CLINICAL CONDITIONS

NUTRITION IN THE MANAGEMENT OF OBESITY

By Gill Cowburn

Obesity is associated with a range of chronic, debilitating diseases so its increasing prevalence in the United Kingdom is an important public health concern. Despite many uncertainties, there is evidence to suggest that effective obesi- ty management programmes offer a combi- nation of approaches and emphasise behaviour modification, cognitive-change strategies, social support, physical activity and nutrition education (1,2).

The health consequences of overweight and obesity and the role of physical activ- ity in its management have been outlined in the previous issue of SportEX Medicine.

Weight management Healthy eating recommendations to reduce the rates of chronic diseases (like coronary heart disease, stroke and some cancers) have remained broadly consistent over the past decade (3,4). Although the percent- age of food energy derived from total fat in the British diet has fallen gradually since the mid 1970s (5), the majority of the pop- ulation still consume more than the recom- mended level of fat and eat fewer portions of fruit and vegetables than required for health (6). There is clearly still a need for dietary change in order to promote health and manage obesity.

The following stages are suggested to help structure a nutrition-related weight man- agement intervention. This framework is adapted from the HEA’s ‘Managing Weight’ handbook (7).

1. Identify which individuals would benefit most from change Clear criteria and methods for establishing risk could be derived locally according to available resources. These might be based on an individuals’ current health status, existing risk factors (ie. type II diabetes or hypertension), body weight and/or adipos- ity (measured by body mass index and

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DEFINING OBESITY Obesity is a chronic condition characterised by excessive overweight together with an increase in stored fat.

waist to hip ratio or waist measurement) and current eating and physical activity behaviour. For some people, weight con- cerns are associated with an eating disor- der and it will be necessary to identify individuals who require more specialised support at this time. Ask openly and sensi- tively about any history of regular use of vomiting and/or laxatives or diuretics as a means of weight control. Also attempt to identify whether an individual has experi- enced episodes of loss of control over eat- ing (ie. regular, sudden bouts of fast eat- ing, eating greater quantities than normal and being unaware of the eating episode until after it has occurred). Find out about local specialist support services to which anyone with such a history may wish to be referred.

2. Assessment Although the first stage establishes who is most likely to benefit from change, it will be necessary to clarify if such individuals are interested in considering change. You may want to explore their beliefs about

health in relation to food and their weight. A weight history will give an indication of the type of approaches they have used in the past to manage their weight and offer some clues about useful and unhelpful strategies.

You could ask your patient to consider the pros and cons of making changes and of maintaining their current behaviour. It might be useful to know how confident they feel about their ability to make suc- cessful changes and to explore any con- cerns they have about dietary behaviour change. You’ll also want to assess their cur- rent eating habits, perhaps using a written food diary or asking your client to recall their usual eating habits in a ‘typical day’. You may need to correct misconceptions or provide further information about the risks of continuing their current behaviour pat- terns. Do this in a ‘neutral’ manner by pro- viding an overview of current scientific evi- dence rather than telling people what would be best for them. At this stage of the discussion you may find out that your