Health Professional's Guide to Treatment of Overweight and Obesity

space where one lives, among other factors,54 and prevalence of obesity.55

and is associated with the incidence For example, a meta-analysis of prospective cohort

studies from the United States, Australia, and Europe found that higher walkability and less urban sprawl were associated with lower obesity incidence.55

Given that

physical activity is important for maintaining weight loss, supportive physical envi- ronments are likely needed for facilitating this healthy behavior change.

Considering the Mode of Care Delivery

With advances in technology, there have been substantial changes in the way health information is collected, tracked, and communicated between health care profes- sionals and patients.56

Especially since COVID-19 first appeared in December 2019,

providers have sought to provide health care remotely through technology-based methods to reduce the spread of the virus while maintaining much-needed care.57

These advancements in technology include the use of the internet for self-

management support (eg, through secure portals), social networking or eHealth communities, telehealth (eg, videoconferencing), mobile health (mHealth, includ- ing wearable physical activity monitors and mHealth apps), and electronic health records.56-58

Chapter 17 provides more information on this topic. As for the mode of delivery, some evidence suggests that various modes of

delivering weight loss support—in person, in a group setting, or via the tele- phone—are equally effective.5,59

The 2013 AHA/ACC/TOS guidelines reflect a high

strength of evidence for comprehensive weight loss interventions delivered in person, though the strength of evidence is moderate for electronically delivered interventions and low for interventions delivered via telephone.24

Nonetheless,

research continues and more work is needed to evaluate the utility and effective- ness of interventions delivered via communication technology, such as video-based telehealth.5,59

Telehealth may not be suitable for people with unreliable telephone

service or poor internet access. Limited evidence exists regarding the delivery of interventions primarily through technology and with no human intervention (eg, through a website platform, text messages, or smartphone apps).5,59

However, these

technology-based tools are very important for supporting weight loss through the self-monitoring of diet, physical activity, and body measurements, and for pro- viding real-time feedback to patients and their health care providers.5,57,59

These

tools facilitate a platform for remote delivery of care, which may greatly enhance the feasibility and affordability of the long-term support essential for maintaining weight loss.57

Managing Relapses

Given the obesogenic environment and the challenges of managing energy intake over one’s lifespan, weight regain can occur even when a client follows the various strategies that have been outlined here. Earlier intervention to “get back on track” increases the likelihood of reinitiating lapsed behaviors and reversing weight gain. This highlights the value of self-weighing and other forms of self-monitoring in long- term management. Clients may find it useful to identify a weight or other threshold at which they will reengage with interventions and support. Thus, retreatment and managing lapses or relapses are crucial aspects of long-term weight management.45

278 SECTION 3: Interventions for the Treatment of Overweight and Obesity

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