Is Dietary Non-Adherence unique to obesity and weight loss? Results from a randomized clinical trial

Objective: Weight stigma is associated with poor dietary adherence, yet adherence is essential for weight loss and maintenance. This study aimed to determine differences in dietary adherence and perceived hunger between lean and two groups of individuals with obesity. Methods: In a 6-week outpatient dietary intervention (23males; age 48±14), lean participants (n=23; BMI 23±2 kg/m2 ) received a weight maintaining diet (WMEN) and participants with obesity (BMI 36±7) were randomized to either WMEN (n=18) or 35% calorie reduced (CR) diet (n=19). All food was provided and multiple All food was provided and multiple adherence and hunger ratings were assessed daily and weekly on an outpatient basis and in person at twice weekly visits (e.g. 24h recall, diaries, etc.). Results: Weight decreased more in individuals with obesity CR group (β=-0.301kg/week, p=0.02) compared to lean and individuals with obesity WMEN groups. However, total percent adherence did not differ between groups (p=0.60) and hunger scores did not change across groups over time (p=0.08). Conclusions: Results indicate there are no differences in dietary adherence between lean and individuals with obesity and adherence is not associated with adiposity or hunger. Thus, the belief that non-adherence (e.g. lack of willpower) is unique to obesity is untrue and may perpetuate weight bias and stigma.