Non-dieters more successful at boosting health than dieters, study
finds
Main Category: Obesity / Weight Loss / Fitness News
Article Date: 31 May 2005 - 15:00 PDT

Behavior change and self-acceptance trump dieting hands-down when it
comes to achieving long-term health improvements in obese women,
according to a two-year study by nutrition researchers at the
University of California, Davis.

The findings suggest that significant improvements in overall health
can be made, regardless of weight loss, when women learn to recognize
and follow internal hunger cues and begin feeling better about their
size and shape. Results of the study will appear in the June issue of
the Journal of the American Dietetic Association.

"We have been ingrained to think that seriously large people can only
make improvements in their health if they diet and slim down," said
nutrition researcher and professor Linda Bacon, who conducted the
study along with Judith Stern, a UC Davis professor of nutrition and
internal medicine. "But this study tells us that you can make
significant improvements in both metabolic and psychological health
without ever stepping on the scales or counting calories. You can
relax about food and eat what you want."

Although this study included only women, the researchers say that
there is no reason to believe that the results would be different for
men.

For years it has been known that obesity is associated with a number
of serious health problems, including heart disease, diabetes, stroke
and even some cancers. To avoid such medical complications, health
professionals have encouraged their obese patients to lose weight. But
dieting has not proven successful in the long run. Initial weight loss
is often followed by a return to at or near the original weight, with
no improvements in health indicators such as blood pressure or
cholesterol levels.

Faced with the dismal track record of dieting, the rising prevalence
of obesity, and the premise that obesity itself may be relatively
benign compared with health habits, nutritionists and health
professionals began to look for a more effective way of dealing with
the health risks. One model that has arisen is known as Health at
Every Size. Rather than focusing on calorie counting, this approach
encourages obese individuals to actually back off from monitoring how
much food they eat and, instead, train themselves to pay more
attention to internal body cues that signal hunger and fullness.

The UC Davis study was developed to scientifically examine the
effectiveness of the Health at Every Size approach compared with
traditional dieting. The study started off with 78 female participants
ranging in age from 30 to 45 years old. Half were assigned to a
dieting group and half to a non-dieting Health at Every Size group.
Dieters and non-dieters

Members of the dieting group were told to moderately restrict their
food consumption, maintain food diaries and monitor their weight. They
were provided with information on the benefits of exercise, on
behavioral strategies for successful dieting, and on how to count
calories and fat content, read food labels and shop for appropriate
foods.

Participants in the non-dieting group were instructed to let go of
restrictive eating habits associated with dieting. Instead they were
counseled to pay close attention to internal body cues indicating when
they were truly hungry or full, and to how the food made them feel.
They also received standard nutritional information to help them
choose healthful foods, and participated in a support group designed
to help them better understand how culture influences the experience
of obese people and to become more accepting of their larger bodies.
In addition, they were encouraged to identify and deal with barriers,
including negative self-image, which might get in the way of enjoying
physical activity.

The study spanned two years, with each group meeting for 24 weekly
treatment sessions and, after that, for six monthly optional support
group meetings. They also attended five testing sessions: at the
beginning of the study, halfway through the treatment at 12 weeks,
following treatment at 26 weeks, after the support meetings ended at
52 weeks and for follow-up at 104 weeks. At the testing sessions,
factors such as blood pressure and cholesterol levels were measured.
The participants' levels of physical activity also were evaluated, as
were their eating behaviors and attitudes toward weight, body shape
and eating. Study results

Almost all (92 percent) of the non-dieting group stayed in the study
throughout the treatment period, while almost half (42 percent) of the
dieters dropped out before finishing treatments. This reinforces
another message of the research -- that in the long run, people are
much more likely to stick with a non-diet than a diet.

When the researchers tallied the results from the participants who
completed the study, they found that:

-- The non-dieters maintained their same weight throughout the study.
The dieting group lost 5.2 percent of their initial weight by the end
of the 24-week treatment period, but regained almost all of it by the
end of the two-year study.

-- The non-dieters showed an initial increase in their total
cholesterol levels, but this significantly decreased by the end of the
study, as did their levels of LDL cholesterol or "bad" cholesterol.
The dieters showed no significant change in total or LDL cholesterol
levels at any time.

-- Both groups significantly lowered their systolic blood pressure
during the first 52 weeks of the study. By the end of the study at 104
weeks, however, the non-dieters had sustained this improvement, while
the diet group had not.

-- By the end of the two-year study, the non-dieters had almost
quadrupled their moderate physical activity. The dieting group had a
significant increase in physical activity right after the treatment
period ended but had slipped back to their initial levels by the end
of the study.

-- The non-dieters demonstrated significant improvements in self-
esteem and depression at the end the study, while the diet group
demonstrated a worsening in self-esteem. The dieters' depression
levels initially improved but then returned to baseline.

In summary, while the non-dieters did not lose weight, they succeeded
in improving their overall health, as measured by cholesterol levels,
blood pressure, physical activity and self-esteem. The dieters, on the
other hand, were not able to sustain any of the short-term
improvements they experienced and worsened in terms of their self-
esteem.

"Given the difficulties most obese people experience in sustaining
weight loss, the findings suggest that people are better advised to
focus on behavior change than weight to achieve their health goals,"
said Stern, the researcher who is a UC Davis professor of nutrition
and internal medicine.

The study was funded in part by the National Institutes of Health, the
U.S. Department of Agriculture's Western Human Nutrition Research
Center and the National Science Foundation.

Pat Bailey,
pjbailey@ucdavis.edu
530-752-9843
University of California - Davis
http://www.ucdavis.edu