Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors

Bacon, Linda; Keim, Nancy L.; Loan, Marta D. Van; Derricote, M; Gale, Barbara; Kazaks, Alexandra; Stern, Judith S.

doi:10.1038/sj.ijo.0802012

Cited by 203 publications

(238 citation statements)

References 43 publications

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“…Although this is not atypical for studies involving weight reduction (e.g., Dalle et al, 2005; 566 Douketis, Macie, Thabane, & Williamson, 2005; Fabricatore et al, 2009), attrition in weight-567 neutral programs has been shown to be better in comparison to conventional weight-management 568 programs (Bacon et al, 2002(Bacon et al, , 2005. Given that the attrition analyses revealed little evidence to 569 suggest characteristics that were predictive of study completion (aside from the significant 570 association with race/ethnicity), we can only speculate about what could have been done 571 differently to encourage better adherence at the 24-month follow-up.…”

Section: Internalized Weight Stigma Moderates Eating Behavior 24mentioning

confidence: 99%

“…drive for thinness, body dissatisfaction, poor interoceptive awareness, and depression (e.g., 84 Bacon et al, 2002;Bacon, Stern, Van Loan, & Keim, 2005; Mensinger, Calogero, Stranges, & 85 Tylka, 2016; for reviews, see Cadena-Schlam & Lopez-Guimera, 2014;Clifford et al, 2015; and 86 Schaefer & Magnuson, 2014). Although this body of research demonstrated effectiveness for 87 weight-neutral programs, what is less clear is whether there are moderators that strengthen or 88 weaken their effectiveness.…”

Section: Internalized Weight Stigma Moderates Eating Behaviormentioning

confidence: 99%

“…Although weight-neutral 507 programs (e.g., Bacon et al, 2002; Provencher et al, 2009;Robison et al, 2007), such as Health 508…”

Section: Clinical Implications and Limitations 505mentioning

confidence: 99%

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Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

2016

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT INTERNALIZED WEIGHT STIGMA MODERATES EATING BEHAVIOR 2 ! Abstract 36Weight stigma is a significant socio-structural barrier to reducing health disparities and 37 improving quality of life for higher weight individuals. The aim of this study was to examine the 38 impact of internalized weight stigma on eating behaviors after participating in a randomized 39 controlled trial comparing the health benefits of a weight-neutral program to a conventional 40 weight-management program for 80 community women with high body mass index (BMI > 30, 41 age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings 42 using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 43 24-months post-randomization. Eating behavior outcome measurements included the Eating 44Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear 45 mixed models were used to test for higher-order interactions between internalized weight stigma, 46 group, and time. Findings revealed significant 3-way and 2-way interactions between 47 internalized weight stigma, group, and time for disordered and adaptive eating behaviors, 48 respectively. Only weight-neutral program participants with low internalized weight stigma 49 improved global disordered eating scores. Participants from both programs with low internalized 50 weight stigma improved adaptive eating at 6 months, but only weight-neutral program 51 participants maintained changes at follow-up. Participants with high internalized weight stigma 52 demonstrated no changes in disordered and adaptive eating, regardless of program. In order to 53 enhance the overall benefit from weight-neutral approaches, these findings underscore the need 54 to incorporate more innovative and direct methods to reduce internalized weight stigma for 55 women with high BMI. 56Key Words: internalized weight stigma, disordered eating, intuitive eating, obesity, 57 health at every size, conventional weight-management 58 obesity is a pervasive stigmatization of people with a higher weight statusÑa stigmatization that 63 is on the rise among adults and children (Andreyeva, Puhl, & Brownell, 2008; Harriger, 64 Calogero, Witherington, & Smith, 2010;Latner & Stunkard, 2003). Indeed, weight 65 discrimination has been well-documented in educational, workplace, and healthcare settings 66 (e.g., Giel, Thiel, Teufel, Mayer, & Zipfel, 2010;Neumark-Sztainer, Story, & Harr...

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Section: Internalized Weight Stigma Moderates Eating Behavior 24mentioning

confidence: 99%

Section: Internalized Weight Stigma Moderates Eating Behaviormentioning

confidence: 99%

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Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

2016

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“…Where interventions that focus on relaxation of restraint (a so-called 'undieting' approach) have been compared with those promoting restraint, the inclusion of restraint produces better weight loss results. [49][50][51][52] Longitudinal studies overwhelmingly show that increases in restraint over time are associated with greater weight loss, 45,[53][54][55] and also with better weight maintenance after weight loss. [56][57][58][59][60] Studies of long-term weight suppressors (people who have successfully maintained a weight loss) show that this group have high levels of restraint together with low levels of disinhibition 42,[61][62][63] and report vigilant self-monitoring of eating behaviors and weight.…”

Section: Widely Used Methods Of Measuring Dietary Restraint Confound mentioning

confidence: 99%

Dietary restraint and self-regulation in eating behavior

2011

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Self-control is generally viewed as highly desirable. In the eating behavior domain, however, the dominance of restraint theory has made the proposition that individuals should attempt to control their eating more controversial. This review discusses evidence from the dietary restraint literature and from studies of self-regulation processes to examine how far self-imposed control around food can be seen as beneficial for effective weight management. Epidemiological and field study evidence provides little support for the proposition that restrained eating causes disinhibited eating patterns. Restraint is often initiated as a response to weight gain, and the co-occurrence of disinhibited and restrained eating patterns on an individual level might better be explained by restraint acting as a marker for overeating tendencies. A sustained effort to monitor and control food intake characterizes successful long-term weight maintenance, suggesting that self-regulation in the eating domain is essential for those with a tendency to gain weight. Evidence from the literature on cognitive self-regulation suggests that there may be potential for people to learn to self-regulate better, both through training and controlled exposure techniques. Integration of the disparate theories of self-regulation is needed to identify the best ways of promoting self-regulation in order to support effective weight control, both in clinical and community settings.

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“…Are patients made aware of the high likelihood of failure, of the risks, and of any alternatives (Bacon et al, 2002(Bacon et al, , 2005Goodman, 1995;Lyons and Miller, 1999;Miller and Jacob, 2001: throughout this article many of the references are from studies that researched people of one gender, usually women; age and ethnicity vary between studies.)? And if not, what is going wrong in obtaining informed consent?…”

Section: Ethics As If Health Promotion Matteredmentioning

confidence: 99%

Is A Weight-Centred Health Framework Salutogenic? Some Thoughts on Unhinging Certain Dietary Ideologies

Aphramor

2005

Soc Theory Health

125

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Does promoting weight loss improve health? This paper draws on diverse writings in empowerment, social justice, critical obesity literature, feminism and stress biology to challenge the appropriateness of the continued reliance on a reductionist metaphor of 'energy balance' in understanding fatness. It examines some of the scientific and philosophical premises underlying mainstream UK dietary antiobesity guidelines and argues that the evidence supporting a link between promoting weight-loss and improving health is, at best, contentious. A central theme is that the current weight-loss schema helps to naturalise a fatness discourse that not only represents large people in offensively stereotyped ways but also fails to integrate people's lived experience as gendered, situated bodies in an inequitable world.

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Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors

Cited by 203 publications

References 43 publications

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Dietary restraint and self-regulation in eating behavior

Is A Weight-Centred Health Framework Salutogenic? Some Thoughts on Unhinging Certain Dietary Ideologies

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