Five-phase Training and Education Plan With Tools. Table 3 provides a 5-phase training and education plan and tools, both for learning and implementing a comprehensive WPIE therapeutic intervention: (1) introduction to WPIE,12,64-66 (2) assessment tools,67,31 (3) elements of integrative eating,12,68-72 (4) overeating styles,73-84 and (5) in action71,85-87 (Table 3). All content and tools, which are free on the MakeWeightLossLast.com Web site, may be used to assign readings, to implement behavioral changes, to provide self-monitoring strategies, and/or to offer a basis for discussion.
Ultimately, the goal of the WPIE intervention was to use the overeating-styles profile to (1) identify and monitor Barbara’s trouble spots and strengths, (2) evaluate the strategies that worked best for her, (3) reinforce her successes as she continued to improve on her personal overeating-styles continuum, (4) help her to overcome obstacles, (5) provide her with additional goals when her immediate goals had been achieved; and, in essence, (6) help her to achieve a sense of self-efficacy and the confidence that she could attain and maintain weight loss by practicing the whole person integrative-eating dietary lifestyle on her own.
Results
Throughout Barbara’s 1-year, integrative-eating intervention and after 2 years of practicing and implementing the integrative-eating principles and program, the researchers saw an improved ability for Barbara to move from the end of the continuum with the 7 overeating styles to the optimal WPIE side of that continuum. At the 1-year follow-up, Barbara had just turned 65 years old. Still following the WPIE principles, Barbara continued to eat 3 meals daily; avoided processed food, sugar, and white flour; no longer had cravings; and used a meal plan so that she did not have to make decisions about what and how much to eat.
At the start of the intervention, Barbara weighed 107 kg and wore a size 3×; 2 years later, she guesstimates that she may weigh approximately 75 kg. Barbara has an aversion to living by the scale and so does not weigh herself. She wears a medium, size 12. She attributes the weight loss to the wholeness of the integrative-eating program and to overcoming each of the overeating styles, at first to varying degrees and, then, more and more, so that she eventually replaced at her own pace her disordered eating behaviors and aversion to traditional dieting with deep changes from within that enabled her to enjoy and savor her new relationship to food, eating, and herself.
Discussion
The 7 overeating styles that the authors have newly discovered are undoubtedly linked to overeating; 5 of the 7 are linked with being overweight or obese.32 Taken together, the overeating styles appear to consist of a dynamic web of food-related eating behaviors, emotions, beliefs, habits, thoughts, sensations, environments, and social behaviors. Starting a weight-loss program that ignores those underlying causes of overeating may increase the odds of becoming entangled again in the web of overeating styles. The current case study had demonstrated how addressing the multidimensional elements of food and eating using the WPIE model (Table 1) and program (Table 3) can be applied as a treatment plan for overcoming the overeating styles.
Is it possible for others to overturn their overeating styles by adopting the integrative-eating guidelines? To find out, the first author provided 2 one-hour lectures on integrative eating and the 7 overeating styles to 43 health-psychology students at
A clinical study by research scientist Erica Oberg has suggested that the whole person integrative-eating program may be an effective approach for helping people with type 2 diabetes to self-manage their eating and blood-sugar levels. After Bradley implemented a 12-week study with an intervention to improve overeating styles, the blood-glucose levels of the participants were significantly reduced. The degree to which participants improved their overeating styles correlated more strongly with a reduced HbA1c (P = .046) than with the percentage of calories from carbohydrates. Those results have raised the possibility that how an individual eats plays an important role in how he or she metabolizes food.88,89
Why might the integrative-eating approach have worked for Barbara after a lifetime of struggles with her weight? First, the overeating-styles questionnaire provided an immediate and clear profile of Barbara’s specific overeating behaviors and dynamics.31 Second, the profile served as a well-defined, step-by-step compass for replacing Barbara’s specific overeating styles with WPIE food choices and behaviors (Table 2). Third, the 5-phase training and education plan (Table 3) provided practical tools for Barbara to change from an overeating dietary lifestyle to one of integrative eating. Indeed, during the coaching intervention, as Barbara slowly created and internalized the integrative-eating dietary lifestyle, her overeating diminished, and, in turn, she lost weight and kept it off.
The strengths of the WPIE approach are 4-fold: (1) modification of the overeating styles is positive in that it can lead to less overeating and to more enjoyment of food; (2) the choice of where to begin can be flexible and patient centered; (3) use of the approach has no adverse physical or emotional reactions88,89; and (4) the approach allows generalization to other aspects of a person’s life, such as enjoying time with family or friends.
A further strength to the WPIE model is the support for its validity. There is (1) construct validity, because the overeating styles that emerged from the factor analysis were similar, but opposite in frequency of practice to the 6 principles that have provided eating guidelines for millennia; (2) there is high face validity, because the questionnaire asked about specific, easily identified eating activities that may or may not occur daily; and (3) there is predictive validity, because each of the overeating styles revealed by a multiple regression analysis to be independently and significantly related to overeating. The greatest challenges, however, are that the WPIE intervention takes time, a sustained effort, and an ongoing commitment from the health professional to teach it and for clients to practice it. Coaching is especially helpful as a method of implementing, monitoring, and creating sustainable change.
Conclusions
The research on WPIE and the discovery of the overeating styles reveal that the reasons for overeating and weight gain are due to a newly identified complex of interconnected internal and external food and eating dynamics. The case study suggests that identifying and modifying these dynamics and then nourishing the “whole person” physically, emotionally, spiritually, and socially through WPIE may mean she or he does not need to compensate with overeating and satiety. Due to the favorable response in this case study, with long-term resolution of the client’s overeating and obesity, further studies, including a clinical trial, are warranted to determine the efficacy of WPIE for preventing, managing, and reversing overeating.
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