In simplistic terms, the Non-Diet Approach is a flexible, gentle way of choosing what to eat and when with no guilt, body shaming or restrictions. It goes against the traditional view of achieving weight loss via dieting/energy restriction. The primary aim is to banish the practices of dieting and instead promote a more holistic approach that encompasses emotional and physical health. The Non-Diet Approach focuses on optimising health and well-being through health-related behaviours. At its core are building skills in responding to internal eating cues, developing self-care and a non- judgemental attitude towards self and food. It is a weight-neutral approach.

The main features of the Non-Diet Approach are:

• Accepting and Embracing body cues
– hunger/fullness awareness, mindful eating
• Accepting and Embracing all foods
– debunking diets, normalising eating, elimination of demonization of foods, dealing with binge foods
• Accepting and Embracing body shape
– acknowledging size diversity, rejecting body and weight goals, dressing with pride
• Accepting and Embracing movement
– finding enjoyable movement
• Accepting and Embracing non-diet nutrition
– enjoy food variety

Whilst working with clients using the Non-Diet Approach, each of these features is addressed using a series of skill-building exercises. The Non-Diet Approach works well with patients with a chronic dieting history, emotional and non-hungry eating behaviours with associated guilt and for those with body image issues and rigid notions of “good” and “bad” foods.
Weight and weight loss goals/outcomes are not assessed discussed or included in the approach.

Outcome measures

So without weight as a focus, where do we look for our outcome measures with the Non-Diet Approach? Working with the Non-Diet Approach, we focus on goals including emotional, physical or mental goals. Eg I can easily walk hills for 30 mins without stopping. We work on new bahvious, cues and reward techniques

Measures we may do may include

• Biochemical measures eg blood sugar or lipid levels, waist circumference
• Psychological measures – such as quality of life scores and eating behaviour score
• Behaviour change measures – restrictive eating, dietary quality changes, physical activity changes
• Symptom change measures

Evidence for the Non Diet Approach

To date, the majority of Non-diet approach intervention studies have focused on exploring the use of this paradigm in group settings. In one such RCT, (4), obese subjects who were chronic dieters, participants were split into two groups – those who received group education around non diet wellness methods and those who received traditional weight loss group education. Both groups were held weekly for six months with both receiving six months after care. After one year period, those in the “diet” group demonstrated an increase in cognitive restraint whilst there was a decrease in non-diet group. Both developed significant improvements in both metabolic fitness, psychological and eating behaviour variables. A significant weight loss was achieved in the traditional group but not in the non-diet group. Attrition rates were 41% in the traditional diet group vs. 8% in the non- diet group.

A more recent, 2016, study (5) involved eighty women, all with a BMI over 30 Kg/m2. The women were randomized to six months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, fruit and vegetable intake, intuitive eating, and physical activity. Results at the end of intervention showed that the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI and weight. Significant positive changes were observed in both groups between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach.

Evidence is positioning weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight. More research is being undertaken in order to demonstrate long term effectiveness especially in individual interventions.

What about weight loss with the Non Diet Approach?

The Non-Diet Approach should not, in any case, be confused with avoiding weight loss. Often, weight loss is a result of using the Non-Diet Approach as clients “find their own healthy weight” by reducing unhealthy eating behaviours.

The Non-Diet Approach should also not be mistaken for eating “free for all”. Accepting and embracing all foods and Non-Diet Nutrition is a vital part of the approach as is learning to recognise body cues. Patients following the Non-Diet Approach learn to increase food variety and to recognise how foods affect their feelings of well-being. The ultimate aim is to improve health indices and dietary quality.

The understanding that weight loss may be a “side effect” of the approach can initially appear somewhat contradictory.

Check out our Sheena Hendon Health weight loss programmes here https://sheenahendonhealth.co.nz/holistic-weight-loss-programmes/

Refs:

1. Mann et al. Medicare’s search for effective obesity treatments: diets are not the answer. Am J psychology 2007
2. Bacon and Aphramor Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 2011
3. Willer, F. The Non Diet Approach Guidebook for Dietitians 2013
4. Bacon, L. Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. International Journal of Obesity and Related Disorders. 2002.
5. Mensinger, J. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 2016