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. Author manuscript; available in PMC: 2019 Sep 1.
Published in final edited form as: Fam Syst Health. 2018 Jul 12;36(3):347–356. doi: 10.1037/fsh0000362

The Role of Partner Autonomy Support in Motivation, Well-Being, and Weight Loss Among Women with Higher Baseline BMI

Katelyn M Gettens 1, Noémie Carbonneau 2, Richard Koestner 3, Theodore A Powers 4, Amy A Gorin 5
PMCID: PMC6131030  NIHMSID: NIHMS974370  PMID: 29999341

Abstract

Introduction

The association of partner autonomy support with women’s motivation for healthy eating, weight-related health behavior change, and psychological well-being, has been largely overlooked. Results of two studies showed that the positive association between autonomy support and a variety of motivational and psychological outcomes was especially pronounced for women with high BMI (+1SD) compared to low BMI (−1SD).

Methods

In Study 1, autonomy support was measured as male partners’ report of their behavior in a cross-sectional design. In Study 2 autonomy support was measured as female participants’ perceptions of their partners’ behavior in longitudinal home environment-based behavioral weight loss intervention.

Results

Study 1 showed that autonomy support from partners was associated with greater self-determined motivation for healthy eating and self-reported well-being, among women with higher BMI. Study 2 showed that changes in partner autonomy support over 18 months of a home-based weight loss intervention were associated with increases in motivation for treatment and greater weight loss, especially for women who had higher baseline BMI.

Discussion

Both studies demonstrated that autonomy support was associated with adaptive functioning across weight status, but that it was especially potent for women with higher BMI. This pattern of findings is explained in terms of the pressures women with higher BMI may feel about their weight-related behaviors.

Social ecological models suggest that the social environment in which individuals are attempting weight loss is crucial (De la Haye, Robins, Egger & Swinburn, 1997; Mohr & Wilson, 2011, 2010; Gorin, Powers, Koestner, Wing & Raynor, 2014; Gorin et al., 2008; Hruschka, Brewis, Wutich, & Morin, 2011). Findings show that involving partners, spouses (Espeland et al., 2009; Wing et al., 1991), and environmental supports (Gorin et al., 2013) in a weight loss intervention can be beneficial, especially for women, compared to standard individually-focused treatment. Similarities in weight change trajectories among spousal partners also highlight the influence of dyadic dynamics on health behavior change (Cornelius, Gettens, & Gorin, 2016). The social/interpersonal environment likely sets the stage for successful (or unsuccessful) weight loss and maintenance, and requires further consideration.

Research grounded in self-determination theory (SDT) emphasizes the importance of the social/interpersonal environment in the development of obesity (Ryan & Deci, 2017; Ryan, Patrick, Deci, & Williams, 2008; Trief, Cibula, Delahanty, & Weinstock, 2017; Williams, Grow, Freedman, Ryan, & Deci, 1996; Williams, Lynch & Glasgow, 2007; Williams, Minicucci, Kouides, Levesque, Chirkov et al., 2002). SDT posits that autonomy support, (i.e., acknowledging an individual’s feelings and perspective, refraining from pressure and criticism, and encouraging self-initiation) can facilitate health-related goal progress by engendering autonomous motivation (i.e., personally meaningful reasons for behavior rather than being driven by external or internal pressure) toward healthy behaviors (Reeve, Bolt, & Cai, 1999; Ryan & Deci, 2017). Research guided by SDT has linked autonomy support to goal progress, greater relationship quality, and personal well-being (Koestner et al., 2012; Powers et al., 2015, 2008, 2007). Furthermore, work by Gorin et al., (2014) has demonstrated that autonomy support, provided by partners and important others, can promote increased autonomous motivation for weight-related behavior change. In one recent study, autonomy support from one’s existing social network (e.g., family, spouses, and friends), was positively associated with weight loss at 6- and 18-month follow-up (Gorin et al., 2014, 2013).

Despite substantial evidence that autonomy support plays a crucial role in the weight loss process, little is known about whether such support influences certain individuals or groups more than others (Trief et al., 2017). For example, the experience and psychological implications of overweight and obesity affect women differently than men based on social norms (Ali & Lindstrom, 2006; Shentow-Bewsh, Keating & Mills, 2016). Evidence supports that women living with overweight or obesity are more likely to be subjected to evaluative feedback concerning their weight, and may become sensitized to weight-related criticism. It is conceivable that these women may benefit most from support that includes empathic responding and fosters greater autonomy. Therefore, it is crucial to build on evidence that autonomy support from partners can influence women’s motivation for weight-related health behavior change, and to explore the potential moderating effect of women’s weight status.

No study to date has used SDT principles to examine the association between autonomy support and motivation for healthy eating or weight-related goal progress among women of varying weight status. Of the few studies conducted within a SDT framework, findings demonstrated that women’s perception of autonomy support from health educators mediated increased autonomous motivation for physical activity (Silva et al., 2011), and that autonomy support provided by family and friends significantly predicted short-term weight loss at 1-month follow-up, and moderated the effects of a low intensity health behavior change intervention for female undergraduates (BMI range 18.79 kg/m2 – 41.64 kg/m2) (Powers, Koestner, & Gorin, 2008). However, these studies did not distinguish between multiple categories of excessive weight status among their female samples. We propose that autonomy support will be associated with motivation and adaptive functioning, specifically for women with high body mass index (BMI).

Present studies

We conducted two studies to explore the complexities of support style, psychological factors, and weight loss outcomes. We measured perceived and reported autonomy support from male romantic partners on women’s motivation for regulating eating behavior, psychological well-being, and weight loss success. The use of two distinct populations of women and study designs allowed for examination of our hypotheses across multiple weight-related contexts and provides greater confidence in any patterns detected. Furthermore, we captured two complementary perspectives of autonomy support; the perspective of men providing support to their partners (Study 1) and the perspective of women receiving support (Study 2).

Study 1 examined attitudes toward eating among women whose partners reported the extent to which they provide autonomy support for their female partners’ eating behaviors. Data for Study 1 were collected from a community-based survey study in Montreal, Quebec. To further explore the pattern of findings from Study 1, Study 2 made use of a longitudinal weight loss intervention targeting partners from the community and their home environment. We examined the association between perceived autonomy support and weight loss over 18 months. Our study utilized a subset of existing data, collected in the Lifestyle Eating and Activity Program (LEAP) to address new research questions that were not examined in the original study (Gorin et al., 2013). Analyses included only women who were engaged in the LEAP intervention as either primary participants or partners with a male spouse or otherwise committed male partner. We hypothesized that women with high BMI would benefit most from having partners who were autonomy supportive of their healthy eating efforts.

Study 1

Methods

Participants

Participants were 156 heterosexual couples from the province of Quebec, Canada. Women reported their height and weight (22% = obese, 17.6% = overweight, 60.4% normal weight). Mean age was 44.25 for men (SD = 13.14 years) and 43.74 for women (SD = 12.21 years). Most participants identified as Caucasian (98.7%). The average relationship length was 11.05 years (SD = 5.96 years). Regarding relationship status, 61.54% of couples were married, 31.41% were cohabitating, and 7.05% were dating. Women’s average BMI was 26.64 kg/m2 (SD = 5.22).

Procedure

Participants were recruited by a professional survey firm (BIP – Bureau d’intervieweurs professionnels) in the Province of Quebec (http://www.bipresearch.com). Inclusion criteria were being a French-Canadian couple between the ages of 20 and 80. Individuals interested in participating were directed to an online survey website that contained questionnaires. All measures were completed via the Internet. Upon completion of the questionnaires, participants were entered in a prize drawing. All study procedures were reviewed and approved by the Ethics Committee of Université du Québec à Trois-Rivières.

Measures

Demographic variables

Participants completed demographic questions including age, education, occupation, income, relationship status, and relationship length.

Body mass index

Women’s BMI (kg/m2) was calculated using self-reported height and weight.

Men’s provision of autonomy support to their partner

Men were asked to report on the autonomy support they provided to their female partner regarding her eating regulation goals, using the 6-item autonomy support subscale developed by Koestner et al. (2012). A sample item is “I make sure that my partner is able to be open with me about her goals.” In the present study, the Cronbach alpha value for this scale was .90. Responses were scored on a 7-point Likert scale, ranging from (1) “Not at all true” to (7) “Very true.”

Healthy eating regulation

The Regulation of Eating Behaviors Scale (Pelletier, Dion, Slovinec-D’Angelo, & Reid, 2004) was used to assess autonomous and controlled regulation of eating behaviors. Women reported the extent to which each of the 24 items corresponded to reasons they regulate their eating behaviors. Responses were scored on a 7-point Likert scale, ranging from (1) “Does not correspond at all” to (7) “Corresponds exactly.” In the present study, the Cronbach alpha values for the autonomous and controlled regulation scores were .92 and .75 respectively. Sample items are: “…because I take pleasure in fixing healthy meals” (autonomous regulation) and “…because I would feel ashamed of myself if I was not eating healthy” (controlled regulation). Motivation scores were standardized and computed as an index of self-determined motivation for healthy eating by subtracting the controlled motivation score from autonomous motivation.

Psychological well-being

Women’s psychological well-being was assessed in terms of positive and negative affect and life satisfaction. Participants completed a 9-item scale of affect (Emmons, 1992) that included four positive (e.g., joyful) and five negative (e.g., frustrated) items, and the 5-item Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985). All items were rated from (1) “Strongly disagree” to (7) “Strongly agree.” Psychological well-being was calculated as the mean across the measures (after reversing the negative affect score). Each of the scales was internally reliable (all alphas > .80).

Perceived criticism

Four items (α = .86) from the Weight and Dieting Questionnaire were used to measure women’s perceived criticism from their male partner (see Pole, Crowther, & Schell, 2004, for similar procedure). A sample item is “How often does your spouse make negative or critical comments about your weight?” Responses were scored on a 7-point Likert-type scale from (1) “Never/Not at all” to (7) “Very often/Very strongly.”

Results

Preliminary Results

Table 1 shows correlations, means, and standard deviations for key variables. Men’s reported autonomy support was relatively high and women reported moderately high well-being. Women’s BMI was significantly negatively related to self-determined eating motivation but unrelated to well-being. Males’ autonomy support was significantly positively related to women’s self-determined eating motivation and well-being. Women’s perceived criticism from their male partner was negatively associated with men’s reported provision of autonomy support (r = −.23, p < .01), demonstrating the link between women’s experience and men’s report of supportive behavior.

Table 1.

Study 1: Correlations, Means, and Standard Deviations of BMI, Partner Autonomy Support, Self-Determined Motivation, and Well-Being

Variable BMI Partner Autonomy Support Self-Determined Motivation M SD
1. BMI — 26.64 5.22
2. Partner Autonomy Support −.01 – 5.37 1.30
3. Self-Determined Motivation −.30** .26** – 0.00 1.47
4. Well-being .02 .25** .31** 5.58 0.77
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Note. BMI = Body Mass Index;

**

p < .01.

Self-determined regulation of healthy eating behaviors

For each outcome variable (i.e., self-determined regulation of eating behaviors, psychological well-being), we conducted two moderated hierarchical regression analyses. Centered scores of women’s BMI and men’s autonomy support were entered as the first step, followed by their interaction term. Women’s BMI and men’s autonomy support accounted for a significant multiple R of .45, F (3,152) = 12.68 (Table 2). Women’s BMI was significantly negatively associated with self-determined eating motivation (beta = −.30, t = −3.83, p < .001) whereas partner autonomy support was significantly positively associated with self-determined eating motivation (beta = .26, t = 3.45, p < .001). The interaction of women’s BMI and men’s autonomy support was also significantly related to women’s motivation for healthy eating (beta = .22, t = 3.00, p < .01). Simple slopes were plotted using the procedure by Aiken and West (1991). Inspection of simple slopes is useful to visualize how one variable moderates the association between two other variables (James & Brett, 1984). As BMI and autonomy support are continuous variables, simple slopes were examined at high (+1SD) and low (−1SD) levels. Figure 1 shows that men’s provision of autonomy support was especially associated with higher self-determined eating motivation for women with high BMI.

Table 2.

Study 1: Moderated Hierarchical Regression Analyses for BMI, Partner Autonomy Support and the Interaction Term as Predictors of Self-Determined Motivation and Subjective Well-Being

R R2 β t p
SELF-DETERMINED MOTIVATION
 Step 1: BMI .30 .09 −.30 −3.83 < .001
 Step 2: Partner Autonomy Support .39 .15 .26 3.45 < .01
 Step 3: BMI X Partner Autonomy Support .45 .20 .22 3.00 < .01
SUBJECTIVE WELL-BEING
 Step 1: BMI .02 .00 .02 0.29 .77
 Step 2: Partner Autonomy Support .26 .07 .26 3.26 < .01
 Step 3: BMI X Partner Autonomy Support .33 .11 .21 2.75 < .01
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Note. BMI = Body Mass Index. The three steps represent the order of entry for the variables, a procedure that allows for analysis of the unique additive contribution of the different predictors.

Figure 1.

Figure 1

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Interaction between women’s BMI and men’s provision of autonomy support on women’s self-determined regulation of healthy eating behaviors (Study 1). AS = autonomy support. As BMI and AS are continuous variables, simple slopes are examined at high (+1 standard deviation) and low (−1 standard deviation) levels of the two variables (Aiken & West, 1991).

Psychological well-being

Hierarchical multiple regression results revealed that women’s BMI and men’s autonomy support accounted for a significant multiple R of .33, F (3,152) = 6.24, p < .01. Women’s BMI was unrelated to well-being (beta = .02, t = 0.29, p = .77) whereas partner autonomy support was significantly positively associated with well-being (beta = .26, t = 3.26, p < .01). The interaction of women’s BMI and men’s autonomy support was also significantly related to women’s well-being (beta = .21, t = 2.75, p < .01). Inspection of simple slopes (Aiken & West, 1991) revealed that men’s provision of autonomy support was associated with higher well-being for women with high BMI. The graphic pattern of the interaction matched that displayed in Figure 1.

Given these findings, we conducted a second study to test whether women’s baseline BMI would moderate the association of perceived partner autonomy support with motivation and weight loss over time. Study 2 used existing data from an 18-month behavioral weight loss intervention involving spousal support partners (Gorin et al., 2013).

Study 2

Methods

Methods and procedures are outlined in detail in the original paper (Gorin et al., 2013) and briefly reviewed below.

Participants

Study 2 utilized data from the Lifestyle Eating and Activity Program (LEAP), a randomized controlled trial comparing standard behavioral weight loss treatment (BWL) to BWL plus home environment changes (BWL+H). Individuals eligible for LEAP were 21-70 years old, had a BMI between 25kg/m2-50kg/m2, and a household member willing to participate in the study as a support partner. Partners had to reside in the same home as primary participants, be between 15 and 70 years old, and have a BMI between 25 kg/m2-70 kg/m2. For Study 2 we examined women in the BWL+H condition whose identified support partner was their spouse or romantic partner. This yielded a sample of 61 women (MAge = 47.5 ±11.3 years; 84.3% Caucasian) with overweight or obesity (MBLBMI = 36.7 kg/m2± 6.2 kg/m2).

Intervention

Participants met weekly for 6 months, then bi-monthly for 12 months. Participants were prescribed a standard calorie and fat restricted diet (e.g., 1200-1800 kcals/day and 30% fat, depending on initial weight), a physical activity goal of > 200 minutes of moderate intensity physical activity per week by program completion (Wadden et al., 2006), behavioral weight loss skills (e.g., self-monitoring, goal setting, problem solving), and weight loss maintenance strategies. The BWL+H condition targeted the individual and home environment by providing participants with resources including exercise equipment, digital food and body weight scales, mirrors, low-calorie cookbooks, and exercise magazine subscriptions. Partners were encouraged to engage in the same weight loss strategies as primary participants to model healthy behaviors in the home.

Measures

Assessments were conducted at baseline and 18-month time points. BMI was calculated as weight, measured by research staff to the nearest 0.1 kg, divided by height, measured in meters2 (kg/m2). Demographic information was collected at baseline via self-report.

Perception of autonomy support from partners

The 15-item Important Other Climate Questionnaire (IOCQ; Williams et al., 2006) was used to assess women’s perception of autonomy support from their partner. Items were rated on a 7-point Likert scale from (1) “Not true at all” to (7) “Very true”. All questions, apart from one, were stated in the positive direction, for example, “I feel that my partner has provided me choices and options about my weight.” The IOCQ has strong validity as demonstrated across prior studies (Gorin et al., 2013; Williams et al., 2006). Change scores (from baseline to 18 months) were calculated for this variable.

Women’s self-determined motivation for weight control

The 12-item Treatment Self-Regulation Questionnaire (TSRQ; Ryan & Connell 1989) was used to assess change in women’s self-determined reasons for weight control. Change was calculated from baseline to 18-month follow-up. Six items assess autonomous reasons for weight control (e.g., “I want to lose weight because it is consistent with my life goals”) and six items assess controlled reasons (e.g., “I want to lose weight because others would be upset with me if I didn’t”). An index was created by subtracting controlled motivation from autonomous motivation. All items were rated on a 7-point Likert scale from (1) “Not true at all” to (7) “Very true”. The range of possible scores is 6-42 for both scales. The TSRQ scales demonstrate adequate reliability and validity (autonomous self-regulation, α = .82; controlled self-regulation, α = .83; Gorin et al., 2014).

Results

Preliminary Results

Table 3 shows means, standard deviations, and correlations for key variables. Women’s BMI at baseline and 18 months were highly correlated. Women’s baseline BMI was unrelated to the other variables. Women’s BMI at 18 months was significantly negatively associated with autonomy support and self-determined motivation. Finally, men’s autonomy support and women’s self-determined motivation were significantly positively related.

Table 3.

Study 2: Correlations, Means, and Standard Deviations of BMI (at Baseline and 18 months), Motivation for Treatment (at Baseline and 18 months), and Change in Partner Autonomy Support Over 18 months

Variable BMI Baseline BMI 18 months Motivation for Treatment at Baseline Motivation for Treatment at 18 months M SD
1. BMI Baseline — 34.13 6.55
2. BMI 18 months .80** — 31.22 6.51
3. Motivation for Treatment at Baseline .05 .03 — 0.00 1.26
4. Motivation for Treatment at 18 months −.08 −.25* .59** — 0.00 1.42
5. Change in Partner Autonomy Support Over 18 months −.05 −.35** .08 .39** −0.02 1.07
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Note. BMI = Body Mass Index;

**

p < .01,

*

p < .05.

Self-determined regulation of treatment

For each outcome variable (i.e., self-determined regulation of treatment, weight loss over 18 months), we conducted two moderated hierarchical regression analyses. Baseline motivation, women’s BMI, and perceptions of change in partner autonomy support accounted for a significant multiple R of .76, F (4,57) = 18.51, p < .001. Women’s baseline BMI was not associated with self-determined treatment motivation at 18 months (beta = −.11, t = −1.02, p = .31). Baseline motivation was positively related to motivation at 18 months (beta = .60, t = 5.66, p < .001). Change in partner autonomy support from baseline to 18 months was significantly positively associated with self-determined eating motivation at 18 months (beta = .34, t = 3.45, p < .01). The interaction of women’s BMI and partner’s autonomy support was also significantly related to change in women’s motivation for healthy eating (beta = .33, t = 3.59, p < .01) (Table 4). Inspection of simple slopes (Aiken & West, 1991) revealed that partner’s provision of autonomy support was associated with higher self-determined treatment motivation for women with high BMI (see Figure 2).

Table 4.

Study 2: Moderated Hierarchical Regression Analyses for Baseline BMI, Change in Partner Autonomy Support and the Interaction Term as Predictors of Self-Determined Motivation and BMI at 18 Months

R R2 β t p
SELF-DETERMINED TREATMENT MOTIVATION AT 18 MONTHS
  Step 1: Baseline BMI .60 .36 −.11 −1.02   .31
   Baseline Motivation .60 5.66 <.001
  Step 2: Change in Partner Autonomy Support .69 .47 .34 3.45 <.01
  Step 3: BMI X Change in Partner Autonomy Support .76 .57 .33 3.59 <.01
BMI AT 18 MONTHS
  Step 1: Baseline BMI .80 .64 .80 10.20 <.001
  Step 2: Change in Partner Autonomy Support .85 .73 −.30 −4.42 <.001
  Step 3: BMI X Change in Partner Autonomy Support .89 .78 −.24 −3.82 <.001
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Note. BMI = Body Mass Index. The three steps represent the order of entry for the variables, a procedure that allows for analysis of the unique additive contribution of the different predictors.

Figure 2.

Figure 2

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Interaction between women’s baseline BMI and men’s change in provision of autonomy support on women’s self-determined regulation of treatment (Study 2). AS = autonomy support. As BMI and AS are continuous variables, simple slopes are examined at high (+1 standard deviation) and low (−1 standard deviation) levels of the two variables (Aiken & West, 1991).

Weight loss over 18 months

Women’s BMI and perceptions of partner autonomy support accounted for a significant multiple R of .755, F (4,56) = 69.08. Change in partner autonomy support from baseline to 18 months was significantly negatively related to women’s BMI at 18 months (beta = −.30, t = −4.42, p < .001). The interaction of women’s BMI and change in partner’s autonomy support was also significantly related to BMI at 18 months (beta = −.24, t = −3.82, p < .001) (Table 4). Inspection of simple slopes (Aiken & West, 1991) revealed that partner’s’ provision of autonomy support was especially associated with higher weight loss.

General Discussion

The present investigation provides evidence that women’s BMI moderates their response to autonomy support from romantic partners. Greater benefit was noted among women with high BMI compared to women with lower BMI. This pattern was seen for healthy eating motivation in Study 1 and weight-loss treatment motivation in Study 2. For women with high BMI, autonomy support was also associated with higher subjective well-being (Study 1), and greater weight loss over 18 months (Study 2). Parallel results from a cross-sectional design and a longitudinal weight loss intervention strengthen our confidence in the pattern of findings, as does our assessment of autonomy support directly from partner reports (Study 1) and from women’s perceptions of support received (Study 2).

Our results suggest that women with higher BMI may benefit most from autonomy support that emphasizes personal choice (e.g., partners asking what would be most helpful, practicing active listening skills, avoiding criticism and control) in regulating their weight. Furthermore, if women have experienced weight-related stigma in the past, this stigmatization may contribute to lower feelings of self-efficacy for controlling their diet and weight (Major et al., 2014). These women may respond more favorably to receiving autonomy support for weight related behaviors from important others, specifically romantic support partners, as this may be a salient corrective experience.

Published studies show harmful psychological consequences of weight-related stigma. The effect of these stigmatizing experiences is pervasive, extending to psychological distress, symptoms of depression, higher cortisol levels, and increased risk of gaining additional weight (Hunger & Major, 2015; Hunger, Major, Blodorn, & Miller, 2015; Kahan & Puhl, 2017; Obrien et al., 2016; Tomiyama, 2014). Women with higher BMI may experience higher levels of weight-related stigma and feel additional pressure due to social factors, such as an emphasis on an idealized thin female body.

While the results of this study provide important information about ways in which autonomy support might function among women of differing weight status, the study was limited in several important ways. Participants in both studies were predominantly white, middle aged, well-educated women. Additionally, while our pattern of findings was robust and replicated in both studies, Study 2 had a small sample size. Our results, therefore, may not be generalizable to more diverse groups of women or more diverse partner support dynamics. Furthermore, because the two studies were conducted at different times and in different countries, different measures were used to assess the SDT process model and support styles, and Study 1 used self-reported height and weight to calculate BMI. Future studies should use identical measures of autonomy support and BMI status. Finally, these analyses focused only on the influence of autonomy support provided by romantic support partners.

Understanding complex aspects of partner support may inform interventions for couples, helping to maximize the positive effect that support can have on women who intend to lose weight. Additional work is needed to determine how partners can support their spouses and loved ones in choosing weight-related behaviors to maximize success. Future studies should also consider the effect of support provided by other important individuals including friends, family, and co-workers, to understand whether women with higher BMIs exhibit similar responses to autonomy support for eating-related efforts when support is provided by someone besides their romantic partner.

Acknowledgments

This research was supported by Fonds de Recherche du Québec - Société et Culture (FRQSC) and the National Heart, Lung, Blood Institute (NHLBI) HL77082

Contributor Information

Katelyn M. Gettens, Department of Psychological Sciences, University of Connecticut

Noémie Carbonneau, Department of Psychology, Université du Québec à Trois-Rivières.

Richard Koestner, Department of Psychology, McGill University.

Theodore A. Powers, College of Arts and Sciences, University of Massachusetts Dartmouth

Amy A. Gorin, Department of Psychological Sciences, University of Connecticut

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