Eatit's Obesity Intervention: Effects on Weight, Eating Habits and Health

Inclusion Criteria:

• Age 18 years or older

• Body mass index (BMI) ≥ 30

• BMI 27-30 in combination with at least one of the following:

1. Has received a diagnosis of obesity from another healthcare provider.

2. Has a comorbidity (according to the defined diagnosis list under the headingComorbidities below).

3. Has central obesity, defined as waist circumference > 80 cm for women or > 94cm for men.

4. Kostindex score of 4 or lower - eligible for treatment due to increased risk ofrapid future weight gain. Dietitian-led intervention may significantly impactweight development in this group.

• Ability to read and understand Swedish

• Does not currently use, and does not plan to initiate the use of,appetite-suppressing medication

• Not pregnant

• Patients with BMI > 40, As long as there is no contraindication for treatment,treatment is offered. A dietitian may deny the patient the Eatit program if thedietitian assesses that the need for care is too great, and that Eatit's treatmentcannot meet the patient's needs.

Comorbidities:

• Cardiovascular disease This is a large group of diagnoses, e.g. previous myocardialinfarction or stroke, angina pectoris, heart failure, etc.

• Hypertension

• Elevated blood pressure, above 130/85 mmHg or ongoing treatment for previouslydiagnosed hypertension

• Hyperlipidemia

• Triglyceride levels ≥ 1.7 mmol/L or on treatment for elevated triglycerides, or LDL > 3.0 mmol/L at low risk, or on treatment for high cholesterol, or reduced HDL-C <40mg/dL for men, <50 mg/dL for women, or on treatment for HDL-C

• Obstructive sleep apnea

• Type 1 diabetes

• Type 2 diabetes

• Prediabetes (fasting glucose ≥ 6.1 or HbA1c > 42 without a diabetes diagnosis)

• Fatty liver

• Polycystic ovary syndrome, PCOS

• Osteoarthritis in the lower body (e.g. hip, knee, or foot)

Exclusion Criteria:

• BMI: Patients with BMI < 27 are excluded from treatment.

• Medical conditions: Patients with conditions where weight loss or weight gain mayworsen the disease are excluded. For example: cancer or chronic obstructivepulmonary disease, COPD.

• Multimorbidity: Individuals with extensive comorbidities may have complex healthcareneeds requiring more comprehensive medical support than Eatit can provide.

• Untreated depression may hinder participation in the program and should be managedwith medical or psychological support.

• Untreated or ongoing eating disorder (bulimia nervosa, binge eating disorder,anorexia, atypical anorexia, ARFID) should be treated in a specialized eatingdisorder unit.

• Severe psychiatric illness (such as psychosis or schizophrenia) without ongoingsupport.

• Ongoing substance abuse (alcohol, narcotics, or medication) is a contraindicationfor participation and requires specialized addiction care.

• Suicidal behavior or self-harm in the past six months. Acute mental illness requiresimmediate and specialized interventions.

• Requires individual assessment. Certain conditions require individual evaluation asthey may negatively affect treatment outcomes. This means that the treatingdietitians should ask follow-up questions to ensure that participation in theprogram is feasible.

• Symptoms of binge eating not meeting criteria for binge eating disorder: Ensure thatthe person is willing to work with the program, not skip meals, and will inform youif the binge eating worsens.

• Depression under psychiatric care: Ask follow-up questions about what support theperson is receiving and his or her current mental state.

• Bipolar disorder: Ask follow-up questions about what support the person is receivingand his or her current mental state.

• Exhaustion syndrome/stress: Ask follow-up questions to determine whether treatmentis feasible at this time or if the patient needs to manage the stress in other waysfirst.

• Neuropsychiatric disorders: To benefit from the program, sufficient concentrationability and capacity for structure/planning in daily life are required. In case of aneuropsychiatric diagnosis, follow-up questions should be asked about whether theperson believes that he or she can manage texts and tasks that take approximately 2-3 hours per week.

• High degree of psychiatric comorbidity has in some studies been shown to be acomplicating factor, and this should also be considered at the start of treatment.Ask follow-up questions about what support the person is receiving and his or hercurrent mental state.

• Severe sleep problems: Sleep deprivation may lead to increased appetite and reducedcognitive capacity, making it difficult to engage with treatment. Ask follow-upquestions about possible undiagnosed sleep apnea or potential need for other care toaddress the sleep problems.