영양사의 저탄수화물 식단 코칭을 병행한 한의치료가 섭식태도에 미치는 효과: KEAT-26 척도를 이용한 후향적 연구

Effects of Korean Medicine Combined with Dietitian-Led Low-Carbohydrate Diet Coaching on Eating Attitudes: A Retrospective Study Using the KEAT-26 Questionnaire

Objectives: This study evaluated the effects of a collaborative Korean medicine-dietitian intensive coaching program incorporating low-carbohydrate diet (LCD) education on eating attitudes using the Korean version of the Eating Attitudes Test-26 (KEAT-26). Methods: A retrospective pre-post study was conducted among adults participating in dietitian-led coaching programs at Korean medicine clinics from December 2023 to December 2024. Participants received individualized dietary coaching with LCD education alongside Korean medicine obesity treatment. KEAT-26 questionnaires were administered before and after at least 14 days of intervention. Total and subscale scores (dieting, bulimia/food preoccupation, oral control) were compared using paired statistical tests. High-risk classification used sex-specific cut-offs (≥19 for males, ≥22 for females). We also explored an adjusted scoring, reversing five LCD-related items (Q6, Q7, Q16, Q22, Q26). Results: Among 153 participants (138 females, 15 males), baseline KEAT-26 total score was 12.2±7.5, with 11.8% classified as high-risk. Post-coaching scores significantly increased to 14.9±7.5 (P<0.001). Bulimia/food preoccupation scores improved (-0.8±2.3, P<0.001), while oral control scores worsened (+3.1±3.8, P<0.001). Standard scoring showed increased high-risk participants (11.8% to 20.3%), whereas the exploratory adjusted scoring showed an improvement (53.6% to 26.1%). Conclusions: The Korean medicine-dietitian collaborative program effectively reduced binge-related behaviors but increased dietary control behaviors, leading to higher KEAT-26 scores. These findings highlight KEAT-26's limitations in evaluating modern lifestyle interventions, particularly LCD education, where healthy dietary practices are misclassified as pathological. Results suggest developing modified assessment tools distinguishing between disordered eating and evidence-based nutritional behaviors.