Submitted to: Journal Of The American Dietetic Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/1/2005
Publication Date: 3/11/2005
Citation: Bacon, L., Stern, J.S., Van Loan, M.D., Keim, N.L. Size acceptance and intuitive eating improves health for obese female chronic dieters. Journal Of The American Dietetic Association. J Am Diet Assoc. 105(6):929-936, 2005. Interpretive Summary: In the United States, to combat the rise in obesity and overweight, public policy endorses the use of weight loss diets to achieve a reduced body weight. However, most individuals who intentionally reduce their body weights are more likely to regain weight within 1-5 years of weight loss. As an alternative to a diet approach for improving wellness in obese individuals, we tested a 'Health At Every Size' model to see if health outcomes were comparable to the traditional dieting approach. At 2 years after completing the Health At Every Size program, participants maintained body weight, risk factors related to heart disease decreased ('bad' cholesterol was reduced), eating behavior normalized, and psychological factors like self-esteem, depression and body image improved. In those participating in the traditional diet program, many of these factors improved initially, but the improvement was not sustained at 2 years. These findings are important because they demonstrate that improvements in health can occur, even when body weight does not change, if obese individuals participate in a Health At Every Size program that supports healthy lifestyle changes.
Technical Abstract: Encouraging weight loss and dieting has limited long-term success in mitigating obesity and its associated health risks. The objective of this study was to examine a model that encourages "Health At Every Size" (HAES) as opposed to weight loss. HAES supports homeostatic regulation by eating intuitively in response to internal cues of hunger, satiety and appetite. Seventy-eight obese, Caucasian female chronic dieters (30-45 years of age) were randomly assigned to either the HAES program or a traditional diet program. All volunteers participated in weekly group intervention meetings for 6 months, followed by monthly aftercare group support for 6 months. Outcome measures, including anthropometry, metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), psychology (self-esteem, depression, body image), were obtained at baseline, 6 mon post-intervention, 1-year and 2-year follow-up. Cognitive restraint decreased in HAES group and increased in Diet group, indicating that both groups implemented their programs. Attrition at 6 mon was high in Diet group (41%) compared to 8% in HAES group. Fifty percent of both groups returned for 2-y evaluation. HAES group maintained weight, improved in all outcome variables, and sustained improvements. Diet group lost weight and showed initial improvement in many variables at one year, but weight was regained and little improvement was sustained at two years. The HAES approach enabled participants to maintain long-term behavior change; Diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.