Weight Management E-Book

Dympna Pearson

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 397

Veröffentlichungsjahr: 2012

Beschreibung

Weight Management

A Practitioner’s Guide Dympna Pearson and Clare Grace

Amid an alarming rise in the prevalence of obesity, there has been a similar rapid expansion in the theory and evidence base surrounding its management but limited detail on the practical application of lifestyle treatments. This exciting new book provides practitioners and those studying to become healthcare professionals with a much-needed modern guide which clearly presents the latest evidence underpinning obesity interventions and how to deliver these in practice.

Written by renowned experts Dympna Pearson and Clare Grace, the book is intended as a ready reference for those working in both acute and community settings throughout the different and demanding stages of the weight management process. It explains how effective evidence-based programmes, structured to address the key components of diet and physical activity and integrated with a behavioural approach, can achieve improved outcomes. Bringing together evidence of best practice, it considers in detail the practical application of these approaches and provides clear answers to frequently encountered challenges.

Key Features

• A practical guide to tackling weight management
• Primary focus on lifestyle interventions in adults covering diet, exercise and behavioural therapy
• Step-by-step framework of care for overweight and obese individuals

Related Titles

Textbook of Obesity: Biological, Psychological and Cultural Influences
Edited by Sharon Akabas, Sally Ann Lederman and Barbara J. Moore
ISBN: 978-0-470-65588-7

Food and Western Disease: Health and Nutrition from an Evolutionary Perspective
Staffan Lindeberg
ISBN: 978-1-4051-9771-7

Leseprobe

Contents

Foreword

Acknowledgements

Introduction

Note to readers

Section 1 Background Information

1 Why Treat Obesity?

What is the scale of the obesity problem?

Why does it matter?

Factors that increase the risk of obesity

Obesity and its causes

Health benefits of modest weight loss

Conclusion

2 Health Professionals’ Attitudes Towards Obesity and its Management

What does the evidence say about discrimination and weight bias in society?

Where does weight bias come from?

What are the consequences of weight bias?

What is the impact of weight bias in the health care setting?

What can we do to reduce weight bias?

Conclusion

Reflective exercises

Recommendations for reducing weight bias in your practice

3 Treatment Options: The Evidence for What Works

Introduction

Combined approaches

Dietary treatments

Physical-activity treatments

Behaviour modification

Drug treatment

Surgical treatment

Conclusion

Section 2 Practical Application

4 Preventing Overweight and Obesity

Prevention of overweight and obesity

What to do?

Conclusion

5 Providing A Person-centred Weight-management Service

Integrating a behavioural approach

Identifying overweight and obesity

Planning weight-management interventions in your setting

More on motivation…

Exploring treatment options

Conclusion

6 Building a Picture: The Assessment

Undertaking a comprehensive assessment

What are the components of the assessment?

7 Finding Solutions: Supporting Patients to Establish a Solid Foundation

Introduction

Integrating a behavioural approach

The building blocks needed for a solid foundation

Understanding energy balance

Key dietary recommendations

Recommendations for physical activity

Developing essential skills: laying the foundations­

Conclusion

8 Next Steps: Continuing to Develop Expertise

Review appointments

Becoming skilled at weight management

9 Staying on Track: Weight Maintenance

Introduction

Defining successful weight maintenance

Changes in weight

Causes of weight regain

What works?

Implications for practice

Practical application

Conclusion

10 Getting the Most out of Brief Contacts

Introduction

What is a brief contact?

Limitations of brief contacts

Getting the most out of brief contacts

Brief interventions (if ongoing support includes brief review appointments)

Implications for services

Examples of brief contacts

Conclusion

11 Evaluating Individual Weight-management Interventions

Introduction

What is monitoring and evaluation?

What makes evaluation challenging?

Getting started

Collecting information

What to evaluate

Conclusion

12 Common Challenges and Misconceptions

Introduction

Causes of obesity

Physical activity

Diet

Note on patient dialogues

Section 3 Appendices

Appendix 1 Adult Weighing Scales Specification Guide

Classification of scales

Calibration

Appendix 2 How to Measure Height

Appendix 3 How to Measure Weight

Appendix 4 Measuring Overweight and Obesity using Body Mass Index

Appendix 5 Measuring-tape Position for Waist Circumference

Measuring waist

How to measure waist circumference

Appendix 6 Medications

Appendix 7 Screening for Binge-eating Disorder

Appendix 8 General Practice Physical Activity Questionnaire

Annex 1

Appendix 9 PAR-Q & YOU

Appendix 10 Estimated Energy Requirement (EER)

BMR

PAL

EER

EER for weight loss

Appendix 11 Prescribed Energy Deficit (PED)-Ready Reckoner

Female

Male

Appendix 12 Portions Commonly Used for the ‘Eatwell Plate’ (To Check Nutritional Adequacy of the Diet)

Appendix 13 Example of 1500 kcal based on ‘Eatwell Plate’ Portions

Appendix 14 Example of 1800 kcal based on ‘Eatwell Plate’ Portions

Appendix 15 Cookery Books

Appendix 16 NICE Guidance on Referral to Slimming Groups

Appendix 17 Weighed Portions for Where More Precision is Required

Section 4 Resources

List of Resources

Additional Books and Resources

Books

Useful Web sites

Guidelines and Reports

Section 5 Tools

Tool 1 Weight History Chart

Tool 2 Typical Day

Tool 3 Activity Charts

24 hours

Time spent on activity (minutes)

Steps recorded

Tool 4 My Change Plan

Tool 5 Plate Model

Tool 6 Diary Sheet

Tool 7 Weight Record Chart

Tool 8 Blank Menu of Options

Tool 9 Menu of Options A

Tool 10 Menu of Options B

Tool 11 Menu Chart

Tool 12 Assessment of Diet Quality

Tool 13 Weighing It All Up: ‘I Want To, But…’

Tool 14 Behavioural Strategies

Index

This edition first published 2012© 2012 by Dympna Pearson and Clare Grace

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Library of Congress Cataloging-in-Publication Data

Pearson, Dympna.Weight management : a practitioner’s guide / Dympna Pearson, Clare Grace.p. cm.Includes bibliographical references and index.

ISBN 978-1-4051-8559-2 (pbk.)1. Obesity–Treatment. 2. Reducing diets. 3. Exercise therapy. I. Grace, Clare. II. Title.RC628.P36 2012616.3′98–dc23

2012007651

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in printmay not be available in electronic books.

Cover Image: Mark Wragg/iStockphotoCover design by Steve Thompson

‘As with any chronic disease we rarely have the opportunity to cure, but we do have the opportunity to treat the patient with respect. Such an experience may be the greatest gift a doctor can give an obese patient.’

(From Stunkard A. Talking with patients. In: Stunkard A, Wadden T, editors.Obesity: Theory and Therapy. New York: Raven Press; 1993)

Foreword

With one in four adults in England now obese, and almost a third of children being either overweight or obese, it is easy to see why obesity is one of the most serious and complex health challenges we are facing in the UK today. The financial cost to the NHS, according to current estimates, is more than £4 billion, and yet obesity is a health issue that, paradoxically, attracts enormous public interest but still remains a worryingly low priority within medicine.

The costs to patient health are well documented, and we know that obesity is a contributing factor in cardiovascular disease, type 2 diabetes, cancer and early death. But beyond that, the social and psychological cost to people with obesity can be enormous.

On a daily basis we are confronted with stories in the media telling us how fat we are becoming, and of the latest faddy diet, obesity ‘miracle pill’ or ‘undeserving, greedy over-eaters’ receiving NHS-funded gastric band operations.

With this continued negative focus, it is unsurprising that the perception remains that dealing with obesity is as simple as ‘eat less and do more’, when all evidence suggests that there is a multitude of behavioural, environmental and genetic factors that are responsible and that, most importantly, there is no magic bullet to ‘cure’ obesity.

Weight Management: A Practitioner’s Guide is an excellent resource which identifies the various ways practitioners can help their obese patients take control of their own weight, while challenging them to confront their own perceptions of obese patients, and make changes to their practice accordingly.

Patients with obesity do not want to be defined by their weight, and the tools, guidance and resources within this book will help practitioners help place their patients at the centre of their own care from the very first consultation, allowing them to make effective changes that will improve their health and quality of life.

Dr Clare GeradaChair of the Royal College of General Practitioners

Acknowledgements

We wish to express our sincere thanks to the many colleagues who have helped us with this book, in particular Karen Allen, Cheryl Flanagan, Joanne Jones and Alison Macleod for their dietetic expertise and wisdom in reviewing early versions and their ongoing enthusiasm for its development. We would like to express our gratitude to Jill McMullan and Hannah Stewart for their help with analysing the food diaries.

Also, we wish to thank our families for their love, support, encouragement and endless patience.

Introduction

The aim of this book is to support and inspire practitioners working in weight management on how best to manage obesity, with a primary focus on lifestyle interventions in adults.

There are numerous obesity textbooks guiding us on the alarming rise in the prevalence, the causes and the consequences of obesity, and the theory and evidence on how it should be managed. However, surprisingly little detailed attention has been given to the specifics of clinical practice. What is the best way of raising the issue of overweight? When and how should we assess eating and activity ­behaviour? What is the most effective dietary treatment? These are just some of the many issues that arise when working with overweight patients, and which this book aims to address.

It brings together evidence of best practice, considers in detail the practical application of these approaches and provides clear answers to frequently encountered challenges. It is packed with practical tools and examples from practice and will guide you step by step through a framework of care for overweight and obese individuals.

Although we now know more about what works in weight management, the complexity and relapsing nature of obesity highlights the importance of further investment in training and research. Many health professionals report low confidence in their abilities to help obese patients and this is likely to have a negative impact on treatment outcomes, as well as the patient’s and the practitioner’s experience. Practitioners often relate poor confidence to inadequate training in the practical lifestyle recommendations and behavioural approaches to weight management. While this book is not a substitute for high-quality skills training, it does provide an opportunity for practitioners to learn through self-reflection, gather additional knowledge and insight, and relate their experiences to those presented in practical examples. The book is also designed to allow practitioners to dip into relevant ­sections as the need or the practice-related question arises.

Much of the recent focus in obesity management has centred on prevention of overweight, particularly in children. This includes pre-conception and maternal nutrition, weaning and infant feeding, as well as pre-school nutrition. These ­interventions early in life are inextricably linked to the whole family, making it impossible to separate management of obesity from prevention. It is essential that sufficient focus is given to treatment of adults with established obesity, as their behaviours will be modelled within families and by children.

This book focuses on lifestyle treatment in adults, primarily one-to-one ­interventions, and does not address the complexities of childhood obesity, which merits its own dedicated practitioner guide.

The first section begins by exploring why treating obesity is so important and considers some of the key causal issues involved. It then explores practitioners’ attitudes to obesity and how these might influence practice. This is followed by a brief overview of the evidence for lifestyle treatments, with additional information on drug and surgical interventions as adjuncts to lifestyle programmes. The second section guides the reader through the practical aspects of a patient-centred weight-management intervention and includes suggestions on how to adhere to best practice when time is limited. The ongoing challenge of weight maintenance and how to evaluate the impact of treatment are also addressed. Given obesity management is littered with myths and misconceptions, these are the subject of the final chapter, and practical examples are provided to help the practitioner relate this information to their daily practice.

We hope you find this book helpful.

Note to readers

Throughout this book we have chosen to use the term ‘patient’ rather than ‘client’. This reflects our belief that obesity is a chronic disease, and individuals often need support to manage, not only their weight, but also the associated diseases. We ­recognise that some readers may prefer to substitute the term ‘client’, particularly if working in non-health care settings.

1

Background Information

1

Why Treat Obesity?

‘Obesity poses a threat on a similar scale to climate change’ [1]

What is the scale of the obesity problem?

Obesity is one of the most serious and complex health challenges faced by the UK, Europe and most of the rest of the world. There has been a dramatic doubling in its prevalence over the last 25 years with most adults in England now overweight, and 1 in 4 obese (24% men; 25% women) [2]. Alarmingly similar trends have been observed in children, with 14.4% of 2–10 year olds obese in 2009 [3]. If current trends continue, future prevalence predictions are dire, with suggestions that 9 in 10 adults in England could be obese by 2050 [4].

This will have profound cost implications for the NHS and the wider economy. Current estimates for the NHS suggest obesity costs £4.2 billion/year, with wider economic costs (reduced productivity, loss of earnings, increased benefits) of £16 billion/year. If future prevalence predictions are accurate, this may rise to £10 billion/year and £50 billion/year, respectively [4].

A strong social inequality exists in the prevalence of obesity, although the factors responsible are unclear: in men, 18% are obese in social class I versus 28% in social class V; in women, 10% are obese in social class I versus 25% in social class V [5]. Unfortunately, there is limited information on whether prevalence varies by ethnicity as most surveys only include small numbers from various ethnic groups. However, in 2004, a higher prevalence of obesity was found in black African, black Caribbean and Pakistani women compared to the general population [6].

Why does it matter?

Obesity is known to shorten life, is a risk factor for a range of major co-morbidities and can have profound effects on an individual’s psychological and social well being. There are also wider economic and social consequences for society that make addressing obesity a compelling, albeit challenging, issue.

Obesity shortens life