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Deeply informed by both contemporary feminist theory and Michel Foucault's genealogical method and analytics of power work, this thesis is concerned with older women's experiences of their body self-transformation by locating its practice within a particular context-a commercial weight management setting. Based on six months of participant-observation and biographical interviews with 36 older female clients belonging to a commercial weight-loss organisation this thesis reports the results that argues that commercial weight-loss organisations appropriate and debase the askeses-practices of care of the self that Foucault theorised, increasing older women's capacities at the same time as they encourage participation in the ever tightening webs of power. The study found that Foucault's portrayal of the ways in which individuals are drawn into or pressurized to conform to expectations and normative constructs was demonstrated in the use of powerful and dominant discourses relating to aging and weight -loss dieting. Such discourses influenced older women's self-narratives and others expectations about their capabilities, behaviour and concerns. Here, there was an over-riding sense that the older women were discursively negated, and positioned as 'other', in relation to body management practices like weight-loss dieting, such that both the meanings that they attribute to their experiences of weight loss and the extent to which they could benefit from organisational resources, varied by their stage in the lifecourse. However, within these broader discursive categories I also found labyrinths of supportive discourses that were more enabling and attempted to reify these particular constructions for the older women. From this position and from the unfolding evidence I became convinced that older women as subjects of normalising disciplinary practices really are empowered at the same time that they are disempowered because other successes can follow their weight loss. Freedom is therefore not an impossibility for a normalised subject.

The two most common forms of obesity management are currently behavioural and surgical interventions. This research aimed to explore the impact of behavioural and surgical interventions on weight loss outcome and to assess the mechanisms of change involved in this process with a focus on social cognitions, adaptive and maladaptive eating. The thesis consists of three studies which were designed using the Health Action Process Approach model as a theoretical framework. For study one a longitudinal design was adopted and data were collected from individuals undergoing behavioural and surgical weight loss interventions pre-treatment, at three months and six months post-treatment. Part one investigated the differences in social-cognitions between individuals undergoing behavioural and surgical interventions and parts two to four investigated predictors of adaptive and maladaptive eating and their role in weight loss. Building on this, study two used a qualitative design to investigate the long-term experience of patients undergoing surgery for weight loss with a particular focus on eating behaviour. Finally, study three was a Randomised Controlled Trial of a planning prompt to enhance weight reduction in individuals undergoing surgical weight loss interventions. Overall results showed that obese participants having either surgery or behavioural interventions vary along a number of different dimensions and that the roles of eating behaviours for the prediction of weight loss differ in these two populations. Not only does the mode of management influence the success of patient outcomes, but also the changes in the mechanisms necessary to bring about these outcomes. Based on the results of the studies it would seem that when trying to understand weight loss, a single model such as the HAP A although useful for study design, cannot be applied to all populations and that not only do the weightings given to different components vary between populations but also the associations between components and outcomes.

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Many studies have shown that dieting behaviour is popular amongst adolescent girls and there is a growing body of researchw hich suggests that similar patterns of dieting behaviour can be found in girls as young as 9 or 10. Although adolescent dieting is common relatively little is known about the reasons for its emergence. Previous research by Pike and Rodin (1991) found higher levels of weight concern and dissatisfactions with family functioning in mothers of eating disordered adolescent girls. The present study sought to extend this research by examining the maternal influences on weight and dieting concerns at a younger age. The present study investigated dieting motivation and underlying attitudes to weight and shape between mothers and their young adolescent daughters. Twenty girls with high dietary restraint scores were interviewed in addition to twenty girls whose restraint score fell on or below the mean. The mothers of all forty subjects were also interviewed and assessments were completed including dietary restraint,body esteem, self-esteem and body figure preferences and the family enviromnent scale. The high restraint girls reported being more dissatisfied with their body shape and tended to have lower body esteem compared to the comparison group of girls. These differences were not merely a reflection of higher body weight. Although no relationship was found between the mothers' and daughters' restraint scores the mother daughter relationship did appear to be significant in other ways. The high restraint mothers and daughters both had low body esteem scores and desired to lose more weight than the comparison group of girls and mothers. Family functioning appeared to be different between the two groups. The high restraint mothers and daughters perceived the family to be less cohesive, to have lower levels of organisation and place less emphasis on moral and religious issues. This study has reinforced the growing recognition that pre-adolescent girls may hold high dieting motivation. It has also highlighted the significance of the family system and mother-daughter relationship in the development of disordered eating. The parallel with the findings of Pike and Rodin supports the role that mothers may play in the transmission of cultural values regarding weight, shape and appearance. Importantly it also places dieting within a wider context of dissatisfaction with family functioning. Clinicians should be aware of these issues as they have important implications for early intervention and prevention of eating disorders.

Weight loss maintenance is a crucial element of effective weight management. Professional face to face contact is known to be beneficial but costly in terms of manpower in supporting weight maintenance. In the USA, the use of the internet to maintain contact and motivation with clients has been explored. This study seeks to investigate the benefits to weight maintenance of dietetic support via email with a group of successful weight loss patients from a National Health Service Dietetic Clinic.

The present thesis aimed to explore potential weight loss using Self- Compassion and Mindfulness. Interested in the Greek population due to increasing rates of obesity (see Panagiotakos et aI., 2004), this thesis starts with a chapter of translations of the Self-Compassion and Mindfulness scales and psychometric evaluations of the Greek versions (i.e., Chapter 2).The Greek versions were shown to be reliable and valid measures. Chapter 3 investigated the relationship of Self-Compassion and Mindfulness traits to weight differences in a stressful environment, and whether relationships of constructs that promote weight loss failure (e .g ., automatic thoughts) are mediated through the presence of Self-Compassion and Mindfulness traits. Higher scores in Self-Compassion and Mindfulness related to more lost weight, and the re lationship of constructs that predicted weight loss failure were intervened by Self-Compass ion and Mindfulness. Chapter 4 aimed to detennine whether and how Mindfulness and SelfCompassion relate to maladaptive eating attitudes, 8M[, and self-control. Further, meditation practices were used to explore if Mindfulness and Self-Compassion - isolated and combined predict weight loss, and questioned through follow-ups whether lost weight and learned meditat ions are maintained. Those who displayed higher scores in Self-Compassion and Mindfulness showed less maladaptive eating att itudes and more adaptive self-control. Furthe r, resu lts indicated that Self-Compassion with Mind fulness assisted more weight loss than Mindfulness and control conditions.

Commercial weight loss programmes (CWLPs) are structured weight loss programmes, which are provided to the public by commercial organisations for profit. These programmes offer a weight management service for overweight or obese adults who are willing and able to pay for their participation. There are few studies that have shown CWLPs are more effective than either usual or standard care in various healthcare settings. The extent to which elements of CWLPs contribute to weight reduction is not clear from these studies. The studies presented in this thesis aimed to i) systematically review the effectiveness of CWLPs in randomised controlled trials and ii) to evaluate the effectiveness of a pharmacist-led weight management clinic, Boots Pharmacy Weight Loss Programme (BPWLP), in achieving meaningful weight loss of the initial body weight at three months in overweight and obese clients who received a combination of orlistat, and diet and exercise advice. The systematic review evaluated percentage weight loss or change and used a narrative synthesis. Nine electronic databases (1980-2011) were searched. The review studies published in English were included and their quality was assessed, including assessment of risk of bias. The number of total titles, abstracts and full articles reviewed were 8484, 772 and 153, respectively. The final number of papers included in the review was 20 randomised studies of CWLPs, which were selected based on the application of inclusion and exclusion criteria. The evaluation of the BPWLP involved analysis of data from randomly collected customer record forms (CRFs) for clients who participated in the programme from January 2006 to January 2009. Five hundred and fifty-seven records were collected from 10 Boots pharmacies. Demographics data, history information, biometric data and information about the supply of orlistat were collected. Change in body weight (kg) was compared at baseline and three months using Wilcoxon Signed Rank Test. Seventy percent of the studies included in the systematic review were conducted in the US. There were three potential elements of effective CWLPs, which were calorie restriction, exercise and support. At 12 weeks, mean weight loss ranged from 3.3 to 12.7 kg. The mean weight loss in the BPWLP was 5.8 kg (p < 0.001). Similarly, sensitivity analysis using last-observation-carried-forward (LOCF) showed a statistically significant weight loss (p < 0.001) associated with the BPWLP. Sixty-two percent of clients, who completed the BPWLP, lost at least 5% of their initial body weight at three months. Although the BPWLP had a high dropout rate (70%), clients mainly left the programme because they achieved their desired weight loss. The studies presented in this thesis have shown that CWLPs are effective in helping clients to lose weight. The systematic review shows that the combination of calorie restriction, structured exercise and support is an effective first-line strategy in obesity treatment. The BPWLP, which uses orlistat 120 mg in combination with advice and support on diet and exercise, was shown to be effective in achieving weight loss for clients and is considered a second-line treatment. Health care professionals and policy makers should acknowledge and adopt such strategies in order to tackle the problem of obesity. In particular, pharmacists have an important role to play in facilitating effective weight reduction through the provision of dietary and exercise advice and the prescribing of orlistat. Further study should focus on the factors which contribute to long-term weight maintenance and the cost-effectiveness of CWLPs.