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Dietary and Behavioural Interventions in the Management of Obesity

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Advanced Practice in Endocrinology Nursing

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Abstract

Obesity is a chronic, often progressive disease, with a complex web of psychological, social, and biological factors underpinning why people overeat, struggle to be active, and gain excess body weight and adiposity. As such its management is not simply about eating less and exercising more, rather there is a need to understand the drivers to excess weight gain with comprehensive assessment identifying modifiable factors. Multicomponent programmes including dietary treatment, physical activity, and behaviour modification are more effective than interventions focusing on one aspect alone (Avenell et al. 2004). Rather than one superior dietary intervention there are a range of effective evidence-based treatments that can be matched to patient preferences and the presence and/or severity of comorbid disease. Behavioural modification focuses on patient-centred care, incorporating motivational, behavioural, and cognitive elements and recognizes that nurse’s attitudes and skills can have a profound effect on patient outcomes.

Nurses are on the frontline of obesity management raising the issue of weight where appropriate, undertaking assessment of patient’s complex needs, signposting to services and providing education and support for weight loss and maintenance. Given the escalating prevalence of obesity, it is essential that nurses have a comprehensive understanding of how best to treat this condition. Obesity management is particularly relevant in the endocrine setting given the range of conditions closely linked with excess weight, such as type 2 diabetes mellitus (T2D) or polycystic ovarian syndrome, and in which comprehensive management may improve associated symptoms and risks.

Qualitative research exploring nursing beliefs about their role in managing obesity identify its assigned importance but highlight the desire for more obesity training, an infrastructure which supports high quality care, a greater understanding of evidence-based treatments, and improved access to resources (Nolan et al. 2012).

This chapter addresses some of these concerns, presenting an overview of the evidence base related to dietary and behavioural modification in obesity management, considers the assessment process, and highlights training opportunities and educational resources where appropriate.

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Abbreviations

BMI:

Body mass index

CBT:

Cognitive behavioural therapy

CVD:

Cardiovascular disease

DSM-5:

Diagnostic and Statistical Manual of Mental Disorders

GI:

Glycaemic index

GL:

Glycaemic load

HbA1c:

Glycated haemoglobin

IER:

Intermittent energy restriction

LC:

Low carbohydrate

LDL:

Low density lipoprotein

LED:

Low energy diet

MI:

Motivational interviewing

MR:

Meal replacements

NICE:

National Institute for Health and Clinical Excellence

PAL:

Physical activity level

T2D:

Type 2 diabetes

TDR:

Total diet replacement

VLED:

Very low energy diet

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Authors and Affiliations

  1. Relish Nutrition Consultancy, North Yorkshire, UK

    Clare Grace

  2. University College London, London, UK

    Adrian Brown

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  1. School of Health Sciences, City, University of London, London, UK

    Sofia Llahana

  2. Department of Oncology, Skåne University Hospital, Lund, Sweden

    Cecilia Follin

  3. Northwest Pituitary Center Oregon Health and Sciences University, Portland, OR, USA

    Christine Yedinak

  4. Churchill Hospital, University of Oxford, Oxford, UK

    Ashley Grossman

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Grace, C., Brown, A. (2019). Dietary and Behavioural Interventions in the Management of Obesity. In: Llahana, S., Follin, C., Yedinak, C., Grossman, A. (eds) Advanced Practice in Endocrinology Nursing. Springer, Cham. https://doi.org/10.1007/978-3-319-99817-6_55

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