weight management...broaching the topic
TRANSCRIPT
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: [email protected]
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