Original articleA Health at Every Size intervention improves intuitive eating and diet quality in Canadian women
Introduction
Over the last decades, the rising rates of overweight and obesity have been contrasting with the high prevalence of dieting and eating disorders. In response to the poor success rate of restrictive diets for sustainable weight loss and health improvement [1], [2], a new weight paradigm has emerged [3]. This paradigm centers on healthy eating and physical activity as promising chronic disease-prevention strategies, without focusing on weight loss [4]. One example is the Health at Every Size® (HAES®) approach, which advocates a holistic health-centered approach emphasizing self-acceptance and well-being, rather than weight loss [5] (Health at Every Size® and HAES® are registered trademarks of the Association for Size Diversity and Health). Such non-diet approaches have been found to improve eating behaviors, well-being, body image and psychological health [6].
With regards to the dietary and weight management components of HAES® interventions, they are based on intuitive eating principles [5]. Eating intuitively is eating in response to hunger and satiety cues and respecting physical body signals to determine when, what and how much to eat [7]. Intuitive eating principles aim at developing a healthy relationship between food, mind and body, and encourage the mindfulness of emotions and the pleasure derived from eating [7]. During HAES® programs, nutrition topics are addressed through discussions, experimentations, and reflections on food intakes and eating behaviors rather than through nutrition education and suggestions about healthier food choices. It can be questioned whether or not such non-diet interventions can increase the quality of food intake. Given that the HAES® philosophy encompasses intuitive eating principles, it can be expected that such programs positively influence diet quality since intuitive eaters are expected to naturally lean towards foods that support their health and body functioning [7]. As opposed to restrained eaters, who are likely to end up transgressing their own dieting rules [8], not having such rules among intuitive eaters may prevent them from food cravings. However, as raised by Smith and Hawks [9], one could wonder if intuitive eaters, who eat in accordance with personal desires [7], may end up with a lower diet quality. Limited research exists on the effects of non-diet programs on diet quality. Such interventions seem to have positive impacts on diet quality in some studies [10], [11], whereas no association was observed in others [12], [13]. These mixed results thus underline the need for further investigation.
The purpose of this study is to investigate the effects of a HAES® program on intuitive eating and diet quality in women. We hypothesized that the HAES® program increases intuitive eating and induces improvements in diet quality. We also hypothesized the presence of a positive association between intuitive eating and diet quality.
Section snippets
Overview
A HAES® program, named “Choisir de maigrir?” (“What about losing weight?”), was created in the 1990s as an alternative approach for women struggling with weight-related problems. In 2006, the Quebec government launched an action plan to reduce the prevalence of obesity and of obesity-related health problems. This HAES® program was identified as one of the actions to put forward. The program has then been implemented in various Health and Social Services Centers (HSSC) of the province of Quebec
Results
Baseline characteristics of the sample are presented in Table 3. No difference was observed between the two groups at baseline according to age, BMI, ethnicity, education, family income, intuitive eating (total and subscales scores), and HEI (total and components scores). Results from the FFQ at baseline (energy intake and servings of each group of the Canada's Food Guide) are presented in Table 4. No statistically significant difference between the two groups was observed. No difference was
Discussion
In accordance with our hypothesis, the HAES® intervention was successful at increasing the intuitive eating scores at short and long term. These results are concordant with others [13], where a 10-week intuitive eating program induced a shift away from restrictive dieting and emotional eating towards intuitive-eating lifestyle behavior. A partial regress in the changes by the 6-month follow-up was although observed, which can be partly explained by the length of the intervention (only ten
Strengths and limitations
The originality of this study is based on its evaluation of a program offered in local health centers in the province of Québec. While the quasi-experimental design could be viewed as a limitation, this real-life community context increases the public health relevance of the results. Another strength is the comparison with a control group composed of women with the same characteristics than the program participants. The real-life context however brings its limitations, such as the fact that
Conclusion
This HAES® intervention showed its efficacy at improving intuitive eating total and subscales scores. Our study also revealed that women who participated to the HAES® intervention improved the quality of their food intakes at short but not long term, and that their diet quality was positively related to their intuitive eating score. Further studies are however needed to better understand the association between diet quality and intuitive eating among the general population.
Funding sources
This research project was supported by a Canadian Institutes of Health Research (CIHR) GIR 99712 operating grant (Population Health Intervention Research) and by the Heart and Stroke Foundation.
Statement of authorship
All authors have participated sufficiently in the work to take public responsibility for the content of the paper and have read and approved the final manuscript.
Conflict of interest
Authors report no conflict of interest.
Acknowledgments
The authors would like to acknowledge the excellent work of Mélodie Daoust, Marie-Pierre Gagnon-Girouard, Julie Maltais-Giguère and Amélie Samson in different aspects of the data collection process. The authors would also like to thank ÉquiLibre–Groupe d'action sur le poids for the opportunity to use Choisir de Maigrir?, the HSSC health professionals for their help during data collection, and the participants for their collaboration throughout the study.
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- 1
At the time of the study, she was a doctoral student at the Institute of Nutrition and Functional Foods at Laval University, Québec, QC, Canada.