weight management...broaching the topic

Professor Annie S. Anderson Centre for Public Health Nutrition Research Centre for Research into Cancer Prevention and Screening Ninewells Medical School, University of Dundee email: a.s.anderson@dundee.ac.uk

Weight management – broaching the subject

Population based approaches....

“It makes little sense to expect individuals to

behave differently from their peers; it is more

appropriate to seek a general change in

behavioural norms and in the circumstances which

facilitate their adoption.”

Geoffrey Rose, 1982

Marketing

Availability

Marketing energy density…. Value Offers

Pricing

2007 Tillydrone, Aberdeen – no ball games – approx. 70 signs!

Cycle Glasgow?

Endorsing weight management

Everyone's responsibility....

Including health professionals and all agencies concerned with reducing occurrence and recurrence of cancer

(n=810, 68% wanted to weigh less and 45% currently trying to lose weight)

Having received a HP advice to lose weight tripled odds (OR =3.71) of wanting to weigh less and trying to lose weight (OR = 3.53)

Cancer survivors - agree or strongly agree (%)

POSITIVE STATEMENTS Physical Activity Healthy Eating Weight loss (for overweight patients)

Beneficial 87 93 87

Helpful 89 90 88

Encouraging 86 89 87

NEGATIVE STATEMENTS Insensitive 15 10 14

Placing the blame 20 18 24

Interfering 15 10 14

Unnecessary 17 11 15

87-93% of cancer survivors or members of social networks thought it was the “doctors duty” to provide advice on diet/activity/weight

15cm

Participant comments “If I could get in the car and drive to the kitchen I would” “I’m now proud to say I can leave the car outside and walk

into town” “Our fruit bowl used to be full of sh**e, car keys, letters etc,

anything but fruit. Now it’s full of fruit!” “When you suggested going for a walk I thought you had

two heads! Now I go to the gym three times each week”

Medical Colleges (2013) – A report and a campaign

The role of the GP

Conclusions

Although the term “obese” is overwhelmingly viewed as negative, some recognise that it could be motivational from a health professional, if used sensitively and whilst offering support and advice to lose weight

Many people with excess weight are comfortable with the term “overweight” and its motivational value may be low?

People may be more motivated to make the lifestyle changes needed to lose weight if they were made aware of links between ill-health and excess weight

Healthcare Professionals should make patients aware of the following health benefits associated with sustained modest weight loss A improved lipid profiles reduced osteoarthritis-related disability B lowered all-cause , cancer and diabetes mortality in some patient groups reduced blood pressure improved glycaemic control reduction in risk of type 2 diabetes potential for improved lung function in patients with asthma

SIGN, 2010

Starting points We are all in this together…..chances are we will gain up to 0.4kg per year… Consider avoiding weight gain as first priority!

Emphasise the importance of modest weight loss for health benefit- realistic expectations

Avoid Blame/Guilt… start here!

143 patients, average age 46.8 years, 90% female , BMI 36.1kg/m2,

Weight loss expectations versus goals

Dutton et al (2010) Weight loss goals of patients in a health maintenance organisation Eating Behaviours 11 , 74-78

Starting points Options range from – Endorsement (importance of body weight) – Key messages – Brief Interventions – NHS, Community and Commercial slimming

groups – NHS Dietitians

and in Scotland………???

Sales of fruit increased by 20% in a supermarket trial when life size cut outs of

local health workers were displayed encouraging shoppers to eat more healthily

http://www.healthierchoicespilot.com/

Starting points Options range from – Endorsement (importance of watching weight) – Key messages – Brief Interventions – NHS, Community and Commercial slimming

groups – NHS Dietitians

Key Messages- simple Avoid sugary drinks. Limit fast foods and takeaway meals Limit cakes, biscuits and sweets Choose low fat (dairy and other) options Eat at least 5 fruits + veg every day Be active .. try to have at least a brisk walk or 2 x 15 minute) walk every day

Starting points Options range from – Endorsement (importance of watching weight) – Key messages – Brief Interventions

Referalls

– NHS, Community and Commercial slimming groups

– NHS Dietitians and muti-disciplinary teams

Brief Interventions Ten Top Tips for a Healthy Weight- based on habit formation theory

After 8 weeks, intervention group had lost 2.0kg compared to 0.4kg in control group After 32 weeks, average weight loss 3.2 kg, 54% losing > 5% body weight

A little less brief- the 5 A’s

http://www.obesitynetwork.ca/register4/CON-5As-PPT.pdf

A little less brief- the 5 A’s

Ask permission to discuss weight and explore readiness to change,

May I talk to you about your weight? Would it be alright if we discussed your weight? Are you ready to work on your weight? Would it be ok if I helped?

A little less brief- the 5 A’s

Assess Assess health status/BMI etc

A little less brief- the 5 A’s

Advise Health Risks and Benefits, modest weight loss, long term strategies

“What would losing weight mean to you personally … dress size, picking up grandchildren, kicking a ball around, self pride…..”

A little less brief- the 5 A’s

Agree SMART goals Use effective behavioural techniques including goal setting, self monitoring, relapse prevention

A little less brief- the 5 A’s

Assist Address facilitators- e.g. social support , follow up

Starting points Options range from – Endorsement (importance of watching weight) – Key messages – Brief Interventions – NHS, Community and Commercial slimming

groups – NHS Dietitians and multi-disciplinary teams

7838 (20% = 1567) 30.5m UK adults are OW or OB 1 dietitian for 19,464 OW/OB people

Conclusions

Weight management • is important in cancer prevention and for

people living with cancer • Is everyone’s responsibility (individual and

public approaches needed) We face these challenges together looking forward Sensitive and supportive approaches offer a first step in the weight management pathway