Treatment Format and Structure


Recent reviews of the nondiet interventions—mindful eating, intuitive eating, and HAES—found that the duration of interventions was highly variable, ranging from 1.5 to 12 months, with 60- to 90-minute sessions on average.104


However,


most interventions lasted between 3 and 5 months, with some including monthly follow-up sessions or subsequent group-based opportunities to provide ongoing support for behavior change.104,105


Interventions were almost exclusively delivered


in groups, with the majority of interventions being delivered in person. Most treatment programs included weekly homework assignments that varied across approaches and interventions.70,82,106


In all three types of nondiet interventions,


didactic information on nutrition, exercise, and eating behaviors was provided, but it was given considerably less emphasis than in traditional weight-management programs.72,94


Typically, weigh-ins, weight loss goals, and calorie-counting or food


records were either secondary to intervention aims or actively discouraged as part of these treatment approaches.74,80 Although similar in many ways, these three interventions differ in key aspects


of their treatment structure and format. Because mindful eating emphasizes med- itation, a brief meditation is commonly included in each session to promote body awareness and enhance meditative practice. Intuitive eating interventions may involve having participants keep records of hunger, satiety, and fullness in order to better monitor satiety and promote intuitive eating. Finally, HAES groups tradi- tionally include a strong element of social support and self-advocacy, with patients or clients learning techniques to assert themselves, reject stigma, and produce change to empower themselves.82,86


Empirical Support


Although the purpose of this chapter is to evaluate weight-management approaches for individuals with obesity, all three alternative approaches covered in this section are partially or radically opposed to weight loss as a primary health outcome for people with obesity. As one might expect, intuitive eating, mindful eating, and HAES interventions are less successful at producing short-term weight loss than tradi- tional dieting programs.76,83,107


In general, trials comparing HAES or intuitive eating


interventions with traditional weight loss programs found that more conventional programs produced greater weight loss.82,86,108


However, multiple reviews of all three


alternative approaches concluded that these programs appear to promote weight maintenance and reduce weight gain during the intervention and through repeated follow-up.76,105,107


Importantly, due to the nature of weight-neutral approaches, only


some studies included outcomes on weight, thus limiting results and conclusions about efficacy for sustained prevention of weight gain. Moreover, most of these approaches are still relatively new, and studies evaluating longer-term weight out- comes of nondiet interventions (ie, beyond 24-month follow-up) are lacking. Apart from weight-related outcomes, there is some support for the use of


these alternative approaches in improving other indicators of health. In general, reviews suggest positive or neutral effects on physiological markers of health for all three approaches. Reviews identified generally positive improvements in blood pressure with HAES interventions, although this effect was not maintained at follow-up.86,104,107


clients with obesity, particularly with HAES interventions, and positive or neutral findings were reported regarding improvements in cholesterol levels.86,107


242 SECTION 3: Interventions for the Treatment of Overweight and Obesity


Additional benefits were found for glycemic control in patients or


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