weight loss - case study

'We talked about the need to continue to work on separating emotions and food and I warned against swapping an obsession with eating for an obsession with exercise.'

given her reduced intake and we discussed the need to try and find ways of coping with stress that didn’t involve food, i.e. trying more successfully to separate food and emo- tions. Phyllis was given the aim to get eating back up to the level of the meal plan. Her follow-up appointment was a month later and she arrived two hours late due to severe snow. However, her weight was back up to 71.8kg and she reported that she eating more sensibly. She was now going to the gym three times per week. We talked about the need to continue to work on sepa- rating emotions and food and I warned against swapping an obsession with eating for an obsession with exercise. She was going on holiday to the Caribbean with her family, so she came again six weeks later. She reported that the holi- day was boring - apart from getting second degree burns! Unlike at Christmas, the boredom had not precipitated a crisis with her eating and she described that she had eaten ‘loads’ and put on ‘loads’ of weight – in fact less than a kilogram (72.5kg). She was much more relaxed and was enjoying food again. On further discussion she was clearly developing a more balanced approach to food – on holi- day some days she had cake, some days she didn’t and had loads of fruit instead. I congratulated her on her prog- ress and pointed out to her how far she had come. She was given a follow-up appointment for three months – but to ring and come back sooner if there were problems. It is intended that she will be discharged at that appointment if her good progress continues.

The scale of obesity

We are seeing an increasingly varied number of cases along the obesity spectrum and over the coming months more of them will be presented. From morbidly obese teenagers and children who have tried ‘everything’ from slimming clubs to MEND, but are still obese; to teenagers who fear they will become overweight and so stop eating altogether; to teenagers like Phyllis, who do lose signifi- cant amounts of weight, quite appropriately and then don’t know how to stop.

Although obesity has inevitably always been a part of dietetic practice – including paediatrics – the presenta- tion of obesity is changing exponentially. Due to the sheer numbers of overweight children, we only see those who are obese in our hospital paediatric department. How- ever, the numbers of obese children we are seeing and the scale of the obesity they are presenting with, is almost beyond comprehension. As healthcare professionals, we have to work fast to consider the most appropriate ways to deal with these children. The paediatric obesity epi- demic is here and if we can’t find ways to turn the tide, obesity in adults will become the norm in the next gen- eration and the implications of that socially and for the healthcare economy are unthinkable.

34

into research

by Dr Amelia A Lake, Senior Lecturer in Food & Nutrition, Applied Biosciences, School of Applied Sciences

Dr Amelia A Lake trained as a dietitian and worked in the NHS before taking up a research post with Newcastle University where she completed a PhD and held a National Institute for Health Research Postdoctoral Fellowship on the theme of Obesogenic Environments. Amelia is currently a Senior Lecturer in Food and Nutrition at Northumbria University and her research interests include the obesogenic environment, the workplace, food environments and food choice.

Change...again

I am writing this on the eve of the election. By the time this June issue of NHD is in print, we will have digested the news about our country’s political future. At this moment in time, however, there is a sense of the unknown.

While Athens deals with riots, stories are circulating about our country’s very own austerity measures and the impact that they could have on our everyday lives as well as our profession- al lives. By the time you read this, perhaps more will have been revealed about the extent of any measures a new Govern- ment may have to take, but then again, maybe not! As I have mentioned in previous columns my research focuses on change; dietary change, change in foodscapes, changing behaviours and how to enable change. The con- cept of change was sprinkled throughout the electoral TV debates. Regardless of what happens there is a strong sense that this country will experience change. How that will affect society remains to be seen. Focusing on dietitians, a profes- sion that has a role in the front line of the NHS, public health, education, industry, sport and many more areas, the impact of this change will unfold over time. Regardless of where dietetics and nutrition professionals

are, policy has major influences on our work. For example, at a simple level, policy influences the foods available to con- sumers in this country.

The influence of food policy

In my research on the topic of the food environment, I have been considering how availability of, and accessibility to food influences intake. Whilst ultimately I am interested in answering the question of ‘why people eat what they eat’, I have been interested in the broader issues that influence individuals’ dietary choices. I have explored issues around measuring the food environment and collecting accurate data on the foodscape (1,2), how planning permission has been granted to food outlets and, more recently, the issues around food policy.

Until I began working with my colleague Dr Jane Midg- ley, Lecturer in Planning at Newcastle University, I was rather naive about the complexities of food policy. Food policy cuts across many government departments and is multi-level both nationally and in Europe. In our forthcoming book (3), Jane and I conclude that food policy is currently more focused on the individual rather than on the environment, particularly the broader food policy environment, which appears to influence individual food choices. That policy environment is potentially going to change...again and we will be watching that potential change with great interest.

References 1 Burgoine, T, Lake AA, et al (2009). Changing foodscapes 1980-2000, using the ASH30 Study. Ap- petite 53(2): 157-165 2 Lake AA, Burgoine T, et al (Accepted in press). The Foodscape: classification and field validation of secondary data sources. Health & Place 3 Lake AA and Midgley JL (Forthcoming 2010). Food policy and food governance - changing behaviours. Obesogenic Environments: complexities, perceptions and objective measures. Lake AA, Townshend T and Alvanides S. Wiley-Blackwell.

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