Abstract
BackgroundDieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults.MethodsGrounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives.ResultsSeveral categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively.ConclusionsThe model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.
Highlights
Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach
Emerging categories which determined dieting and non-dieting attempts included the focus of each approach; attributions about dieting failure; attitudes towards established diets; personal autonomy; perceived knowledge and self-efficacy with an approach; the time perspective of change, and the perceived identity of the person
We found that questioning claims and motives of the dieting industry in the face of a viable alternative led to a non-dieting approach, and have noted identical attitudes in overweight/obese adults blogging on the Fatosphere fat-acceptance community [44]
Summary
Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. Obese individuals perceive that these public health messages a) overemphasise the physical health risks associated with obesity while underemphasising the social (e.g., stigma) and psychological (e.g., distress) dimensions, b) focus too much on weight measurement and weight loss, c) neglect discussion of the day-to-day management of obesity-related comorbidities, d) avoid discussion of the risk behaviours which lead to obesity such as unhealthy eating and sedentary lifestyles, and e) do not convey information about the complex aetiology of obesity and the need for comprehensive solutions [6] This absence of both aetiological information and the promotion of complex, evidence-based solutions was perceived by these participants to push obese individuals towards extreme, unproven, expensive, short-lived solutions which were perceived to be unable to improve health and wellbeing. The emphasis on personal responsibility encapsulated in these public health messages appeared to produce guilt, blame, shame, and a feeling of failure in those who were obese [6]
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