Lyne Mongeau

Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention

BACKGROUND Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches. OBJECTIVE To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention. DESIGN Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006. PARTICIPANTS/SETTING Premenopausal overweight/obese women (n=144; mean age of 42.3+/-5.6 years), recruited from free-living, general community. INTERVENTION Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48). MAIN OUTCOME MEASURES Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost > or =1.2 k cal x kg(-1) x 15 minutes(-1) [> or =4.8 metabolic equivalents]). STATISTICAL ANALYSES PERFORMED Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design. RESULTS Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (-0.9+/-0.2 and -1.3+/-0.5, respectively) and the social support group (-0.4+/- 0.2 and -1.4+/-0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5+/-0.2 in HAES group vs 2.7 +/- 0.2 in social support group; susceptibility to hunger: 4.2+/-0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3+/-0.2 for situational susceptibility to disinhibition and 5.9+/-0.5 for susceptibility to hunger). CONCLUSIONS These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.

Short-term effects of a "Health-At-Every-Size" approach on eating behaviors and appetite ratings.

Objective: To assess the effects of a “Health‐At‐Every‐Size” (HAES) intervention on eating behaviors and appetite ratings in 144 premenopausal overweight women.

Psychological Impact of a “Health-at-Every-Size” Intervention on Weight-Preoccupied Overweight/Obese Women

The aim of the present study was to assess the impact of a “Health-at-every-size” (HAES) intervention on psychological variables and body weight the weight-preoccupied overweight/obese women. Those women were randomized into three groups (1) HAES, (2) social support (SS), (3) waiting-list (WL), and were tested at baseline, post-treatment and six-month and one-year follow-ups. All participants presented significant psychological improvement no matter if they received the HAES intervention or not. However, even if during the intervention, the three groups showed improvements, during the follow up, the HAES group continued to improve while the other groups did not, even sometimes experiencing some deterioration. Furthermore, in the HAES group only, participants weight maintenance 12 months after the intervention was related to their psychological improvement (quality of life, body dissatisfaction, and binge eating) during the intervention. Thus, even if, in the short-term, our study did not show distinctive effects of the HAES intervention compared to SS and WL on all variables, in the long-term, HAES group seemed to present a different trajectory as psychological variables and body weight are maintained or continue to improve, which was not the case in other groups. These differential long-term effects still need to be documented and further empirically demonstrated.

Restricting marketing to children: consensus on policy interventions to address obesity.

Obesity presents major challenges for public health and the evidence is strong. Lessons from tobacco control indicate a need for changing the policy and environments to make healthy choices easier and to create more opportunities for children to achieve healthy weights. In April 2011, the Alberta Policy Coalition for Chronic Disease Prevention convened a consensus conference on environmental determinants of obesity such as marketing of unhealthy foods and beverages to children. We examine the political environment, evidence, issues, and challenges of placing restrictions on marketing of unhealthy foods and beverages within Canada. We recommend a national regulatory system prohibiting commercial marketing of foods and beverages to children and suggest that effective regulations must set minimum standards, monitor compliance, and enact penalties for non-compliance.

Health Canada's new guidelines for body weight classification in adults: challenges and concerns

In 2003 Health Canada released its new Canadian Guidelines for Body Weight Classification in Adults ,[1][1]an update of the weight classification system that had been in use in this country since 1988.[2][2]The guidelines were updated in response to advances in the understanding of the relation

Curbing the obesity epidemic: the need for policy action in a risk-balanced, orchestrated, comprehensive strategy.

Lyne Mongeau is working for the Ministry of Health and Social Services of the Government of Québec as Coordinator of the 2006–2012 Government Action Plan to Promote Healthy Lifestyle and Prevent Weight-related Problems. Investing for the Future. She is also a clinical professor at Université de Montréal, Departement of Social and Preventive Medicine. Her research interests are around obesity and weightrelated problems, prevention and public policies.

Body weight classification

James Douketis notes that waist circumference cut-offs have been validated, citing an excellent paper by Janssen and collaborators.1 Those authors demonstrated that the use of waist circumference cut-off points helps to identify subjects at increased health risk within normal-weight, overweight and class I obese BMI categories, but their study was not a validation of waist cut-offs. Accordingly, they acknowledged that their results do not imply that the specific cut-off values of 102 cm for men and 88 cm for women are the ideal threshold values denoting increased risk.1 They also pointed out that the waist circumference values that best predict health risk within different BMI categories are still unknown.1 We acknowledge that more research is needed on waist circumference cut-offs and on other indicators to better assess the health risks of people in the overweight category, especially given that decreasing the BMI cut-off for this category (from 27 to 25 kg/m2) has resulted in increased heterogeneity in terms of health risk.2 In addition, we wish to stress our concern about reducing the lower limit for the normal weight category (from 20 to 18.5 kg/m2). In our current sociocultural context, where thinness is highly valued, such changes to BMI categories could intensify peoples (notably womens) excessive concern about body weight,3which unfortunately may lead them to seek rapid weight loss and to use unhealthy and even dangerous weight loss methods.4The impact of these changes in BMI classification is not trivial and must be recognized. Reducing the lower BMI cut-off for normal weight (to 18.5 kg/m2) may lead to risks associated with delayed identification of eating disorders, but such a change can also prevent early recognition of disordered attitudes and behaviours concerning eating and physical activity, a situation that precedes the onset of eating disorders and affects more adult women than do eating disorders.5 Although Douketis is correct in stating that the guidelines are not designed for intervention purposes in individuals, the BMI remains well known to the public. BMI calculators can be found easily on the Internet and in magazines, and it is impossible to control how people will interpret their BMI in the absence of advice from a health care provider. Finally, we agree that more discussion is needed concerning the guidelines. It is essential for health care providers to be better informed on how to interpret and use the new weight classification system. Simone Lemieux Departement des sciences des aliments et de nutrition Universite Laval Sainte-Foy, Que. Marie-Claude Paquette Lyne Mongeau Institut national de sante publique du Quebec Sainte-Foy, Que. For the members of the GTPPP (Quebec Provincial Working Group on Weight Related Issues)

Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec

Purpose: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting. Design: Quasi-experimental design evaluating eating behaviors and psychological factors. Setting: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada). Participants: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group. Intervention: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating. Measures: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up. Analysis: Group, time, and interaction effects analyzed with mixed models. Results: Significant group by time interactions were found for flexible restraint (P = .0400), disinhibition (P < .0001), susceptibility to hunger (P < .0001), intuitive eating (P < .0001), obsessive–compulsive eating (P < .0001), body-esteem (P < .0001), depression (P = .0057), and self-esteem (P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term. Conclusion: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.

From Diets to Healthy and Pleasurable Everyday Eating

Publisher Summary Eating is obviously a complex and central behavior to human life, but it is important not to neglect ones relationship with the body as an influence on eating. To fully understand and effectively intervene in weight- and food-related problems, the issues linked to obesity must of course be examined, but also those associated with the quest for thinness, prevalent in modern societies. This chapter outlines the origins as well as the various aspects of life underlying the quest for thinness and weight loss. The quest for thinness and the world of diets are not flukes of history. Their origins are numerous and complex. While womens bodies have often been targeted by transformations and diktats, never in the course of history have womens bodies been so thin. While not explaining everything, there are some fundamental factors that coherently represent the rise of the obsession with thinness and the oppression of the overweight. Among the suddenly available array of products related to weight and the body we find healthy, “light,” and ready-made foods. These products illustrate particularly the resolution of the Judaeo-Christian dilemma, reconciling consumption and abstinence. “Light” food is the perfect example: large quantities, but with fewer calories. In addition, manufactured products were found to be helpful to women who were employed and thus had less time to prepare meals. Finally, the relationship with the body was also affected by the advent of the consumer era.