Weight science: evaluating the evidence for a paradigm shift

Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES

Re-orientating dietetic interventions for adults with eating and weight concerns: A qualitative study of the Well Now course – Part 1

© 2016 The Authors. Published by Ryerson University Library and Archives, available online: https://doi.org/10.32920/cd.v3i2.1014This research examines the impact of attending a Well Now course on participants’ wellbeing and contrasts this with their reports of previous experiences of seeking support with weight concerns. The Well Now course teaches health-gain and body respect. As such, it offers people a way of making sense of their experiences around food and eating that is premised on criticality, compassion and respect. This is the first of two articles discussing research findings. This was a qualitative, community-based study using semi-structured interviews and focus groups. The participants were women and men who had completed a 6 session Well Now course. Interviews and focus groups were recorded and transcribed verbatim and data were manually sorted. Coding categories were developed and participants’ quotes were assigned to these using thematic analysis. The study had ethics approval*. Participants described how engaging with the Well Now philosophy in a supportive group had beneficially impacted their health and sense of self-worth. The reorientation made available through Well Now enhanced psychosocial variables and behaviours known to impact on health, such as mood, self-esteem, eating/exercise habits and interpersonal relationships. They recounted instances where recommendations to follow a weight-corrective approach, and attendant size bias seen in health practitioner’s attitudes, had had a detrimental impact on their wellbeing and sense of self-worth. A professional commitment to socio-politically aware practice is recommended as a means of advancing equity, helping people heal from body shame and meeting our ethical responsibilities as health practitioners.  Published onlin

Re-orientating dietetic interventions for adults with eating and weight concerns: A qualitative study of the Well Now course – Part II

© 2016 The Authors. Published by Ryerson University Library and Archives, available online: https://doi.org/10.32920/cd.v3i2.1017This research examines the impact of attending a Well Now course on participants’ wellbeing and contrasts this with their reports of previous experiences of seeking support with weight concerns. The Well Now course teaches health-gain and body respect. As such, it offers people a way of making sense of their experiences around food and eating that is premised on criticality, compassion and respect. This is the second of two articles discussing research findings. This was a qualitative, community-based study using semi-structured interviews and focus groups. The participants were women and men who had completed a six session Well Now course. Interviews and focus groups were recorded and transcribed verbatim and data were manually sorted. Coding categories were developed and participants’ quotes were assigned to these using thematic analysis. The study had ethics approval. Participants described how engaging with the Well Now philosophy in a supportive group had beneficially impacted their sense of wellbeing and self-worth. The reorientation made available through Well Now enhanced psychosocial variables and behaviours known to impact on health, such as mood, self-esteem, eating/exercise habits and interpersonal relationships. They recounted instances where recommendations to follow a weight-corrective approach, and attendant size bias seen in health practitioner’s attitudes, had had a detrimental impact on their wellbeing and sense of self-worth. A professional commitment to socio-politically aware practice, such as Well Now, is recommended as a means of advancing equity, helping people heal from body shame and meeting our ethical responsibilities as health practitioners.Published onlin

Validity of claims made in weight management research: a narrative review of dietetic articles

<p>Abstract</p> <p>Background</p> <p>The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored.</p> <p>Methods</p> <p>A narrative literature review of journal articles in <it>The Journal of Human Nutrition and Dietetics </it>from 2004 to 2008.</p> <p>Results</p> <p>Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence.</p> <p>Conclusions</p> <p>Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.</p

A Feasibility Trial Of A Co-created Digital Self-management Programme For Adults With Polycystic Ovary Syndrome (Hope PCOS)

Introduction: Polycystic ovary syndrome (PCOS) has significant impact on depression, anxiety, psychological wellbeing and health-related quality of life. We co-created a theory-led, evidence-based, 6-week, digital self-management and positive wellbeing intervention (Hope PCOS), delivered to UK adults. We tested the intervention’s potential to improve mental health and wellbeing outcomes and its acceptability and usability for adults living with PCOS. Methods: This was a mixed methods feasibility randomised controlled trial conducted online, with a pre-post, waitlist-controlled design. Primary outcomes were recruitment, completion (≥ 3 intervention sessions) and follow-up rates. At baseline, participants reported demographic information, PCOS symptoms, depression (Patient Health Questionnaire (PHQ-9)), anxiety ((Generalised Anxiety Disorder Assessment (GAD-7)), polycystic ovary syndrome health-related quality of life (PCOSQ-50), psychological wellbeing (Warwick-Edinburgh Mental Wellbeing Scale, WEMWBS) and self-efficacy (Self-Efficacy to Manage Chronic Disease Scale (SEMCD6)) before randomisation to an intervention group (IG) receiving the intervention immediately or a waitlist control group (CG) receiving the intervention 12 weeks later. PHQ-9, GAD-7, PCOSQ-50, WEMWBS and SEMDC6 were reassessed at 6 and 12 weeks. IG participants reported the usability of the digital intervention (system usability scale (SUS)) and acceptability via qualitative exit interviews. Results: Of 131 eligible, consented participants, 83% (N=109, age M=37.1, SD=8.6 years) completed baseline measures and were randomised to the IG (n=54) or the CG (n=55). Baseline clinical caseness was high for depression (n=77, 70.6%) and anxiety (n=78, 71.6 %). Twenty-one participants (39%) in the IG completed ≥3 intervention sessions. At 6-week follow-up, completion of secondary outcomes was n=32 (59%) for IG and n= 38 (69%) for CG; at 12 weeks, n=31 (57%) for IG and n= 38 (69%) for CG. Twelve IG participants took part in the exit interviews. Exploratory descriptive statistics suggest there were greater improvements in depression, anxiety, psychological wellbeing, self-efficacy and quality of life for the intervention group completers compared to the waitlist control group. SUS data and thematic analysis suggest the intervention was usable, acceptable, relevant and interesting. Participants reported experiences including feeling seen and valued, having the difficulties of lifestyle change acknowledged, and learning valuable lessons, particularly how to monitor and manage emotions, prioritise self-care and complete personal goals. Conclusions: This novel intervention was rated as usable and acceptable, with potential for improving mental health and wellbeing outcomes. More research is needed to identify for whom the intervention is beneficial and on implementation in practice.<br/