The Effects of a “Health at Every Size®”-Based Approach in Obese Women: A Pilot-Trial of the “Health and Wellness in Obesity” Study

This study explored the effects of Health at Every Size®-based intervention on obese women by qualitatively evaluating participants’ perception towards the program and quantitatively evaluating changes related to psychological, behavioral and body composition assessments. A prospective one-year quasi-experimental mixed-method trial was conducted. The mixed method design was characterized by a spiral method, and quantitative and qualitative findings were combined during the interpretation phase. The qualitative data involved three focus groups; and quantitative data comprised physiological, psychological and behavioral assessments. Initially, 30 participants were recruited; 14 concluded the intervention. From the focus groups, the following interpretative axes were constructed: the intervention as a period of discoveries; shifting parameters: psychological, physical and behavioral changes; eating changes, and; redefining success. Body weight, body mass index, total body fat mass and body fat percentage were significantly decreased after the intervention (-3.6, -3.2, -13.0, and -11.1%, respectively; p≤0.05, within-time effect). Participants reported being more physically active, and perceiving better their bodies. Eating-wise, participants reported that the hunger and satiety cues and the consumption of more frequent meals facilitated their eating changes. Finally, participants reported that they could identify feelings with eating choices and refrain from the restrained behavior. These qualitative improvements were accompanied by modest but significant improvements in quantitative assessments. Clinicaltrials.gov registration: NCT02102061

“É lá, perto da moça gorda”: estudo qualitativo sobre as percepções de mulheres gordas acerca de seus corpos e discriminações relacionadas ao peso corporal

We investigated fat women’s perceptions of their own bodies and their experiences with weightrelated discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental

Eating pleasure in a sample of obese brazilian women: a qualitative report of an interdisciplinary intervention based on the health at every size approach

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 Sao 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 eating119914701482sem informaçãosem informaçã

Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The “Health and Wellness in Obesity” study

<div><p>Health at Every Size^® (HAES^®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES^®-based intervention in obese women. This was a prospective, seven-month, randomized (2:1), controlled, mixed-method clinical trial. The intervention group (I-HAES^®; n = 39) took part in an intensified HAES^<b>®</b>-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES^<b>®</b>-based intervention. Before and after the interventions, participants were assessed for physiological, psychological, and behavioral parameters (quantitative data) and took part in focus groups (qualitative data). Body weight, body mass index, and waist and hip circumferences did not significantly differ within or between groups (P > 0.05). I-HAES^® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, even though the majority of the I-HAES^® participants indicated that they were engaged in or had plans to include physical activity in their routines. I-HAES^® resulted in improvements in eating attitudes and practices. The I-HAES^® group showed significantly improved all Body Attitude Questionnaire subscale and all Figure Rating Scale scores (P ≤ 0.05 for all parameters, within-group comparisons), whereas the CTRL group showed slight or no changes. Both groups had significant improvements in health-related quality of life parameters, although the I-HAES^® group had superior gains in the “physical health,” “psychological health,” and “overall perception of quality of life and health” (P = 0.05, 0.03, and 0.02, respectively, between-group comparisons) domains. Finally, most of the quantitative improvements were explained by qualitative data. Our results show that this new intensified HAES^®-based intervention improved participants’ eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels, showing that our novel approach was superior to a traditional HAES^®-based program.</p></div

Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The “Health and Wellness in Obesity” study - Fig 4

<p><b>(Left panel): Results from the intensified HAES</b>^<b>®</b><b>-based intervention group WHOQOL-BREF questionnaire pre- and post-intervention. (Right panel): Results from the control group WHOQOL-BREF questionnaire pre and post intervention.</b> I-HAES^®, intensified HAES®-based intervention group; CTRL, control group. ^§ Significant difference when compared to intensified HAES^®-based intervention group post-intervention (P ≤ 0.05). ^ø Significant difference within group post-intervention (P ≤ 0.05). ^† Significant difference when compared to intensified HAES^<b>®</b>-based intervention group pre-intervention (P ≤ 0.05).</p

Dietary frequency intake of ultra-processed foods, fruits and vegetables of women participating in a randomized controlled trial based on the Health at Every Size^® approach.

<p>Dietary frequency intake of ultra-processed foods, fruits and vegetables of women participating in a randomized controlled trial based on the Health at Every Size^® approach.</p

Representation of the codes that composed some of the resultant topics.

<p>Representation of the codes that composed some of the resultant topics.</p