Description
Book SynopsisWeight 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 out
Trade Review
“I volunteered to review the text on publication and hope you find it as helpful as I do.” (The Newsletter of the Irish Nutrition & Dietetic Institute, 1 August 2013)
“This will be useful for practitioners who are not as experienced in working with the overweight and obese population. However, even practitioners with experience can benefit from the chapters on behavioral approaches that can be used when engaging in one-on-one counseling sessions.” (Doody’s, 17 May 2013)
Weight Management: A Practitioner’s guide
Dympna Pearson & Clare Grace
£37.99; Wiley-Blackwell 2012
ISBN: 978-1-4051-9771-7 (also available as an e-book)
This important book bridges the gap between behaviour change theory and the treatments that research has been shown to be effective. It aims to demonstrate how behavioural approaches can be embedded within practice to encourage patient empowerment and active decision-making. It’s major strengths are the breadth and depth of material presented, the engaging conversational style of writing and the huge number of resources and tools included. Written by two well known and respected practitioners in the field of weight management, it benefits from their academic, clinical and training expertise. It is different from other books in this area because of the experience of the authors - this gives the book a practical element often missing from more theoretical publications.
Progression throughout the book is logical. Section 1 starts with setting the scene (obesity prevalence, causes & consequences). Healthcare professionals’ attitudes towards obesity and the potential effects of these upon patients are explored and the evidence for treatment options presented. Section 2 is devoted to practical application of the evidence, and how behavioural theory can be embedded in practice. It moves sequentially through prevention, assessment, finding and implementing solutions & maintaining change. Additional sections include the use of brief contacts, evaluation of individual weight management interventions and common challenges and misconceptions. The role of the healthcare professional is clarified at every stage of the consultation, and although the authors recognise the many difficulties that exist in weight management, they suggest how to incorporate best practice within realistic constraints. Structure and clarity are emphasised throughout.
For anyone with an interest in weight management this is a great read. Written in an engaging style, it breaks complex ideas and theories into more accessible ‘chunks’, and concrete examples of using behavioural approaches are given throughout to illustrate how theory can be embedded into practice.
For those involved in weight management it is a must. Behaviour change is recognised as central to effective weight management and the practical applications of theory throughout are invaluable. However the authors are careful to emphasise that training is needed – reading this book will not equate to effectively facilitating behaviour change in others. Anyone who has already undertaken behaviour change training will find in this book a useful tool to help embed the training, and for those thinking of doing the training it puts the current thinking and evidence into context.
For the public health practitioner or those commissioning weight management services, this book helps to clarify and pull together evidence on what treatments and approaches have been shown to be effective, and to increase understanding of what should be included in commissioned services. The useful and comprehensive chapter on evaluation of individual weight management services gives examples of evaluation at different stages of interventions and what can be measured for each, emphasising the importance of considering evaluation from the beginning of the planning process. In addition the emphasis throughout on evidence-based practice clarifies treatments shown to be effective.
All in all this is a great addition to the published work on weight management, written by practitioners uniquely equipped to do so. It is good value for money and thoroughly recommended.
Statement on conflict of interest:
Hilda Mulrooney has served as a Committee member of domUK with both Clare Grace and Dympna Pearson, and has worked with Dympna Pearson in LNDS in the past. In addition she facilitates regularly on Behaviour Training courses run by Dympna Pearson.
Table of ContentsForeword 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
