Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review.

OBJECTIVE

To determine the overall effect of non-diet, weight-neutral interventions on factors such as weight, biochemical measures, food and activity behavior, body image, and mental health.

DESIGN

Systematic review of intervention literature.

SETTING

Group classes in community and worksite settings (14 studies), and individual counseling (1) and online education (1) in college settings.

PARTICIPANTS

Eighteen research articles (representing 16 studies) evaluating non-diet interventions using quasi-experimental and randomized study designs with either a comparison or control group.

MAIN OUTCOME MEASURES

Anthropometric, physiological, psychological, and dietary intake.

ANALYSIS

Systematic search of 168 articles and review of 18 articles meeting inclusionary criteria.

RESULTS

Non-diet interventions resulted in statistically significant improvements in disordered eating patterns, self-esteem, and depression. None of the interventions resulted in significant weight gain or worsening of blood pressure, blood glucose, or cholesterol, and in 2 studies biochemical measures improved significantly compared with the control or diet group. Primary limitations were inconsistent definitions of non-diet approaches and the use of different assessment instruments for measuring outcomes.

CONCLUSIONS AND IMPLICATIONS

Because of the long-term ineffectiveness of weight-focused interventions, the psychological improvements seen in weight-neutral, non-diet interventions warrant further investigation.