Véronique Provencher, RD PhD: Institute of Nutraceuticals and Functional Food (INAF)

1. "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Véronique Provencher, RD PhD: Institute of Nutraceuticals and Functional Food (INAF) Catherine Bégin, PhD: Laval University (UL) Angelo Tremblay, PhD: UL Lyne Mongeau, RD PhD: Institut national de santé publique du Québec Louise Corneau, RD MSc: INAF Sylvie Dodin, MD MSc: UL Sonia Boivin, PhD: UL Simone Lemieux, RD PhD: INAF JOURNAL OF THEAMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

2. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Introduction • Currently recommended weight-control strategies: • Focus on energy-restricted diets and increased physical activity (National Institute of Health, 2000; Lau et al, 2007). • However, a majority of individuals do not maintain weight loss over time (Mann et al, 2007), and questions have been raised about the long-term beneficial effects of dieting (e.g., Brownell & Rodin, 1994) • Increased appetite sensations, obsessive thoughts about food and eating, and overeating in response to negative emotions and stress (Doucet et al, 2000; Hart & Chiovari, 1998; Chaput et al, 2007; Polivy, 1996; Polivy & Herman, 1985) are some of the consequences. • Development of acceptable, sustainable weight-control strategies remains a challenging issue for public health organizations. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

3. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Introduction • A shift from the traditional “weight-centered” approach to a more “health-centered” approach has been recently suggested (Parham, 1996; Robison JI, 1999; Miller, 2005): • The “Health-At-Every-Size” (HAES) approach argues that health is related to behaviors independently of body weight status → weight loss is not considered as the main outcome. • HAES interventions rather focus on a healthy lifestyle by promoting overall health benefits of behavioral changes related to dietary habits and physical activity, with an emphasis on size acceptance and non-dieting. • What are long-term effects of a HAES intervention on health outcomes? JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

4. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Aim of the Study • Among healthy premenopausal overweight or obese women (n=144), characterized by a preoccupation about their weight and eating : • Assess the long-term effects of a HAES intervention on eating behaviors, appetite sensations, weight status, metabolic parameters and physical activity level in comparison to a social support intervention group and a waiting-list control group. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

5. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Study Design • Randomized controlled trial in which women were assigned to one of the three treatment conditions: • HAES group (n=48); • SS group (n=48); • Waiting-list control group (n=48). • Measurements of dependent variables were taken at baseline (T=0), at the end of the intervention period (T=4 months), and at 6-month and 1-y post-intervention (T=10 months and T=16 months). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

6. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention HAES Group- “Choisir de Maigrir?” • Small groups of 12 women who participated in 14 weekly sessions (13 X 3h sessions and 1 X 6h intensive-day session). • Led by a registered dietitian and a clinical psychologist. • Target = general well-being and positive ways of having a healthy and satisfying lifestyle. • Complete workbook + guided by the health professionals through self-reflection and observations, group discussions, practical exercises, and lectures. • Topics discussed: enjoyment of physical activity and healthy nutrition, recognition of internal cues of hunger and satiety, identification of external influences on eating behaviors and food intake, and acceptation of their own and others’ body image. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

7. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Social Support Group • Small groups of 12 women who participated in 14 weekly sessions (14 X 2h sessions). • Same registered dietitian and clinical psychologist involved in the HAES groups were also in charge of the SS groups. • Main goal = to reproduce the structural social support provided by the group itself, as it can be observed in a group setting. • Topics discussed in the HAES groups were repeated in the SS groups • Health professionals were not active leaders, but rather facilitators of the group • Discussion = they never tried to influence the content and direction of the discussion and they did not give any verbal nor printed information. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

8. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Measurements • Eating behaviors (Three Factor Eating Questionnaire): • Cognitive dietary restraint: Conscious control over food intake with concerns about shape and weight. • Disinhibition: Overconsumption of food in response to a variety of stimuli and associated with a loss of control on food intake. • Susceptibility to hunger: Food intake in response to feelings and perceptions of hunger. • Anthropometric profile: • Weight, height and body mass index (BMI) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

9. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Figure 1: Between and within groups’ pairwise differences for situational susceptibility to disinhibition at baseline (T=0), at post-treatment (T=4 months) and at follow-up (T=10 months and 16 months) in HAES, SS and control groups T=0: n=48 in the HAES group; n=46 in the SS group; n=46 in the control group T=4 months: n=44 in the HAES group; n=39 in the SS group; n=38 in the control group T=10 months: n=43 in the HAES group; n=36 in the SS group; n=34 in the control group T=16 months: n=40 in the HAES group; n=34 in the SS group; n=32 in the control group Significant within-group changes (in comparison to baseline): *p‹0.05; **p‹0.01; ***p‹0.0001. Significant between-group differences (in comparison to the control group): †p‹0.05. HAES = “Health-at-Every-Size”; SS = Social Support. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

10. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Figure 2: Between and within groups’ pairwise differences for susceptibility to hunger at baseline (T=0), at post-treatment (T=4 months) and at follow-up (T=10 months and 16 months) in HAES, SS and control groups. T=0: n=48 in the HAES group; n=46 in the SS group; n=46 in the control group T=4 months: n=44 in the HAES group; n=39 in the SS group; n=38 in the control group T=10 months: n=43 in the HAES group; n=36 in the SS group; n=34 in the control group T=16 months: n=40 in the HAES group; n=34 in the SS group; n=32 in the control group Significant within-group changes (in comparison to baseline): *p‹0.05; **p‹0.01; ***p‹0.0001. Significant between-group differences (in comparison to the control group): †p‹0.05. HAES = “Health-at-Every-Size”; SS = Social Support. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).

11. Serum Vitamin C (mg/dl) by Salad Intake "Health-At-Every-Size" and eating behaviors: one-year follow-up results of a size acceptance intervention Conclusions • When compared to a control group, a HAES (health at every size) approach appears to have beneficial effects on eating behaviors related to disinhibition and hunger. • The role of social support (SS) appears to be an important factor in adopting eating behavior changes, since no distinctive effects were observed between the HAES and the SS groups. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Provencher V, et al. J Am Diet Assoc. 2009; 109 (November).