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Northam K, Hinds M, Bodepudi S, Stanford FC. The Patient's Journey in Obesity within the United States: An Exercise of Resilience against Disease. Life (Basel) 2024; 14:1073. [PMID: 39337858 PMCID: PMC11433301 DOI: 10.3390/life14091073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/26/2024] [Accepted: 08/21/2024] [Indexed: 09/30/2024] Open
Abstract
Obesity is often viewed as a result of patient failure to adhere to healthy dietary intake and physical activity; however, this belief undermines the complexity of obesity as a disease. Rates of obesity have doubled for adults and quadrupled for adolescents since the 1990s. Without effective interventions to help combat this disease, patients with obesity are at increased risk for developing type 2 diabetes, heart attack, stroke, liver disease, obstructive sleep apnea, and more. Patients often go through several barriers before they are offered pharmacotherapy or bariatric surgery, even though evidence supports the use of these interventions earlier. This partially stems from the cultural barriers associated with using these therapies, but it is also related to healthcare provider bias and limited knowledge of these therapies. Finally, even when patients are offered treatment for obesity, they often run into insurance barriers that keep them from treatment. There needs to be a cultural shift to accept obesity as a disease and improve access to effective treatments sooner to help decrease the risk of health complications associated with obesity.
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Affiliation(s)
- Kayla Northam
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Dartmouth College, Lebanon, NH 03756, USA
- Department of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | - Sreevidya Bodepudi
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
| | - Fatima Cody Stanford
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Nutrition Obesity Research Center, Harvard Medical School, Boston, MA 02114, USA
- Department of Medicine-Neuroendocrine Unit and Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Allnutt AE, Smith DJ, Torrence WA, Alexander DS. Examining weight bias attitudes and obesity beliefs among undergraduate students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1814-1819. [PMID: 35834745 DOI: 10.1080/07448481.2022.2093114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 05/23/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Objective: This cross-sectional study examined the weight bias attitudes and obesity beliefs of health science (HS), nursing, and pre-medicine undergraduate students. Methods: Using snowballing and convenience sampling strategies, students (N = 139) completed an online survey, including a 24-item Antifat Attitudes Scale (AFAS) and eight-item Belief About Obese Persons (BAOP) scale. Results: HS students have higher weight bias than nursing and pre-medicine students combined (M = 43.45, SD = 10.75), t(137) = -2.45, p = .016). A negative correlation exists between AFAS and BAOP suggesting high weight bias influences a belief that obesity is controllable. Gender positively predicted weight bias attitudes (ß = -11.43, t = -4.33, p < .001) and obesity beliefs (ß = 3.75, t = 3.01, p = . 003). Conclusions: Findings confirm that HS students have weight bias attitudes. This supports undergraduate curricular changes on obesity etiology that may improve treatment plans of individuals who are obese.
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Affiliation(s)
| | - Daniel J Smith
- Concordia University Chicago, River Forest, Illinois, USA
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Clarke ED, Stanford J, Gomez-Martin M, Collins CE. Revisiting the impact of Health at Every Size® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta-analysis. Nutr Diet 2024; 81:261-282. [PMID: 38563692 DOI: 10.1111/1747-0080.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024]
Abstract
AIMS To (1) synthesise evidence from Health at Every Size® interventions on physical and psychological health in people with overweight and obesity and (2) report between-group differences within interventions evaluating the impact of Health at Every Size® interventions on health and health-related outcomes. METHODS Six databases (Medline, Embase, Cochrane, PsychInfo, CINAHL, and Scopus) were searched from inception until November 2022. Included studies were conducted in adults with overweight or obesity, used Health at Every Size®-based interventions compared with control interventions and reported dietary, physical and/or psychological outcomes, including diet quality, anthropometry, or quality of life. Data on between-group differences were extracted. Risk of bias was assessed using ROB2. Random-effects meta-analyses were undertaken for outcomes with at least three studies reporting the same or comparable data. RESULTS From 128 studies identified, 19 full-text articles (10 unique studies, 6 published since 2017), were included. Meta-analysis found a significant reduction for susceptibility to hunger in Health at Every Size® intervention groups relative to controls (p = 0.005), with no significant difference (p > 0.05) between Health at Every Size® interventions and control groups for anthropometric, psychological or cardiometabolic outcomes (total cholesterol, HDL cholesterol, triglycerides, systolic or diastolic blood pressure). CONCLUSION Health at Every Size® interventions had similar results compared with weight-based interventions on anthropometric outcomes and cardiometabolic outcomes. Health at Every Size® interventions had a significant benefit for reducing susceptibility to hunger. The decision to use a Health at Every Size®-based intervention should be personalised to individual needs. Further research in more diverse populations is required using standardised outcome measures to facilitate future meta-analyses.
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Affiliation(s)
- Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jordan Stanford
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Maria Gomez-Martin
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Pemau RC, González-Palacios P, Kerr KW. How quality of life is measured in studies of nutritional intervention: a systematic review. Health Qual Life Outcomes 2024; 22:9. [PMID: 38267976 PMCID: PMC10809546 DOI: 10.1186/s12955-024-02229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases. METHODS We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion. RESULTS Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America. CONCLUSIONS Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.
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Affiliation(s)
| | - Patricia González-Palacios
- Department of Nutrition and Food Science, University of Granada, Granada, Spain
- Biomedical Research Institute (IBS), Granada, Spain
| | - Kirk W Kerr
- Abbott Nutrition, 2900 Easton Square Place, Columbus, OH, 43219, USA.
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Schmid J, Linxwiler A, Owen E, Caplan H, Jenkins KR, Bauer KW, Zawistowski M, Weeks HM, Sonneville KR. Weight-inclusive, intuitive eating-based workplace wellness program associated with improvements in intuitive eating, eating disorder symptoms, internalized weight stigma, and diet quality. Eat Behav 2024; 52:101840. [PMID: 38134818 PMCID: PMC11002983 DOI: 10.1016/j.eatbeh.2023.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The use of weight-inclusive programming within a workplace wellness context remains understudied. METHODS The present study is a pilot/feasibility study of a 3-month, virtual, weight-inclusive, intuitive eating-based workplace wellness program. Program participants (n = 114), who were all employees at a large public university in the Midwest, received weekly emails with a link to an instructional video related to intuitive eating and were encouraged to meet virtually with their health coach. Participants provided self-report data on behavioral and psychological outcomes including intuitive eating, internalized weight stigma, eating disorder symptoms, and diet quality at baseline, post-intervention (3 months from baseline), and follow-up (6 months from baseline). Changes in behavioral and psychological outcomes from baseline to post-intervention and follow-up were examined using paired t-tests, with Cohen's d effect sizes reported. Generalized linear models were used to examine whether participant characteristics and program engagement were associated with program outcomes. RESULTS Increases in intuitive eating and decreases in internalized weight stigma and eating disorder symptoms were seen from baseline to post-intervention (Cohen's d = 1.02, -0.47, and -0.63, respectively) and follow-up (Cohen's d = 0.86, -0.31, and -0.60). No changes in dietary quality were seen at post-intervention, but a significant reduction in intake of added sugars, fast food, and sugar sweetened beverages were observed at follow-up (Cohen's d = -0.35, -0.23, -0.25). CONCLUSIONS This study provide preliminary support for the acceptability and potential impact of a weight-inclusive workplace wellness program that should be tested in a rigorous randomized trial.
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Affiliation(s)
- Jane Schmid
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Ashley Linxwiler
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Erica Owen
- MHealthy, University of Michigan Health and Well-Being Services, United States of America.
| | - Heather Caplan
- Weight Inclusive Nutrition and Dietetics, United States of America.
| | - Kristi Rahrig Jenkins
- MHealthy, University of Michigan Health and Well-Being Services, United States of America.
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Matthew Zawistowski
- Department of Biostatistics, University of Michigan School of Public Health, United States of America.
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
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Cowan S, Dordevic A, Sinclair AJ, Truby H, Sood S, Gibson S. Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study. Menopause 2023; 30:738-749. [PMID: 37192829 DOI: 10.1097/gme.0000000000002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Chronic inflammation is associated with obesity and is an underlying pathophysiology for cardiovascular disease (CVD) development in postmenopausal women. This study aims to determine feasibility and efficacy of an anti-inflammatory dietary intervention to lower levels of C-reactive protein in weight stable postmenopausal women with abdominal obesity. METHODS This mixed-methods pilot study used a single arm pre-post design. Thirteen women followed a 4-week anti-inflammatory, dietary intervention, optimizing consumption of healthy fats, low glycemic index wholegrains, and dietary antioxidants. Quantitative outcomes included change in inflammatory and metabolic markers. Focus groups were undertaken and thematically analyzed to explore participants lived experience of following the diet. RESULTS There was no significant change in plasma high-sensitivity C-reactive, protein. Despite discouraging weight loss, median (Q1-Q3) body weight decreased by -0.7 (-1.3 to 0 kg, P = 0.02). This was accompanied by reductions in plasma insulin (0.90 [-0.05 to 2.20] mmol/L), Homeostatic Model Assessment of Insulin Resistance (0.29 [-0.03 to 0.59]), and low-density lipoprotein:high-density lipoprotein ratio (0.18 [-0.01 to 0.40]) ( P ≤ 0.023 for all). Thematic analysis revealed that postmenopausal women have a desire to improve meaningful markers of health status that do not focus on weight. Women were highly engaged with learning about emerging and innovative nutrition topics, favoring a detailed and comprehensive nutrition education style that challenged their proficient health literacy and cooking skills. CONCLUSIONS Weight-neutral dietary interventions targeting inflammation can improve metabolic markers and may be a viable strategy for CVD risk reduction in postmenopausal women. To determine effects on inflammatory status, a fully powered and longer-term randomized controlled trial is required.
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Affiliation(s)
- Stephanie Cowan
- From the Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Aimee Dordevic
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | | | - Helen Truby
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Surbhi Sood
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
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Pereira RA, Alvarenga MDS, de Andrade LS, Teixeira RR, Teixeira PC, da Silva WR, Cuppari L. Effect of a Nutritional Behavioral Intervention on Intuitive Eating in Overweight Women With Chronic Kidney Disease. J Ren Nutr 2023; 33:289-297. [PMID: 35122994 DOI: 10.1053/j.jrn.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/23/2021] [Accepted: 01/01/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent women with chronic kidney disease and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group. DESIGN AND METHODS This is a prospective noncontrolled clinical trial of a behavioral multisession group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale 2, translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey questionnaire was applied to assess health-related quality of life. RESULTS Of the 33 patients who began participation in the study, 23 patients (median [interquartile range]: age = 62.0 years [58.0-68.0]; 52.2% with diabetes; body mass index = 32.6 kg/m2 [30.2-39.3]; estimated glomerular filtration rate = 28.0 mL/min/1.73 m2 [22.0-31.0]) completed the intervention. Except for the IE subscale Body-Food Choice Congruence, the IE total score and all its subscales (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) improved after the intervention. In a cross-sectional analysis, more intuitive eaters were older and had better scores for health-related quality of life. CONCLUSIONS The nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of chronic kidney disease patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.
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Affiliation(s)
| | - Marle Dos Santos Alvarenga
- Post Graduation Program in Public Health Nutrition, Public Health School, University of São Paulo, São Paulo, Brazil
| | | | | | - Paula Costa Teixeira
- Eating Disorders Program, Psychiatry Institute, Clinical Hospital of Medicine School, University of São Paulo, São Paulo, Brazil
| | - Wanderson Roberto da Silva
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University, Araraquara-SP, Brazil
| | - Lilian Cuppari
- Nutrition Program, Federal University of São Paulo, São Paulo, Brazil; Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
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Hagan S, Nelson K. Are Current Guidelines Perpetuating Weight Stigma? A Weight-Skeptical Approach to the Care of Patients with Obesity. J Gen Intern Med 2023; 38:793-798. [PMID: 36138274 PMCID: PMC9971382 DOI: 10.1007/s11606-022-07821-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
Significant controversy exists regarding the evidence to support the clinical benefits and risks of weight loss interventions for individuals with obesity. United States Preventative Task Force (USPSTF) guidelines recommend weight loss for all individuals with obesity while weight-neutral models such as Health at Every Size promote weight inclusivity, focusing on body acceptance rather than weight loss. We discuss how lifestyle-based weight-centric paradigms, such as the USPSTF Guidelines, may increase weight stigma and weight cycling, and many of their purported clinical benefits are not supported by existing evidence. However, we also acknowledge the clear benefits of metabolic surgery in high-risk individuals, and the potential benefits for pharmacotherapy for obesity in selected patients. Herein we describe a weight-skeptical approach to the care of patients with obesity that aims to use available evidence to support patient-centered care.
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Affiliation(s)
- Scott Hagan
- VA Puget Sound Health Care System, Seattle, WA, USA.
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
| | - Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Hensley-Hackett K, Bosker J, Keefe A, Reidlinger D, Warner M, D'Arcy A, Utter J. Intuitive Eating Intervention and Diet Quality in Adults: A Systematic Literature Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1099-1115. [PMID: 36274010 DOI: 10.1016/j.jneb.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/07/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality. METHOD PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively. RESULTS Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed. DISCUSSION Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality. IMPLICATIONS FOR RESEARCH AND PRACTICE Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.
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Affiliation(s)
- Katie Hensley-Hackett
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Josephine Bosker
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ashleigh Keefe
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Dianne Reidlinger
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Molly Warner
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; My Nutrition Clinic, Robina, Queensland, Australia
| | - Anna D'Arcy
- My Nutrition Clinic, Robina, Queensland, Australia
| | - Jennifer Utter
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Department of Dietetics and Foodservices, Mater Health, South Brisbane, Queensland, Australia.
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Quinn N, Zeglin RJ, Boggs C, Glusenkamp H, Rule M, Hicks-Roof K, Terrell KR. Sex at every size: A content analysis of weight inclusivity in sexual functioning research. Body Image 2022; 43:420-428. [PMID: 36345080 DOI: 10.1016/j.bodyim.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
Sexual functioning research has been slow to address sizeism within its volumes. Much of the sexual health science has adopted a weight normative model rather than a weight inclusive model. The purpose of this study was to, through systematic literature review, describe the sexual functioning research landscape with respect to weight inclusivity. The review included three databases (Google Scholar, Medline and Ebsco) between 2010 and 2020. Each article was double coded for weight inclusivity and sexual functioning. Sixty-seven articles met the criteria and were included in analysis. The articles, overall, only endorsed weight inclusive tenets 16 % of the time. Articles were most weight inclusive when discussing sexual satisfaction (22.5 %). Meanwhile, when discussing sexual arousal, the articles were the least weight inclusive (16.7 %). These findings suggest there is needs to be greater education and intention for sex educators, therapists, and clinicians, to explore and enhance body positivity and sexual health.
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11
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Esteves GP, Mazzolani BC, Smaira FI, Mendes ES, de Oliveira GG, Roschel H, Gualano B, Pereira RMR, Dolan E. Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy. Rheumatol Adv Pract 2022; 6:rkac029. [PMID: 35539442 PMCID: PMC9080102 DOI: 10.1093/rap/rkac029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022] Open
Abstract
Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We review available evidence in this area and provide nutritional recommendations that might ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, might counteract some of the specific challenges faced by these patients. Importantly, we identify a dearth of empirical data on how nutritional intervention might impact health-related outcomes in this population. Further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.
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Affiliation(s)
- Gabriel P Esteves
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Bruna Caruso Mazzolani
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Elizabeth Silva Mendes
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Gabriela Guimarães de Oliveira
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Rosa Maria R Pereira
- Bone Metabolism Laboratory, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
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Savila F, Leakehe P, Bagg W, Harwood M, Letele D, Bamber A, Swinburn B, Goodyear-Smith F. Understanding engagement with Brown Buttabean Motivation, an Auckland grassroots, Pacific-led holistic health programme: a qualitative study. BMJ Open 2022; 12:e059854. [PMID: 35393331 PMCID: PMC8990259 DOI: 10.1136/bmjopen-2021-059854] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The aim was to understand how participants engage with Brown Buttabean Motivation (BBM) a grassroots, Pacific-led holistic health programme and the meaning it has in their lives. The objectives were to explore the impact BBM had on all aspects of their health and well-being, what attracted them, why they stayed, identify possible enablers and barriers to engagement, and understand impact of COVID-19 restrictions. DESIGN Qualitative study with thematic analysis of semi-structured interviews of BBM participants, followed by theoretical deductive analysis of coded data guided by Pacific Fonofale and Māori Te Whare Tapa Whā health models. In this meeting-house metaphor, floor is family, roof is culture, house-posts represent physical, mental, spiritual and sociodemographic health and well-being, with surroundings of environment, time and context. SETTING Interviews of BBM members conducted in South Auckland, New Zealand, 2020. PARTICIPANTS 22 interviewees (50% female) aged 24-60 years of mixed Pacific and Māori ethnicities with a mixture of regular members, attendees of the programme for those morbidly obese and trainers. RESULTS Two researchers independently coded data with adjudication and kappa=0.61 between coders. Participants identified the interactive holistic nature of health and well-being. As well as physical, mental and spiritual benefits, BBM helped many reconnect with both their family and their culture. CONCLUSIONS BBM's primary aim is weight-loss motivation. Many weight loss studies provide programmes to improve physical exercise and nutrition, but seldom address sustainability and other core factors such as mental health. Programmes are often designed by researchers or authorities. BBM is a community-embedded intervention, with no reliance external authorities for its ongoing implementation. It addresses many factors impacting participants' lives and social determinants of health as well as its core business of exercise and diet change. Our results indicate that BBM's holistic approach and responsiveness to perceived community needs may contribute to its sustained success.
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Affiliation(s)
| | - Paea Leakehe
- Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Warwick Bagg
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | | | | | - Boyd Swinburn
- Epidemiology & Biostatistics, The University of Auckland, Auckland, New Zealand
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13
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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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14
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Jessen-Winge C, Ilvig PM, Thilsing T, Lee K, Fritz H, Christensen JR. Health professionals' perceptions of weight loss programmes and recommendations for future implementation: a qualitative study. BMJ Open 2020; 10:e039667. [PMID: 33208329 PMCID: PMC7677371 DOI: 10.1136/bmjopen-2020-039667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Obesity is an increasing public health challenge and most weight loss programmes are still inadequate to support sustainable weight loss. One reason for the continued lack of success might be the dominant biomedical, individualised approach to weight loss. Holistic approaches that focus on overall health and well-being in addition to weight loss are increasingly recommended. In Denmark, health professionals in the municipalities are responsible for developing and conducting weight loss programmes. The objective of this study was to explore what health professional's perceived as an ideal, holistic weight loss programme that could be feasibly implemented in the municipalities. DESIGN A phenomenological-hermeneutical qualitative study was performed using semistructured interviews. SETTING Thirty-two Danish municipalities were weight loss programmes are developed and conducted. PARTICIPANTS Thirty-five health professionals with experience conducting weight loss programmes. RESULTS Three themes emerged from the analysis: Support from the social network are important both during and after a weight loss, Changing the self-belief by positive discussions and doing activities, Maintaining changes through daily life. CONCLUSION Future municipal weight loss programmes should emphasise overall health and well-being instead of weight loss and adopt a holistic approach including a focus on social relationships, meaningful activities and successes as part of a balanced daily life.
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Affiliation(s)
- Christina Jessen-Winge
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Health, University College Copenhagen, Kobenhavn, Denmark
| | - Pia Marie Ilvig
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Trine Thilsing
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Kim Lee
- Department of Public Health, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Heather Fritz
- Department of occupational therapy, Wayne State University, Detroit, Michigan, USA
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15
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Strategies designed to increase the motivation for and adherence to dietary recommendations in patients with chronic kidney disease. Nephrol Dial Transplant 2020; 36:2173-2181. [DOI: 10.1093/ndt/gfaa177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Chronic kidney disease (CKD) often requires several dietary adjustments to control the disease-related disturbances. This is challenging for both patients and healthcare providers, and particularly for dietitians, who deal closely with the poor adherence to dietary recommendations. Factors associated with poor adherence within the CKD scenario and the need for a shift in the paradigm have already been indicated in several studies; however, rarely are any different and/or potential strategies actually formulated in order to change this paradigm. In this review, we aimed to explore the concepts and factors surrounding adherence to dietary recommendations in CKD and further describe certain potential strategies for a nutritional counseling approach. Such strategies, while poorly explored within CKD, have shown positive results in other chronic disease scenarios. It is timely, therefore, for healthcare providers to acquire these new counseling skills; nevertheless, this would require a rethinking of the traditional attitudes and approaches in order to build a partnership, based on a nonjudgmental and compassionate style in order to guide behavior change. The reflections presented in this review may contribute towards enhancing motivation and the adherence to dietary recommendations in CKD patients.
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16
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Rauchwerk A, Vipperman-Cohen A, Padmanabhan S, Parasram W, Burt KG. The Case for a Health at Every Size Approach for Chronic Disease Risk Reduction in Women of Color. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1066-1072. [PMID: 32948446 DOI: 10.1016/j.jneb.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
The conventional approach to chronic disease management in women of color is a dieting-for-weight-loss approach, which has not been proven to be effective. The purpose of this article is to highlight the shortcomings of the dieting-for-weight-loss approach and demonstrate the potential efficacy of the Health at Every Size approach when working with women of color to prevent and address chronic diseases. The article's areas of focus are weight stigma, bias, and size discrimination; the implications of differing weight perceptions and motivations for change; and weight as the primary determinant of health and biological factors affecting weight.
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Affiliation(s)
- Autumn Rauchwerk
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Anne Vipperman-Cohen
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Sridevi Padmanabhan
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Woheema Parasram
- Program in Nutrition, Health, and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Kate G Burt
- Dietetics, Foods, and Nutrition, Department of Health Sciences, Lehman College, City University of New York, New York, NY.
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17
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Weight Management Interventions for Adults With Overweight or Obesity: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 121:1855-1865. [PMID: 33069660 DOI: 10.1016/j.jand.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
The objectives of this evidence scoping review were to identify and characterize studies investigating weight management interventions provided by a registered dietitian nutritionist or international equivalent (RDN) among adults with overweight or obesity. A medical librarian conducted an electronic literature search in 6 databases-MEDLINE (Ovid), Embase (Ovid), PyscINFO (Ovid), Cochrane CENTRAL (Ovid), Cochrane Database of Systematic Reviews (Ovid), and CINAHL (Ebsco). Except for narrative review, gray literature, and case study or report, all types of peer-reviewed articles published between January 2008 and April 26, 2019 were eligible. Two content advisors, who are experts in adult weight management, guided the process and reviewed the search plan and findings. The literature search resulted in 30,551 records with 16 additional records identified through other sources. A total of 29,756 records were excluded during the first round of screening due to duplication or irrelevancy. Of the 811 full-text articles that were screened, 139 met the criteria and were included. Approximately 51% and 43% of the studies were conducted in the community setting and in the United States or Canada, respectively. Over 97% of the studies were clinical or quasi-experimental trials. A total of 6 different intervention delivery modes were reported, which resulted in 22 combinations of the modes of delivery. RDNs delivered the weight management intervention (especially the nutrition component) in all studies, but some (61%) also involved an interdisciplinary team to deliver other components of the intervention. The average length of the intervention was about 10 months with a follow-up that ranged from 0 to 9 years. The commonly reported outcomes were anthropometrics, endocrine, and cardiovascular measures; dietary intake; and physical activity. Based on the scoping review, there were systematic reviews and evidence-based practice guidelines on weight management interventions but none of them met the a priori inclusion or exclusion criteria. Therefore, it would be beneficial to conduct a systematic review and develop an evidence-based practice guideline on adult weight management interventions provided by an RDN to guide practitioners and to evaluate their effects on health and nutrition-related outcomes.
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18
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Ramos MH, Silva JM, De Oliveira TAV, da Silva Batista J, Cattafesta M, Salaroli LB, Soares FLP. Intuitive eating and body appreciation in type 2 diabetes. J Health Psychol 2020; 27:255-267. [PMID: 32787671 DOI: 10.1177/1359105320950791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our objective was to explore the socio-demographic, clinical, and nutritional factors of body appreciation in type 2 diabetics. This is a cross-sectional observational study with 179 adults and older adults (60 ± 10 years old). Most of the sample was female (n = 133; 74.3%). Through logistic regression analysis, it was observed that being perceived as overweight was associated with a 91.6% lower chance of being satisfied with one's body. Trusting hunger and satiety cues doubled the chances of body satisfaction. Thus, eating more intuitively, attending to the signs of hunger and satiety, is associated with greater body satisfaction in type 2 diabetics.
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Affiliation(s)
| | - Julia Marcelino Silva
- Department of Integrated Health Education, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Jussara da Silva Batista
- Department of Integrated Health Education, Federal University of Espírito Santo, Vitória, Brazil
| | - Monica Cattafesta
- Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
| | - Luciane Bresciani Salaroli
- Department of Integrated Health Education, Federal University of Espírito Santo, Vitória, Brazil.,Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil.,Graduate Program in Nutrition and Health, Federal University of Espírito Santo, Vitória, Brazil
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19
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Sabatini F, Ulian MD, Perez I, Pinto AJ, Vessoni A, Aburad L, Benatti FB, Lopes de Campos-Ferraz P, Coelho D, de Morais Sato P, Roble OJ, Unsain RF, Schuster RC, Gualano B, Scagliusi FB. Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach. J Acad Nutr Diet 2019; 119:1470-1482. [PMID: 30940423 DOI: 10.1016/j.jand.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/05/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. OBJECTIVE We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DESIGN The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. PARTICIPANTS Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. RESULTS Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. CONCLUSION HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.
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