Introduction
Thinness has become a symbol of beauty, success and acceptance for women in Westernized societies. Adolescent girls are particularly vulnerable to the social pressures to be thin, and dieting can now be considered the norm, with rates typically exceeding 66% for this population.

The growth spurt and increase in body fat that occurs with puberty may predispose the adolescent girl to weight preoccupation, body shape dissatisfaction and harmful weight control practices. Dieting during the teenage years has been associated with anxiety, depression, low self-esteem, nutritional deficiencies, impaired concentration ability, as well as inhibited growth. In extreme cases, dieting has been linked to the development of eating disorders.

To date, few attempts have been made to address or prevent the problem of teenage dieting. The HUGS for Teens program, based on the non-diet paradigm, was developed to promote healthy lifestyle choices in teenagers.

Goals
To determine the extent of body weight and body shape dissatisfaction in a small group of South African female teenagers.
To determine past weight control practices amongst the sample group.
To evaluate the effectiveness of the HUGS for Teens program in meeting its objectives:
Improve body image and self-esteem
Decrease weight preoccupation, diet-related behavior and dieting.
Establish the framework for lifelong healthier lifestyle choices.
Promote the acceptance of different body shapes and sizes.

Methods
35 Grade 9 girls from three “middle-upper” class schools in Cape Town took part in the study.
Subjects were randomly assigned to test group (HUGS) and control group (NI).
Programs were run over 10 weeks, after school hours for 60 - 90 minutes.
Both programs were offered by the same person to reduce facilitator bias.

Measurements (made during weeks 1 and 10):
Demographic questionnaire
HUGS Lifestyle Quiz: - A validated LIKERT-response scale used to assess diet behavior.
Body Shape Questionnaire (BSQ):- Measures concerns about body shape and the extent of body shape dissatisfaction
Rosenberg’s Self-esteem scale (RSE): Useful in assessing self-esteem in adolescent populations.
Food Habits Questionnaire: Used to determine quantitative and qualitative changes in food habits

PROGRAM COMPONENTS
HUGS for Teens	Nutrition Intervention
Taking Responsibility for their own lifestyle choices	Traditional nutrition education
Eating for Health and energy	Promotion of physical activity as a means of health and weight control
Using physical activity as a source of energy and fun	Evaluation of different weight loss products
Working with body signals of hunger and satiety
Appreciating size and diversity based on genetic and growth factors
Looking critically at media messages surrounding health/body image
Program Activities Included: Facilitated group discussions Take home activities Self discovery exercises	Program activities included: Nutrition education talks by the facilitator Facilitated group discussions

Comparative Results
Attitudes towards body weight and shape
A total of 89% of the sample group wanted to lose weight even though only 17% were classified as “at risk of being overweight”.
77% of the girls were unhappy with their body shape.
85% of the girls who were unhappy with their body shape had participated in some form of weight loss behavior in the past year.
A history of dieting was obtained from 77% of the girls.

Change in scores on the HUGS Quiz
Self-acceptance scores: significant improvement in both groups, (almost 3 times greater in the HUGS groups)
Self-nourishment: Participation in the HUGS program was associated with a significant improvement in whereas the NI group was not.

Changes in self-esteem
At baseline, the sample group had a low self-esteem
The HUGS participants showed a significant improvement in self-esteem whereas NI participants did not

Changes in body image
Body image: prior to intervention, the sample group, on average, had a very poor body image.
HUGS program: brought about a significant improvement in body image.
NI program: failed to bring about a significant improvement

Changes in food habits
Total fat intake: Neither group showed a significant decrease. (The NI group already showed very low fat levels). Although a slow decrease in fat intake is encouraged in the HUGS program, a low fat diet is not encouraged due to the fact that many weight conscious teens take low fat advice to extreme levels, often depriving their bodies of essential nutrients needed for growth. This would explain why participants in the HUGS program did not decrease fat intake greatly.
Better food habits: A significant improvement was seen in the HUGS group, but not in the NI group.

Conclusions:
Baseline data indicates very high levels of poor self-esteem, body shape dissatisfaction, and weight preoccupation in this sample of South African teenage girls.
These dysfunctional attitudes are associated with a dieting lifestyle, and other harmful weight control practices, which may entail serious long-term implications for the developing teen.
Participation in the HUGS program led to significant improvements in self-esteem, greater self-acceptance, and thus a reduction in weight preoccupation and dieting behaviors.
These improvements were not seen in the participants of the traditional approach (NI)
Participation in the HUGS program also resulted in improved food habits, not seen in the NI group. (The failure of the NI program to bring about an improvement in better food habits can be attributed to the fact that nutrition education very often does not bring about a change in food habits in teenagers due to lack of urgency, peer pressure and food preferences.) Conversely, with the HUGS program, the teens are taught lifestyle skills to empower the teen to make more appropriate food choices instead of focusing on the food pyramid, exchanges and portion sizes. Result: empowerment is more likely to translate into better food habits than knowledge acquisition.
Emphasis is on: individual responsibility, acquisition of lifestyle skills and “listening to one’s body”, as opposed to instilling nutrition knowledge.
These findings indicate the Non-diet Lifestyle approach, which emphasizes healthier, enjoyable eating, active living, and self-acceptance, may be more effective than traditional nutrition education in addressing the weight preoccupation and excessive dieting associated with poor self-concept in “middle-upper” class, South African teenage girls.

These short-term results indicate improvements in body image and self-esteem, decrease in diet and weight preoccupation, and improvement in better food habits. Therefore, it can be concluded the Teen and Diets: No Weigh program can, indeed, make a contribution towards the promotion of healthy lifestyle choices and the prevention of disordered eating patterns amongst our vulnerable female teenage population.