Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 31646460.
Research Unit for Dietary Studies at The Parker Institute, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
JMIR Public Health Surveill. 2024 Nov 29;10:e59455. doi: 10.2196/59455.
Lifestyle interventions for weight loss are generally ineffective in achieving clinically meaningful long-term reductions in body weight and may contribute to negative behavior such as weight cycling or disordered eating. Negative focus on high weight may also contribute to weight stigma. Weight stigma includes negative attitudes and discriminatory behavior toward people with big bodies and can result in psychological stress and unfavorable health outcomes. Taken together, it is possible that the potential harms of lifestyle-based weight loss interventions may exceed the potential benefits. Weight-neutral health (WNH) has emerged as an alternative strategy advocating for size diversity, intuitive eating, and joyful physical movement, all without placing emphasis on weight reduction.
This protocol outlines the study design for the co-design process of developing a WNH complex intervention, engaging relevant stakeholders in Denmark.
We base our understanding of WNH on the principles from Health at Every Size: body acceptance, joyful movement, intuitive eating, and weight stigma reduction. The co-design development process is based on the Medical Research Council's framework for complex interventions and applies methods from human-centered design through 4 iterative design phases of engaging stakeholders-discover: search existing literature, and conduct interviews with Danish municipal stakeholders working with WNH and other expert stakeholders; define: coproduction of seminars with health professionals (HPs) with knowledge of WNH, and semistructured interviews with people with BMI≥30 kg/m2 who have participated in existing WNH interventions; design: content-creating workshops with HPs and people with BMI≥30 kg/m2; and validate: evaluate seminars, plan feasibility, and produce materials. The data will be analyzed thematically to build a scaffold for the intervention activities and components. In further analysis, we will explore how health is performed, meaning the actions and dialogues that arise when dealing with health guidelines, the societal body, weight, and health expectations, in the context of the intervention.
The project is fully funded. As of August 2024, the co-design process was in the closing phase. In total, 15 HPs were included, some of whom have larger body sizes. This provides a dual perspective, combining their personal experiences of living with a high BMI with their professional expertise. In total, 16 people with BMI≥30 kg/m2 have generously shared their experiences with WNH programs, including the difficulties of moving away from external demands and personal wishes for weight loss. Their contributions have nuanced and unfolded our understanding of the principles of WNH in a Danish setting.
The intervention designed in and from the co-design process will be tested for feasibility in 2025. The findings from the feasibility study will inform a future randomized controlled trial and present novel findings in the field of health management. The long-term goal is to implement the intervention in a Danish municipal setting free of charge.
减肥的生活方式干预措施通常无法有效实现具有临床意义的长期体重减轻，并且可能导致体重循环或饮食失调等负面行为。对高体重的负面关注也可能导致体重污名化。体重污名化包括对大体重人群的负面态度和歧视行为，可能导致心理压力和不利的健康结果。综上所述，基于生活方式的减肥干预措施的潜在危害可能超过潜在益处。体重中立健康（WNH）作为一种替代策略出现，倡导体型多样性、直觉饮食和愉悦的身体运动，所有这些都不强调减肥。
本研究方案概述了在丹麦与相关利益相关者共同设计 WNH 综合干预措施的研究设计。
我们基于健康大小每一个（Health at Every Size）的原则来理解 WNH：身体接受、快乐运动、直觉饮食和体重污名化减少。共同设计开发过程基于医学研究委员会（Medical Research Council）的复杂干预措施框架，并通过 4 个迭代设计阶段应用以人为中心的设计方法，这些阶段包括：利益相关者参与阶段-发现：搜索现有文献，并对从事 WNH 和其他专家利益相关者工作的丹麦市政利益相关者进行访谈；定义阶段-与具有 WNH 知识的卫生专业人员共同举办研讨会，并对参加过现有 WNH 干预措施的 BMI≥30kg/m2 的人进行半结构化访谈；设计阶段-与卫生专业人员和 BMI≥30kg/m2 的人一起举办内容创作工作坊；验证阶段-评估研讨会、计划可行性并制作材料。将对数据进行主题分析，为干预活动和组成部分构建一个支架。在进一步的分析中，我们将探讨在干预背景下，健康是如何表现出来的，即当涉及到健康指南、社会身体、体重和健康期望时，所采取的行动和对话。
该项目已获得全额资助。截至 2024 年 8 月，共同设计过程已进入收尾阶段。共有 15 名卫生专业人员参与，其中一些人身材较大。这提供了双重视角，将他们与高 BMI 相关的个人生活经验与他们的专业知识结合在一起。共有 16 名 BMI≥30kg/m2 的人慷慨地分享了他们对 WNH 项目的经验，包括摆脱外部需求和个人减肥愿望的困难。他们的贡献使我们对丹麦背景下 WNH 原则的理解更加细致入微。
将在共同设计过程中设计的干预措施将于 2025 年进行可行性测试。可行性研究的结果将为未来的随机对照试验提供信息，并在健康管理领域提出新的发现。长期目标是在丹麦市政环境中免费实施该干预措施。
