Patients with advanced cancer (PWAC) are living months-years longer. With advances in oncological care, their illness can be considered chronic rather than terminal. This population of survivors emerged within the last two decades and their needs are not well understood nor are appropriate resources available. A particular concern is depression. Both clinical and subclinical depressive symptomatology can impede functioning and quality of life (QOL). Using secondary clinical data from a palliative rehabilitation program (PRP), the thesis objectives were to a) examine pre-post changes in functioning and QOL, b) examine the mechanisms of change in depressive symptomatology, and c) examine the longitudinal course of depressive symptomatology. Study 1 examined pre-post changes in QOL and functioning. Outcomes from 67 PRP patients were analyzed using paired t-tests. Results revealed ameliorations in the majority of domains (e.g. physical functioning, malnutrition) including self-reported “depression.” These results counter the existing literature that has shown that these typically stay stable until one month before death, when they drastically worsen. This begins to support that rehabilitation may be beneficial for PWAC. Study 2 focused on the finding that depression scores decreased. Changes in systemic inflammation, exercise, and general self-efficacy (GSE) from 80 PRP patients were examined as predictors of change in depressive symptomatology using a hierarchical linear regression. The model accounted for 15% of change in depression symptomatology, and GSE was the only significant predictor. This suggests that a GSE theoretical framework may be helpful in reducing depressive symptomatology in interdisciplinary palliative rehabilitation. Study 3 focused on longitudinal depressive symptomatology. Three-month follow-up data from 80 patients were analyzed using a repeated measures ANOVA for continuous data and a Cochrane’s Q analysis for grouped data. Results revealed that patients maintained reduced scores at follow-up. This counters the existing literature, in which longitudinal maintenance is poor following exercise-based interventions. Therefore, PRP may offer something beyond what other published interventions have previously. These finding will be discussed in the context of other existing literatures and the implications will be discussed.

Notre thèse s’inscrit dans le champ de la Promotion de la Santé définit par l’Organisation Mondiale de la Santé. L’activité de la recherche consiste principalement à évaluer l’efficacité de la Promotion de la Santé au travers de programmes d’interventions, pour ainsi démontrer ses effets sur la santé des populations et par la même son utilité sociale. Dans le cadre de cette thèse, nous nous demandons si le programme est la seule modalité d’intervention en Promotion de la Santé alors même qu’il répond à des attendus de la Santé Publique. Nous proposons une modalité alternative plus en phase avec la Promotion de la Santé, à savoir la notion de dispositif dont la figure centrale est le sujet. Mais parce que les interventions de professionnels au sein d’un dispositif peuvent différer en fonction de leur perception du terme de santé, cela nécessite un temps d’explicitation pour déterminer leurs intentions. Nous nous appuyons sur les théories de l’intervention interdisciplinaire et des conceptions en santé pour déterminer les fondements d’un dispositif en Promotion de la Santé. L’intervention interdisciplinaire est principalement conditionnée à l’engagement des professionnels qui auront, au préalablement, déterminé un problème commun. Les conceptions en santé participent, quant à elles, à structurer nos actions dans les situations quotidiennes relatives à notre santé, elles peuvent aussi éclairer les situations qui concernent les professionnels qui ont à décider et agir dans une perspective promotrice de santé des sujets qu’ils accompagnent. Ceci nous permet d’alimenter un objet de recherche en Promotion de la Santé autour de l’implantation d’un dispositif. En inscrivant les sujets comme point nodal d’un dispositif, nous nous interrogeons sur ce qui leur permettrait de décider d’y participer ce qui constitue notre question de recherche. Pour ce faire, nous avons étudié un dispositif en Promotion de la Santé, EST03, qui vise l’accompagnement d’acteurs territoriaux qui interviennent auprès d’enfants et d’adolescents. Nous nous sommes focalisés sur un moment clé que sont les prémices de ce dispositif où des professionnels sont en situation de déterminer leur engagement. Nous avons conçu deux protocoles permettant le recueil puis l’analyse de discours de 63 sujets, par la méthode de l’entretien semi-dirigé, concernant leur activité professionnelle et les liens avec le terme de santé. Nous avons utilisé le logiciel d’analyse de contenu qualitatif Nvivo 11© et avons élaboré deux étapes d’analyse. La première a permis la constitution de 812 références. La deuxième étape de l’analyse a permis de révéler 28 conceptions en santé mobilisées par les sujets. En utilisant une mesure de similarité nous avons observé l’existence d’une conception collective en santé dans une situation asynchrone puis avons confirmé la présence d’un méta-système de conceptions en santé. Nous discutons d’une limite méthodologique quant à la situation même de l’entretien entendue comme une situation perturbatrice. Cette dernière interroge l’engagement du chercheur dans sa posture avec l’objet de recherche mais qui permet d’être en phase avec la temporalité réelle des prémices d’un dispositif. Nous revenons sur l’hypothèse principale en indiquant que le processus d’explicitation des conceptions en santé constitue un indicateur de mobilisation des professionnels par son effet déclencheur. Le méta-système de conceptions en santé observé permet, quant à lui, d’établir une liaison avec la notion d’activité collective mais également avec le concept sociologique de la négociation. Cela nous permet d’établir quelques conditions préalables à un dispositif en Promotion de la Santé à savoir l’explicitation des conceptions en santé des sujets en amont du dispositif, l’activité collective comme modalité d’organisation du dispositif, la reconnaissance et la valorisation explicites des institutions quant à l’activité collective des professionnels et la coordination des tâches / Our thesis falls within the scope of Health Promotion defined by the World Health Organization. The research activity consists mainly of evaluating the effectiveness of Health Promotion through intervention programs, thus demonstrating its effects on the health of the populations and by the same its social utility. In the framework of this thesis, we wonder if the program is the only modality of intervention in Health Promotion even though it responds to expectations of Public Health. We propose an alternative modality more in line with the Promotion of Health, namely the concept of device whose central figure is the subject. But because the interventions of professionals within a device can differ according to their perception of the term of health, it requires a time of explanation to determine their intentions. We rely on theories of interdisciplinary intervention and health conceptions to lay the foundation for a Health Promotion device. Interdisciplinary intervention is mainly conditioned by the commitment of professionals who will have previously identified a common problem. The health conceptions participate, as for them, to structure our actions in the daily situations relating to our health, they can also enlighten the situations which concern the professionals who have to decide and act in a perspective promoter of health of the subjects which they accompany. This allows us to feed an object of research in Health Promotion around the implementation of a device. By listing topics as a nodal point of a device, we question what would allow them to decide to participate in what constitutes our research question. To do this, we studied a device in Health Promotion, EST03, which aims to support territorial actors who intervene with children and adolescents. We focused on a key moment that is the beginnings of this device where professionals are in a position to determine their commitment. We conceived two protocols allowing the collection and the analysis of speeches of 63 subjects, by the method of the semi-directed interview, concerning their professional activity and the links with the term of health. We used the qualitative content analysis software Nvivo 11 © and developed two analysis steps. The first allowed the constitution of 812 references. The second stage of the analysis revealed 28 health conceptions mobilized by the subjects. Using a similarity measure, we observed the existence of a healthy collective design in an asynchronous situation and then confirmed the presence of a meta-system of healthy conceptions. We discuss a methodological limit on the very situation of the interview as a disruptive situation. The latter questions the commitment of the researcher in his posture with the research object but which allows to be in phase with the real temporality of the beginnings of a device. We return to the main hypothesis by indicating that the process of explaining conceptions in health is an indicator of mobilization of professionals by its triggering effect. The meta-system of conceptions in health observed makes it possible to establish a link with the notion of collective activity but also with the sociological concept of negotiation. This allows us to establish some prerequisites for a device in Health Promotion, namely the explanation of the health conceptions of the subjects upstream of the device, the collective activity as modality of organization of the device, recognition and valorization of the collective activity of professionals by the institutions and the coordination of tasks

Made available in DSpace on 2015-07-22T20:50:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Associação Fundo de Incentivo à Psicofarmacologia (AFIP) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Introdução: A complexidade da fisiopatologia na Esteatose Hepática Não Alcóolica (EHNA) envolve uma interface entre as adipocinas e a regulação neuroendócrina do balanço energético, incluindo o papel do sistema Neuropeptídeo Y/Proteína agouti relacionada. Objetivo: estabelecer a relação entre a razão NeuropeptídeoY/Proteína relacionada Agouti (AgRP) e a adiponectinemia, bem como avaliar a influência de neuropeptídeos orexígenos nos aspectos nutricionais de adolescentes obesos com EHNA submetidos a uma intervenção interdisciplinar de longo prazo. Métodos: Recrutou-se adolescentes obesos pós-púberes para participarem de uma intervenção interdisciplinar. O grupo foi analisado de acordo com a presença ou não de EHNA pela ultrassonografia (US). As amostras de sangue foram coletadas para a mensuração da glicemia, transaminases hepáticas e perfil lipídico, resistência e sensibilidade insulínica. As concentrações de Adiponectina, NPY e AgRP foram avaliadas por ELISA e a mensuração da gordura visceral e subcutânea pela US. A ingestão alimentar foi aferida por meio de registro alimentar de 3 dias. Resultados: No início da terapia, observou-se que parâmetros clínicos importantes como massa corporal, IMC, gordura visceral, HOMA-IR, QUICKI, triglicérides, VLDL-colesterol e transaminases hepáticas apresentaram-se mais alterados em pacientes com EHNA, os quais melhoram após tratamento. Além disso, a energia total e ingestão de macronutrientes reduziram significativamente em ambos os grupos. Observou-se correlação positiva entre AgRP e a gordura visceral em todos os pacientes, e correlação negativa entre NPY/AgRP com a concentração de adiponectina apenas em adolescentes obesos com EHNA. Ao analisar a influência da dieta nos neuropeptídeos orexígenos, apenas os pacientes com EHNA apresentaram correlação positiva entre a ingestão de ácidos graxos saturados com os neuropeptídeos orexígenos (NPY e AgRP); e carboidrato com NPY. Foi observada correlação positiva entre ingestão de energia, (%) de lipídio e ácidos graxos saturados com o acúmulo de gordura visceral. Conclusão: Os pacientes com EHNA apresentaram parâmetros clínicos mais alterados ao compará-los àqueles que não possuíam esta doença, incluindo a correlação negativa entre adiponectina e NPY/AgRP. Estes resultados sugeriram que adolescentes obesos com EHNA apresentaram perfil inflamatório alterado, o qual pode influenciar na regulação neuroendócrina do balanço energético indicando uma barreira adicional na terapia de redução de peso. Além disso, nossos achados revelaram uma importante influência da composição da dieta no sistema orexígeno, sendo essencial considerar a ingestão excessiva de gordura saturada como um fator determinante para o desenvolvimento de EHNA. / BACKGROUND: The complexity physiophatology in the Non Alcoholic Fatty Liver Disease (NAFLD) involves interplay between adipokines and neuroendocrine regulation of energy balance, including the role of Neuropeptide Y/Agouti Related Protein system. AIM: establishing the relationship between Neuropeptide Y/Agouti Related Protein (NPY/AgRP) ratio and adiponectinemia, as well as to assess the influence of orexigenic neuropeptides in the nutritional aspects of NAFLD obese adolescents submitted to a long-term interdisciplinary approach. METHODS: A group of post-pubescent obese adolescents were recruited and included in the interdisciplinary intervention. The group was analyzed according to the presence or ausence of NAFLD by ultrassonography (US). Blood samples were collected to measure glycemia, hepatic transaminases and lipid profile, insulin resistance and sensitivity. Adiponectin, NPY and AgRP concentrations were measured by ELISA and the measurement of visceral ans subcutaneous fat by US. Food intake was measured using 3-day diet records. RESULTS: It was observed at baseline that important clinical parameters including body weight, BMI, visceral fat, HOMA-IR, QUICKI, triglycerides, VLDL-cholesterol and hepatic transaminases were more altered in NAFLD patients. After the intervention, these parameters, total energy and macronutrient intake were reduced significantly in both groups. The most important finding was the positive correlation between AgRP with visceral fat in all patients, and negative correlation between NPY/AgRP with adiponectin only in NAFLD obese adolescents. Analyzing the influence of the diet in the orexigenic neuropeptides, only the NAFLD patients presented a positive correlation between the saturated fatty acids intake and the orexigenic neuropeptides (NPY and AgRP); and carbohydrate with NPY. Indeed, it was observed a positive correlation between energy intake, lipid (%) and saturated fatty acids with visceral fat accumulation. CONCLUSION: NAFLD patients presented more altered clinical parameters than non-NAFLD, including the negative correlation between adiponectin and NPY/AgRP. These results suggested that NAFLD obese adolescents presented an altered inflammatory profile that can influence the neuroendocrine regulation of energy balance suggesting and additional impairment in the weigth loss therapy. Moreover, our findings showed an important influence of diet composition in the orexigenic system, being essential consider that the excessive saturated fatty acids intake could be a determinant factor to increase nonalcoholic fatty liver disease. / FAPESP: 2008/53069-0 / FAPESP: 2006/00684-3 / FAPESP (CEPID/Sono): 9814303-3 / TEDE

Résumé : Objectif : Identifier les facteurs associés avec le succès d’une intervention multidisciplinaire de prise en charge et de prévention des maladies chroniques dans un contexte de soins de santé de première ligne. Devis : Étude corrélationnelle prédictive d’analyse secondaire des données du projet PR1MaC, un essai randomisé contrôlé analysant les effets d’une intervention intégrant un programme de prise en charge et de prévention Contexte : Huit cliniques de soins de première ligne de la région Saguenay-Lac-Saint-Jean. Participants : un échantillon de 160 patients (52,5% d’hommes) référés par des professionnels de première ligne. L’analyse a porté sur le groupe intervention seulement. Mesure de résultats primaire : Mesure d’amélioration significative dans les huit domaines du «Health Education Impact Questionnaire». Résultat : L’analyse de régression multivariée a démontré qu’être plus jeune, être célibataire et avoir un salaire plus bas a mené à plus d’amélioration au niveau du domaine « Bien-être émotionnel »; avoir de bonnes habitudes alimentaires et cibler moins de facteurs de risque durant l’intervention a mené à plus d’amélioration au niveau du domaine « Approches et attitudes constructives »; être plus jeune, avoir plus de temps de contact avec les professionnels et avoir une concertation des professionnels a mené à plus d’amélioration dans le domaine « Approches et attitudes constructives »; avoir plus de temps de contact avec les professionnels a aussi eu une influence sur l’amélioration du domaine « Engagement positif et actif dans la vie » et avoir un plus grand nombre de professionnels intervenant chez une même personne a démontré plus d’amélioration dans le domaine « Acquisition des techniques et habiletés ». Aucun facteur prédictif n’a pu être identifié pour les domaines « Comportements de santé », « Intégration sociale et soutien » et « Auto-surveillance et discernement ». Seulement les résultats statistiquement significatifs sont présentés (valeur p ≥ 0,05). La petite taille de l'échantillon ainsi que la possibilité d'une perte de signification des résultats après certains ajustements statistiques suggèrent que ces observations devraient faire l'objet d'une validation plus approfondie dans d'autres études. Conclusion : La tentative d’identification des facteurs prédictifs de résultats de cette recherche contribue à la compréhension des mécanismes complexes de l’efficacité et offre des pistes quant à l’optimisation des programmes de prévention et de gestion des maladies chroniques. // Abstract : Context : Research on the factors associated with the successes of chronic disease prevention and management (CDPM) interventions is scarce. Objectives : To identify the factors associated with the successes of an interprofessional CDPM intervention among adult patients in primary healthcare (PHC) settings. Design : Secondary analysis of data from the PR1MaC project; a pragmatic randomized controlled trial looking at the effects of an intervention involving the integration of CDPM services in PHC. Settings : Eight PHC practices in the Saguenay - Lac - Saint - Jean region of Quebec, Canada. Participants : A sample of 160 patients (84 males) referred by PHC providers constituted the sample (mean age 52.66 ± 11.5 years); 98.5% presented two or more chronic conditions analysis focused on the intervention arm sample only. Main and secondary outcome measures : Dichotomic substantive improvement in the eight domains of the Health Education Impact questionnaire (hei Q) measured at baseline and three months later. Results : Multivariate logistic regression analysis showed that being younger, being single and having a lower family income led to a better improvement in the emotional wellbeing domain; having healthy eating habits and less objectives during the intervention led to improvement in the constructive attitudes and approaches domain; being younger, a longer intervention and a consensus of professionals led to improvement in the health services navigation domain; a longer intervention led to improvement in the positive and active engagement in life domain and having more professionals involved led to improvement in the Skills and techniques acquisition domain. No predictive factors were identified for the Health - directed behaviour, Social interaction and support and S elf - monitoring and insight domains. Only significant results are presented here (p - value ≥ 0.05). The small sample and the lost of significance after statistical adjustments suggest that observations should be validated by other studies. Conclusion: In an attempt to make causal inferences in regards to improvement, this research contributes to the understanding of the complex mechanisms of efficiency and provides information about the optimisation of CDPM program delivery.

Introdução: A abordagem \"Health at Every Size®\" (HAES®) vem sendo utilizada para o cuidado de pessoas com obesidade. Objetivo: Compreender os efeitos de uma nova intervenção interdisciplinar baseada na abordagem HAES®, especialmente acerca dos processos de escolhas alimentares. Métodos: Este foi um ensaio clínico prospectivo randomizado controlado, de sete meses, que empregou o desenho de métodos mistos. Cinquenta e oito mulheres obesas compuseram a amostra e foram alocadas aleatoriamente nos grupos intervenção (I-HAES®, n = 39) ou controle (CTRL, n = 19). A intervenção do grupo I-HAES® consistiu em uma nova proposta de cuidado baseada na abordagem HAES®, consistindo de atividade física três vezes por semana, atendimento nutricional individual quinzenal e cinco oficinas filosóficas. Já a intervenção do grupo CTRL consistiu em uma intervenção tradicional baseada nesta abordagem, consistindo de palestras bimestrais. Para ambos os grupos foram feitos ao início e final da intervenção exames de sangue, testes de função muscular, aferição de peso corporal e das circunferências da cintura e quadril, além do preenchimento de escalas e questionários autoaplicados. Duas entrevistas individuais semiestruturadas e dois grupos focais foram conduzidos com todas as participantes. Os dados qualitativos foram analisados pela técnica da análise de conteúdo e os quantitativos pelos softwares estatísticos SAS e SPSS. Resultados: Embora ambos os grupos tenham reportado melhoras na qualidade da alimentação, estas foram mais expressivas no grupo I-HAES®. Essa melhora se relacionou com o maior engajamento com experiências culinárias e com o aumento no planejamento da alimentação. Outras estratégias que impactaram positivamente nas escolhas alimentares desse grupo foram comer com atenção, com tempo adequado e de acordo com as sensações de fome e saciedade. Inicialmente, as participantes de ambos os grupos relataram que seus corpos traziam consequências físicas e psicológicas negativas, impactavam na sua autoavaliação e eram alvo de estigmatização. Posteriormente, grande parte do grupo I-HAES® reportou que, embora a perda de peso ainda fosse uma expectativa, elas estavam satisfeitas com outros ganhos que tiveram, não colocavam mais a perda de peso como central para sua felicidade e entenderam que as mudanças se dariam em longo prazo. O peso corporal, o índice de massa corporal e as circunferências da cintura e quadril não diferiram significativamente intra ou entre grupos (p > 0,05). O grupo I-HAES® apresentou aumento no consumo de oxigênio máximo e no teste funcional -timed-stand? (P = 0,004 e P = 0,004, comparação entre grupos). Não foram observadas diferenças intra ou entre grupos para as medidas objetivas de atividade física, embora a maioria das participantes do grupo I-HAES® tenha reportado estar engajadas ou ter planos para incluir atividades físicas em suas rotinas. Ambos os grupos apresentaram melhoras relacionadas à qualidade de vida, mas no grupo I-HAES® estas foram mais expressivas. Conclusões: Uma nova intervenção baseada na abordagem HAES® pareceu superior a uma intervenção tradicional. Embora não tenham sido observadas mudanças no peso corporal e em níveis de atividade física, essa nova intervenção melhorou as escolhas, atitudes e práticas alimentares das participantes, sua percepção de imagem corporal, capacidade física e qualidade de vida. / Introduction: The \"Health at Every Size®\" (HAES®) approach is being more and more used to the care of people with obesity. Objective: To understand the effects of a new interdisciplinary intervention based on the HAES® approach, especially regarding food choice processes. Methods: This was a prospective, seven-month, randomized, controlled, mixed-method, clinical trial. Fifty-eight obese women composed the sample and were randomly allocated into the intervention (I-HAES®) or control (CTRL) groups. The I-HAES® intervention consisted of a new proposal of care based on the HAES® approach, comprising physical activity classes three times a week, biweekly individual nutritional sessions, and five philosophical workshops. The CTRL intervention consisted of a traditional intervention based on this approach, comprising bimonthly lectures. Both groups were assessed at the beginning and after the intervention for blood tests, aerobic condition, body weight and waist and hip circumferences, muscle function, in addition to the filling of scales and questionnaires self-administered. Two semi-structured individual interviews and two focus groups were conducted with all participants. The qualitative data were analyzed using the content analysis technique, whereas the quantitative data were analyzed using the statistical software SAS and SPSS. Results: Although both groups reported improvements in food quality, they were more expressive in the I-HAES® group. It seems that this improvement was related to this group higher engagement with culinary experiences and the increase in food planning. Other strategies that positively impacted on the food choices of this group were eating mindfully, deliberately, and in response to hunger and satiety cues. Initially, participants of both groups reported that their bodies had negative physical and psychological consequences, impacted their self-assessment, and were subject to stigmatization. After the intervention, most of the I-HAES® group reported that although weight loss was still an expectation, they were satisfied with other gains they had, no longer placed weight loss as central to their happiness and understood that the changes would take place in the long term. Body weight, body mass index, and waist and hip circumferences did not differ significantly within or between groups (p > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, although most participants in the I-HAES® group reported that they were engaged in or had plans to include physical activities in their routines. Both groups presented improvements related to quality of life, but in the I-HAES® group these were more expressive. Conclusions: A new intervention based on the HAES® approach seemed superior to a traditional intervention. Although no changes were observed in body weight and physical activity levels, this new intervention improved participants\' food choices, eating attitudes and practices, their perception of body image, physical capacity and quality of life.

Introdução: A abordagem \"Health at Every Size®\" (HAES®) vem sendo utilizada para o cuidado de pessoas com obesidade. Objetivo: Compreender os efeitos de uma nova intervenção interdisciplinar baseada na abordagem HAES®, especialmente acerca dos processos de escolhas alimentares. Métodos: Este foi um ensaio clínico prospectivo randomizado controlado, de sete meses, que empregou o desenho de métodos mistos. Cinquenta e oito mulheres obesas compuseram a amostra e foram alocadas aleatoriamente nos grupos intervenção (I-HAES®, n = 39) ou controle (CTRL, n = 19). A intervenção do grupo I-HAES® consistiu em uma nova proposta de cuidado baseada na abordagem HAES®, consistindo de atividade física três vezes por semana, atendimento nutricional individual quinzenal e cinco oficinas filosóficas. Já a intervenção do grupo CTRL consistiu em uma intervenção tradicional baseada nesta abordagem, consistindo de palestras bimestrais. Para ambos os grupos foram feitos ao início e final da intervenção exames de sangue, testes de função muscular, aferição de peso corporal e das circunferências da cintura e quadril, além do preenchimento de escalas e questionários autoaplicados. Duas entrevistas individuais semiestruturadas e dois grupos focais foram conduzidos com todas as participantes. Os dados qualitativos foram analisados pela técnica da análise de conteúdo e os quantitativos pelos softwares estatísticos SAS e SPSS. Resultados: Embora ambos os grupos tenham reportado melhoras na qualidade da alimentação, estas foram mais expressivas no grupo I-HAES®. Essa melhora se relacionou com o maior engajamento com experiências culinárias e com o aumento no planejamento da alimentação. Outras estratégias que impactaram positivamente nas escolhas alimentares desse grupo foram comer com atenção, com tempo adequado e de acordo com as sensações de fome e saciedade. Inicialmente, as participantes de ambos os grupos relataram que seus corpos traziam consequências físicas e psicológicas negativas, impactavam na sua autoavaliação e eram alvo de estigmatização. Posteriormente, grande parte do grupo I-HAES® reportou que, embora a perda de peso ainda fosse uma expectativa, elas estavam satisfeitas com outros ganhos que tiveram, não colocavam mais a perda de peso como central para sua felicidade e entenderam que as mudanças se dariam em longo prazo. O peso corporal, o índice de massa corporal e as circunferências da cintura e quadril não diferiram significativamente intra ou entre grupos (p > 0,05). O grupo I-HAES® apresentou aumento no consumo de oxigênio máximo e no teste funcional -timed-stand? (P = 0,004 e P = 0,004, comparação entre grupos). Não foram observadas diferenças intra ou entre grupos para as medidas objetivas de atividade física, embora a maioria das participantes do grupo I-HAES® tenha reportado estar engajadas ou ter planos para incluir atividades físicas em suas rotinas. Ambos os grupos apresentaram melhoras relacionadas à qualidade de vida, mas no grupo I-HAES® estas foram mais expressivas. Conclusões: Uma nova intervenção baseada na abordagem HAES® pareceu superior a uma intervenção tradicional. Embora não tenham sido observadas mudanças no peso corporal e em níveis de atividade física, essa nova intervenção melhorou as escolhas, atitudes e práticas alimentares das participantes, sua percepção de imagem corporal, capacidade física e qualidade de vida. / Introduction: The \"Health at Every Size®\" (HAES®) approach is being more and more used to the care of people with obesity. Objective: To understand the effects of a new interdisciplinary intervention based on the HAES® approach, especially regarding food choice processes. Methods: This was a prospective, seven-month, randomized, controlled, mixed-method, clinical trial. Fifty-eight obese women composed the sample and were randomly allocated into the intervention (I-HAES®) or control (CTRL) groups. The I-HAES® intervention consisted of a new proposal of care based on the HAES® approach, comprising physical activity classes three times a week, biweekly individual nutritional sessions, and five philosophical workshops. The CTRL intervention consisted of a traditional intervention based on this approach, comprising bimonthly lectures. Both groups were assessed at the beginning and after the intervention for blood tests, aerobic condition, body weight and waist and hip circumferences, muscle function, in addition to the filling of scales and questionnaires self-administered. Two semi-structured individual interviews and two focus groups were conducted with all participants. The qualitative data were analyzed using the content analysis technique, whereas the quantitative data were analyzed using the statistical software SAS and SPSS. Results: Although both groups reported improvements in food quality, they were more expressive in the I-HAES® group. It seems that this improvement was related to this group higher engagement with culinary experiences and the increase in food planning. Other strategies that positively impacted on the food choices of this group were eating mindfully, deliberately, and in response to hunger and satiety cues. Initially, participants of both groups reported that their bodies had negative physical and psychological consequences, impacted their self-assessment, and were subject to stigmatization. After the intervention, most of the I-HAES® group reported that although weight loss was still an expectation, they were satisfied with other gains they had, no longer placed weight loss as central to their happiness and understood that the changes would take place in the long term. Body weight, body mass index, and waist and hip circumferences did not differ significantly within or between groups (p > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, although most participants in the I-HAES® group reported that they were engaged in or had plans to include physical activities in their routines. Both groups presented improvements related to quality of life, but in the I-HAES® group these were more expressive. Conclusions: A new intervention based on the HAES® approach seemed superior to a traditional intervention. Although no changes were observed in body weight and physical activity levels, this new intervention improved participants\' food choices, eating attitudes and practices, their perception of body image, physical capacity and quality of life.