In Brazil, more than 50% of adults is overweight or obese (1). Obesity is a chronic, complex and multifactorial disease that is associated with increased risk of comorbidities such as type 2 diabetes (2), dyslipidemia (3) and cardiovascular disease (CVD) (4). In addition to affecting physical health, obesity has been associated with decrease in mental and social health (5). People with obesity have higher levels of anxiety, depression, binge eating, low self-esteem, social discrimination, disability with early retirement, and death (6, 7). Increasing prevalence of this condition is placing a major burden on the public health system with a large impact on the economy (4).
Several strategies have been used to minimize the impacts caused by obesity. Among these, lifestyle interventions that combine changes in eating behavior and regular exercise should be incorporated as a first step by those seeking weight loss (8–14). Current guidelines advocate the need for lifestyle changes, but calorie-restricted diets and/or macronutrient-manipulated diets continue to be the most widely used method to promote weight reduction and prevent CVD (9, 15).
However, it is noteworthy that the consumption of healthy food for a large portion of the Brazilian population is relatively expensive (16). Low-income families are more likely to choose unhealthy foods, which are industrialized and have high energy density contributing to increases in body mass index (BMI) and waist circumference, as well as a low self-assessment of health conditions (17). Therefore, cost-effective strategies for health promotion in overweight and obese people are essential and need to be incorporated by the Brazilian public health system (18, 19).
Although previous studies have shown that low-calorie diets and/or macronutrient manipulation are effective to promote short-term weight loss, it is not known whether one diet is more effective than others. Regarding weight loss and maintenance of lost weight, ~90–95% of treated people regain body mass over the time (20). On the other hand, Alvarenga et al. (21) and Wolever et al. (22) found that new nutritional strategies based on behavioral treatment without prescribing restrictive diets have satisfactory long-term results. For these authors, food does not perform only the function of nurturing physiological needs, but it goes beyond and fulfills the function of psychological and social needs. Thus, other perspectives for obesity treatment have emerged and were tested by the scientific community (18, 19).
It is noteworthy that overweight people, especially women, are more likely to have self-criticism and negative body image (23), which is stimulated by the standards of beauty imposed by society. The search for the ideal body promotes body image dissatisfaction and lower self-esteem, resulting in impairments in physical and mental health. Despite the constant efforts of those seeking weight loss, failure rates are high, which demonstrates how difficult it is to combat this twenty first century disease.
Another issue of weight loss intervention program is the adherence to diet changes. The literature points out that adherence rates can be very variable depending on the type of diet adopted and the individual wish for a lifestyle change (24). People often procrastinate the nutritional planning during a weight loss program, particularly women with poor health status (25). It is possible that, regardless of the nutritional counseling model, a close follow-up with the dietitian and health team can be the most effective factor to promote weight loss in people with obesity. People need time to change their eating habits and require continuous reinforcement to maintain a new lifestyle (24).
Given the worrisome prevalence of obesity, the number of strategies for weight loss and the high rates of failure, the aim of the present study was to investigate the effects of two different nutritional strategies: group nutrition counseling (GNC) or individualized nutrition prescription (INP), with a concurrent exercise program on the physical, nutritional and mental health of overweight or obese women after 12-weeks of intervention. As a hypothesis, it is believed that both nutritional strategies along with concurrent exercise would be effective to improve the health condition of overweight or obese women.