¹Department of Nutrition, University of California at Davis, Davis, California, USA

²Biological Sciences Department, City College of San Francisco¾Phelan Campus, San Francisco, California, USA

³USDA-ARS¾Western Human Nutrition Research Center, University of California at Davis, Davis, California, USA

⁴Division of Endocrinology, Clinical Nutrition and Cardiovascular Medicine, Department of Internal Medicine, University of California at Davis, Davis, California, USA

Correspondence to: L, Bacon, Biology Department, City College of San Francisco, 50 Phelan Drive, San Francisco, CA 94112, USA. E-mail: lbacon@ccsf.edu

Context: Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance.

Objective: To evaluate the effects of a 'health-centered' non-diet wellness program, and to compare this program to a traditional 'weight loss-centered' diet program.

Design: Six-month, randomized clinical trial.

Setting: Free-living, general community.

Participants: Obese, Caucasian, female, chronic dieters, ages 30-45 y (n=78).

Interventions: Six months of weekly group intervention in a non-diet wellness program or a traditional diet program, followed by 6 months of monthly after-care group support.

Outcome Measures: Anthropometry (weight, body mass index); metabolic fitness (blood pressure, blood lipids); energy expenditure; eating behavior (restraint, eating disorder pathology); psychology (self-esteem, depression, body image); attrition and attendance; and participant evaluations of treatment helpfulness. Measures obtained at baseline, 3 months, 6 months and 1 y.

Results (1 y after program initiation): Cognitive restraint increased in the diet group and decreased in the non-diet group. Both groups demonstrated significant improvement in many metabolic fitness, psychological and eating behavior variables. There was high attrition in the diet group (41%), compared to 8% in the non-diet group. Weight significantly decreased in the diet group (5.9±6.3 kg) while there was no significant change in the non-diet group (-0.1±4.8 kg).

Conclusions: Over a 1 y period, a diet approach results in weight loss for those who complete the intervention, while a non-diet approach does not. However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behavior, while at the same time effectively minimizing the attrition common in diet programs.

International Journal of Obesity (2002) 26, 854-865. doi:10.1038/sj.ijo.0802012

non-diet intervention; eating behavior; metabolic fitness; weight loss