Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach

Weight-neutral interventions for people with obesity and the perspective of patients, carers and healthcare professionals: a mixed methods review

OBJECTIVES

This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the effects of weight-neutral interventions for managing obesity in children and adults (quantitative data). To explore the views, perspectives and experiences of children and adults receiving the intervention, their close family members or, if appropriate, carers, and healthcare personnel who recommend or deliver weight-neutral interventions to determine their feasibility and acceptability and any factors that create barriers and facilitators to optimal implementation (qualitative data). To determine whether the programme theories, components and delivery of interventions take account of the views, perspectives and experiences of intervention recipients and whether patient-centred interventions have greater effects.

'A healthy lifestyle is a journey': exploring health perceptions and self-defined facilitators to health through photo-elicitation

OBJECTIVE

The aim of this study was to explore health perceptions and self-defined facilitators to health in general population. An additional aim of the study was to assess if these perceptions were connected with the context of the Covid-19 pandemic.

DESIGN

We applied photo-elicitation method by gathering original photographs and narratives (captions) via social media and e-mails. Participants (N = 50) were asked to answer the question: 'What does it mean to be healthy?'. Data were collected online in Poland. We generated and interpreted the main themes associated with common perceptions of health and self-defined facilitators to health using polytextual thematic analysis.

RESULTS

The health perception themes were, health as: a 'long journey'; keeping balance; and self-acceptance. The main facilitators to health were: enjoyment of activities that are part of a healthy lifestyle; planning time for rest; contact with nature, and supportive relationships. Participants' perceptions of how Covid-19 impacted on their health differed.

CONCLUSIONS

The findings provide evidence for individual health perceptions and self-defined facilitators to health and can support the development of future health interventions.

Effects of health at every size based interventions on health-related outcomes and body mass, in a short and a long term

Objective

This study aims to provide rapid and up-to-date evidence on the effectiveness of Health at Every Size (HAES) interventions compared to controls or other conventional approaches in individuals with overweight or obesity, with the goal of developing more effective and body-diverse respectful strategies.

Methods

A review of literature was carried out using the following databases: PubMed, Scopus, Embase, Web of Science, and SciELO. Research articles were selected based on predefined inclusion and exclusion criteria. Extracted data included study characteristics (design, setting, population demographics, sample size, intervention characteristics, study duration, and follow-up period) and health-related outcomes.

Results

The search yielded 324 articles, of which 20 articles met the inclusion and exclusion criteria. The majority of studies focused on lifestyle improvement, particularly in nutrition, body image, and relationships with food, utilizing a HAES approach. Additionally, other studies examined outcomes such as general well-being, body weight, body composition, cardiovascular risk, and changes in physical activity. Long-term results were particularly noted in studies incorporating physical activity interventions.

Conclusion

HAES interventions appear to be a feasible strategy for promoting overall health and wellness, regardless of body size or shape. However, further evaluation is needed to assess the sustainability of these changes and their long-term impact, as current evidence suggest a they may not be maintained over time.

Effects of a lifestyle intervention on cardiovascular risk factors in systemic lupus erythematosus patients: The study "Living well with lupus"

OBJECTIVE

The aim of the present study was to investigate the effects of a lifestyle intervention on cardiometabolic risk factors in patients with systemic lupus erythematosus with a high cardiovascular risk profile.

METHODS

This trial was conducted in Sao Paulo, Brazil between August 2020 and March 2023. The patients were randomly assigned to lifestyle intervention or control. The intervention was a 6-month multifaced program focused on behavioral changes through personalized recommendations for increasing physical activity (structured and non-structured) and improving eating aspects. Cardiometabolic risk score (primary outcome), anthropometry and visceral fat, aerobic capacity, blood pressure, inflammatory and oxidative stress markers, and blood flow and endothelial function were assessed before and after the intervention.

RESULTS

A total of 80 patients were randomized. Twelve and 6 patients dropped out due to personal reasons in the intervention and control groups, respectively. Average adherence rate for the intervention was 56.9%. Intention-to-treat analysis showed no significant difference between groups in the cardiometabolic risk score (intervention group - Pre: 1.7 ± 3.6; Post: -1.6 ± 4.0; control group - Pre: -1.9 ± 3.6; Post: -2.0 ± 3.8; estimated mean difference between groups at post: -0.4; 95% confidence intervals: -2.7; 1.9; p = 0.96). This finding was confirmed by exploratory, per-protocol analysis. No significant differences were observed between adherents vs. non-adherent participants. Secondary outcomes did not change between groups.

CONCLUSION

This 6-month, individualized, lifestyle intervention did not improve cardiovascular risk factors in SLE patients with a high cardiovascular risk profile.

TRIAL REGISTRATION

clinicaltrials.gov (NCT04431167).

Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study

We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30–39.9 kg/m²) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (β = 0.83, p <0.001), fasting glycemia (β = 0.45, p = 0.036), total cholesterol (β = 1.48, p = 0.024), LDL (β = 1.33, p = 0.012), clustered cardiometabolic risk (β = 0.18, p = 0.006), and quality of life (β = −1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

The weight of words: Discursive constructions of health in weight-neutral peer-reviewed journal articles

Weight-neutral approaches to health, like the Health at Every Size® (HAES®) approach arose in response to emerging evidence showing the negative health consequences of weight-focused approaches through the effects of stigma and marginalization in many settings, including healthcare. While the discourses of dominant 'weight-normative' approaches are well-researched and described, little is known about how language and discourse is creating certain 'truths' about weight-neutral approaches. The aim of this study was to explore how academic discourses create truths about weight-neutral approaches to health. A discourse analysis of 63 academic journal articles was conducted. We found that the language used in academic literature is creating confusing and contradictory messages about weight and weight-neutral approaches to health (like the HAES® approach) through: (i) the continued use of stigmatising and normative labels like 'overweight' and 'obese', (ii) paradoxical language like 'flexible restraint', and (iii) a focus on individual responsibility and blame for health and weight without acknowledgement of broader societal and systemic factors. More research is needed to characterize weight-neutral approaches and develop a clearer framework for researchers wishing to engage with the weight-neutral paradigm of health.

Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review

With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.

What Is Commensality? A Critical Discussion of an Expanding Research Field

Commensality (the act of eating together) is studied in a range of disciplines and often considered important for social communion, order, health and well-being, while simultaneously being understood as in decline (especially the family meal). However, such claims are also contested in various ways. In this paper, we discuss the expanding field of commensality research and critically reflect on the debates surrounding its social functions, including its role in public health. We illuminate the deep social and cultural significance of commensality, through time and space, and conclude that whether or not commensality is the preferred social form of eating for any given individual, it is difficult to escape its sociocultural desirability and idealization. As a cross-cultural phenomenon in both past, present, and future, we suggest that commensality deserves further research. This includes commensality as a research topic in itself and as an entry point to unveil different dimensions of social relations between people, as well as interactions between humans and material objects.