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
Foreword xv Acknowledgements xvi Introduction xvii Section 1 Background Information 1 1 Why Treat Obesity? 3 What is the scale of the obesity problem? 3 Why does it matter? 3 Obesity and early death 4 Obesity and type 2 diabetes 4 Obesity and cancer 5 Obesity and cardiovascular disease 5 Quality of life 5 Factors that increase the risk of obesity 6 Smoking cessation 6 Certain medications 7 Obesity and its causes 7 Why do practitioners need a good understanding of obesity causes? 7 What are the causes of obesity? 8 Biology and genes 9 Eating and activity behaviours 10 The obesogenic environment 10 Health benefi ts of modest weight loss 11 Conclusion 11 References 12 2 Health Professionals’ Attitudes Towards Obesity and its Management 15 What does the evidence say about discrimination and weight bias in society? 16 In employment 16 In education 16 In health care 17 Where does weight bias come from? 17 Media and TV images 17 Cultural factors 18 Beliefs about the causes of obesity 18 What are the consequences of weight bias? 18 Psychological consequences 18 Social and economic consequences 18 Physical consequences 18 What is the impact of weight bias in the health care setting? 18 What can we do to reduce weight bias? 19 Conclusion 19 Reflective exercises 20 Recommendations for reducing weight bias in your practice 21 References 21 3 Treatment Options: The Evidence for What Works 24 Introduction 24 Combined approaches 24 Dietary treatments 25 Eating frequency and patterns 25 Improving the quality of the diet 25 Low-fat diets 25 The 600 kcal defi cit approach 26 Meal replacements 26 Very-low-calorie diets 27 Low-glycaemic-index diets 28 Low-carbohydrate diets 29 Fad diets 29 Physical-activity treatments 29 How much activity is needed? 30 Intensity and type of activity 31 Behaviour modification 32 An integrated approach 32 Key strategies 33 Drug treatment 36 Surgical treatment 37 Conclusion 38 References 38 Section 2 Practical Application 45 4 Preventing Overweight and Obesity 47 Prevention of overweight and obesity 47 Pre-conception and antenatal care 47 The early years 47 As life goes by 48 Medications 49 What to do? 49 If the response is negative 50 Support materials 50 Conclusion 51 References 51 5 Providing A Person-centred Weight-management Service 53 Integrating a behavioural approach 53 Working in a person-centred way 53 How to integrate a behavioural approach in practice? 54 Identifying overweight and obesity 57 Interpreting BMI 57 Planning weight-management interventions in your setting 58 Aiming for a coordinated and structured approach 58 Deciding on the duration and frequency of appointments 59 How and when to begin conversations about weight 60 Exploring whether this is the right time to begin 62 More on motivation… 63 Is the patient really sure they have the time and commitment required? 63 Discussing and agreeing a way forward 64 Exploring treatment options 64 Lifestyle treatment 64 Group-based programmes 64 Commercial and self-help programmes 67 Drug treatment 67 Surgery 68 Conclusion 68 References 68 6 Building a Picture: The Assessment 70 Undertaking a comprehensive assessment 70 What are the components of the assessment? 70 The Beginning 71 The Story So Far 72 Dealing with Expectations 74 The Here and Now 76 The Ending 81 References 82 7 Finding Solutions: Supporting Patients to Establish a Solid Foundation 83 Introduction 83 Integrating a behavioural approach 83 Step 1: Identify the Problem 84 Step 2: Explore Options 84 Step 3: Choose Preferred Option/s 85 Step 4: Develop a Plan 85 Step 5: Implement the Plan 87 Step 6: Review the Plan 88 The building blocks needed for a solid foundation 89 Providing information in a helpful way – an essential practitioner skill 90 Understanding energy balance 91 Calories in vs calories out 91 Recommended rates of weight loss 91 How many calories? 91 Key dietary recommendations 92 How to commence self-monitoring to understand current eating patterns 93 How to encourage regular eating 94 How to ensure a nutritionally adequate diet 94 How to use the ‘eatwell plate’ to achieve an energy deficit 94 How to read the calorie content on labels 99 Keeping a daily record 99 How to compare calorie intake with weight-loss achieved 101 When to refer on to specialist services 103 Further dietary options 104 Conclusion 105 Recommendations for physical activity 106 Current physical activity guidelines for all adults 106 Recommendations for weight management 106 First steps towards achieving physical-activity recommendations for weight management 107 Practical application of physical-activity recommendations 108 Developing essential skills: laying the foundations 114 Self-monitoring 114 Goal-setting 118 Conclusion 119 References 119 8 Next Steps: Continuing to Develop Expertise 121 Review appointments 121 Introduction 121 Suggested structure for review appointments 121 Review progress at 3 and 6 months 122 Topics for review appointments 123 More on healthy eating 146 Becoming skilled at weight management 152 Exploring motivation (‘ Do I want to, and can I? ’) 153 Self-monitoring (keeping a record) 153 Stimulus control 153 Problem-solving 154 Goal-setting (Developing a Plan) 155 Dealing with diffi cult situations 156 Support 156 Rewards 158 Exploring ambivalence (‘ I want to, but I can’t …’) 159 Relapse prevention (dealing with setbacks) 160 Emotional eating 161 Dealing with hunger 162 Cravings 162 More behavioural strategies 163 References 164 9 Staying on Track: Weight Maintenance 165 Introduction 165 Defining successful weight maintenance 165 Changes in weight 166 Causes of weight regain 166 What works? 166 National Weight Control Registry (NWCR) data 167 Implications for practice 168 Practical application 169 During the assessment 169 During the weight-loss phase 169 During the weight-maintenance phase 170 Learning how to deal with setbacks 172 Conclusion 172 References 173 10 Getting the Most out of Brief Contacts 175 Introduction 175 What is a brief contact? 175 Limitations of brief contacts 176 Getting the most out of brief contacts 176 Unhelpful approaches 177 Raising the issue 178 Engaging in a helpful conversation and exploring motivation 179 Is now the right time? 179 Discussing options 179 Signposting the most suitable option 181 Continuing to offer support 181 Brief interventions (if ongoing support includes brief review appointments) 182 What not to do 182 Making the best use of available time for ongoing brief contacts 182 Implications for services 182 Examples of brief contacts 183 Conclusion 184 References 184 11 Evaluating Individual Weight-management Interventions 186 Introduction 186 What is monitoring and evaluation? 187 Some definitions 187 The seven pillars 187 Evaluation can mean different things to different people 189 Evaluation can vary at different times 189 What makes evaluation challenging? 191 Getting started 192 Collecting information 192 What to evaluate 194 Effectiveness 194 Clinical outcomes 194 Risk factors 195 Activity and eating behaviours 195 Psychological health 197 Health care utilisation and cost outcomes 198 Patient experience 198 Safety 202 Conclusion 202 References 203 12 Common Challenges and Misconceptions 204 Introduction 204 Causes of obesity 204 ‘It’s my fault I’m obese’ 204 ‘I must have a slow metabolism’ 205 ‘It’s my genes, not my lifestyle’ 206 ‘I’ve been told I’m not eating enough to lose weight’ 207 Physical activity 208 ‘I can’t lose weight because my medical problems stop me from exercising’ 208 ‘Exercise makes me eat more’ 209 ‘I’ve been swimming for 20 minutes twice a week for 2 months and haven’t lost any weight’ 210 Diet 211 ‘Certain foods can burn fat’ 211 ‘I know breakfast is important but I just can’t eat in the morning’ 212 ‘Carbs are fattening’ 213 ‘Eating late at night causes weight gain’ 214 Note on patient dialogues 215 References 215 Section 3 Appendices 217 Appendix 1 Adult Weighing Scales Specification Guide 219 Appendix 2 How to Measure Height 220 Appendix 3 How to Measure Weight 222 Appendix 4 Measuring Overweight and Obesity using Body Mass Index 226 Appendix 5 Measuring-tape Position for Waist Circumference 227 Appendix 6 Medications 229 Appendix 7 Screening for Binge-eating Disorder 230 Appendix 8 General Practice Physical Activity Questionnaire 231 Appendix 9 PAR-Q & YOU 233 Appendix 10 Estimated Energy Requirement (EER) 235 Appendix 11 Prescribed Energy Defi cit (PED)-Ready Reckoner 237 Appendix 12 Portions Commonly Used for the ‘Eatwell Plate’ (To Check Nutritional Adequacy of the Diet) 240 Appendix 13 Example of 1500 kcal based on ‘Eatwell Plate’ Portions 242 Appendix 14 Example of 1800 kcal based on ‘Eatwell Plate’ Portions 244 Appendix 15 Cookery Books 246 Appendix 16 NICE Guidance on Referral to Slimming Groups 247 Appendix 17 Weighed Portions for Where More Precision is Required 248 Section 4 Resources 249 List of Resources 251 Additional Books and Resources 253 Section 5 Tools 255 Tool 1 Weight History Chart 257 Tool 2 Typical Day 258 Tool 3 Activity Charts 259 Tool 4 My Change Plan 260 Tool 5 Plate Model 261 Tool 6 Diary Sheet 262 Tool 7 Weight Record Chart 263 Tool 8 Blank Menu of Options 265 Tool 9 Menu of Options A 266 Tool 10 Menu of Options B 267 Tool 11 Menu Chart 268 Tool 12 Assessment of Diet Quality 269 Tool 13 Weighing It All Up: ‘ I Want To, But …’ 271 Tool 14 Behavioural Strategies 272 Index 273
About the Authors Dympna Pearson is a Registered Dietitian with extensive experience of working in different clinical settings and of providing training for healthcare professionals. Her particular interests are lifestyle change in relation to diabetes, coronary heart disease and weight management. Clare Grace is a Registered Dietitian with many years of experience in the clinical management of obesity and has a particular interest in the research underpinning weight management interventions. She provides regular obesity management training for healthcare professionals and students.
Reviews for Weight Management: A Practitioner's Guide
<p> I volunteered to review the text on publication and hopeyou find it as helpful as I do. (The Newsletter ofthe Irish Nutrition & Dietetic Institute, 1 August2013) <p> This will be useful for practitioners who are not asexperienced in working with the overweight and obese population.However, even practitioners with experience can benefit from thechapters on behavioral approaches that can be used when engaging inone-on-one counseling sessions. (Doody s,17 May 2013) <p>Weight Management: A Practitioner sguide <p>Dympna Pearson & Clare Grace <p>GBP37.99; Wiley-Blackwell 2012 <p>ISBN: 978-1-4051-9771-7 (also available as an e-book) <p>This important book bridges the gap between behaviour changetheory and the treatments that research has been shown to beeffective. It aims to demonstrate how behavioural approaches can beembedded within practice to encourage patient empowerment andactive decision-making. It s major strengths are the breadthand depth of material presented, the engaging conversational styleof writing and the huge number of resources and tools included.Written by two well known and respected practitioners in the fieldof weight management, it benefits from their academic, clinical andtraining expertise. It is different from other books in this areabecause of the experience of the authors - this gives the book apractical element often missing from more theoreticalpublications. <p>Progression throughout the book is logical. Section 1 startswith setting the scene (obesity prevalence, causes &consequences). Healthcare professionals attitudes towardsobesity and the potential effects of these upon patients areexplored and the evidence for treatment options presented. Section2 is devoted to practical application of the evidence, and howbehavioural theory can be embedded in practice. It movessequentially through prevention, assessment, finding andimplementing solutions & maintaining change. Additionalsections include the use of brief contacts, evaluation ofindividual weight management interventions and common challengesand misconceptions. The role of the healthcare professional isclarified at every stage of the consultation, and although theauthors recognise the many difficulties that exist in weightmanagement, they suggest how to incorporate best practice withinrealistic constraints. Structure and clarity are emphasisedthroughout. <p>For anyone with an interest in weight management this is a greatread. Written in an engaging style, it breaks complex ideas andtheories into more accessible chunks , and concreteexamples of using behavioural approaches are given throughout toillustrate how theory can be embedded into practice. <p>For those involved in weight management it is a must. Behaviourchange is recognised as central to effective weight management andthe practical applications of theory throughout are invaluable.However the authors are careful to emphasise that training isneeded reading this book will not equate to effectivelyfacilitating behaviour change in others. Anyone who has alreadyundertaken behaviour change training will find in this book auseful tool to help embed the training, and for those thinking ofdoing the training it puts the current thinking and evidence intocontext. <p>For the public health practitioner or those commissioning weightmanagement services, this book helps to clarify and pull togetherevidence on what treatments and approaches have been shown to beeffective, and to increase understanding of what should be includedin commissioned services. The useful and comprehensive chapter onevaluation of individual weight management services gives examplesof evaluation at different stages of interventions and what can bemeasured for each, emphasising the importance of consideringevaluation from the beginning of the planning process. In additionthe emphasis throughout on evidence-based practice clarifiestreatments shown to be effective. <p>All in all this is a great addition to the published work onweight management, written by practitioners uniquely equipped to doso. It is good value for money and thoroughly recommended. <p> <p>Statement on conflict of interest: <p>Hilda Mulrooney has served as a Committee member of domUK withboth Clare Grace and Dympna Pearson, and has worked with DympnaPearson in LNDS in the past. In addition she facilitates regularlyon Behaviour Training courses run by Dympna Pearson.
