Evaluating a 'health-centered' treatment approach in obese female restrained eaters.

摘要

There are currently two paradigms within the field of obesity treatment. The traditional “weight-centered” paradigm seeks to improve health by decreasing obesity through cognitive dietary restraint and weight loss, whereas an alternative “health-centered paradigm” shifts the focus to reducing cognitive restraint and improving health behaviors and self-acceptance, irrespective of weight outcome. Restrained eaters (RE) are individuals who are chronically concerned about their weight and attempt to control or reduce it by limiting their energy intake. RE have a demonstrated refractoriness towards traditional treatment, and may be better served by a health-centered “non-diet” program.; Obese female RE (n = 78), ages 30–45, body mass indices (BMI) 30–45, were stratified based on degree of dietary restraint, BMI, and age. Fifty percent were assigned to a “non-diet” treatment program oriented toward reducing their restrained eating (encouraging eating in response to physiologic cues, i.e., hunger and satiety), and 50% were assigned to a control group, a conventional behavioral energy restriction weight loss program. Both groups met weekly for six months, followed by a monthly after-care program lasting six months. The specific aims were to demonstrate maintenance or improvement in the following four areas: (1) quality of life; (2) eating behavior-, body image-, and weight-related measures; (3) physical activity; and (4) metabolic fitness.; The study is ongoing, and preliminary results are presented in three publications. The first publication notes an alarmingly high prevalence of osteoporosis/osteopenia in the subject population, which is associated with a high degree of eating restraint and a greater history of diet attempts. The second publication concludes that a non-diet program can produce similar short-term improvements in psychological health and eating behaviors, while at the same time effectively minimizing the attrition problems and feelings of failure common to participants in diet programs. The third publication documents significant improvements in many aspects of dietary quality comparable between groups, which were maintained one year post initiation of treatment. It also notes a significant increase in energy expenditure in the non-diet group, and a significant decrease in the diet group, indicating that a non-diet was more effective in helping to maintain activity improvements.