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Dimitrov Ulian M, Pinto AJ, de Morais Sato P, Benatti FB, Lopes de Campos-Ferraz P, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Rogero MM, Sampaio G, Gualano B, Scagliusi FB. Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study. Front Nutr 2022; 9:598920. [PMID: 35273983 PMCID: PMC8902219 DOI: 10.3389/fnut.2022.598920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30–39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (β = 0.83, p <0.001), fasting glycemia (β = 0.45, p = 0.036), total cholesterol (β = 1.48, p = 0.024), LDL (β = 1.33, p = 0.012), clustered cardiometabolic risk (β = 0.18, p = 0.006), and quality of life (β = −1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Ana Jéssica Pinto
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Priscila de Morais Sato
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Fabiana B Benatti
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil.,School of Applied Sciences, State University of Campinas, Limeira, Brazil
| | | | - Desire Coelho
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Odilon J Roble
- Faculty of Physical Education, State University of Campinas, Campinas, Brazil
| | - Fernanda Sabatini
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Isabel Perez
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Luiz Aburad
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - André Vessoni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Ramiro Fernandez Unsain
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marcelo Macedo Rogero
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Food Research Center (FoRC), CEPID-FAPESP, Research Innovation and Dissemination Centers São Paulo Research Foundation, São Paulo, Brazil
| | - Geni Sampaio
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Fernanda B Scagliusi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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2
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Zafir S, Jovanovski N. The weight of words: Discursive constructions of health in weight-neutral peer-reviewed journal articles. Body Image 2022; 40:358-369. [PMID: 35149443 DOI: 10.1016/j.bodyim.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
Weight-neutral approaches to health, like the Health at Every Size® (HAES®) approach arose in response to emerging evidence showing the negative health consequences of weight-focused approaches through the effects of stigma and marginalization in many settings, including healthcare. While the discourses of dominant 'weight-normative' approaches are well-researched and described, little is known about how language and discourse is creating certain 'truths' about weight-neutral approaches. The aim of this study was to explore how academic discourses create truths about weight-neutral approaches to health. A discourse analysis of 63 academic journal articles was conducted. We found that the language used in academic literature is creating confusing and contradictory messages about weight and weight-neutral approaches to health (like the HAES® approach) through: (i) the continued use of stigmatising and normative labels like 'overweight' and 'obese', (ii) paradoxical language like 'flexible restraint', and (iii) a focus on individual responsibility and blame for health and weight without acknowledgement of broader societal and systemic factors. More research is needed to characterize weight-neutral approaches and develop a clearer framework for researchers wishing to engage with the weight-neutral paradigm of health.
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Affiliation(s)
- Shoa Zafir
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | - Natalie Jovanovski
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
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3
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The role of body composition assessment in obesity and eating disorders. Eur J Radiol 2020; 131:109227. [DOI: 10.1016/j.ejrad.2020.109227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022]
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Willer F, Hannan-Jones M, Strodl E. Australian dietitians' beliefs and attitudes towards weight loss counselling and health at every size counselling for larger-bodied clients. Nutr Diet 2019; 76:407-413. [PMID: 30811815 DOI: 10.1111/1747-0080.12519] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 01/17/2023]
Abstract
AIM Research suggests that dietitians now employ weight-neutral (WN) approaches (Health at Every Size (HAES), Intuitive Eating and non-diet) as well as more traditional weight-centric (WC) approaches (weight loss counselling) to address adult weight concerns. This study aimed to compare the knowledge of and attitudes towards WN practice compared with WC practice in Australian dietitians who work with larger-bodied clients as delineated by practice approach. METHODS A cross-sectional web-based knowledge, attitudes and practices survey was conducted with Australian dietitians who counsel adults with a body mass index >25 kg/m2 . Based on their responses, dietitians were categorised into WC (preferring weight loss counselling), WN (preferring HAES counselling) or mixed approach (MA). Between-group comparisons were conducted using Pearson's chi- squared tests for knowledge and practice and independent t-tests for attitudes. RESULTS Of the 317 respondents, 18.3% fulfilled the criteria for WN practitioners, 30.3% for WC practitioners and the remainder were classified as providing a MA. Weight-neutral approaches were more positively regarded generally than WC approaches (84.5% vs 53.9%) as well as considered professionally responsible (86% vs 58.7%) and perceived as more helpful for clients (61.2% vs 35%). Knowledge of WN practice goals was poor with only 36.9% (n = 117) of the participants indicating correctly that this mode of treatment is incompatible with a weight loss goal. CONCLUSIONS Weight-neutral practice was considered acceptable by Australian dietetics professionals who counsel larger-bodied people regardless of their personal practice preference although many displayed inaccurate knowledge of WN approaches.
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Affiliation(s)
- Fiona Willer
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mary Hannan-Jones
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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da Luz FQ, Hay P, Touyz S, Sainsbury A. Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches. Nutrients 2018; 10:E829. [PMID: 29954056 PMCID: PMC6073367 DOI: 10.3390/nu10070829] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 12/29/2022] Open
Abstract
Obesity and eating disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided to these individuals, there is a need for greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional and/or behavioral interventions simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required. Future research investigating the effects of integrated medical, psychological and nutritional treatment programs addressing weight management and eating disorder psychopathology in individuals with obesity and comorbid eating disorder behaviors—such as binge eating—is necessary.
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Affiliation(s)
- Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
- CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020, Brazil.
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Stephen Touyz
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia.
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Dietary approaches to weight-loss, Health At Every Size® and beyond: rethinking the war on obesity. SOCIAL THEORY & HEALTH 2018. [DOI: 10.1057/s41285-018-0070-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Donnachie C, Wyke S, Hunt K. Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators. BMC Public Health 2018; 18:291. [PMID: 29486743 PMCID: PMC5830073 DOI: 10.1186/s12889-018-5179-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/16/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Receiving information about one's weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men's reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences. METHODS We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis. RESULTS Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be 'like them' and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change. CONCLUSION Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings.
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Affiliation(s)
- Craig Donnachie
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Science, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS UK
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
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Webb JB, Vinoski ER, Bonar AS, Davies AE, Etzel L. Fat is fashionable and fit: A comparative content analysis of Fatspiration and Health at Every Size ® Instagram images. Body Image 2017. [PMID: 28624756 DOI: 10.1016/j.bodyim.2017.05.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In step with the proliferation of Thinspiration and Fitspiration content disseminated in popular web-based media, the fat acceptance movement has garnered heightened visibility within mainstream culture via the burgeoning Fatosphere weblog community. The present study extended previous Fatosphere research by comparing the shared and distinct strategies used to represent and motivate a fat-accepting lifestyle among 400 images sourced from Fatspiration- and Health at Every Size®-themed hashtags on Instagram. Images were systematically analyzed for the socio-demographic and body size attributes of the individuals portrayed alongside content reflecting dimensions of general fat acceptance, physical appearance pride, physical activity and health, fat shaming, and eating and weight loss-related themes. #fatspiration/#fatspo-tagged images more frequently promoted fat acceptance through fashion and beauty-related activism; #healthateverysize/#haes posts more often featured physically-active portrayals, holistic well-being, and weight stigma. Findings provide insight into the common and unique motivational factors and contradictory messages encountered in these fat-accepting social media communities.
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Affiliation(s)
- Jennifer B Webb
- UNC Charlotte, Department of Psychological Science, United States.
| | - Erin R Vinoski
- UNC Charlotte, Department of Public Health Sciences, United States
| | | | | | - Lena Etzel
- Queens University, Department of Psychology, United States
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Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 2016; 105:364-74. [PMID: 27289009 DOI: 10.1016/j.appet.2016.06.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022]
Abstract
Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight.
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Affiliation(s)
- Janell L Mensinger
- Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA, 19611, USA.
| | | | - Saverio Stranges
- Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, USA
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Lanoye A, Gorin AA, LaRose JG. Young Adults' Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development. Curr Obes Rep 2016; 5:14-22. [PMID: 26923688 PMCID: PMC5621592 DOI: 10.1007/s13679-016-0188-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight-related constructs. The aim of this review is to explore young adults' attitudes toward obesity and weight management, with particular attention to those factors that may play a role in the development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults' perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group.
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Affiliation(s)
- Autumn Lanoye
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA, 23284, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 4th Floor, Richmond, VA, 23219, USA
| | - Amy A Gorin
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 4th Floor, Richmond, VA, 23219, USA.
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