OBESITY Food groups

Bread, other cereals and potatoes

Fruit and vegetables Milk and dairy foods

Meat, fish and alternatives

Foods containing fat Foods containing sugar

What’s included

Other cereals include breakfast cereals, pasta, rice, oats, noodles, millet and cornmeal

Includes fresh, frozen and canned fruit and vegetables, dried fruit and fresh fruit juice

Includes milk, cheese, yoghurt and fromage frais

Includes meat, poultry, fish, eggs, nuts, beans and pulses

Includes margarine, butter, low-fat spread, other spreading fats, cooking oils, oily salad dressings or

mayonnaise, cream, crisps, chocolate, biscuits, cakes, sweets, sugar, jam

Table 1: The food groups of The balance of good health

patient is unwilling or unable to attempt change at the moment. Remind them that they can return for support at another time.

3. Changing eating behaviour A food diary or ‘typical day’ recall gives a general indication of eating patterns and the types of foods chosen rather than an accurate nutritional analysis. However it provides a useful starting point for discus- sion about options for eating behaviour change. The aim of dietary management of obesity is to incorporate a daily energy deficit of 500kcal/2000kJ below estimated energy requirements (2,8). This deficit leads to moderate weight losses which appear to confer health benefits (8). Recommending daily energy deficits greater than this is unlikely to increase safe weight loss and may result in the per- son eating insufficient nutrients to meet their needs.

● Compare your client/patient’s current eating behaviour with ‘The balance of good health’ in table 1 in order to help them think realistically about the changes they are willing to attempt. They could make changes to the proportion of foods they eat - by eating more of, or less of some food groups. For example, they might con- sider eating more from the bread, cereals and potatoes group and less foods con- taining fat and/or sugar.

● You could suggest they think about mak- ing changes to the types of foods they eat, by choosing a low fat spread instead of butter or margarine; using semi-skimmed

milk instead of whole milk or choosing wholegrain breakfast cereals instead of sugar or honey-coated varieties.

● They may want to try changing the amounts of foods they eat by eating larg- er portions of rice and pasta and smaller servings from the meat, fish and alterna- tives group or eat larger portions of veg- etables and smaller servings of foods con- taining fat and/or sugar such as puddings and cake.

● You could also suggest they make changes to the frequency with which they eat foods, perhaps eating fruit more often and eating higher fat foods less often.

Different people may decide to adopt one type of change or try a combination of approaches depending on their likes and dislikes and their experience of previous change attempts. Encourage them to be realistic about the amount of time change can take and to set small, specific, achiev- able goals which will fit in with other peo- ple in their household (9). Remind people to anticipate any difficulties - planning ahead may help them to cope with prob- lems which arise.

4. Monitoring change You could agree to support your patient’s eating behaviour change by following them up in person or by telephone. Alternatively they could enlist support from friends, work mates or family. Patients could com- plete another eating diary and compare this with their previous behaviour. They could also compare their current behaviour

against agreed goals or check their progress against agreed success criteria. If things go wrong, remind them that encountering problems provides valuable learning about which strategies are helpful or not for them. There will be other approaches they might find more success- ful - it is common for several attempts to be made before a change is incorporated into everyday life.

References 1. NHS Centre for Reviews and Dissemination, University of York, 1997.

Systematic review of

interventions in the treatmentand prevention of obesity. CRD Report 10. York Publishing Services Ltd. York 2. Cowburn G, Hillsdon M and Hankey C. Obesity management by lifestyle strategies. British Medical Bulletin 1997:53;2,389-408 3. Department of Health - The Cardiovascular Review Group Committee on Medical Aspects of Food Policy 1994. Nutritional aspects of car- diovascular disease HMSO, London 4. Department of Health - The Working Group on Diet and Cancer of the Committee on Medical Aspects of Food and Nutrition Policy 1998. Nutritional aspects of the development of cancer The Stationery Office, London 5. British Heart Foundation Health Promotion Research Group 1999. Coronary heart disease statistics British Heart Foundation, London 6. Ministry of Agriculture, Fisheries and Food 1998. National Food Survey 1997. The Stationery Office, London 7. Health Education Authority 1998. Managing weight: a workbook for health and other profes- sionals Health Education Authority, London 8. Scottish Intercollegiate Guidelines Network 1996. Obesity in Scotland. Integrating preven- tion with weight management: a national clini- cal guideline recommended for use in Scotland. Scottish Intercollegiate Guidelines Network, Edinburgh 9. Foster C. Readiness to change SportEX Medicine 1999,3,24-26

SportEX 17 Types and quantities Eat plenty of these foods, including some at

every meal - choose wholegrain, brown or high fibre kinds whenever you can

Eat plenty of these foods and choose as wide a variety as you can

Eat moderate amounts of these foods, choosing lower fat alternatives whenever you can

Eat moderate amounts of these foods, choosing lower fat alternatives whenever you can

Eat these foods in small amounts or infrequently