School of Psychology, Pavillon Félix-Antoine-Savard, Laval University, 2325 Allée des Bibliothèques, Québec, QC, G1V 0A6, Canada.
Institute of Nutrition and Functional Foods, Laval University, 2440 boul. Hochelaga, Québec, QC, G1V 0A6, Canada; School of Nutrition, Pavillon Paul-Comtois, Laval University, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada.
Appetite. 2019 Dec 1;143:104403. doi: 10.1016/j.appet.2019.104403. Epub 2019 Aug 22.
Health At Every Size® (HAES®) interventions have been increasingly recognized as a sustainable strategy in obesity management. Nevertheless, heterogeneity among obese individuals leads to challenges as it translates in mixed responses to treatment. In this context, our objective was to identify trajectories of responses to a non-diet intervention for adult overweight/obese women to highlight profiles of responders.
Based on data from a multicentric quasi-experimental study, a latent class growth modeling (LCGM) was performed. Two hundred and ten women with high body mass index (BMI ≥ 25, M = 36.53) who followed a non-diet intervention offered in Health and Social Services Centres completed questionnaires at T = 0, 4 and 16 months. Outcomes used in the LCGM were intuitive eating and body esteem, two central components in HAES® interventions. Types of responders were then profiled on sociodemographic, weight, lifestyle, psychological and eating variables.
The LCGM revealed a 4-trajectory model (p < .001), comprising non-responders (14.67%), moderate improvement with low maintenance responders (49.89%), moderate improvement with high maintenance responders (29.28%) and high functioning partial responders (6.56%). Analysis of variances showed significant differences between all types of responders with medium to large effect sizes on depressive symptoms, self-esteem and disinhibited eating (p < .001; η = .23, 0.30 and 0.16 respectively). Fewer differences were found on sociodemographic, lifestyle, health and weight variables. Overall, non-responders (14.67%) had a distinctive profile compared to the other groups by consistently expressing poorer psychological functioning, less adapted eating behaviors and reaching more frequently the clinical cutoff for severe depression (p = .001).
Findings strongly support the relevance of considering psychological characteristics to move towards personalized healthcare in obesity management.
健康体型（HAES）干预措施已逐渐被视为肥胖管理的可持续策略。然而，肥胖个体之间的异质性导致治疗效果的混合反应，这带来了挑战。在这种情况下，我们的目的是确定针对超重/肥胖成年女性的非节食干预措施的反应轨迹，以突出反应者的特征。
基于多中心准实验研究的数据，进行了潜在类别增长建模（LCGM）。210 名高体重指数（BMI≥25，M=36.53）的女性参加了在卫生和社会服务中心提供的非节食干预措施，她们在 T=0、4 和 16 个月时完成了问卷。LCGM 中使用的结果是直观饮食和身体自尊，这是 HAES 干预措施的两个核心组成部分。然后根据社会人口统计学、体重、生活方式、心理和饮食变量对反应者类型进行特征描述。
LCGM 显示了一个 4 轨迹模型（p<.001），包括无反应者（14.67%）、低维持中度改善反应者（49.89%）、高维持中度改善反应者（29.28%）和高功能部分反应者（6.56%）。方差分析显示，在抑郁症状、自尊和抑制性饮食方面，所有类型的反应者之间存在显著差异，具有中等至较大的效应量（p<.001；η=0.23、0.30 和 0.16）。在社会人口统计学、生活方式、健康和体重变量上的差异较小。总体而言，无反应者（14.67%）与其他组相比表现出明显不同的特征，表现为较差的心理功能、较少适应的饮食行为，并且更频繁地达到严重抑郁的临床截止值（p=.001）。
研究结果强烈支持考虑心理特征的重要性，以推动肥胖管理中个性化医疗保健的发展。
