The terms ‘overweight’ and ‘obese’ are most simply defined as an abnormal or excessive accumulation of fat that will impair health. Using definitions of overweight and obesity, world health authority data has demonstrated that world wide obesity has doubled over the past 30 years affecting over 200 million men in 2008 and nearly 300 million women, while as many as 1.5 billion adults are currently overweight.
Body Mass Index is used as tool for determining the actual risks to an individual of being overweight or obese. This tool is a simple index of weight- for- height (calculated by dividing a person’s weight in kilograms by the square of their height in meters (kg/m2) and is used alongside charts to determine their relative health risk. We shall return to BMI in later lessons however, here it would be helpful to familiarise yourself with the World Health Authority definition of being overweight as having a BMI greater or equal to 25 and definition of obesity as having a BMI greater or equal to 30. For children and teenagers different criteria are used which take into account differences in body fat between girls and boys as well as differences at various ages.
Unfortunately the explosion of obesity rates has also had a significant impact on health. Raised BMI is a major risk factor for cardiovascular diseases, diabetes, osteoarthritis as well as certain cancers such as those affecting the breast and colon. As a result of these health effects, overweight and obesity is now the fifth leading risk for deaths worldwide with at least 2.8 million adults dying on an annual basis as a result of being overweight or obese. Sadly the future health of our children will also be affected by rising obesity rates - as many as 43 million children, younger than 5 years of age, were defined as being overweight in 2010, a figure which is rapidly increasing.
Some causes of obesity include genetics, diet, exercise, lifestyle choices, psychology, disease and disorders. Before we can devise an appropriate intervention for weight loss it is necessary to consider when and how we gain weight and with this in mind we shall now consider a range of different factors in turn.
Managing the Psychology can be as Important as Managing the Physiology
To support weight loss it is important to consider the contribution of psychology to weight management. An individual’s psychology can have a big influence on their weight.
To support someone to lose weight it is important to address the psychological aspects. Some areas to consider are:
Develop a positive mental approach to healthy lifestyle
- Focus on being healthy rather than losing weight.
- See healthy food and exercise as being enjoyable (reward) rather than a chore (punishment)
Identify and address emotional issues
- Identify emotional triggers for unhealthy eating and develop alternative strategies to deal with the emotion e.g. going for a walk, talking to a friend, take deep breaths.
Address brain chemical contribution
- Exercise to increase dopamine levels instead of eating
- Use portion control to monitor how much to eat, rather than rely on messages from the brain.
Positive thinking, affirmations and visualisation
- Reframe success and failure
- Visualise yourself as already being your ideal weight.
- Use affirmations to reduce effects of emotional eating.
Set realistic, achievable goals
- Monitor goals through journaling and diary writing
Getting someone to start a diet and exercise program is the most obvious task for any weight loss consultant. If someone comes to you for help, they are likely to have the motivation to start doing what you prescribe. To be effective though; they need to keep doing it, and that may be a much harder thing to achieve.
Your client should be made aware of triggers to relapses so that they can hopefully avoid them. As an adviser you should encourage your client to reflect on previous relapses and provide tips to avoid them.
Here are a few tips which may prove useful
- Stick to a routine. Breaking an established routine is one of the fastest ways to relapse. Clients should therefore, be advised to continue with any new routines that have been successful e.g. keeping up with a new exercise program or their resolve to eat breakfast.
- Continued monitoring. As clients start losing weight they may stop keeping a food diary to keep track of eating patterns. Unfortunately this may prevent them from spotting unhealthy foods that may start to creep back into their diet. For these clients it is easy for them to believe that a piece of cake eaten was a ‘one off’ while a food diary may show where these ‘one off treats’ are starting to become a more regular occurrence.
- Keep up with regular weight checks. Research has highlighted that regular weight checks are positively linked with both losing weight and maintaining weight loss. A weekly weight check will allow clients to see where any lost weight starts to creep back and allow clients to lose the odd pound or kilogram they have regained before it turns into many more.
- Provision of a reward system for losing weight and keeping it off. Rewards are incentives to keep the motivation going and can be a slights break from the diet or exercise program or something meaningful to your client e.g. having a bubble bath or buying a new dress.
Avoid a Relapse
Clients unfortunately suffer relapses where they have returned them to their old behaviour. As an advisor you should try and identify the causes for the relapse and offer positive suggestions and support to help get them back on track. Also reassure your client that relapse is an inevitable part of behaviour change.