Research Article| Volume 54, ISSUE 10, P894-901, October 2022

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Narrative-focused Group Counseling Improves Intervention Outcomes in Women With Obesity



      To investigate the effects of narrative group counseling combined with diet modification and exercise plans on weight loss in Iranian women with obesity.


      Parallel 2-arm clinical trial.


      Fifty-six Iranian women with obesity (aged 18–50 years).


      The intervention group included weekly diet, exercise, and narrative-focused group counseling, whereas the comparison group included dietary modification and exercise sessions for 8 months (32 sessions).

      Main Outcome Measure

      Anthropometric and body composition parameters, blood biochemical parameters (high-density lipoproteins, low-density lipoproteins, triglycerides, fasting blood sugar, ghrelin, obestatin), physical activities, and appetite scores.


      McNemar test was used for the variables that were not normally distributed and for scaling. Furthermore, t tests were used to compare quantitative variables with normal distributions. The original P (0.05) was adjusted to P = 0.0031 using the Bonferroni correction.


      Weight, body mass index, body fat proportion, and hip circumference decreased significantly in the intervention vs comparison group. Serum low-density lipoproteins, triglycerides, total cholesterol, fasting blood sugar, appetite score, and ghrelin decreased, whereas obestatin increased significantly in the intervention vs comparison group.

      Conclusions and Implications

      Narrative-focused group counseling combined with traditional strategies was effective in achieving significant changes in weight, body mass index, and appetite. Future studies with a more diverse audience and a longer follow-up are warranted.

      Key Words

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        • Najafi F
        • Soltani S
        • Karami Matin B
        • et al.
        Socioeconomic - related inequalities in overweight and obesity: findings from the Persian cohort study.
        BMC Public Health. 2020; 20: 214
        • Cercato C
        • Fonseca FA.
        Cardiovascular risk and obesity.
        Diabetol Metab Syndr. 2019; 11: 74
        • Hall KD
        • Kahan S.
        Maintenance of lost weight and long-term management of obesity.
        Med Clin North Am. 2018; 102: 183-197
        • Chan RSM
        • Woo J.
        Prevention of overweight and obesity: how effective is the current public health approach.
        Int J Environ Res Public Health. 2010; 7: 765-783
        • Turk MW
        • Yang K
        • Hravnak M
        • Sereika SM
        • Ewing LJ
        • Burke LE.
        Randomized clinical trials of weight loss maintenance: a review.
        J Cardiovasc Nurs. 2009; 24: 58-80
        • McKian SS
        • Rabiei S
        • Bemana H
        • Ramezani M.
        Experimental design and statistical evaluation on the effect of narrative therapy on body image and body mass index in Iranian overweight and obese women.
        Obes Med. 2019; 14100097
        • Etchison M
        • Kleist DM.
        Review of narrative therapy: research and utility.
        Fam J. 2000; 8: 61-66
        • McKian SS.
        Exploring the role of narrative therapy in obesity: overcoming body image disturbances.
        in: İ İlkılıç H Ertin Brömer R Zeeb H Health, Culture and the Human Body. Hayat Foundation for Health and Social Services, 2014: 667-679
        • Mishler E.
        Narrative and identity: the double arrow of time.
        in: de Fina A Schiffrin D Bamberg M Studies in Interactional Sociolinguistics. Cambridge University Press, 2006: 30-34
        • Alimoradi M
        • Abdollahi M
        • Vazirijavid R
        • McKian SS
        • Daneshvar S
        • Ajami M.
        Evaluation of metaphors (life and self) of obese and overweight individuals in comparison with normal weight's.
        Prog Nutr. 2019; 21: 251-260
      1. Pfeiffer S, In-Albon T. 1.10 – Family Systems. In: Asmundson GJG, ed. Comprehensive Clinical Psychology. 2nd ed. Elsevier; 2022:185–201.

        • Botella L
        • Herrero O.
        A relational constructivist approach to narrative therapy.
        Eur J Psychother Couns Health. 2000; 3: 407-418
        • McAdams DP
        • Janis L
        Narrative Identity and Narrative Therapy.
        The Handbook of Narrative and Psychotherapy: Practice, Theory, and Research. Sage Publications, Inc, 2004: 159-173
        • Frank AW.
        What is narrative therapy and how can it help health humanities?.
        J Med Humanit. 2018; 39: 553-563
        • Matos M
        • Santos A
        • Gonçalves M
        • Martins C.
        Innovative moments and change in narrative therapy.
        Psychother Res J Soc Psychother Res. 2009; 19: 68-80
        • Bamberg M.
        Who am I? Narration and its contribution to self and identity.
        Theor Psychol. 2011; 21: 3-24
        • Timper K
        • Brüning JC.
        Hypothalamic circuits regulating appetite and energy homeostasis: pathways to obesity.
        Dis Model Mech. 2017; 10: 679-689
        • Aly GS
        • Hassan NE
        • Anwar GM
        • et al.
        Ghrelin, obestatin and the ghrelin/obestatin ratio as potential mediators for food intake among obese children: a case control study.
        J Pediatr Endocrinol Metab. 2020; 33: 199-204
        • Eveleth PB
        • Andres R
        • Chumlea WC
        • et al.
        Uses and interpretation of anthropometry in the elderly for the assessment of physical status. Report to the Nutrition Unit of the World Health Organization: the Expert Subcommittee on the use and interpretation of anthropometry in the elderly.
        J Nutr Health Aging. 1998; 2: 5-17
        • Golan M.
        Eating disorders treatment: an integrative model by means of narrative counseling, motivational interviewing, and traditional approaches. In: Jáuregui-Lobera I, ed.
        Relevant Topics in Eating Disorders. InTech, 2012: 231-252
        • Moghaddam MHB
        • Aghdam F
        • Asghari Jafarabadi M
        • Allahverdipour H
        • Nikookheslat S
        The Iranian version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability.
        World Appl Sci J. 2012; 18: 1073-1080
        • Mohammadi MR
        • Akhondzadeh S
        • Keshavarz SA
        • Mostafavi SA.
        The characteristics, reliability and validity of the Persian version of Simplified Nutritional Appetite Questionnaire (SNAQ).
        J Nutr Health Aging. 2019; 23: 837-842
        • Craig CL
        • Marshall AL
        • Sjöström M
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Christiansen B
        • Borge L
        • Fagermoen MS.
        Understanding everyday life of morbidly obese adults-habits and body image.
        Int J Qual Stud Health Well-being. 2012; 7: 17255
        • Manore MM.
        Exercise and the Institute of Medicine recommendations for nutrition.
        Curr Sports Med Rep. 2005; 4: 193-198
        • National Health Service
        NIHR Southampton Biomedical Research Centre Procedure for Using the Bodystat Quadscan 4000 Bioelectrical Impedance Machine.
        National Health Service. 2014 (Accessed March 23, 2022)
        • Kim YH
        • Chiu CY
        • Cho S
        • Au EWM
        • Kwak SN.
        Aligning inside and outside perspectives of the self: a cross-cultural difference in self-perception.
        Asian J Soc Psychol. 2014; 17: 44-51
        • Muda WA
        • Kuate D
        • Jalil RA
        • Nik WS
        • Awang SA.
        Self-perception and quality of life among overweight and obese rural housewives in Kelantan, Malaysia.
        Health Qual Life Outcomes. 2015; 13: 19
        • Sialvera TE
        • Papadopoulou A
        • Efstathiou SP
        • et al.
        Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low-density lipoprotein (LDL)-cholesterol: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial.
        J Hum Nutr Diet. 2018; 31: 197-208
        • Virtanen J
        • Penttinen M
        • Kautiainen H
        • Korhonen P.
        The impact of lifestyle counselling on weight management and quality of life among working-age females.
        Scand J Prim Health Care. 2021; 39: 382-388
        • Drozek D
        • DeFabio A
        • Amstadt R
        • Dogbey GY.
        Body mass index change as a predictor of biometric changes following an intensive lifestyle modification program.
        Adv Prev Med. 2019; 20198580632
        • Mefferd K
        • Nichols JF
        • Pakiz B
        • Rock CL.
        A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors.
        Breast Cancer Res Treat. 2007; 104: 145-152
        • Tok Ö
        • Kişioğlu SV
        • Ersöz HÖ
        • Kahveci B
        • Göktaş Z
        A 4-week diet with exercise intervention had a better effect on blood glucose levels compared to diet only intervention in obese individuals with insulin resistance.
        J Sports Med Phys Fitness. 2021; 61: 287-293
        • Zehsaz F
        • Farhangi N
        • Gahremani M.
        Influence of endurance training-induced weight loss on the levels of ghrelin and obestatin of obese women with polycystic ovary syndrome.
        Sport Sci Health. 2020; 16: 703-711
        • Cummings DE
        • Weigle DS
        • Frayo RS
        • et al.
        Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery.
        N Engl J Med. 2002; 346: 1623-1630

      Linked Article

      • Making sure to keep the person in personalized nutrition
        Journal of Nutrition Education and BehaviorVol. 54Issue 10
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          Personalized nutrition focuses on the concept that individuals may respond very differently to foods and may require different dietary patterns to achieve the best health. Personalized or precision nutrition falls under the umbrella of personalized medicine, a medical model that calls for medical practices, interventions, and products to be customized to the individual based on their risk of disease. Personalized medicine relies upon an individual's genetic profile to identify the most appropriate path forward for disease prevention and treatment.
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