title: Engagement in New Dietary Habits-Obese Women's Experiences from Participating in a 2-Year Diet Intervention.
abstract: BACKGROUND
  Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.
  
  
  OBJECTIVE
  The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.
  
  
  METHODS
  Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.
  
  
  RESULTS
  A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".
  
  
  CONCLUSIONS
  We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87, Umeå, Sweden. christina.ahlgren@physiother.umu.se.|Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden. christina.ahlgren@physiother.umu.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Ahlgren
authors.affiliation: Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.|Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sandberg
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Bernt
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Olsson
authors.affiliation: Department of Food and Nutrition, Umeå University, Umeå, Sweden.|Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Christel
authors.initials: C
authors.lastname: Larsson
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87, Umeå, Sweden.|Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden.
authors.forename: Anncristine
authors.initials: A
authors.lastname: Fjellman-Wiklund
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D004032:Diet / Q000379:methods / Q000523:psychology; D004038:Diet, Reducing / Q000379:methods / Q000523:psychology; D005191:Family Characteristics; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D040242:Risk Reduction Behavior
keywords: Dietary habits; Engagement; Experience; Intervention; Obese; Qualitative study