Motivation and perceived competence for healthy eating and exercise among overweight/obese adolescents in comparison to normal weight adolescents

Background The current literature on determinants of behavior change in weight management lacks sufficient studies on type of motivation among children/adolescents, on perceived competence, and in relation to healthy eating. This study aimed to investigate type of motivation and levels of perceived competence for healthy diet and exercise, as well as general self efficacy among adolescents. We hypothesized that overweight/obese adolescents would demonstrate lower autonomous motivation and perceived competence regarding diet and exercise, and lower self-efficacy in general, and that the scores would be influenced by socioeconomic factors. Methods Normal weight (n = 40, body mass index < 85% for age and gender) and overweight or obese adolescents (n = 60, body mass index ≥ 85% for age and gender) aged 13-18 years were recruited from pediatric ambulatory clinics. Information was collected about demographics, socioeconomic factors, and lifestyle behaviors. The study subjects completed a survey including the Treatment Self-Regulation Questionnaire (TSRQ) and the Perceived Competence Scale (PCS) for healthy eating and exercise, and the General Self-Efficacy Scale (GSES). Composite scores for the three scales were compared between the two groups using the using the two-sample t-test (for normal data) or the Mann-Whitney U test (for non-parametric data). Relationships between the composite scores and patient characteristics were determined using Pearson or Spearman's correlations. Results The average age of the total cohort was 15.9 ± 1.9 years. 54% were female, and 82% identified as Latino/Hispanic. In comparison to normal weight subjects, overweight/obese adolescents exhibited higher scores for controlled motivation (mean ± standard deviation 28.3 ± 9.3 vs 18.1 ± 8.1) and higher perceived competence [median and 25-75% interquartile range 22.5 (19.0-26.0) vs 20.0 (15.5-25.0)] in relation to eating a healthy diet. These differences persisted after adjustment for age, sex, paternal education, and family income. Conclusions Overweight/obese adolescents did not lack autonomous motivation but demonstrated higher controlled motivation and perceived competence for healthy eating in comparison to normal weight adolescents, independent of socioeconomic factors. In the clinical practice of weight management, providers should carefully assess adolescents for type of motivation and perceived competence, while accounting for potential barriers to behavior change.