The purpose of this qualitative study was to explore the process of how women maintain their weight and continue healthy eating behaviors after completing a weight management program, which emphasized low-energy density foods. This is important since many women regain weight after participating in weight management programs. Theoretical sampling strategies guided participant recruitment. Inclusion criteria were: self-reported African American or Caucasian women aged 30 and older who lost ≥ 5% of their body weight during their participation in the EatRight weight management program at least one year ago or longer. Height and weight was measured. Participants that remained > 5% below their baseline weight were considered maintainers (n = 9); those above this criterion were considered non-maintainers (n = 14). The researcher and co-interviewer asked open-ended questions regarding healthy eating behaviors, including reasons for starting a weight loss program, how other factors influenced them, and strategies for continuing. Analysis was conducted using the systematic design of grounded theory, which included open, axial, and selective coding. Categories emerged during open coding and were connected during axial coding; categories were integrated to form a theory during selective coding. The core category was labeled "approach to healthy eating". Both maintainers and non-maintainers had similar reasons for wanting to lose weight, namely to improve their overall health and appearance. They also experienced many of the same types of stress, made a number of previous weight loss attempts, and lived in an obesogenic environment. Both groups of women reported "being tired" of constantly "struggling" with their weight and used a set of strategies, including planning ahead, self-monitoring, and resetting their eating patterns. However, a key difference was that the maintainers consistently demonstrated determination with a mindful and positive attitude toward healthy eating, which became fully integrated into their lifestyles. Non-maintainers engaged in strategies for healthy eating less consistently, frequently returned to mindless eating patterns, and allowed other priorities to dictate their behaviors. Based on these findings, future intervention programs need to encourage participants to collectively merge a positive mindset and determined attitude with consistent behaviors changes for long-term healthy lifestyles.

Keywords. Grounded theory; healthy eating; women; weight management program.