Evaluation of a weight management program using the intuitive eating approach for clinically overweight and obese adults : a thesis presented for partial fulfilment of requirement for the degree of Master of Science in Nutrition and Dietetics at Massey University (Albany) New Zealand

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Background: Maintained weight loss has been shown to reduce the risks associated with excess weight. However, weight maintenance is short lived in ~80% of adults attempting weight-loss interventions that have poor long-term sustainability (e.g. calorie restriction). The non-diet approach uses intuitive eating and mindful eating practices while debunking the diet mentality. Aim: This study aimed to conduct a long-term (one year) assessment of a 24-week weight management program (Eating for your Health) using an intuitive eating approach in hospital referred overweight and obese adults. Design: Twenty-four program completers were followed up after one-year, using a mixed method approach (quantitative and qualitative). Weight, height, waist and hip circumferences were measured, and changes in eating behaviour, quality of life and program progress were assessed. Paired sample t- test and One-way Anova was used to compare changes between different time points. Three, one-hour focus groups (n=13) were conducted, using six themes. Thematic analysis was used to capture and transcribe data within these themes. Results: A significant improvement in mean (+SD) total Intuitive eating level was seen from baseline to one-year follow-up (3.33 (+ 0.39) to 3.52 (+0.46) (p<0.04 respectively). Restrained, emotional and external eating behaviour respectively, did not change significantly from baseline 2.65 (+0.78), 1.92 (+0.88), 2.51 (+0.64) to one-year follow-up 2.61 (+0.77), 1.86 (+0.85), 2.45 (+0.70). Positive change was observed in sugar intake decreasing from 4.2 to 2.2 (p=0.02) servings at one-year follow-up whereas no changes were seen for fruit, vegetable, carbohydrate, dairy, alcohol or water intake. More than half (59%) of the participants maintained their weight with 27% losing weight and 14% gaining weight. Participants believed the group setting encouraged joint activities and peer learning, whilst individual sessions with a dietitian supported personalised goal setting. Intuitive and mindful eating education and strategies was valued most, whilst unsupportive home environments, readily available food at work and cultural beliefs and practices were barriers for using this approach. Conclusion: Intuitive eating-based weight management programs can achieve weight loss and positive eating behaviour. The results from this study will aid in improving current non-diet approach programs within the hospital and implementing future programs.
Weight loss, New Zealand, Psychological aspects, Social aspects, Obesity, Prevention, Overweight persons, Attitudes, intuitive eating, mindful eating, primary healthcare weight management, group education