Humans, Interpersonal Relations, Obesity, General Medicine, Middle Aged, medicine.disease, Group Processes, Psychiatry and Mental health, Clinical Psychology, Alliance, Treatment Outcome, Italy, Psychotherapy, Group, Positive relationship, Female, medicine.symptom, Psychology, Clinical psychology, Follow-Up Studies
Abstract

A time-lagged design was used to examine how the perceptions of alliance to the group as a whole by the other group members at an earlier point in the group were related to an individual group member’s perceptions of alliance to the group as a whole at a later point in the group. We also examined how treatment outcome moderated this relationship. Seventy-three patients diagnosed as overweight or obese participating in 10 short-term therapy groups provided data for analyses. Group members completed measures of cohesion to the group and alliance to the group as a whole at the third, sixth, and last session of 12-session groups as well as pre- and posttest ratings on Obesity-Related Well-Being and the Outcome Questionnaire– 45. As hypothesized, earlier ratings of alliance to the group as a whole by the other group members were related to later ratings of alliance to the group as a whole by the group member. Also as hypothesized, when group members had a better outcome, there was a significant positive relationship between perceptions of alliance to the group as a whole by the other group members at an earlier point in the group and an individual group member’s perceptions of alliance to the group as a whole at a later point in time. When members had a worse outcome, there was no relationship between perceptions of alliance to the group as a whole by the other group members at an earlier point in the group and an individual group member’s perceptions of alliance to the group as a whole at a later point in the group.

Published
2014

8. AN INNOVATIVE MODEL FOR CHANGING THE LIFESTYLES OF PERSONS WITH OBESITY AND/OR TYPE 2 DIABETES MELLITUS

Author

Feo, P., Fatone, C., Burani, P., Piana, N., Pazzagli, C., Battistini, D., Capezzali, D., Pippi, R., Chipi, B., and claudia mazzeschi

Subjects
Adult, Male, Patient Care Team, obesity, diabetes, exercise, Cost-Benefit Analysis, Directive Counseling, motivation, nutrition, Middle Aged, Diabetes Mellitus, Type 2, Italy, Weight Loss, Humans, Female, Life Style, Follow-Up Studies
Abstract

To describe the multidisciplinary lifestyle intervention model used in an experimental CURIAMO (Centro Universitario Ricerca Interdipartimentale Attività Motoria) project designed to validate the short- and long-term efficacy of the model in obesity and Type 2 diabetes.Over a 3-yr period, about 1000 adults (70% diabetes-free and overweight or obese; 30% with Type 2 diabetes and overweight or obese).Age range 18-80 yr, body mass index27 kg/m2 with or without Type 2 diabetes mellitus; participants will be divided into three age groups (18-45, 45-65, 65-80 yr). The study duration will be from 5 to 6 yr: 1 yr of intervention followed by a mean follow-up period of 4 yr. In the first years, after a 4- month intensive lifestyle intervention, subjects will follow a maintenance programme. The intervention, which includes seven steps, involves the following experts: endocrinologists, sport medicine doctors or cardiologists, psychologists, dietitians, educators, nurses, exercise physiologists, and promoters of outdoor activities.The main endpoint of the study is to measure the efficacy of the lifestyle improvement intervention, defined as a loss of at least 7% of body weight combined with an increase of at least 10 MET/h-1·week-1 of energy expenditure by physical activity, after 1 yr and during the follow-up. A cost/utility analysis of the model will be made in participants with diabetes.We expect that the CURIAMO model will be highly effective, and that the aim of the intervention will be achieved in more than 70% of cases.

Published
2011

9. The Codevelopment of Group Relationships: The Role of Individual Group Member's and Other Group Members' Mutual Influence and Shared Group Environment

Author

Salvatore Gullo, Gabriele Profita, Chiara Pazzagli, Dennis M. Kivlighan, Gianluca Lo Coco, Claudia Mazzeschi, Lo Coco G., Gullo S., Profita G., Pazzagli C., Mazzeschi C., and Kivlighan D.M.

Subjects
Adult, Male, Social Psychology, medicine.medical_treatment, PsycINFO, Group relationship, Social Environment, law.invention, Group psychotherapy, Interpersonal relationship, Randomized controlled trial, Group (periodic table), law, Surveys and Questionnaires, medicine, Humans, 0501 psychology and cognitive sciences, Interpersonal Relations, Obesity, Social influence, 05 social sciences, group relationships, Social environment, General Medicine, Middle Aged, APIM, Object Attachment, Codevelopment, Group therapy, 050106 general psychology & cognitive sciences, Psychiatry and Mental health, Clinical Psychology, Sexual Partners, Psychotherapy, Group, group therapy, group relationships, codevelopment, obesity, APIM, Female, Psychology, Group development, Clinical psychology
Abstract

Although recent research has provided empirical support for the codevelopment of group interaction (defined as development in a common direction of perceptions of group relationships), no studies have yet investigated the "causes" of codevelopment among group members in the long term. The aim of the current study is to examine how the perceptions of an individual group member, and other group members, regarding group relationships influence each other over the course of treatment. We analyzed group data from 168 adult obese patients who participated in (1 of 20) 12-session therapy groups for weight management. Group relationships were measured by the Group Questionnaire (Krogel et al., 2013), which was administered to group members in early, middle and late group sessions. The longitudinal version of the group actor-partner interdependence model was used to analyze the influence among members. Results showed that there is no mutual influence in the codevelopment of both positive bonding and negative relationship. However, positive bonding of other group members in the middle of the group influenced positive bonding of the individual group member in the late group session. Moreover, individual group member negative relationships in early and middle sessions influenced other group member negative relationships in middle and late sessions. Finally, there was evidence of mutual influence in the codevelopment of positive working early in the group. The findings show that the process of influence among members is complex with regard to the specific dimension of the group relationship assessed and the time spent in group treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Published
2019

10. Examining the relationship between group member gender, gender composition, and outcomes of weight management therapy groups

Author

Salvatore Gullo, Claudia Mazzeschi, G. Lo Coco, Jill D. Paquin, Dennis M. Kivlighan, Chiara Pazzagli, Kivlighan, D., Lo Coco, G., Gullo, S., Pazzagli, C., Mazzeschi, C., and Paquin, J.

Subjects
050103 clinical psychology, obesity, Social Psychology, Group (mathematics), medicine.medical_treatment, 05 social sciences, Treatment outcome, 050109 social psychology, Weight control, medicine.disease, Obesity, group therapy, Group psychotherapy, group therapy, gender, obesity, outcome, gender composition, Settore M-PSI/08 - Psicologia Clinica, gender composition, Weight management, medicine, gender, outcome, 0501 psychology and cognitive sciences, Psychology, Composition (language), Applied Psychology, Clinical psychology
Abstract

Presently there is a lack of evidence regarding the impact of gender composition of mixed-gender weight management therapy groups on members' posttreatment outcomes. As such, the current study tested the association between the gender composition of mixed-gender narrative therapy groups for weight management and members' posttreatment outcomes. Specifically, we examined the variability in group members' adjusted posttreatment psychological (Outcome Questionnaire-45 [OQ-45]) and obesity-related (Obesity Related Well-Being [ORWELL 97]) symptoms as a function of the quadratic proportion of female members in a group, and the interaction between group member gender and the quadratic proportion of female group members. Pre- and posttreatment OQ-45 and ORWELL 97 data was collected from 32 men and 67 women participating in 15 short-term weight-management therapy groups. Results indicated that the quadratic proportion of female group members was significantly related to adjusted posttreatment OQ-45 scores, such that group members reported fewer psychological symptoms at posttreatment in more proportionally balanced groups of men and women. This relationship was not significant for adjusted posttreatment ORWELL 97 scores. Additionally, in an exploratory analysis we found a significant interaction between group member gender, the proportion of female group members, and group members' adjusted posttreatment OQ-45 scores, indicating that the relationship between gender composition and adjusted posttreatment OQ-45 scores was stronger for men than women. These preliminary findings suggest that the gender composition of weight management groups is an important factor in group members' posttreatment psychological outcomes.

Published
2017

11. All bonds are not the same: A response surface analysis of the perceptions of positive bonding relationships in therapy groups

Author

Claudia Mazzeschi, Salvatore Gullo, Veronica Oieni, Chiara Pazzagli, Dennis M. Kivlighan, Gianluca Lo Coco, Kivlighan, D., Lo Coco, G., Oieni, V., Gullo, S., Pazzagli, C., and Mazzeschi, C.

Subjects
050103 clinical psychology, Psychotherapist, Positive bonding, Social Psychology, media_common.quotation_subject, medicine.medical_treatment, 05 social sciences, Treatment outcome, Weight control, Group Questionnaire, Group therapy, Obesity, Response surface analysis, Applied Psychology, Group psychotherapy, 050106 general psychology & cognitive sciences, Response surface analysi, Perception, Settore M-PSI/08 - Psicologia Clinica, medicine, 0501 psychology and cognitive sciences, Psychology, media_common, Clinical psychology
Abstract

Intrapersonal split alliances were defined as discrepancies in how group members perceived their positive bonding relationships with the group leader, the other group members, and the group-as-a-whole, and were related to group members' outcome. Participants were 168 patients (116 women and 52 men) diagnosed as overweight or obese who participated in 1 of 20, 12-session, therapy groups for weight management. Group members completed the Outcome Questionnaire-45 (OQ-45, Lambert et al., 2004) pre- and posttreatment and the Group Questionnaire (GQ, Krogel et al., 2013) at early, middle and late group sessions. Early, middle, and late ratings were aggregated because bond scores were consistent across time. Two-level (members within groups), polynomial regressions and response surface analyses were used to examine congruency and discrepancy in ratings of Positive Bonding Relationships to the leader, group members, and group-as-a-whole. When the discrepancy between positive bonding relationships with the leader and positive bonding relationships with the group members increased, and when the discrepancy between positive bonding relationships with the group members and positive bonding relationships with the group-as-a-whole increased, there was less symptom improvement. The findings show that, like interpersonal split alliances, intrapersonal split alliances are harmful for treatment progress and need to be recognized and addressed by the group leader.

Published
2017

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