Gut feelings and lived experiences: a qualitative study of 'anti-diet' dietitians' and psychologists' motivations and experiences regarding the weight-neutral approach

This paper examines whether the motivations and experiences of 'anti-diet' dietitians and psychologists represent a paradigm shift in healthcare. We conducted four 2-hour, discipline-specific focus groups with a total of 16 female participants residing in Australia. Our reflexive thematic analysis generated four themes that we consider to be stages of a weight-neutral paradigm shift: (1) a recognition of a mismatch between one's weight-centred training and one's lived experience of diet culture, which subsequently informs (2) gut feelings that influence their decision to reject the weight-centric paradigm, thereby leading to (3) exploring the anti-diet knowledge base and then subsequently (4) promoting or advocating for the weight neutral paradigm. Our findings represent a four-stage paradigm shift in action; emphasising the significance of lived experience in the weight-neutral turn, as well as differences in symbolic power between health professionals. Future research should focus on potential ruptures or conflicts within the weight-neutral paradigm itself, and look more deeply into the experiences of other health professionals who are critical of the weight-centred approach.

Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression

A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants' available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η² = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η² = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η² = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.