Rethinking Eating and FITness for Men

Obesity is one of the greatest threats to modern public health. It is associated with
negative physical and mental health outcomes as well as increased healthcare expenditures.
Throughout the time period that the prevalence of overweight and obesity have been monitored
in the United States, men have consistently been more likely than women to be overweight
and; conversely, women have been more likely to be obese. Recent trends suggest that this
situation may be changing. Over the past decade, the prevalence of obesity has increased
among men while it has stabilized among women. For the first time, men and women have near
equal rates of obesity where approximately 35.7% of American adults are classified as obese;
meanwhile, men continue to be more overweight than women.

The epidemiological trends have lead to a focus on creating weight loss programs that can
aid overweight and obese adults in losing excess weight. Behavioral interventions for
obesity have demonstrated the ability to produce weight losses of approximately 5-10% of
initial body weight. These weight losses have been associated with decreased risk for type
II diabetes, reduced blood pressure, and improvement in mental health outcomes.
Unfortunately, men typically do not take advantage of such programs. Across multiple
literature reviews, men consistently make up approximately 27% of study samples. This has
lead to a situation where researchers have little information about how to enroll men in
weight loss programs and what kind of programs are of interest to men. In order to combat
the increased obesity in men and help them to avoid the negative consequences of obesity, it
is important to help overweight and obese men change their eating and physical activity
habits within the context of organized weight loss programs.

The REFIT (Rethinking Eating and FITness) intervention is an intervention developed to
address men's needs for weight loss while balancing their need to perform behaviors which
are seen as masculine. Men typically eat a diet that is associated with weight gain rather
than weight loss. The REFIT intervention will focus on changing eating and exercise
behaviors within a structured weight loss program that will allow men to maintain their
autonomy. Autonomy is a central characteristic of enacted masculinity and has been described
in qualitative research as a necessary aspect of a weight loss program for men. The
intervention will focus on encouraging changes in eating and activity through increasing
self-efficacy, autonomous motivation, outcome expectancies, and self-regulation for weight
loss behaviors. The development of this intervention has been guided by qualitative research
focused on what men want and need from weight loss programs as well as previous research
focused on weight loss among both men and women. The approach to be used in the REFIT
intervention is innovative as a combination of the "small changes" approach that has been
used in weight gain prevention as well as the client centered deficit approaches used by
Lutes and colleagues and Sbrocco and colleagues in weight loss programs.

Inclusion Criteria:

- Male

- 18-65 years of age

- Body mass index between 25-40 kg/m²

- Able to access the Internet at least twice weekly

- Able to read and write in English

- Able to attend two group sessions at the UNC Weight Research Program clinic site

Exclusion Criteria:

- Lost more than 10 pounds over the last 6 months

- Currently participating in another weight loss program

- Report a diagnosis of schizophrenia, bipolar disorder, or substance abuse, or
depression leading to hospitalization during the previous year

- Currently being treated for cancer

- Unable to exercise safely (as defined as endorsement of items 1-4 of the Physical
Activity Readiness Questionnaire)

- Heavy use or abuse of alcohol (as defined as a score of 8 or higher on the Alcohol
Disorders Identification Test)