Developing Intervention Program Based on Narrative Therapy and Evaluating Its Effectiveness on Lifestyle and Biological Health, and Weight Management in Overweight Adults

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Ali Afrooz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8093051/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Title: Developing Intervention Program Based on Narrative Therapy and Evaluating Its Effectiveness on Lifestyle and Biological Health, and Weight Management in Overweight Adults Background : Overweight and obesity are multidimensional conditions involving biological, psychological, and social factors. Traditional interventions often prioritise diet and exercise while overlooking the underlying narratives that shape self-concept, agency, and health behaviour. This study developed and evaluated a narrative therapy-based intervention to enhance lifestyle practices, biological health, and weight management among overweight adults. Methods : Fifteen adults aged 35–45 (five men, ten women; BMI 25–29.9) participated in a ten-week narrative therapy program comprising ten group and five individual sessions. A mixed-method design was used, combining quantitative measures (BMI, weight, lifestyle index, and health-related self-efficacy) with qualitative data from reflective journals and interviews analysed thematically and narratively. Reflexive autoethnography captured the participants’ experiential perspectives, with facilitator reflections providing insight into relational and symbolic dynamics of lifestyle change. Results : Men showed reductions in BMI (28.44→26.92) and weight (86.9→81.9 kg), and significant increases in lifestyle index (54.2→70.6) and health-related self-efficacy (33.0→53.0). Women demonstrated similar patterns: BMI (28.27→26.33), weight (76.5→71.3 kg), lifestyle index (55.1→70.0), and self-efficacy (34.0→54.0). All changes were significant ( p < .001). Qualitative analysis revealed five key themes as re-authoring identity, reconnection with the body, intrinsic motivation, collective healing, and integration of change. Women’s narratives emphasised compassion and acceptance; men’s centred on mastery and control. Conclusion : The narrative therapy-based intervention produced meaningful improvements in lifestyle, biological health, and health-related self-efficacy. By reshaping self-narratives of health and capability, participants achieved measurable behavioural and emotional transformation. Narrative approaches can thus complement biomedical and behavioural strategies in sustainable weight management. Narrative therapy lifestyle and biological health weight management overweight adults 1. Introduction Obesity is a growing public health concern with significant psychological and physiological implications. Studies indicate a marked increase in obesity and overweight during the pandemic, posing serious threats globally (Roth et al., 2024 ; Aryee et al., 2023 ; Weir, 2021). The World Health Organization (WHO) (2024) warns that the next pandemic could be one of overweight and obesity. In Iran, overweight and obesity are similarly prevalent (Alipour et al., 2025 ; Pourfarzi et al., 2022 ; Ejtehad et al., 2021 , Zerafati Shoa, et al., 2021; Lotfi Kangarshahi, et al., 2019 ; TabataiMolazi, & Larijani, 2002 ). Obesity is multifactorial, influenced by genetic, environmental, and behavioural factors, and is characterised by excessive fat accumulation that negatively impacts health and quality of life (Hamer et al., 2024 ; Neri et al., 2024 ). While overweight is frequently treated as a purely physiological issue, psychological factors—such as self-perception, identity, and motivation—play a crucial role. Traditional interventions focus on diet and exercise, often overlooking these underlying narratives, which may affect long-term adherence to change (Pigsborg et al., 2023 ). This study develops a narrative therapy-based intervention to facilitate self-reflection, identity reconstruction, sustainable biological health and lifestyle changes among overweight adults. 1.1. Explanation and Clarification of the Topic The study integrates narrative therapy with behaviour modifications and lifestyle interventions to improve biological health and weight management. The intervention aims to: Identify and reshape maladaptive lifestyle and weight-related narratives. Enhance self-efficacy and intrinsic motivation through narrative exploration and practical interventions. Encourage long-term behavioural modifications and emotional regulation. Bridge psychological and physiological aspects of overweight management. This study addresses the psychological dimension of weight management, often overlooked in conventional interventions. It introduces a structured, narrative therapy-based model tailored to overweight adults and integrates psychotherapy, behaviour modification, and lifestyle interventions. This interdisciplinary approach promotes sustainable behavioural change, bridging gaps between psychological and physiological care. 1.2. Research Questions and Objectives Main Research Question : How effective is narrative therapy on lifestyle, biological health, and weight management in overweight adults? Hypotheses : Narrative therapy will shift self-narratives related to body image, and weight management. Participants will show greater adherence to lifestyle changes compared to conventional programmes. The intervention will improve biological health, psychological well-being, and reduce emotional eating. The intervention will facilitate sustainable changes in eating habits, physical activity, and overall health behaviours. Objectives : Develop a structured narrative therapy-based intervention. Assess its impact on self-narrative transformation, motivation, biological health, and weight-related behaviours. Evaluate the sustainability of post-intervention behavioural changes. Explore participants’ subjective experiences of adopting new narratives and lifestyle practices. 2. Literature Review Overweight and obesity are critical public health concerns, with significant biological, psychological, and social implications (WHO, 2024; Shalitin et al., 2025 ; Hamer et al., 2004; Zervos et al., 2022 ) and Haley et al. ( 2022 ), have emphasised the critical importance of addressing overweight and obesity as top priorities in public health. Among studies, Catania et al. ( 2022 ) conducted research aiming to systematically investigate disordered eating behaviours and control measures in both clinical and non-clinical populations. The findings of this study revealed that loss of control is a common feature in eating disorder behaviours. However, limited research has been conducted on the transdiagnostic nature of control within this domain. While numerous studies have examined lifestyle interventions, dietary strategies, and cognitive-behavioural approaches, the literature addressing the integration of psychological narratives and self-perception in weight management remains limited, including in Iran. Narrative therapy has shown promise in addressing weight-related challenges. McSpadden-Walker and Eckert ( 2021 ) highlighted its potential to counteract sizeism and fat stigma, nurturing empowerment and reducing mental health burdens such as depression, anxiety, and low self-esteem. Similarly, MacKean et al. ( 2010 ) demonstrated that combining narrative therapy with diet therapy improved body image and weight loss outcomes among overweight women in Iran. Weber et al. (2007) reported reductions in depression and self-criticism following narrative therapy, while Zolfalipormaleki et al. ( 2023 ) showed its effectiveness in reducing social physique anxiety. Other psychological interventions, including cognitive-behavioural therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness, have been effective in managing obesity-related psychological distress and promoting lifestyle change (Neri et al., 2024 ; Iturbe et al., 2022 ; Zervos et al., 2022 ). Coaching psychology has also contributed, emphasizing the relational aspect between coach and coachee to support behaviour modification, health awareness, and sustainable lifestyle changes (Zandvoort et al., 2008 ; Muñoz Obino et al., 2016 ; Silberman et al., 2020 ). Research conducted by Markey et al. ( 2016 ) reaffirmed the significant impact of psychological factors and interventions on obesity and being overweight. Their study aimed to offer a comprehensive understanding of the psychological factors contributing to obesity. According to their findings, crucial factors include the importance of body image, addressing emotional states related to food addiction, and proposing therapeutic interventions. Their approach highlighted the interpersonal nature of obesity and underscored the complexity of these issues, which are influenced by a multitude of factors requiring careful examination. Moreover, the study emphasised the profound effect of body image on obesity, a factor that has been extensively studied across various research endeavours. It is noteworthy that numerous studies have underscored the influence of psychological factors on concerns related to obesity and being overweight. In their review, Sarwer and Polonsky ( 2016 ) investigated the psychological dimensions of obesity, revealing a significant psychosocial burden associated with the condition. Their research concluded that obesity is often accompanied by challenges related to mood, self-esteem, quality of life, and body image. Such psychological disturbances frequently drive individuals to seek treatment. Moreover, Sarwer and Polonsky ( 2016 ) emphasised that successful obesity treatment teams often include mental health specialists, whose involvement plays a crucial role in achieving positive treatment outcomes. Several studies highlight the psychosocial dimensions of obesity, including the influence of stress, emotional eating, and social perceptions (Dakanalis et al., 2023 ; Cotter & Kelly, 2018 ; DeJong & Kleck, 2022 ). Reward sensitivity and conditioned food behaviors further contribute to overeating and obesity risk (Sutton et al., 2022 ), underscoring the need for interventions that address deeply ingrained behavioural patterns. Neuroscientific research has identified brain regions, particularly the orbitofrontal cortex and prefrontal cortex, as central to food reward processing and self-regulation, linking neural mechanisms to eating behaviours and susceptibility to obesity (Rolls, 2023 ; Lowe et al., 2019 ; Stice et al., 2016 ). Taken together, these findings highlight the critical role of psychological and neural factors in weight management. Narrative therapy emerges as a promising approach to reshape self-narratives, enhance motivation, and support sustainable lifestyle changes. The current study builds on these insights by proposing a narrative therapy-based intervention for overweight adults, integrating psychological, behavioural, and coaching strategies while considering the feasibility of online sessions and the importance of the professional-participant relationship. 3. Methods 3.1. Participants Fifteen adults (aged 35–45; 5 men and 10 women) with BMI 25–29.9 were recruited through purposive available sampling. Inclusion criteria included willingness to participate in group and individual sessions and provision of informed consent. Exclusion criteria encompassed significant medical conditions requiring specialised care or conflicting weight-loss treatments. 3.2. Intervention Design The ten-week intervention integrated narrative therapy principles with lifestyle and behaviour modification strategies. Participants attended ten 120-minute group sessions and five 60-minute individual sessions. · Group sessions focused on re-authoring maladaptive weight-related narratives, nurturing awareness of bodily cues, and developing intrinsic motivation and collective support. Sessions facilitated discussion, storytelling, and practical lifestyle strategies. Example session themes included “From ‘I’ve Failed So Many Times’ to ‘I’m Beginning My Story Anew’” and “From ‘I’m Disconnected from My Body’ to ‘I Can Listen to My Body with Care’.” · Individual sessions provided tailored therapeutic support, addressing personal barriers and setting individualised goals. Sample themes included “From ‘My Weight Defines Me’ to ‘I Am More Than a Number’” and “From ‘I Don’t Know How to Change’ to ‘My Choices Can Reflect My Values’.” 3.3. Data Collection Quantitative Measures: Pre- and post-intervention assessments included BMI, weight, lifestyle index, and health-related self-efficacy. Qualitative Measures: Semi-structured interviews and reflective journals captured participants’ experiences. Reflexive autoethnography from the facilitator enriched understanding of relational and symbolic dynamics. 3.4. Data Analysis Paired t-tests compared pre- and post-intervention outcomes for quantitative measures. Thematic analysis of qualitative data identified recurring patterns related to self-narrative transformation, motivation, and lifestyle change. 3.5. Ethical Considerations The study adhered to the Declaration of Helsinki and institutional ethical guidelines. Participants provided written informed consent, data were anonymised, and potential emotional distress was monitored with professional support available. In addition, this study received ethical approval from the University of Tehran Ethics Committee, Faculty of Psychology and Education. All participants provided written informed consent prior to participation. No clinical intervention beyond standard psychotherapeutic practice was administered; therefore, clinical trial registration was not required. 3.6. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 3.7. Conflict of Interest The author declares that there is no conflict of interest. 3.8. Data Availability The datasets generated and/or analysed during the current study contain sensitive psychological and health-related information and are therefore not publicly available due to confidentiality restrictions. Anonymised data are available from the corresponding author. 4. Results 4.1. Quantitative Outcomes Participants demonstrated significant improvements in physiological and lifestyle measures following the intervention. Measure Men (Pre → Post) Women (Pre → Post) Significance (p) BMI 28.44 → 26.92 28.27 → 26.33 < .001 Weight (kg) 86.9 → 81.9 76.5 → 71.3 < .001 Lifestyle Index 54.2 → 70.6 55.1 → 70.0 < .001 Health Self-Efficacy 33.0 → 53.0 34.0 → 54.0 < .001 4.2. Qualitative Outcomes Thematic analysis revealed five key themes: 1. Re-authoring Identity: Transforming self-narratives related to body image and health. 2. Reconnection with the Body: Developing awareness and mindfulness of bodily cues. 3. Intrinsic Motivation: Sustaining change through internalised goals. 4. Collective Support and Healing: Leveraging group interactions for accountability and encouragement. 5. Integration of Change: Applying insights to consistent lifestyle adjustments. Women emphasised compassion and relational support, whereas men focused on mastery and control. 5. Discussion The narrative therapy-based intervention led to significant improvements in BMI, weight management, lifestyle practices, and health-related self-efficacy. Qualitative findings suggest that reshaping personal narratives was central to sustained behavioural change. Participants’ engagement in storytelling, identity reconstruction, and group support facilitated intrinsic motivation and emotional regulation, enhancing adherence to lifestyle modifications. These results align with previous studies highlighting the role of psychological interventions in obesity management (e.g. Zolfalipormaleki et al., 2023; McSpadden-Walker & Eckert, 2021; MacKean et al., 2010). Unlike conventional diet-focused programmes, narrative therapy addresses underlying beliefs, self-perception, and social context, promoting sustainable change. Integration of qualitative and quantitative outcomes underscores the intervention’s holistic impact, combining behavioural, biological, and emotional improvements. Limitations include small sample size, potential self-report bias, and limited intervention duration. Future research should examine long-term outcomes, scalability, and comparisons with alternative psychological interventions. 6. Conclusion Narrative therapy offers a promising approach for overweight adults, enhancing lifestyle, biological health, and weight management. By re-authoring self-narratives and nurturing intrinsic motivation, participants achieved meaningful behavioural and emotional change. Narrative approaches can complement traditional biomedical strategies, contributing to sustainable weight management programmes. Declarations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Zahed conceived and designed the study, conducted the research, collected and analysed the data, and drafted the main manuscript. Afrooz supervised the research process, provided methodological guidance, and contributed to the interpretation of the findings. Zahed and Afrooz jointly revised and refined the manuscript. All authors reviewed and approved the final version of the manuscript. Data Availability Data AvailabilityThe datasets generated and/or analysed during the current study contain sensitive psychological and health-related information are anonymised data are available from the corresponding author. References Alipour G, Abolghasemi A, Akbari B. Evaluation of the Weight Self-Efficacy Model Based on Body Image Concern and Psychological Distress with the Mediation of the Core Belief of Eating in Overweight Women. J Appl Psychol Res. 2025;16(3):53–67. Aryee EK, Ozkan B, Ndumele CE. Heart failure and obesity: the latest pandemic. Prog Cardiovasc Dis. 2023;78:43–8. Catania J, Spirou D, Gascoigne M, Raman J. (2022). Loss of control as a transdiagnostic feature in obesity-related eating behaviours: A systematic review. Eur Eat Disorders Rev. Cotter EW, Kelly NR. Stress-related eating, mindfulness, and obesity. Health Psychol. 2018;37(6):516. Dakanalis A, Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Vasios GK, Giaginis C. The association of emotional eating with overweight/obesity, depression, anxiety/stress, and dietary patterns: a review of the current clinical evidence. Nutrients. 2023;15(5):1173. DeJong W, Kleck RE. The social psychological effects of overweight. Physical appearance, stigma, and social behavior. Routledge; 2022. pp. 65–88. Ejtehad H, Ghozbani, Peikari, Reisi L, Afshin. Obesity and healthy lifestyle during COVID-19. Sci J Kurdistan Med Univ. 2021;26(5):38–50. Haley EN, Dolbier CL, Carels RA, Whited MC. A brief pilot self-compassion intervention for women with overweight/obesity and internalized weight bias: Feasibility, acceptability, and future directions. J Contextual Behav Sci. 2022;23:59–63. Hamer O, Kuroski JA, Bray EP, Harris C, Blundell A, Schneider E, Watkins C. (2024). Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review. BMJ open, 14(12), e082973. Iturbe I, Echeburúa E, Maiz E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review. Clin Psychol Psychother. 2022;29(3):837–56. Lotfi Kangarshahi A, Dehghani Arani F, Rostami R, AshratTalesh SH, Abolhasani M. Comparing Efficacy of Cognitive Behavioural Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) on Activity Increasing and Weight Decreasing in Obese Individuals with Coronary Artery Stenosis. Q J HEALTH Psychol. 2019;8(31):53–78. Lowe CJ, Reichelt AC, Hall PA. The prefrontal cortex and obesity: a health neuroscience perspective. Trends Cogn Sci. 2019;23(4):349–61. MacKean SS, Eskandari H, Borjali A, Ghodsi D. The comparison between efficacy of narrative therapy and diet therapy on body image in women with overweight and obesity. Pajoohandeh J. 2010;15(5):225–32. Markey CN, August KJ, Bailey LC, Markey PM, Nave CS. The pivotal role of psychology in a comprehensive theory of obesity. Health Psychol open. 2016;3(1):2055102916634365. McSpadden-Walker L, Eckert DW. Healing the Harms of Sizeism. Empowering Fatness with Narrative Therapy; 2021. Muñoz Obino KF, Pereira A, C., Caron-Lienert RS. (2016). Coaching and barriers to weight loss: an integrative review. Diabetes metabolic syndrome obesity: Targets therapy, 1–11. Neri LDCL, Mariotti F, Guglielmetti M, Fiorini S, Tagliabue A, Ferraris C. Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review. Front Nutr. 2024;11:1250683. Pigsborg K, Kalea AZ, De Dominicis S, Magkos F. Behavioral and psychological factors affecting weight loss success. Curr Obes Rep. 2023;12(3):223–30. Pourfarzi F, Sadjadi A, Poustchi H, Amani F. Prevalence of overweight and obesity in Iranian population: A population-based study in northwestern of Iran. J Public Health Res. 2022;11(1):jphr–2021. Rolls ET. The orbitofrontal cortex, food reward, body weight and obesity. Soc Cognit Affect Neurosci. 2023;18(1):nsab044. Roth J, Qiang X, Marbán SL, Redelt H, Lowell BC. The obesity pandemic: where have we been and where are we going? Obes Res. 2024;12(S11):S88–101. Sarwer DB, Polonsky HM. The psychosocial burden of obesity. Endocrinol Metabolism Clin. 2016;45(3):677–88. Shalitin S, Phillip M, Yackobovitch-Gavan M. Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates. Pediatr Res. 2025;97(5):1554–65. Silberman JM, Kaur M, Sletteland J, Venkatesan A. (2020). Outcomes in a digital weight management intervention with one-on-one health coaching. PLoS ONE, 15(4), e0232221. Stice E, Lawrence NS, Kemps E, Veling H. Training motor responses to food: A novel treatment for obesity targeting implicit processes. Clin Psychol Rev. 2016;49:16–27. Sutton CA, L'Insalata AM, Fazzino TL. (2022). Reward Sensitivity, Eating Behaviour, and Obesity-Related Outcomes: A Systematic Review. Physiology &Behaviour , 113843.Weber, M.; Davis, K. & Mc Phie, L. (2007) ‘ Narrative Therapy, Eating Disorders and Groups: Enhancing Outcomes in Rural NSW’. Taylor &Farncis Group: UK [Online]. Available: https://www.tandfonline.com/ doi/abs/10.1080/03124070600985970 TabataiMolazi A, Larijani B. Review of obesity prevalence and its management in Iran. Iran J Diabetics Metabolism. 2002;12(5):357–74. Weber M. Narrative therapy, 'eating disorders', and assessment: Exploring constraints, dilemmas, and opportunities. Int J Narrative Therapy Community Work. 2007;2007(2):63–70. Weir K. (2021, May). The extra weight of COVID-19. Monitor on Psychology , 52 (5). https://www.apa.org/monitor/2021/07/extra-weight-covidBrown , C. and Augusta-Scott, T. (2007) Narrative Therapy, Sage Publishing, UK: London. World Health Organization. (2024). Obese and overweight. Zandvoort M, Irwin JD, Morrow D. Co-active coaching as an intervention for obesity among female university students. Int Coaching Psychol Rev. 2008;3(3):191–206. Shoa Z. Azadbakht, Asgari Taee, Farzaneh, Taghdisi, &Araiaian (2021). Dietary patterns related to obesity in adults in Tehran. Iran J health Educ health promotion, 9(4), 327–49. Zervos K, Koletsi M, Mantzios M, Skopeliti N, Tsitsas G, Naska A. An Eight-Week Mindful Eating Program Applied in a Mediterranean Population with Overweight or Obesity: The EATT Intervention Study. Psychol Rep. 2022;125(2):1011–40. https://doi.org/10.1177/0033294120988104 . Zolfalipormaleki S, Kivi G, H., Rezai Sharif A. Effectiveness of Narrative Therapy on Social Physique Anxiety in Obese and Overweight Women. J Ardabil Univ Med Sci. 2023;23(3):278–91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8093051","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":557786788,"identity":"dec43d29-f4be-4d30-bbaa-3f46e344b9f2","order_by":0,"name":"Elnaz Zahed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYDACdihtwMBg+ADCZGzAr4UZocXYgCGBRC1mEhAtBAA/M+/Bjz8Y6uTN2Zu3VfP+YJDnb2Bu+4BPi2QzX7KEBAOb4c6eY2W3eRIYDGccYGyegU+LwWEeAwkDBh7GDTdyzEBaGDcwMDbjdZj9YR7jHwkMEvYb7r8xKwZqsSeoxYCZx0ziAINB4oYbPGbMQC2JBLVIHOYxs2wwSEjecCatWHJOmkTyjMMEtPC39xjf/FFRZ7vh+OGNH97Y2Nj2t7c/xqsF6jyErYiYGgWjYBSMglFAPgAAYpY9g5niWjIAAAAASUVORK5CYII=","orcid":"","institution":"University of Tehran","correspondingAuthor":true,"prefix":"","firstName":"Elnaz","middleName":"","lastName":"Zahed","suffix":""},{"id":557786793,"identity":"f0b1f194-ec64-4619-8673-246c50b4f681","order_by":1,"name":"G. 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Introduction","content":"\u003cp\u003eObesity is a growing public health concern with significant psychological and physiological implications. Studies indicate a marked increase in obesity and overweight during the pandemic, posing serious threats globally (Roth et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Aryee et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Weir, 2021). The World Health Organization (WHO) (2024) warns that the next pandemic could be one of overweight and obesity. In Iran, overweight and obesity are similarly prevalent (Alipour et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Pourfarzi et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ejtehad et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Zerafati Shoa, et al., 2021; Lotfi Kangarshahi, et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; TabataiMolazi, \u0026amp; Larijani, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eObesity is multifactorial, influenced by genetic, environmental, and behavioural factors, and is characterised by excessive fat accumulation that negatively impacts health and quality of life (Hamer et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Neri et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). While overweight is frequently treated as a purely physiological issue, psychological factors\u0026mdash;such as self-perception, identity, and motivation\u0026mdash;play a crucial role. Traditional interventions focus on diet and exercise, often overlooking these underlying narratives, which may affect long-term adherence to change (Pigsborg et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study develops a narrative therapy-based intervention to facilitate self-reflection, identity reconstruction, sustainable biological health and lifestyle changes among overweight adults.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1. Explanation and Clarification of the Topic\u003c/h2\u003e\u003cp\u003eThe study integrates narrative therapy with behaviour modifications and lifestyle interventions to improve biological health and weight management. The intervention aims to:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIdentify and reshape maladaptive lifestyle and weight-related narratives.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEnhance self-efficacy and intrinsic motivation through narrative exploration and practical interventions.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEncourage long-term behavioural modifications and emotional regulation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eBridge psychological and physiological aspects of overweight management.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThis study addresses the psychological dimension of weight management, often overlooked in conventional interventions. It introduces a structured, narrative therapy-based model tailored to overweight adults and integrates psychotherapy, behaviour modification, and lifestyle interventions. This interdisciplinary approach promotes sustainable behavioural change, bridging gaps between psychological and physiological care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.2. Research Questions and Objectives\u003c/h2\u003e\u003cp\u003e\u003cb\u003eMain Research Question\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eHow effective is narrative therapy on lifestyle, biological health, and weight management in overweight adults?\u003c/p\u003e\u003cp\u003e\u003cb\u003eHypotheses\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNarrative therapy will shift self-narratives related to body image, and weight management.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eParticipants will show greater adherence to lifestyle changes compared to conventional programmes.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe intervention will improve biological health, psychological well-being, and reduce emotional eating.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe intervention will facilitate sustainable changes in eating habits, physical activity, and overall health behaviours.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDevelop a structured narrative therapy-based intervention.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAssess its impact on self-narrative transformation, motivation, biological health, and weight-related behaviours.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEvaluate the sustainability of post-intervention behavioural changes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eExplore participants\u0026rsquo; subjective experiences of adopting new narratives and lifestyle practices.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"2. Literature Review","content":"\u003cp\u003eOverweight and obesity are critical public health concerns, with significant biological, psychological, and social implications (WHO, 2024; Shalitin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Hamer et al., 2004; Zervos et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and Haley et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), have emphasised the critical importance of addressing overweight and obesity as top priorities in public health. Among studies, Catania et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) conducted research aiming to systematically investigate disordered eating behaviours and control measures in both clinical and non-clinical populations. The findings of this study revealed that loss of control is a common feature in eating disorder behaviours. However, limited research has been conducted on the transdiagnostic nature of control within this domain. While numerous studies have examined lifestyle interventions, dietary strategies, and cognitive-behavioural approaches, the literature addressing the integration of psychological narratives and self-perception in weight management remains limited, including in Iran.\u003c/p\u003e\u003cp\u003eNarrative therapy has shown promise in addressing weight-related challenges. McSpadden-Walker and Eckert (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) highlighted its potential to counteract sizeism and fat stigma, nurturing empowerment and reducing mental health burdens such as depression, anxiety, and low self-esteem. Similarly, MacKean et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) demonstrated that combining narrative therapy with diet therapy improved body image and weight loss outcomes among overweight women in Iran. Weber et al. (2007) reported reductions in depression and self-criticism following narrative therapy, while Zolfalipormaleki et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) showed its effectiveness in reducing social physique anxiety.\u003c/p\u003e\u003cp\u003eOther psychological interventions, including cognitive-behavioural therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness, have been effective in managing obesity-related psychological distress and promoting lifestyle change (Neri et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Iturbe et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zervos et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Coaching psychology has also contributed, emphasizing the relational aspect between coach and coachee to support behaviour modification, health awareness, and sustainable lifestyle changes (Zandvoort et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Mu\u0026ntilde;oz Obino et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Silberman et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch conducted by Markey et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) reaffirmed the significant impact of psychological factors and interventions on obesity and being overweight. Their study aimed to offer a comprehensive understanding of the psychological factors contributing to obesity. According to their findings, crucial factors include the importance of body image, addressing emotional states related to food addiction, and proposing therapeutic interventions. Their approach highlighted the interpersonal nature of obesity and underscored the complexity of these issues, which are influenced by a multitude of factors requiring careful examination. Moreover, the study emphasised the profound effect of body image on obesity, a factor that has been extensively studied across various research endeavours.\u003c/p\u003e\u003cp\u003eIt is noteworthy that numerous studies have underscored the influence of psychological factors on concerns related to obesity and being overweight. In their review, Sarwer and Polonsky (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) investigated the psychological dimensions of obesity, revealing a significant psychosocial burden associated with the condition. Their research concluded that obesity is often accompanied by challenges related to mood, self-esteem, quality of life, and body image. Such psychological disturbances frequently drive individuals to seek treatment. Moreover, Sarwer and Polonsky (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) emphasised that successful obesity treatment teams often include mental health specialists, whose involvement plays a crucial role in achieving positive treatment outcomes.\u003c/p\u003e\u003cp\u003eSeveral studies highlight the psychosocial dimensions of obesity, including the influence of stress, emotional eating, and social perceptions (Dakanalis et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Cotter \u0026amp; Kelly, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; DeJong \u0026amp; Kleck, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Reward sensitivity and conditioned food behaviors further contribute to overeating and obesity risk (Sutton et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), underscoring the need for interventions that address deeply ingrained behavioural patterns.\u003c/p\u003e\u003cp\u003eNeuroscientific research has identified brain regions, particularly the orbitofrontal cortex and prefrontal cortex, as central to food reward processing and self-regulation, linking neural mechanisms to eating behaviours and susceptibility to obesity (Rolls, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lowe et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Stice et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTaken together, these findings highlight the critical role of psychological and neural factors in weight management. Narrative therapy emerges as a promising approach to reshape self-narratives, enhance motivation, and support sustainable lifestyle changes. The current study builds on these insights by proposing a narrative therapy-based intervention for overweight adults, integrating psychological, behavioural, and coaching strategies while considering the feasibility of online sessions and the importance of the professional-participant relationship.\u003c/p\u003e"},{"header":"3. Methods","content":"\u003cp\u003e\u003cstrong\u003e3.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifteen adults (aged 35–45; 5 men and 10 women) with BMI 25–29.9 were recruited through purposive available sampling. Inclusion criteria included willingness to participate in group and individual sessions and provision of informed consent. Exclusion criteria encompassed significant medical conditions requiring specialised care or conflicting weight-loss treatments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Intervention Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ten-week intervention integrated narrative therapy principles with lifestyle and behaviour modification strategies. Participants attended ten 120-minute group sessions and five 60-minute individual sessions.\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eGroup sessions\u003c/strong\u003e focused on re-authoring maladaptive weight-related narratives, nurturing awareness of bodily cues, and developing intrinsic motivation and collective support. Sessions facilitated discussion, storytelling, and practical lifestyle strategies. Example session themes included \u003cem\u003e“From ‘I’ve Failed So Many Times’ to ‘I’m Beginning My Story Anew’”\u003c/em\u003e and \u003cem\u003e“From ‘I’m Disconnected from My Body’ to ‘I Can Listen to My Body with Care’.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eIndividual sessions\u003c/strong\u003e provided tailored therapeutic support, addressing personal barriers and setting individualised goals. Sample themes included \u003cem\u003e“From ‘My Weight Defines Me’ to ‘I Am More Than a Number’”\u003c/em\u003e and \u003cem\u003e“From ‘I Don’t Know How to Change’ to ‘My Choices Can Reflect My Values’.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Measures:\u003c/strong\u003e Pre- and post-intervention assessments included BMI, weight, lifestyle index, and health-related self-efficacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Measures:\u003c/strong\u003e Semi-structured interviews and reflective journals captured participants’ experiences. Reflexive autoethnography from the facilitator enriched understanding of relational and symbolic dynamics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePaired t-tests compared pre- and post-intervention outcomes for quantitative measures. Thematic analysis of qualitative data identified recurring patterns related to self-narrative transformation, motivation, and lifestyle change.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Ethical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to the Declaration of Helsinki and institutional ethical guidelines. Participants provided written informed consent, data were anonymised, and potential emotional distress was monitored with professional support available.\u003c/p\u003e\n\u003cp\u003eIn addition, this study received ethical approval from the University of Tehran Ethics Committee, Faculty of Psychology and Education. All participants provided written informed consent prior to participation. No clinical intervention beyond standard psychotherapeutic practice was administered; therefore, clinical trial registration was not required.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e3.6.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.7. Conflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.8. Data Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study contain sensitive psychological and health-related information and are therefore not publicly available due to confidentiality restrictions. Anonymised data are available from the corresponding author.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003e\u003cstrong\u003e4.1. Quantitative Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants demonstrated significant improvements in physiological and lifestyle measures following the intervention.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen (Pre \u0026rarr; Post)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen (Pre \u0026rarr; Post)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance (p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e28.44 \u0026rarr; 26.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e28.27 \u0026rarr; 26.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e86.9 \u0026rarr; 81.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e76.5 \u0026rarr; 71.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eLifestyle Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e54.2 \u0026rarr; 70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e55.1 \u0026rarr; 70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eHealth Self-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e33.0 \u0026rarr; 53.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e34.0 \u0026rarr; 54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt; .001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Qualitative Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis revealed five key themes:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Re-authoring Identity: Transforming self-narratives related to body image and health.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Reconnection with the Body: Developing awareness and mindfulness of bodily cues.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Intrinsic Motivation: Sustaining change through internalised goals.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Collective Support and Healing: Leveraging group interactions for accountability and encouragement.\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;Integration of Change: Applying insights to consistent lifestyle adjustments.\u003c/p\u003e\n\u003cp\u003eWomen emphasised compassion and relational support, whereas men focused on mastery and control.\u003c/p\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThe narrative therapy-based intervention led to significant improvements in BMI, weight management, lifestyle practices, and health-related self-efficacy. Qualitative findings suggest that reshaping personal narratives was central to sustained behavioural change. Participants’ engagement in storytelling, identity reconstruction, and group support facilitated intrinsic motivation and emotional regulation, enhancing adherence to lifestyle modifications.\u003c/p\u003e\n\u003cp\u003eThese results align with previous studies highlighting the role of psychological interventions in obesity management (e.g. Zolfalipormaleki et al., 2023; McSpadden-Walker \u0026amp; Eckert, 2021; MacKean et al., 2010). Unlike conventional diet-focused programmes, narrative therapy addresses underlying beliefs, self-perception, and social context, promoting sustainable change. Integration of qualitative and quantitative outcomes underscores the intervention’s holistic impact, combining behavioural, biological, and emotional improvements.\u003c/p\u003e\n\u003cp\u003eLimitations include small sample size, potential self-report bias, and limited intervention duration. Future research should examine long-term outcomes, scalability, and comparisons with alternative psychological interventions.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eNarrative therapy offers a promising approach for overweight adults, enhancing lifestyle, biological health, and weight management. By re-authoring self-narratives and nurturing intrinsic motivation, participants achieved meaningful behavioural and emotional change. Narrative approaches can complement traditional biomedical strategies, contributing to sustainable weight management programmes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZahed conceived and designed the study, conducted the research, collected and analysed the data, and drafted the main manuscript. Afrooz supervised the research process, provided methodological guidance, and contributed to the interpretation of the findings. Zahed and Afrooz jointly revised and refined the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData AvailabilityThe datasets generated and/or analysed during the current study contain sensitive psychological and health-related information are anonymised data are available from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlipour G, Abolghasemi A, Akbari B. Evaluation of the Weight Self-Efficacy Model Based on Body Image Concern and Psychological Distress with the Mediation of the Core Belief of Eating in Overweight Women. J Appl Psychol Res. 2025;16(3):53\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAryee EK, Ozkan B, Ndumele CE. Heart failure and obesity: the latest pandemic. Prog Cardiovasc Dis. 2023;78:43\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCatania J, Spirou D, Gascoigne M, Raman J. (2022). Loss of control as a transdiagnostic feature in obesity-related eating behaviours: A systematic review. Eur Eat Disorders Rev.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCotter EW, Kelly NR. Stress-related eating, mindfulness, and obesity. Health Psychol. 2018;37(6):516.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDakanalis A, Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Vasios GK, Giaginis C. The association of emotional eating with overweight/obesity, depression, anxiety/stress, and dietary patterns: a review of the current clinical evidence. Nutrients. 2023;15(5):1173.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeJong W, Kleck RE. The social psychological effects of overweight. Physical appearance, stigma, and social behavior. Routledge; 2022. pp. 65\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEjtehad H, Ghozbani, Peikari, Reisi L, Afshin. Obesity and healthy lifestyle during COVID-19. Sci J Kurdistan Med Univ. 2021;26(5):38\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaley EN, Dolbier CL, Carels RA, Whited MC. A brief pilot self-compassion intervention for women with overweight/obesity and internalized weight bias: Feasibility, acceptability, and future directions. J Contextual Behav Sci. 2022;23:59\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamer O, Kuroski JA, Bray EP, Harris C, Blundell A, Schneider E, Watkins C. (2024). Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review. BMJ open, 14(12), e082973.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIturbe I, Echebur\u0026uacute;a E, Maiz E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review. Clin Psychol Psychother. 2022;29(3):837\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLotfi Kangarshahi A, Dehghani Arani F, Rostami R, AshratTalesh SH, Abolhasani M. Comparing Efficacy of Cognitive Behavioural Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) on Activity Increasing and Weight Decreasing in Obese Individuals with Coronary Artery Stenosis. Q J HEALTH Psychol. 2019;8(31):53\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLowe CJ, Reichelt AC, Hall PA. The prefrontal cortex and obesity: a health neuroscience perspective. Trends Cogn Sci. 2019;23(4):349\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMacKean SS, Eskandari H, Borjali A, Ghodsi D. The comparison between efficacy of narrative therapy and diet therapy on body image in women with overweight and obesity. Pajoohandeh J. 2010;15(5):225\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarkey CN, August KJ, Bailey LC, Markey PM, Nave CS. The pivotal role of psychology in a comprehensive theory of obesity. Health Psychol open. 2016;3(1):2055102916634365.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcSpadden-Walker L, Eckert DW. Healing the Harms of Sizeism. Empowering Fatness with Narrative Therapy; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMu\u0026ntilde;oz Obino KF, Pereira A, C., Caron-Lienert RS. (2016). Coaching and barriers to weight loss: an integrative review. Diabetes metabolic syndrome obesity: Targets therapy, 1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeri LDCL, Mariotti F, Guglielmetti M, Fiorini S, Tagliabue A, Ferraris C. Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review. Front Nutr. 2024;11:1250683.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePigsborg K, Kalea AZ, De Dominicis S, Magkos F. Behavioral and psychological factors affecting weight loss success. Curr Obes Rep. 2023;12(3):223\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePourfarzi F, Sadjadi A, Poustchi H, Amani F. Prevalence of overweight and obesity in Iranian population: A population-based study in northwestern of Iran. J Public Health Res. 2022;11(1):jphr\u0026ndash;2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRolls ET. The orbitofrontal cortex, food reward, body weight and obesity. Soc Cognit Affect Neurosci. 2023;18(1):nsab044.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoth J, Qiang X, Marb\u0026aacute;n SL, Redelt H, Lowell BC. The obesity pandemic: where have we been and where are we going? Obes Res. 2024;12(S11):S88\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarwer DB, Polonsky HM. The psychosocial burden of obesity. Endocrinol Metabolism Clin. 2016;45(3):677\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShalitin S, Phillip M, Yackobovitch-Gavan M. Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates. Pediatr Res. 2025;97(5):1554\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilberman JM, Kaur M, Sletteland J, Venkatesan A. (2020). Outcomes in a digital weight management intervention with one-on-one health coaching. PLoS ONE, 15(4), e0232221.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStice E, Lawrence NS, Kemps E, Veling H. Training motor responses to food: A novel treatment for obesity targeting implicit processes. Clin Psychol Rev. 2016;49:16\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSutton CA, L'Insalata AM, Fazzino TL. (2022). Reward Sensitivity, Eating Behaviour, and Obesity-Related Outcomes: A Systematic Review. \u003cem\u003ePhysiology \u0026amp;Behaviour\u003c/em\u003e, 113843.Weber, M.; Davis, K. \u0026amp; Mc Phie, L. (2007) \u0026lsquo;\u003cem\u003eNarrative Therapy, Eating Disorders and Groups: Enhancing Outcomes in Rural NSW\u0026rsquo;.\u003c/em\u003e Taylor \u0026amp;Farncis Group: UK [Online]. Available:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tandfonline.com/\u003c/span\u003e\u003cspan address=\"https://www.tandfonline.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi/abs/10.1080/03124070600985970\u003c/span\u003e\u003cspan address=\"doi/abs/10.1080/03124070600985970\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTabataiMolazi A, Larijani B. Review of obesity prevalence and its management in Iran. Iran J Diabetics Metabolism. 2002;12(5):357\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeber M. Narrative therapy, 'eating disorders', and assessment: Exploring constraints, dilemmas, and opportunities. Int J Narrative Therapy Community Work. 2007;2007(2):63\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeir K. (2021, May). The extra weight of COVID-19. \u003cem\u003eMonitor on Psychology\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.apa.org/monitor/2021/07/extra-weight-covidBrown\u003c/span\u003e\u003cspan address=\"https://www.apa.org/monitor/2021/07/extra-weight-covidBrown\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, C. and Augusta-Scott, T. (2007) Narrative Therapy, Sage Publishing, UK: London.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2024). Obese and overweight.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZandvoort M, Irwin JD, Morrow D. Co-active coaching as an intervention for obesity among female university students. Int Coaching Psychol Rev. 2008;3(3):191\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShoa Z. Azadbakht, Asgari Taee, Farzaneh, Taghdisi, \u0026amp;Araiaian (2021). Dietary patterns related to obesity in adults in Tehran. Iran J health Educ health promotion, 9(4), 327\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZervos K, Koletsi M, Mantzios M, Skopeliti N, Tsitsas G, Naska A. An Eight-Week Mindful Eating Program Applied in a Mediterranean Population with Overweight or Obesity: The EATT Intervention Study. Psychol Rep. 2022;125(2):1011\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0033294120988104\u003c/span\u003e\u003cspan address=\"10.1177/0033294120988104\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZolfalipormaleki S, Kivi G, H., Rezai Sharif A. Effectiveness of Narrative Therapy on Social Physique Anxiety in Obese and Overweight Women. J Ardabil Univ Med Sci. 2023;23(3):278\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Narrative therapy, lifestyle and biological health, weight management, overweight adults","lastPublishedDoi":"10.21203/rs.3.rs-8093051/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8093051/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cdiv class=\"Heading\"\u003eTitle: Developing Intervention Program Based on Narrative Therapy and Evaluating Its Effectiveness on Lifestyle and Biological Health, and Weight Management in Overweight Adults\u003c/div\u003e\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eOverweight and obesity are multidimensional conditions involving biological, psychological, and social factors. Traditional interventions often prioritise diet and exercise while overlooking the underlying narratives that shape self-concept, agency, and health behaviour. This study developed and evaluated a narrative therapy-based intervention to enhance lifestyle practices, biological health, and weight management among overweight adults.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eFifteen adults aged 35\u0026ndash;45 (five men, ten women; BMI 25\u0026ndash;29.9) participated in a ten-week narrative therapy program comprising ten group and five individual sessions. A mixed-method design was used, combining quantitative measures (BMI, weight, lifestyle index, and health-related self-efficacy) with qualitative data from reflective journals and interviews analysed thematically and narratively. Reflexive autoethnography captured the participants\u0026rsquo; experiential perspectives, with facilitator reflections providing insight into relational and symbolic dynamics of lifestyle change.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eMen showed reductions in BMI (28.44\u0026rarr;26.92) and weight (86.9\u0026rarr;81.9 kg), and significant increases in lifestyle index (54.2\u0026rarr;70.6) and health-related self-efficacy (33.0\u0026rarr;53.0). Women demonstrated similar patterns: BMI (28.27\u0026rarr;26.33), weight (76.5\u0026rarr;71.3 kg), lifestyle index (55.1\u0026rarr;70.0), and self-efficacy (34.0\u0026rarr;54.0). All changes were significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Qualitative analysis revealed five key themes as re-authoring identity, reconnection with the body, intrinsic motivation, collective healing, and integration of change. Women\u0026rsquo;s narratives emphasised compassion and acceptance; men\u0026rsquo;s centred on mastery and control.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe narrative therapy-based intervention produced meaningful improvements in lifestyle, biological health, and health-related self-efficacy. By reshaping self-narratives of health and capability, participants achieved measurable behavioural and emotional transformation. Narrative approaches can thus complement biomedical and behavioural strategies in sustainable weight management.\u003c/p\u003e","manuscriptTitle":"Developing Intervention Program Based on Narrative Therapy and Evaluating Its Effectiveness on Lifestyle and Biological Health, and Weight Management in Overweight Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 11:48:19","doi":"10.21203/rs.3.rs-8093051/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"315fbd4f-e982-439e-903a-091a0064946f","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-04T09:24:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 11:48:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8093051","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8093051","identity":"rs-8093051","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}