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ORIGINAL SCIENTIFIC PAPERSquantitative research57%. This could well lead to an over-emphasis ofthe positive outcomes, as those that completedfollow-up may be more likely to have had positiveoutcomes. Obtaining accurate self-reporting onfood and fluid on nutritional intake is notoriouslydifficult and therefore the results of the surveyinstrument may not be reliable. 36,37 This wasaccentuated by having no control group. Unfortunatelyretention rates in the six-week practicenurse–led programme were not recorded.The main implication of this evaluation is that ahealthy lifestyle programme can be successfullyimplemented in a New Zealand primary caresetting. In addition to the evaluation reportedhere, interviews with the participating practicenurse facilitators were conducted. They reportedhigh levels of satisfaction with the programmewhich has been accepted and adopted by primaryhealth care in the region. Other benefits that theAlthough the findings from this evaluation indicatepositive outcomes, they are insufficient toclaim outright that Appetite for Life is effective.Stronger research designs are required. Furtherresearch on the non-dieting approach shouldinclude the impact of this type of intervention onthe lifestyle of other family and household members.The change in lifestyle of the participantsis likely to influence other household membersthrough changes in purchasing and preparation offood for the family. This is particularly importantto explore because of its potential influence onchildhood obesity.A non-dieting healthy lifestyle programme inNew Zealand primary care settings appears promisingfor achieving sustainable lifestyle changesfor women who are overweight. These sustainedchanges are likely to lead to positive health benefitsregardless of whether weight loss occurs.Facilitators identified food tastings, the practicaladvice, effective group dynamics, locally-baseddelivery and support from nutritionists as factorskey to the programme’s successpractice nurse facilitators reported were increasednutrition knowledge, confidence in assistingoverweight clients and skills in motivatingclients for behavioural change. Facilitators identifiedfood tastings, the practical advice, effectivegroup dynamics, locally-based delivery andsupport from nutritionists as factors key to theprogramme’s success.The findings of this evaluation will help tofurther refine and develop Appetite for Life toimprove its success. Future developments willlook to strengthen elements that are known toincrease success in weight loss. As the non-dietingapproach has not developed a strong evidencebase to date, the success factors for a non-dietingapproach have not been reviewed. It is importantthat success factors from other similar types ofinterventions are incorporated into successiveprogramme development.References1. Ministry of Health. A portrait of health. Key results of the2006/07 New Zealand health survey. Wellington: Ministryof Health; 2008.2. Ministry of Health, The University of Auckland. Nutritionand the burden of disease: New Zealand 1997–2011. Wellington:Ministry of Health; 2003.3. Swinburn B, Egger G. Preventive strategies against weightgain and obesity. Obes Rev. 2002;3(4):289–301.4. Mulvihill C, Quigley R. The management of obesity andoverweight: an analysis of reviews of diet, physical activityand behavioural approaches: evidence briefing. 1st edition.NHS: Health Development Agency; 2003.5. Warburton DE, Nicol CW, Bredin SS. Health benefitsof physical activity: the evidence. Can Med Assoc J.2006;174(6):801–9.6. World Health Organization. Diet, nutrition and the preventionof chronic diseases. Geneva: WHO; 2003.7. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise foroverweight or obesity. Cochrane Database Syst Rev.2006(4):CD003817.8. Foreyt J, Goodrick GK. Weight management without dieting.Nutrition Today. 1993;24(2):4–9.9. Polivy J, Herman C. Undieting: a program to help peoplestop dieting. Int J Eat Disord. 1992;11(3):261–268.10. National Health and Medical Research Council. Clinicalpractice guidelines for the management of overweight andobesity in adults. Canberra: National Health and MedicalResearch Council; 2003.11. Ikeda J, Amy NK, Ernsberger P, Gaesser GA, Berg FM, ClarkCA, et al. The National Weight Control Registry: a critique. JNutr Educ Behav. 2005;37(4):203–5.12. Provencher V, Begin C, Tremblay A, Mongeau L, Boivin S,Lemieux S. Short-term effects of a ‘health-at-every-size’approach on eating behaviors and appetite ratings. Obesity(Silver Spring) 2007;15(4):957–66.13. Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptanceand intuitive eating improve health for obese, female chronicdieters. J Am Diet Assoc. 2005;105(6):929–36.286 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE
ORIGINAL SCIENTIFIC PAPErSquantitative research14. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-termweight-loss maintenance: a meta-analysis of US studies. Am JClin Nutr. 2001;74(5):579–84.15. Polivy J. Psychological consequences of food restriction. J AmDiet Assoc. 1996;96(6):589–92; quiz 593–4.16. Bandura A. A social learning theory. Englewood Cliffs, NJ:Prentice Hall Inc.; 1977.17. Janz NK, Becker MH. The health belief model: a decade later.Health Educ Q. 1984;11(1):1–47.18. U.S. Department of Health and Human Services. MakingHealth Communications Work. Bethesda, Maryland: NationalInstitutes of Health; 1992.19. Rogers EM. Diffusion of innovations. New York: FreePress; 1995.20. Garfield SA, Malozowski S, Chin MH, Narayan KM, GlasgowRE, Green LW, et al. Considerations for diabetes translationalresearch in real-world settings. Diabetes Care.2003;26(9):2670–4.21. Ministry of Health. New Zealand Food and Nutrition guidelinestatements for healthy adults. 2007 August 5 [cited 10 July2010]. Available from: http://www.moh.govt.nz/moh.nsf/indexmh/nutrition-foodandnutritionguidelinestatements22. Ministry of Health. Food and nutrition guidelines forhealthy adults: a background paper. Wellington: Ministryof Health; 2003.23. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML,Ainsworth BE, et al. International physical activity questionnaire:12-country reliability and validity. Med Sci Sports Exerc.2003;35(8):1381–95.24. Brown W, Bauman A, Chey T, Trost S, Mummery K. Comparisonof surveys used to measure physical activity usedin Australia and New Zealand. Aust N Z J Public Health.2004;28:128–34.25. White P, Gunston J, Salmond C, Atkinson J, Crampton P. Atlasof socioeconomic deprivation in New Zealand NZDep2006.Wellington: Public Health Intelligence, Ministry of Health;2008.26. Munsch S, Biedert E, Keller U. Evaluation of a lifestyle changeprogramme for the treatment of obesity in general practice.Swiss Med Wkly. 2003;133(9–10):148–54.27. Tanco S, Linden W, Earle T. Well-being and morbid obesityin women: a controlled therapy evaluation. Int J Eat Disord.1998;23(3):325–39.28. Carroll S, Borkoles E, Polman R. Short-term effects of a nondietinglifestyle intervention program on weight management,fitness, metabolic risk, and psychological well-being in obesepremenopausal females with the metabolic syndrome. ApplPhysiol Nutr Metab. 2007;32(1):125–42.29. Crerand CE, Wadden TA, Foster GD, Sarwer DB, PasterLM, Berkowitz RI. Changes in obesity-related attitudes inwomen seeking weight reduction. Obesity (Silver Spring).20 07;15(3):740 –7.30. Rapoport L, Clark M, Wardle J. Evaluation of a modifiedcognitive-behavioural programme for weight management. IntJ Obes Relat Metab Disord. 2000;24(12):1726–37.31. Bacon L, Keim NL, Van Loan MD, Derricote M, Gale B, KazaksA, et al. Evaluating a ‘non-diet’ wellness intervention for improvementof metabolic fitness, psychological well-being andeating and activity behaviors. Int J Obes Relat Metab Disord.2002;26(6):854–65.32. Hawley G, Horwath C, Gray A, Bradshaw A, Katzer L, Joyce J,et al. Sustainability of health and lifestyle improvements followinga non-dieting randomised trial in overweight women.Prev Med. 2008;47(6):593–9.33. Katzer L, Bradshaw AJ, Horwath CC, Gray AR, O’Brien S,Joyce J. Evaluation of a ‘nondieting’ stress reduction programfor overweight women: a randomized trial. Am J Health Promot.2008;22(4):264–74.34. Harvie MN, Bokhari S, Shenton A, Ashcroft L, Evans G, SwindellR, et al. Adult weight gain and central obesity in womenwith and without a family history of breast cancer: a casecontrol study. Fam Cancer. 2007;6(3):287–94.35. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we seemore translation of health promotion research to practice? Rethinkingthe efficacy-to-effectiveness transition. Am J PublicHealth. 2003;93(8):1261–7.36. Vance VA, Woodruff SJ, McCargar LJ, Husted J, HanningRM. Self-reported dietary energy intake of normal weight,overweight and obese adolescents. Public Health Nutr.2009;12(2):222–7.37. Cook A, Pryer J, Shetty P. The problem of accuracy indietary surveys. Analysis of the over 65 UK National Dietand Nutrition Survey. J Epidemiol Community Health.2000;54(8):611–6.ACKNOWLEDGEMENTSKaaren Mathias(Community and PublicHealth, Canterbury DistrictHealth Board) assistedwith drafting the originalmanuscript. Kristi Calderassisted with the dataanalysis (Community andPublic Health, CanterburyDistrict Health Board).FUNDINGCommunity and PublicHealth, CanterburyDistrict Health Boardfunded the developmentof the Appetite for Lifeprogramme. CanterburyDistrict Health Boardfunded the evaluationof the programme.Partnership HealthCanterbury Te Kei oTe Waka funded themanuscript preparationand the ongoing deliveryof Appetite for Lifethrough several generalpractices in Canterbury.COMPETING INTERESTSNone declared.VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 287
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ETHICSObesity, autonomy and the har
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RESEARCH GEMSCommunication skills a
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