Behaviour Therapy For Weight Loss
Behaviour therapy for weight loss teaches patients how to achieve diet and exercise goals. Patients are given dietary advice and are taught how to modify their diet in order to achieve a more healthily diet reducing the amount of salt fat and sugar and calories in their diet and the portion size of meals. Patients are usually advised to aim for a deficit of 500 kcal per day. Patients are also taught how to incorporate exercise in to their daily lives in line with DOH guidelines (30 minutes five times per week) (DOH 2005). Achievable weight and exercise goals are set (Avenell et al 2006). Individuals are encouraged to plan meals and may be given example meal plans and shopping lists. Self monitoring through food and exercise diaries is actively encouraged. Patients learn how to identify high risk situations and triggers (when bored, tired, emotional) to eating so that they can develop coping strategies to enable them to manage and plan for these situations effectively (Costain and Crocker 2003).
Self monitoring can be challenging but is key to sustaining motivation and engagement and is a technique used by many successful weight loss patients (Klem et al 1997). Recording also helps individuals keep track of their goals and stay conscious of what works for them in losing weight and teaches them skills that can be used long after programmes have ended (Avenell et al 2006).
Behaviour therapy programmes usually consist of between 7-12 weekly contacts. Treatment may be group or individual. Group sessions run from between 60-90 minutes, one to one support usually require less time usually around 30 minutes. Treatment sessions begin with a weigh in followed by a review of weekly food and physical activity records. The Heath Professional discusses a new topic every week;
topics may include how to read food labels and how to eat out healthily. The majority of time is devoted to overcoming barriers to enable participants to stay on track. Slip ups are reviewed positively and used as a learning tool. Social support is important for success in losing weight patients need to feel support not judged. Family and friends can be key helpers and changes
may have a beneficial knock on effect on family members and friends (Costain and Crocker 2005) Relapse rates are high so it is important to offer continued support for up to 6 months. NICE found that best weight loss was achieved through structured programme of support combined with exercise 10% weight loss achieved not enough evidence to suggest whether group or one to one better. NICE also found combined approach was better than diet alone or exercise alone.
Government strategy
Cooking compulsory part of curriculum by 2011
Marketing programme to inform parents how to change children’s diet and activity levels/increasing parent’s confidence and knowledge.
Work with food industry in reducing the amount of fat salt and sugar that goes into the food we eat
Regulate the food industry new builds work to ensure fast food outlets are not built near the parks and schools.
Restrictions on advertising of unhealthy foods to children
Campaign promoting walking for health and increasing everyone’s steps by 1000 per day.
Work with employers to see how they can make workplaces healthier part of core business,
Incentives schemes for healthy living
Increase walkingand cycling as a form of transport helping to reduce number of accidents, reduce congestion global warming less cars on the road
Promoting this cos most of the short journeys we do are less than 5 miles.
Ensuring more parks are accessible by foot and bikes.
Clear consistant information on how to lose weight and maintain a healthy weight on NHS choices website
Extra funding for more weight management services
A supportive built environment
There is significant potential for promoting ‘active travel’, particularly given that 55 per cent of trips by car are under 5 miles, with 25 per cent under 2 miles.
11 Promoting walking and cycling as viable alternatives to car use for such journeys could have substantial benefits – not only for promoting healthy weight, but also for climate change, congestion and the wider environment. The methods used by communities that successfully promote active travel include traffic calming, and building more cycle infrastructure. The most successful areas galvanise the whole community, including local businesses, so that everyone contributes.Chapter 1 described how many communities are already putting in place measures to encourage physical activity, often to meet environmental, safety or congestion goals. Local authorities have an important contribution to make in their ‘place-shaping’ role, as planning authorities and working in local partnerships with other agencies. Through local area agreements, they can set specific objectives for their communities. Chapter 3: Achieving the new ambition 21
The Government has a range of policies and programmes in place that aim to support these efforts.
Our continued sponsorship of the Green Flag award scheme and voluntary sector programmes such as British Trust for Conservation Volunteers (BTCVs). Green Gyms provide opportunities for communities to increase their levels of activity in open spaces.
The three Sustainable Travel Towns have increased walking by around 20 per cent and cycling by almost 50 per cent in two years,
19 providing lessons for other communities to emulate (see case study).The ‘Manual for Streets’ gives advice on effective street design that encourages people to walk and cycle to local destinations.
Peterborough Sustainable Travel Demonstration Town
19
Peterborough is one of three towns taking part in the Government’s Sustainable Travel Demonstration Town programme. Peterborough Council has used part of the £3.2 million in funding that is available to implement Individualised Travel Marketing, which works with households to offer tailor-made information and support to enable them to consider alternatives to the car.
Impact
Results from the first phase of the programme include:
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a 13 per cent reduction in car use • a 21 per cent increase in walking • a 25 per cent increase in cycling • a 13 per cent increase in public transport use.
New guidance from NICE sets out the first recommendations – based on evidence of effectiveness and cost-effectiveness – on how to improve the physical environment in order to encourage and support physical activity. It complements previous NICE guidance on obesity and is intended to guide future investment in urban design, transport routes, buildings and school playgrounds. The new guidance is aimed at the NHS and other professionals who have a role in the built or natural environment, including those working in local authorities and the education, community, voluntary and private sectors. NICE’s recommendations include ensuring that:
any planning applications for new developments prioritise the need for people to be physically active as a routine part of their daily life
pedestrians, cyclists and users of other modes of transport that involve physical activity are given the highest priority when developing or maintaining roads
public open spaces and public paths can be reached on foot or by bicycle, and are maintained to a high standard
any new workplaces are linked to walking and cycling networks
during building design or refurbishment, staircases are designed and positioned to encourage use, and are clearly signposted
school playgrounds are designed to encourage varied and physically active play.
NICE has also developed tools to help organisations to implement this guidance.
But if the fabric of our urban and rural spaces is to change so that they encourage healthy living, then we need to go further. A fundamental shift in our built environment will not happen overnight, but there is more that can be done to ensure that health is built more robustly into the fabric of our lives. In particular, the Government will:
• invest in training for planners (urban, rural and transport), architects and designers on the health implications of local plans
(e.g. spatial plans and planning applications) 22 Healthy weight, healthy lives
develop and promote a toolkit that draws together all the ways in which planning policy and powers can be applied to promote physical activity, showcasing examples of good practice where communities have achieved success. This will build on the NICE guidelines.
ensure that the Thames Gateway and the Growth Areas and Growth Points are exemplars of best practice
encourage local planning authorities, when considering planning applications relating to all types of outdoor space, including open space and playing fields, to support the vision of a more physically active society
include options for strengthening the role of assessing health impacts within the current consultation on the New Approach to Transport Appraisals
use the planning policy review announced in the Planning White Paper to identify where changes can be made or additional guidance produced, to help tackle obesity and support healthy communities. This will build on the agenda already set out in The Children’s Plan to improve the usability of public spaces for play
The Government will also work with a number of interested local authorities to sign up to a Healthy Community Challenge Fund. This will test and validate holistic approaches to promoting physical activity. Towns and cities that sign up – badged ‘healthy towns’ – will be expected to invest in infrastructure improvements that implement the lessons of a variety of programmes (e.g. Homezones and Cycling Demonstration Towns). These improvements will need to be combined with efforts to galvanise local members of the community to take action to change both food and activity habits, following the example set by the EPODE model in Europe (see below). The fund will total £30 million during 2008–11, with the expectation that signatories will supplement these funds with their own.
EPODE case study20
EPODE (‘Ensemble prévenons l’obésité des enfants’, or ‘Together, let’s prevent obesity in children’) is a community -based, family -oriented nutrition and lifestyle education programme. It aims to prevent child obesity by bringing together influential individuals and groups in the community –including education and health professionals, retailers and the media –in a campaign of local physical activity and healthy eating initiatives aimed at both children and their parents. Since the programme was launched in 2004, more than 100 French towns have joined the 10 pilot communities. The programme is also being rolled out into Belgium and Spain.
The official results from the 10 EPODE pilot towns will be published in 2009. However, early results seem promising. For example, in 2004, 19 per cent of the children in Saint Jean, a town in the Midi Pyrénées region, were overweight. A year later this figure was down to 13.5 per cent.