Treatment

Lifestyle changes

Lifestyle changes are difficult to achieve and maintain and patients will need ongoing support. Healthcare professionals have a vital role to play in helping patients to recognize the importance of lifelong weight management and in supporting them to achieve this. Often, a few words of encouragement or a genuine enquiry regarding progress can have a significant impact. At other times, a more detailed intervention may be required.

 

Understanding the position at the beginning of treatment

Information gathered in the assessment phase will allow both patient and practitioner to understand more about current eating habits – developing the practice of recording food intake is invaluable. It is useful to record information about the types of food eaten as well as the circumstances of eating.

 

Read more: Understanding the position at the beginning of treatment

Stabilising eating behaviour

The frequency and timing of meals is important as many obese patients describe very erratic or poorly structured diets.14 A common practice is to skip meals or restrain eating in the earlier part of the day, making it difficult to avoid overeating in the latter part of the day. Patients should be assured that having a regular pattern of eating is one of the key strategies people use to help them gain more control over their body weight.15-17 It is interesting to note that in a registry maintained by researchers in America, the majority (78%) of those that have been successful in maintaining a lower body weight for at least one year describe eating breakfast every day or most days.18

 

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Improving the nutritional quality of the diet

In advising about diet it is important to ensure that dietary change does not compromise other aspects of health. The inclusion of fruits, vegetables and wholegrain cereals is of particular importance as these are nutrient dense but low energy foods that have been shown to be protective to health.19¬ñ23 In addition, it is important to consider reducing the risk of conditions such as anaemia and osteoporosis.

 

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Referral to a dietician

Availability of local dietetic support will vary across the country, but most PCTs now employ dietitians, who can offer additional support to the team with respect to:

 

Read more: Referral to a dietician

Resources

Practical resources are provided in the patient material section of this education package.

Guidance on suitable resources can often be obtained from local dietetic services. In addition, the British Dietetic Association is a respected source of information on all aspects of nutrition including obesity (www.bda.uk.com).

A very practical resource is also available from the British Heart Foundation entitled, health "So you want to lose weight - for good".

The booklet provides guidance and suggestions of how to adjust dietary intake in order to achieve weight loss. Details are given about appropriate portion sizes as well as examples of eating plans. The booklet can be provided to patients and acts as a source of information about diet to all health professionals. Details are available on the British Heart Foundation website (www.bhf.org.uk).

Meal replacements

Meal replacements are foods of a fixed calorie and nutrient content that are designed to take the place of a usual meal. Commercially available meal replacements usually come in the form of shakes, stuff soups, bars or portion control meals. The normal recommendation is to replace at least two main meals, generally breakfast and lunch, and to consume a carefully calorie-controlled evening meal. The meals can be supplemented with fruit and vegetables. Meal replacement programmes are generally based on a daily intake of 1200-1500 kcal. In theory the plan can be adjusted to any calorie goal depending on the patient's preference and current energy intake. The role of meal replacements in weight management has been evaluated in several studies.28-31

 

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Very low calorie diets (VLCDs)

Very low calorie diets (VLCDs) are designed to completely replace usual food intake. By definition a diet is described as very low calorie if it provides less than 800 kcal per day.33 It is important that VLCDs provide sufficient protein and meet the daily requirements for vitamins, minerals, electrolytes and fatty acids. VLCDs are usually provided in the form of liquid supplements. Small amounts of low calorie foods such as vegetables may be incorporated into a VLCD. Due to the severe calorie restriction and the potential side effects, VLCDs should not be followed for periods greater than 12-16 weeks. Patients could expect to lose 1.0-2.5 kg per week when strictly adhering to a VLCD.

 

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How much physical activity is important?

The current government recommendation for ensuring good health is that a minimum of 30 min of moderate intensity physical activity is taken on at least five and preferably all days of the week. In addition to planned activity, see increasing the activities of daily living may also make a valuable contribution e.g. using the stairs instead of the lift. It is interesting to note that those that 'fidget' can expend anything from 150-850 kcal extra per day as a result of this 'spontaneous activity'.1

Read more: How much physical activity is important?

Useful tools and agencies

edometers

A pedometer is a simple tool that can be used to provide a measure of activity levels. These devices can be worn on a waistband and are designed to record the number of steps taken. They are relatively inexpensive and easily obtainable through a catalogue or sports shop.

 

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Summary of Key Points

  • Physical activity helps to prevent weight gain/regain
  • Physical activity benefits overall health
  • Being physically active helps to improve general well-being and thus impacts on the ability to follow dietary changes
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    References

    Please click "Read More" to view the references for this section.

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