Weight management experiences of overweight and obese Canadian adults: findings from a national survey

INTRODUCTION

We know little about how the 2006 Canadian Clinical Practice Guidelines for the management and prevention of obesity relate to Canadians' weight management experiences or whether these experiences reflect the recommendations in the Guidelines.

METHODS

We used data from a general population omnibus survey to understand these two issues, particularly in relation to chronic disease. The survey included 23 questions related to weight management practices as well as those related to demographic characteristics.

RESULTS

Of 2004 respondents, 33% were classified as overweight and 20% as obese. In the 12 months before the survey, 48% of overweight and obese respondents reported asking their physician about weight loss, while 30% reported that their physician advised them to lose weight without them specifically asking. With regard to the recommendations within the Guidelines, 14% of overweight and 18% of obese respondents reported having their waist circumference measured, 82% of overweight and 87% of obese respondents reported having their blood pressure measured, and 36% of overweight and 50% of obese respondents reported having a test for diabetes.

CONCLUSION

These findings have implications for chronic disease identification and management.

Dietitians and the internet: are dietitians embracing the new technology?

BACKGROUND

Internet use is increasing and in the future it will become a valuable tool for health professionals seeking and communicating health, diet and nutritional information. This study aimed to explore the use of the Internet by dietitians in the UK.

METHODS

A cross-sectional study was carried out on a random sample of 200 dietitians selected from the British Dietetic Association database. A self-completion questionnaire was distributed to determine access to the Internet and the views of dietitians on the use of the Internet for the provision of health and nutrition information.

RESULTS

Of the 156 respondents to the questionnaire, 96% were female and 4% were male. The results revealed that 66% of respondents had access to the Internet at work, with 39% using the Internet once a week or more. The main reported uses of the Internet were searching for health information, research and communication. Thirteen per cent of respondents reported seeing information obtained from the Internet by patients. Concerns about the use of the Internet for the provision of health information centred on creating unrealistic patient expectations.

CONCLUSION

The research revealed that the Internet does have a role in augmenting current services. A substantial proportion of the dietitians studied were already using the Internet routinely in their work, with the real potential for its use beginning to be realized.

Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use

Dietary supplements use is increasing, despite the lack of evidence to suggest they are needed to meet dietary deficiency in the majority of people. Reasons for consuming dietary supplements are likely to be complex, combining social, psychological, knowledge and economic factors. The Theory of Planned Behaviour (TPB) is a widely used model of social cognition, which has recently been applied to the nutrition field. It was used in a questionnaire, along with a number of additional measures, to explore dietary supplement use in a cohort of women. Data from 303 questionnaires were included in the analysis. The results showed that intentions were the major predictor of dietary supplement use. Health value and susceptibility to illness were also significant predictors of dietary supplement use (total of 82.9% of respondents correctly classified as users or non-users). Intentions themselves were most strongly predicted by attitude, with 70% of variance explained by attitude, subjective norms and perceived behavioural control. Other significant predictors of intentions were control beliefs, normative beliefs and health value. Beliefs underlying dietary supplement use revealed differences between supplement users and non-users in relation to the notion that taking dietary supplements acts as an insurance against possible ill-health, with supplement users believing more strongly than non-users that taking dietary supplements would stop them getting ill and help them to be healthy. Both users and non-users of supplements also perceived the media, in the form of books and magazines, to be a powerful influence on a person's decision to use supplements. The findings of this study highlight the potential of the TPB in exploring supplement-taking behaviour, while throwing light on the factors influencing an individual's motivations to use dietary supplements.

Improving health professionals' management and the organisation of care for overweight and obese people

BACKGROUND

Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services. Health professionals have a key role to play in tackling the obesity problem, but little is known about how they may be encouraged to work more effectively with overweight and obese people.

OBJECTIVES

The main objective was to determine whether health professionals' management or the organisation of care for overweight and obese people could be improved.

SEARCH STRATEGY

We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (May 1997), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to January 1998, EMBASE to December 1997, Cinahl (1982 to November 1997), PsycLit (1974 to December 1997), Sigle (1980 to November 1997), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field.

SELECTION CRITERIA

Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed study quality.

MAIN RESULTS

Twelve studies were included involving more than 393 providers and 3392 patients. Four studies were identified for comparison 1. Three were professional-oriented interventions (the use of reminders and training) and the fourth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Eight studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality.

REVIEWER'S CONCLUSIONS

At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.

A systematic review of interventions to improve health professionals' management of obesity

OBJECTIVE

To determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organisation of care for overweight and obese people.

DESIGN

A systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organisation of Care (EPOC) Group.

PARTICIPANTS

Trained health care professionals and overweight and obese patients.

MEASUREMENTS

Objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors, and measures of body weight, fat, or BMI.

RESULTS

Twelve studies that met all the review inclusion criteria were identified. Three were randomised controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before and after study to improve collaboration between a hospital clinic and GPs. A further eight randomised controlled trials were identified of interventions comparing either the deliverer of weight loss interventions or the setting of the delivery of the intervention. The heterogeneity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity management.

CONCLUSIONS

At present, decisions about improving the provision of services for overweight and obese people must be based on the evidence from patient interventions and good clinical judgement. Future research is required to identify cost-effective strategies for improving health professionals' management and the organisation of care for overweight and obese people.

Vegetarianism in young women: another means of weight control?

OBJECTIVE

To investigate the links between vegetarianism (meat avoidance) and weight control in young women.

METHODS

Self-reported food habits (indicating meat avoidance and weight loss dieting) and dietary restraint (using the Dutch Eating Behavior Questionnaire [DEBQ]) were collected from 131 young adult women. Restraint scores and weight loss behavior were compared between vegetarians and nonvegetarians. In addition, reasons for meat avoidance were identified in the vegetarian subjects.

RESULTS

Vegetarianism, broadly defined, was reported by 34.3% of participants. Vegetarians had significantly higher dietary restraint, but did not differ in current dieting.

DISCUSSION

The relationship between vegetarianism and weight control is complex. Vegetarianism may be best seen as a method for complicating the normalization of eating rather than a simple risk factor for eating disorders.

Diet and lifestyle characteristics associated with dietary supplement use in women

OBJECTIVES

To describe the characteristics of dietary supplement users in a large cohort of women and test the hypothesis that supplement users would be more likely to have a healthier lifestyle than non-users.

DESIGN

Comparison of nutrient intakes from food frequency questionnaire (FFQ) data for 8409 supplement users and 5413 non-users. Use of logistic regression modelling to determine predictors of supplement use in this cohort.

SUBJECTS

13,822 subjects from the UK Women's Cohort Study (UKWCS) for whom data on supplement use was available.

RESULTS

Significant differences in nutrient intakes from FFQ were seen between the two groups, with supplement users having higher intakes of all nutrients, except for fat and vitamin B12. Use of dietary supplements was associated with being vegetarian, vegan or fish-eating, consuming more fruit and vegetables, being more physically active and having a lower alcohol intake. Supplement use was less likely in those with a body mass index above 25 and those who reported smoking regularly.

CONCLUSIONS

The findings are consistent with the hypothesis that supplement use is associated with a healthier lifestyle profile and an adequate nutritional intake, suggesting that supplement users do not need to take supplements to meet a nutrient deficiency.

Treatment of obesity: theory into practice

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.

The use of a low phenylalanine diet in response to the challenging behaviour of a man with untreated phenylketonuria and profound learning disabilities

If phenylketonuria (PKU) is not treated from an early age with a reduced phenylalanine diet, irreversible brain damage may occur. Although dietary intervention can do nothing to alter this impairment once it occurs, there is some evidence to suggest that a low phenylalanine diet may help to reduce the level of behavioural disturbances frequently experienced by people with untreated PKU. Using this evidence, dietary intervention was used in response to the challenging behaviour of a 30-year-old man with profound learning disabilities. Initial improvements were observed, but overall the results were inconclusive. Possible confounding factors are discussed. An unusual reaction to neuroleptic medication whilst on the diet is also documented.