Redefining success in obesity intervention: the new paradigm

Changes in weight status of caregivers of children and adolescents enrolled in a community-based healthy lifestyle programme: Five-year follow-up

Whānau Pakari is a family-centred healthy lifestyle programme for children/adolescents with overweight/obesity in New Zealand. This secondary analysis from our randomised trial within the clinical service assessed 5-year BMI changes in accompanying caregivers (n = 23), mostly mothers. Overall, baseline and 5-year caregivers' BMI were similar (32.50 vs 31.42 kg/m2, respectively; p = 0.31) but two-thirds (65%) experienced BMI reductions. Five-year BMI change was similar in High-intensity and Low-intensity randomisation groups [-1.37 kg/m2 (-4.95, 2.21); p = 0.44]. Caregiver's BMI change was not associated with child's BMI change. Despite no overall BMI reduction, our findings contrast with upward BMI trajectories predicted for NZ adults with overweight/obesity.

Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic status?

Obesity is a significant public health concern affecting more than half a billion people worldwide. Obesity rise is not only limited to developed countries, but to developing nations as well. This paper aims to compare the mean body mass index trends in the World Health Organisation- (WHO-) categorised regions since 1980 to 2008 and secondly to appraise how socioeconomic disparities can lead to differences in obesity and physical activity level across developing nations. Taking into account past and current BMI trends, it is anticipated that obesity will continue to take a significant ascent, as observed by the sharp increase from 1999 to 2008. Gender differences in BMI will continue to be as apparent, that is, women showing a higher BMI trend than men. In the coming years, the maximum mean BMI in more developed countries might be exceeded by those in less developed ones. Rather than focusing on obesity at the individual level, the immediate environment of the obese individual to broader socioeconomic contexts should be targeted. Most importantly, incentives at several organisational levels, the media, and educational institutions along with changes in food policies will need to be provided to low-income populations.

Eating order: a 13-week trust model class for dieting casualties

Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on Satter's How to Eat protocol, within a Health at Every Size framework, was successful for 36 women in improving eating attitudes and behaviors, body image, and self-esteem, regardless of initial degree of eating disturbance or weight. This practice model has the potential for ameliorating societal weight escalation and multigenerational struggles with eating and weight.

Canadian Dietitians’ Understanding of Non-Dieting Approaches in Weight Management

Purpose: How Canadian dietitians define and use non-dieting and size acceptance approaches (SAAs) in the context of weight management was explored.

Methods: Fifteen focus groups with 104 dietitians were conducted in seven Canadian cities. Questions were designed to explore participants’ understanding and use of non-dieting and SAAs, including counselling goals, techniques, and outcome measures. Sessions were tape-recorded, transcribed verbatim, coded, and analyzed using qualitative methods.

Results: Participants generally agreed that non-dieting involves promoting healthy lifestyles and avoiding restrictive diets. Participants also agreed that size acceptance means accepting all body shapes and sizes and promoting comfort with one's body. Many dietitians said they use size acceptance only with appropriate clients, most often with those who are lighter or without other health risks. Others said that size acceptance, by definition, is appropriate for everyone. Opinions varied about the appropriateness of teaching portion sizes or using meal plans, and whether weight loss could be a goal of non-dieting and SAAs.

Conclusions: Views on the usefulness of non-dieting and size acceptance strategies in weight management counselling were related, at least partially, to the different understanding that dietitians had of these approaches. Terminology needs to be clarified when we speak about non-dieting and SAAs. The varied understanding about these concepts should help dietitians reflect on their own perspectives and practice.

Eating as both coping and stressor in overweight control

AIM

The aim of this study was to test a conceptual model proposing that stress evokes eating as coping, that eating then becomes a stressor in itself, and that a coping repertoire specific for overeating is required to moderate its yield of negative mood states.

BACKGROUND

It is known that stressors may evoke eating as a coping response, and that some persons respond to lapses in their dietary regimen with depression and self-criticism. These two findings are linked within the context of a stress and coping paradigm that has in the past been applied to the study of substance abuse.

METHOD

A survey of 79 women who reported overeating was implemented, including the administration of five instruments and a telephone interview.

FINDINGS

Over 43% of the variance in the dependent variable, negative mood states, was explained by hierarchical regression of the independent variables, entered sequentially as exemplars of: social stressors, coping, degree of required calorie consumption, use of overweight control strategies and the interaction between the degree of required weekly calorie consumption and use of overweight control strategies. Significant contributions were made by variables denoting stressors, coping, and the interaction between degree of required calorie consumption and use of overweight control strategies. Of particular interest was the suggestion that for individuals who frequently use strategies to control overeating and overweight, eating may produce negative mood states. Individuals intensively involved in efforts to control their weight may be vulnerable for dysphoria, may require unique nursing interventions, and thus deserve continued study in this context.

The health at any size paradigm for obesity treatment: the scientific evidence

Traditional weight loss (TWL) treatments have been unsuccessful at reducing the prevalence of obesity in the population. Health-care professionals and consumers have criticized TWL treatments as being detrimental to the obese person's health. Consequently, an alternative approach to obesity treatment, the health at any size (H@AS) paradigm, has been proposed. The H@AS paradigm is based on the philosophy that once diet restrictions and barriers to activity have been removed, the individual will develop healthier eating and activity patterns that lead to a naturally healthy body weight. This paper reviews the philosophical foundation and the scientific data that support and oppose the H@AS paradigm and compares it with that of TWL treatments.

The dietitians' philosophy and practice in multidisciplinary weight management

Dietitians are developing a philosophy and a practice protocol of weight management. A professional philosophy of weight management addresses questions about the social, psychological, and biological spectra of weight management: Should overweight be considered in terms of size acceptance or gluttony and sloth? How should emotional overeating and obsessive restriction be managed? Should obesity be considered a chronic disease, or should the idea that health at every size is possible be espoused? A professional practice protocol addresses another set of questions: Is obesity to be viewed as a short-term and long-term health challenge? Regarding the spectrum of antiobesity agents and antidieting approaches of weight management, what professional position and individual practice will be adopted? Should professional contact with patients be continuous or aimed toward self-care? What measures of successful outcomes will be used: weight change or life quality improvement? How should professional responsibility be balanced with personal concerns about eating and health behaviors that affect body weight? What are examples of closing the gap between the vision and the reality of the roles and goals of the dietitian on a weight management team? Dietitians are translating philosophy into practice. Because dietary control alone has a record of limited success in weight loss and less success in maintaining weight loss, the dietitian's expanded role includes helping patients manage weight with coping skills, motivation techniques, physical activity, and food behavior change. The challenge is integrating functional components of practice with dietitians' unique food and nutrition skills that include selection of alternative foods, portion control, and preparing acceptable, tasty foods for lifelong weight management.

Overeating, reversal theory, and weight cycling

America's overweight problem is universally recognized and escalating, despite billions of dollars spent to combat it. For the past century, a unidimensional paradigm was predominantly used to correct the overweight problem by reducing calories through dieting. As a result of the profound failure of traditional diet programs, a phenomenon known as weight cycling was born. In this article, a multidimensional paradigm is emphasized to address weight cycling. Reversal theory extends a new theoretical basis that can account for unpleasant feelings, or tension stress, as a trigger of overeating in women who weight cycle. A case example demonstrates how reversal theory explains overeating as a response to high-tension stress. Results of two studies are presented, describing overweight and normal-weight women's reversal theory states during self-reported episodes of overeating and resisting overeating. The multidimensional paradigm calls for emotional overeating behaviors to be addressed in weight management.

Drug therapy for obesity: an update

As a method of losing weight and maintaining weight loss, calorie-restricted diets are proving ineffective and counterproductive. The best candidates for drug therapy for obesity include patients with comorbidities that can be decreased with weight loss and those at risk for obesity-related comorbidities. The central nervous system properties of the amphetamines have led to chemical alterations of the original molecule in the hope of creating an appetite-suppressant drug without the potential for abuse. Studies demonstrate that serotonergic drugs can induce weight loss in the short term. Patients using nonprescription drugs for weight loss that have not been approved for that purpose should be informed that efficacy is unproved and warned that, in some cases, adverse effects could be serious.

Nonpharmacologic treatment of obesity

Experts agree that overweight and obesity pose a significant public health problem in the United States. Obesity is considered to be a complex, multifactorial disease involving genetics, physiology, psychology, and environment, and is influenced by cultural messages. Comorbidities linked to obesity include coronary heart disease, stroke, hypertension, diabetes mellitus, gout, dyslipidemias, cholecystitis, and gallstones. Pharmacists can help patients with dietary goals by understanding sound principles of weight management.