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ORIGINAL ARTICLE

The clinical obesity maintenance model: a structural equation model Dean Spirou1   · Evelyn Smith2,3   · Katie Wood1 · Jayanthi Raman1  Received: 2 July 2020 / Accepted: 25 September 2020 © Springer Nature Switzerland AG 2020

Abstract Purpose  Theoretical research on the psychological underpinnings of weight management is limited. Recently, the clinical obesity maintenance model (COMM) proposed a theoretical conceptualisation of salient psychological and neuropsychological mechanisms maintaining weight management issues. The current study aimed to empirically test the COMM and elucidate the results in the context of recent empirical findings. Methods  Participants (N = 165) were recruited from university and community settings in Australia. The sample consisted of adults with normal weight (n = 41), overweight (n = 40), and obesity (n = 84). Participants completed self-report questionnaires and a brief neuropsychological test. Structural equation modelling was used to estimate the associations between the hypothesised variables of the COMM and evaluate the model fit. Results  Findings suggested acceptable to good model fit. Furthermore, several direct effects were found. First, cognitive flexibility directly affected eating habit strength. Second, eating habit strength directly affected eating beliefs. Third, eating beliefs directly affected emotion dysregulation. Fourth, emotion dysregulation directly affected depression and binge eating with depression partially mediating this relationship. Finally, depression directly affected binge eating. Conclusion  This was the first study to empirically test the COMM. Overall, findings provide preliminary support for the COMM as a psychological model of weight management and highlight the underlying psychological and neuropsychological mechanisms that may contribute to weight management issues. As this study examined a simplified version of the COMM, future research should continue evaluating this model and consider incorporating these components into more holistic weight management models to improve long-term treatment outcomes. Level of evidence  V, cross-sectional descriptive study Keywords  Obesity · Weight management · Weight maintenance · Psychological factors

The article is part of the Topical Collection on Psychopathological models and eating and weight disorders. * Jayanthi Raman [email protected] Dean Spirou [email protected] Evelyn Smith [email protected] Katie Wood [email protected] 1



Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia

2



School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia

3

Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia



Introduction Obesity is a complex health condition that impacts societies worldwide. It places considerable economic burden on health systems and is a major risk factor for premature death and non-communicable dise