Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T23:39:03.421Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of obesity: Theory into practice

Published online by Cambridge University Press:  08 December 2008

Sara F. L. Kirk
Sara F. L. Kirk*
Affiliation:
Division of Public Health, Nuffield Institute for Health, The University of Leeds, 71–75 Clarendon Road, Leeds LS2 9PL, UK
*
Corresponding author: Dr Sara F. L. Kirk, fax + 44 (0)113 233 3952, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The purpose of the present paper is to outline the current situation in the management of obesity in adults, and to make some suggestions as to how health professionals involved in obesity treatment can best address this growing problem. Dietitians and nutritionists have long been involved in the treatment of obesity, and have a vital role to play in the battle to reverse the increasing prevalence of this major public health problem. However, the current management of obesity is far from ideal. There is evidence to suggest that in general health care, even when there are clearly effective clinical interventions, health professionals may not practise in the best way. Furthermore, some professionals may also hold negative attitudes towards the obese. These are the subject of a systematic review on improving health professionals' practice and organization of care in obesity treatment, the preliminary findings of which will be discussed in the present paper (Harvey et al. 1998a, b). A new approach to obesity is required, encompassing effective treatment and prevention strategies. A greater understanding of the problems faced by the obese individual in attempting to lose weight is also needed, with a range of treatment approaches on offer to acknowledge the heterogeneity of obesity. Those health professionals involved in obesity treatment must consider the impact of dietary advice given in a consultation against the impact of environmental cues that assail the patient as soon as they leave the room. Tackling the obesity epidemic requires action at the individual and population level if we are to see any reduction in prevalence.

Keywords

Obesity managementDietary advice for obesity
Type
Joint Symposium with the British Dietetic Association on ‘Implementing dietary change: theory and practice’ Session 2: Obesity
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 1 , February 1999 , pp. 53 - 58
Copyright
Copyright © The Nutrition Society 1999

References

Bennett, W (1987) Dietary treatments of obesity. Annals of the New York Academy of Sciences 499, 250–263.CrossRefGoogle ScholarPubMed
Blackburn, GL, Wilson, GT, Kanders, BS, Stein, LJ, Lavin, PT, Adler, J & Brownell, KD (1989) Weight cycling: the experience of human dieters. American Journal of Clinical Nutrition 49, 1105–1109.CrossRefGoogle ScholarPubMed
British Dietetic Association (1997) Position Paper. Obesity treatment: future directions for the contribution of dietitians. Journal of Human Nutrition and Dietetics 10, 95–101.CrossRefGoogle Scholar
Cade, J & O'Connell, S (1991) Management of weight problems and obesity: knowledge, attitudes and current practice of general practitioners. British Journal of General Practice 41, 147–150.Google ScholarPubMed
Cadman, L & Wiles, R (1996) Nutritional advice in primary care: evaluation of practice nurse nutrition training programmes. Journal of Human Nutrition and Dietetics 9, 147–156.CrossRefGoogle Scholar
Cowburn, G (1998) Current themes in the dietetic management of obesity. Journal of Human Nutrition and Dietetics 11, 191–196.CrossRefGoogle Scholar
Dublin, LI (1953) Relation of obesity to longevity. New England Journal of Medicine 248, 971–974.CrossRefGoogle ScholarPubMed
Egger, G & Swinburn, B (1997) An ‘ecological’ approach to the obesity pandemic. British Medical Journal 315, 477–480.CrossRefGoogle Scholar
Fox, KR & Dirkin, GR (1992) Psychosocial predictors and outcomes of exercise in patients attending multidisciplinary obesity treatment. International Journal of Obesity and Related Metabolic Disorders 16, Suppl. 1, 84.Google Scholar
Garrow, JS (1992) Treatment of obesity. Lancet 340, 409–413.CrossRefGoogle ScholarPubMed
Gill, T (1997) Key issues in the prevention of obesity. British Medical Bulletin 53, 359–388.CrossRefGoogle ScholarPubMed
Glenny, A-M, O'Meara, S, Melville, A, Sheldon, TA & Wilson, C (1997) Treatment and prevention of obesity: a systematic review of the literature. International Journal of Obesity and Related Metabolic Disorders 21, 715–737.CrossRefGoogle ScholarPubMed
Goldstein, DJ (1992) Beneficial effects of modest weight loss. International Journal of Obesity and Related Metabolic Disorders 16, 397–415.Google ScholarPubMed
Goode, J, Beardsworth, A, Keil, T, Sherratt, E & Haslam, C (1996) Changing the nation's diet: a study of responses to current nutritional messages. Health Education Journal 55, 285–299.CrossRefGoogle Scholar
Hansbro, J, Bridgwood, A, Morgan, A & Hichman, M (1997) Health in England, 1996. London: H. M. Stationery Office.Google Scholar
Hartley, P (1996) Does health education promote eating disorders? European Eating Disorders Review 4, 3–11.3.0.CO;2-I>CrossRefGoogle Scholar
Harvey, EL, Glenny, A-M, Kirk, SFL & Summerbell, CD (1998 a) Improving health professionals management of obesity (protocol) In Cochrane Collaboration Effective Practice and Organisation of Care (EPOC) Module of The Cochrane Database of Systematic Reviews [Bero, L, Grilli, R, Grimshaw, J and Oxman, A, editors] (updated January 1998). Available in The Cochrane Library database (on disk and CD-ROM). The Cochrane Collaboration, issue 1. Oxford, Update Software, 1998 (Updated quarterly).Google Scholar
Harvey, EL, Glenny, A-M, Kirk, SFL & Summerbell, CD (1998 b) Effective professional practice: Protocol for a systematic review of health professionals’ management of obesity. Journal of Human Nutrition and Dietetics 11, 243–247.CrossRefGoogle Scholar
Health Education Authority (1994) Helping People Change. London: HEA.Google Scholar
Health Education Authority (1995) Obesity in Primary Care. A Literature Review. London: HEA.Google Scholar
Helman, A (1997) Nutrition and general practice: An Australian perspective. American Journal of Clinical Nutrition 65, Suppl., 1939S–1942S.CrossRefGoogle ScholarPubMed
Herman, CP & Polivy, J (1980) Restrained eating. In Obesity, pp. 208–225 [Stunkard, AJ, editor]. Philadelphia, PA: W. Saunders.Google Scholar
Hiddink, GJ, Hautvast, JGAJ, Van Woerkum, CMJ, Fieren, CJ & Van't Hof, MA (1995) Nutrition guidance by primary-care physicians: perceived barriers and low involvement. European Journal of Clinical Nutrition 49, 842–851.Google ScholarPubMed
Hoffmann-La Roche Inc. (1995) Obesity: A DecisionBase additional indication. Cited in. Obesity: An Epidemic for the 21st Century? An International Report. Available at http://www.roche-obesity.net/professionals/spotlight/report_ inhalt2.html, 2 June 1998 version.Google Scholar
Hoppé, R & Ogden, J (1997) Practice nurses’ beliefs about obesity and weight related interventions in primary care. International Journal of Obesity and Related Metabolic Disorders 21, 141–146.CrossRefGoogle ScholarPubMed
Jeffery, RW, Folsom, AR, Luepker, RV, Jacobs, DR Jr, Gillum, RF, Taylor, HL & Blackburn, H (1984) Prevalence of overweight and weight loss behavior in a metropolitan adult population: the Minnesota Heart Survey experience. American Journal of Public Health 74, 349–352.CrossRefGoogle Scholar
Kayman, S, Bruvold, W & Stern, JS (1990) Maintenance and relapse after weight loss in women: Behavioral aspects. American Journal of Clinical Nutrition 52, 800–807.CrossRefGoogle ScholarPubMed
Ketley, D & Woods, KL (1993) Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet 342, 891–894.CrossRefGoogle ScholarPubMed
Kirk, SFL & Hill, AJ (1997) Exploring the food beliefs and eating behaviour of successful and unsuccessful dieters. Journal of Human Nutrition and Dietetics 10, 331–341.CrossRefGoogle Scholar
Lapidus, L, Bengtsson, C, Larsson, B, Pennert, K, Rybo, E & Sjostrom, L (1984) Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow-up of participants in the population study of women in Gothenburg, Sweden. British Medical Journal 289, 1257–1261.CrossRefGoogle Scholar
Larsson, B, Svarsudd, K, Welin, L, Wilhelmsen, L & Björntorp, P (1984) Abdominal adipose distribution, obesity, and risk of cardiovascular disease and death: a 13 year follow-up of participants in the study of men born in 1913. British Medical Journal 288, 1401–1404.CrossRefGoogle Scholar
Lowe, MR & Kleifield, EI (1988) Cognitive restraint, weight suppression and the regulation of eating. Appetite 10, 159–168.CrossRefGoogle ScholarPubMed
Mant, D (1997) Effectiveness of dietary intervention in general practice. American Journal of Clinical Nutrition 65, Suppl., 1933S–1938S.CrossRefGoogle ScholarPubMed
Marcus, M (1994) Binge eating and obesity. In Eating Disorders and Obesity: a Comprehensive Handbook, pp. 441–444 [Brownell, KD and Fairburn, CG, editors]. New York, NY: The Guilford Press.Google Scholar
National Institutes of Health Technology Assessment Conference Statement (1992) Methods for voluntary weight loss and control. Nutrition Reviews 50, 340–345.Google Scholar
Pace, P, Bolton, MP & Reeves, RS (1991) Ethics of obesity treatment: implications for dietitians. Journal of the American Dietetic Association 91, 1258–1260.CrossRefGoogle ScholarPubMed
Pavlou, KN, Krey, S & Steffee, WP (1989) Exercise as an adjunct to weight loss and maintenance in moderately obese subjects. American Journal of Clinical Nutrition 49, 1115–1123.CrossRefGoogle ScholarPubMed
Perri, MG, Sears, SF & Clark, JE (1993) Strategies for improving maintenance of weight loss: Toward a continuous care model of obesity management. Diabetes Care 16, 200–209.CrossRefGoogle Scholar
Polivy, J & Herman, CP (1985) Dieting and binging: A causal analysis. American Psychologist 40, 193–201.CrossRefGoogle ScholarPubMed
Pories, WJK, McDonald, KG Jr, Morgan, EJ, Sinha, MK, Dohm, GL, Swanson, MS, Barakat, HA, Khazanie, PG, Leggett-Frazier, N & Long, SD (1992) Surgical treatment of obesity and its effect on diabetes: 10 year follow-up. American Journal of Clinical Nutrition 55, Suppl. 2, 582S–585S.CrossRefGoogle Scholar
Prochaska, JO, DiClemente, CC & Norcross, JC (1992) In search of how people change: Applications to addictive behaviours. American Psychologist 47, 1102–1111.CrossRefGoogle Scholar
Richman, RM, Webster, P, Salgo, AR, Mira, M, Steinbeck, KS & Caterson, ID (1996) A shared care approach in obesity management: the general practitioner and a hospital based service. International Journal of Obesity and Related Metabolic Disorders 20, 413–419.Google Scholar
Rogers, JL, Haring, OM, Wortman, PM, Watson, RA & Goetz, JP (1982) Medical information systems: assessing impact in the areas of hypertension, obesity and renal disease. Medical Care 20, 63–74.CrossRefGoogle ScholarPubMed
Ruderman, AJ (1986) Dietary restraint: A theoretical and empirical review. Psychological Bulletin 99, 247–262.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (1996) Obesity in Scotland. Integrating Prevention with Weight Management. A National Clinical Guideline Recommended for Use in Scotland. Edinburgh: SIGN.Google Scholar
Spitzer, RL, Devlin, M, Walsh, BT, Hasrin, D, Wing, R, Marcus, M, Stunkard, A, Wadden, T, Yanouski, S, Agras, S, Mitchell, J & Nonas, C (1992) Binge eating disorder: a multisite field trial of the diagnostic criteria. International Journal of Eating Disorders 11, 191–203.3.0.CO;2-S>CrossRefGoogle Scholar
Wardle, J (1987) Compulsive eating and dietary restraint. British Journal of Clinical Psychology 26, 47–55.CrossRefGoogle ScholarPubMed
Westenhoefer, J, Broeckmann, P, Münch, A-K & Pudel, V (1994) Cognitive control of eating and the disinhibition effect. Appetite 23, 27–41.CrossRefGoogle ScholarPubMed
Wiseman, CV, Gray, JJ, Mosiman, JE & Ahrens, AH (1992) Cultural expectations of thinness in women: An update. International Journal of Eating Disorders 11, 85–89.3.0.CO;2-T>CrossRefGoogle Scholar
Wooley, SC & Garner, DM (1991) Obesity treatment: the high cost of false hope. Journal of the American Dietetic Association 91, 1248–1251.CrossRefGoogle ScholarPubMed
World Health Organization (1998) Obesity. Preventing and Managing the Global Epidemic. WHO/NUT/NCD/98. Interim Version of the Report of a WHO Consultation on Obesity, 3–5 June, 1997. Geneva: WHO.Google Scholar