Abstract
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®-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES®-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.
Highlights
The rising rates of obesity and the consequent health-related effects and healthcare costs have highlighted the need for approaches to assist people who are obese
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
We showed that a 1-year Health at Every Size1 approach (HAES1)-based intervention comprising an exercise program, nutrition counseling, and philosophical workshops led to improvements in body composition, body dissatisfaction, perception of body size, and symptoms of binge eating in addition to participants reporting behavioral and attitudinal changes towards eating and physical activity, as well as improved food choices [18,19]
Summary
The rising rates of obesity and the consequent health-related effects and healthcare costs have highlighted the need for approaches to assist people who are obese. The success rate of weight-loss approaches regarding sustainable weight loss, reduction of body fat mass, maintenance of body fat-free mass, and other health benefits (e.g., clinical improvement in blood pressure, lipid profile, physical activity levels, disturbed eating behaviors, self-esteem, and body image) [4,5] is limited. In this context, weight-neutral approaches, such as the Health at Every Size approach (HAES1), are of increasing interest [6] (Health at Every Size and HAES1 are registered trademarks of the Association for Size Diversity and Health—ASDAH). The approach encourages the development of a positive body image and the acceptance of different body shapes and sizes; the promotion of eating practices that respect individual nutritional needs and the sensations of hunger, satiety, appetite, and pleasure; the promotion of enjoyable and sustainable physical activities [7]
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