Practical Aspects of Obesity Treatment

Australians are not getting slimmer. Two-thirds of adult men (67%) and over half of adult women (52%) are overweight or obese (Body Mass Index ³ 25kg/m²) (1). For the first time in human history, the number of overweight people in the world rivals the number of underweight (approximately 1.1 billion of each) (2).

Losing weight requires alertness and sustained effort, not only to lose the weight but also to keep it off. Many life stresses, such as job change, financial problems, or a major family illness can impair effort and concentration (3). If any stressors are present the obvious goal of treatment is to prevent further weight gain, rather than focus on weight loss.

One of the first objectives of obesity treatment is determining a client’s readiness to lose weight. They may need to lose weight but be far from making a commitment to do so. It is vitally important that practitioners detect a client’s readiness rather than assume they are ready for weight loss.

Prior to initiating treatment, the practitioner should examine the client’s reasons for, and expectations of, weight loss. Often, their expectations are beyond what is healthy or realistic. However, one must always consider that their satisfaction with treatment will be based on comparing what was obtained to what was expected (4).

Chiropractors and osteopaths as wholistic practitioners are in an ideal position to assist in improving client’s health through weight loss. The health care provider can help the client set realistic and achievable goals. A realistic goal for most obese individuals is to lose 5% to 10% of initial weight (5). Even this modest weight loss can produce notable health benefits, such as improved glycemic control, decreased blood pressure, and reduced lipid levels.

Another useful measure of fat loss is waist circumference, which measures intra-abdominal fat. This is associated with a higher health risk than obesity measured by BMI. The waist measurement should be less than 90 cm for women and 100 cm for men. Abdominal obesity (apple-shaped) is associated with a greater risk of most of the complications of obesity because of the excess accumulation of visceral fat, which is metabolically more active than fat in the gluteofemoral (pear-shaped) type distribution (6). Abnormalities associated with abdominal obesity include insulin resistance, hyperinsulinemia, glucose intolerance, adult-onset diabetes, hypertension, high very-low-density lipoproteins, high low-density lipoproteins, low high-density lipoproteins, high fibrinogen, arthritis, menstrual irregularities, and gallbladder disease (7).

It is important that practitioners express empathy toward clients by communicating acceptance and understanding, while at the same time clarifying the consequences of not changing. Client resistance should be viewed as feedback, to let the practitioner know that other strategies may be more effective. Health care providers should not share society’s prevailing negative view of the overweight, and must go out of their way to create a user-friendly office. Try to have at least one gown that will fit a larger patient. Provide armless chairs in the waiting room and have a scale that can weigh all patients. One of the most unpleasant experiences for an obese client is to weigh more than the scale can accommodate.

Simple techniques the chiropractor or osteopath can incorporate into their practice may include using behavioral therapy techniques such as self monitoring, stimulus control, stress management, reinforcement, cognitive change, and relapse prevention. These can be combined with a monthly interactive seminar from your local Dietitian that you provide at a nominal cost to your clients.

Be proactive in helping your community fight this insidious problem.

Obesity is a multifactorial disorder that involves complex interactions between genetics, metabolism, appetite regulation, behavior, physical activity, and cultural factors. Practitioners must be aware of the latest research into obesity and weight management and be sure that their own prejudices do not interfere with their practice. In order for your client to feel fully supported and understood it is up to you to communicate that you understand what a challenging and frustrating problem weight control is.

Jessica Penwarden
Dietician

Jessica Penwarden is a practicing Dietitian in Brisbane. Contact details available from editor.

References:

1. Eckersley RM: Losing the battle of the bulge: causes and consequences of increasing obesity. MJA, 2001, 174(4), pp 590-592.
2. Ibid.
3. Wadden TA, Letizia KA: Predictors of attrition and weight loss in persons treated by moderate and severe caloric restriction. In Wadden TA, VanItallie TB (eds): Treatment of the Seriously Obese Patient. New York, Guilford Press, 1992, pp 383-410.
4. Wadden TA, Foster GD: Behavioural treatment of obesity. Obesity, 84(2), 2000, pp 441-461.
5. Ibid.
6. Aronne LJ, Obesity. Medical Clinics of North America, 82(1), 1998, pp 161-180.
7. Ibid.