Effect of a Balanced Low-Calorie Diet With or Without Nutrition Education onWeight Loss and Processes of Behavior Change Among Healthy ObeseWomen: A Randomized Clinical Trial

Background: The use of weight-loss dieting has always been overemphasized as the first modality to treat obesity. Success in weight loss is considered a major problem in obese individuals. The processes of behavior change have been used to facilitate intervention promoting change. Only a minority of studies have employed this construct for weight loss. Objectives: The purpose of this study was to assess the effect of a balanced low-calorie diet with or without nutrition education on the weight loss and processes of change among obese women. Patients and Methods: In a randomized clinical trial, 90 apparently healthy obese women age 18 - 50 with body mass index (BMI) of 30 - 40 kg/m2 were recruited from the nutrition clinic in Ardabil, located in the northwest of Iran. Participants were assigned randomly to receive a balanced low-calorie diet with or without nutrition education. Participants completed a processes of change questionnaire at baseline and at three and six months after intervention. A generalized linear model repeated measures analysis of variances was used to assess the time effect as well as the interaction between the time and the group effect. Results: Significant differences were found in the time effect for weight (F = 12.64, df = 2, P < 0.001), BMI (F = 10.90, df = 2, P = 0.001), andcounterconditioning (F = 22.82, df = 2, P < 0.001), and helping relationships (F = 5.47, df = 2, P = 0.006), reinforcement management (F = 3.65, df = 2, P = 0.03), self-liberation (F = 5.05, df = 2, P = 0.008), stimulus control (F = 12.12, df = 2, P < 0.001), and substance abuse subscales (F = 6.72, df = 2, P = 0.002). Significant differences were shown in interaction time and group effect for weight (F = 5.69, df = 2, P = 0.011), BMI (F = 4.91, df = 2, P = 0.018) and counterconditioning (F = 5.11, df = 2, P = 0.008) and stimulus control (F = 5.50, df = 2, P = 0.006) subscales. Conclusions: The findings support the use of nutrition education for more weight loss and improvement in the counter conditioning and stimulus control subscales among obese women attending the nutrition clinic. It seems that nutrition education should be considered important in effective weight-loss interventions.