how can healthcare professionals help patients deal with the obesigenic environment?

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December 2006 Obesity Management 211 T he good news is that more and more healthcare professionals are successfully helping their over- weight and obese patients to make changes in diet and physical activity in order to lose excess body weight. The bad news is that in most cases, most of the lost weight is gradually regained over time. This creates a sense of frustration for both the healthcare professional and the patient. What can a healthcare professional do to increase the chances that patients can sustain their behavior changes and keep the weight off? It may require addressing the environment. We know from the National Weight Control Registry that big behavior changes are required to lose and keep off more than 30 pounds of body weight. Our current environment is not supportive of these behavior changes and works against permanent weight loss. That is a big reason why so few people succeed in keeping their weight off permanently— and, it is a big reason they gained the excess weight in the first place. If we change the environment to be more supportive of healthy eating and physical activity, more people should be able to maintain the behaviors that allow them to keep weight off. This means that you as a healthcare profes- sional cannot stop at just helping your patients make behavior changes. You also have to be concerned about helping change their environment to be more supportive of healthy behaviors. Change is Under Way There are positive signs that different sectors of society are beginning to address how to make our food and physical activity environments more con- ducive to healthy weights. For example, the food industry was one of the first sectors criticized for pro- moting overeating and obe- sity. Many pointed fingers at this industry for provid- ing and promoting the wrong kinds of foods. The initial response by the food industry was largely defensive, pointing out that many healthy choices exist and people could choose them if they wanted. The industry also pointed out that lack of physical activity was a primary cause of obesity. Food Industry Recently, many in the food industry have realized that the obesity epidemic will change things permanently, and they have begun to develop strategies for change. Several of the largest food companies have made significant efforts to improve the nutritional quality of the foods they offer. They have committed to make health and wellness a focus of their business. As an example, PepsiCo, Kraft, and Unilever now provide a package icon that designates which of their products meet specified nutritional guide- lines. While these guidelines are not consistent across companies, they are all tied to recommendations by authoritative credible organizations. While it still has a long way to go, the food industry is making it easier for consumers to identify healthier, good- tasting food choices within food categories, and they are How Can Healthcare Professionals Help Patients Deal with the Obesigenic Environment? Editorial James O. Hill, Ph.D. These are your patients, and you have the ability to help educate and motivate them to make better choices.

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Page 1: How Can Healthcare Professionals Help Patients Deal with the Obesigenic Environment?

December 2006 Obesity Management 211

T he good news is that more and more healthcareprofessionals are successfully helping their over-weight and obese patients to make changes in diet

and physical activity in order to lose excess body weight.The bad news is that in most cases, most of the lost weightis gradually regained over time. This creates a sense offrustration for both the healthcare professional and thepatient. What can a healthcare professional do to increasethe chances that patients can sustain their behavior changesand keep the weight off? It may require addressing theenvironment.

We know from the National Weight Control Registry thatbig behavior changes are required to lose and keep off morethan 30 pounds of body weight. Our current environment is

not supportive of these behavior changes and works againstpermanent weight loss. That is a big reason why so fewpeople succeed in keeping their weight off permanently—and, it is a big reason they gained the excess weight in thefirst place.

If we change the environment to be more supportive ofhealthy eating and physical activity, more people shouldbe able to maintain the behaviors that allow them to keepweight off. This means that you as a healthcare profes-sional cannot stop at just helping your patients makebehavior changes. You also have to be concerned abouthelping change their environment to be more supportiveof healthy behaviors.

Change is Under Way

There are positive signsthat different sectors ofsociety are beginning toaddress how to make ourfood and physical activityenvironments more con-ducive to healthy weights.Fo r ex a m p l e , t h e f o o dindustry was one of the firstsectors criticized for pro-moting overeating and obe-sity. Many pointed fingersat this industry for provid-i n g a n d p r o m o t i n g t h ewrong kinds of foods. The initial response by the foodindustry was largely defensive, pointing out that manyhealthy choices exist and people could choose them ifthey wanted. The industry also pointed out that lack ofphysical activity was a primary cause of obesity.

Food Industry Recently, many in the food industry have realized that

the obesity epidemic will change things permanently, andthey have begun to develop strategies for change. Severalof the largest food companies have made significantefforts to improve the nutritional quality of the foods theyoffer. They have committed to make health and wellness afocus of their business. As an example, PepsiCo, Kraft,and Unilever now provide a package icon that designateswhich of their products meet specified nutritional guide-lines. While these guidelines are not consistent acrosscompanies, they are all tied to recommendations byauthoritative credible organizations.

While it still has a long way to go, the food industry ismaking it easier for consumers to identify healthier, good-tasting food choices within food categories, and they are

How Can Healthcare ProfessionalsHelp Patients Deal with the ObesigenicEnvironment?

Editorial

James O. Hill, Ph.D.

These are your patients, andyou have the ability to help

educate and motivate themto make better choices.

Page 2: How Can Healthcare Professionals Help Patients Deal with the Obesigenic Environment?

212 Obesity Management December 2006

heavily promoting these “better for you” products. Encour-agingly, it appears that more consumers are choosing health-ier products, so it makes economic sense for the companiesto develop and promote more of these products. Here iswhere you, as a healthcare professional, can play a role. Youneed to know what is happening within the food industry sothat you can encourage your patients to take advantage ofthe better choices available in grocery stores.

The food industry will continue to innovate to makehealthier foods available if consumers demand theseproducts. We can all do our part by encouraging ourpatients to consider healthier foods.

RestaurantsThere is room for more progress, but I am convinced

the industry is on the right path. Food companies havefound that promoting good nutrition can be good for busi-ness. Now we need to get other industries, like restau-rants, engaged in changing the food environment. I justfinished reading the recent Keystone Report about therole of food consumed away from home is contributing tothe obesity epidemic. The report describes how Ameri-cans are consuming a large part of their daily energyintake outside the home and, that food eaten away fromhome tends to be less healthy than food eaten at home.

The report makes a compelling case for restaurants to getinvolved in making their food healthier, and it makes severalrecommendations for how they can do this. These includeproviding more information about the nutritional content,advertising lower calorie items, offering more healthyoptions, providing lifestyle education, and providing food insmaller portions. It was a thoughtful, well-written report.

From the response of many in the restaurant industrywho were interviewed following the release of the report,it appears unlikely that many of the recommendations inthe report will occur. Those from the restaurant industrywho commented said that many of the suggestions, suchas nutritional labeling, were not financially feasible.Additionally, they made the point that restaurants providemany options for customers and those who want canorder healthier food and smaller portions (sounds famil-iar). They pointed out that food intake is only part of theissue and that a reduction in physical activity is an impor-tant reason for the obesity epidemic.

Finally, many in the restaurant industry argued that justoffering healthier items will not change the choices madeby customers. All in all, they felt that restaurants werebeing asked to take too much of the responsibility for theintake patterns of their customers. Thus we have a reportthat is satisfying to the public health community but notlikely to lead to much action.

No issue in obesity is more sensitive than the debateabout personal responsibility versus environmental influ-ence. Is the fact that people eat more unhealthy foodsaway from home the fault of the individual or the fault ofthe restaurant? I think that the answer is that both havesome responsibility. People have to take individualresponsibility for what they eat and how much they exer-cise, but the environment can make it more or less diffi-cult to make healthier choices.

Restaurants cannot be expected to make changes, if theircustomers are not interested in those changes. Restaurantsfear that making big changes to menus and advertisinglower-calorie foods will only serve to reduce profits. This

is a legitimate concern. On the other hand, the defense thatrestaurants offer choices and it is solely up to the cus-tomers to decide if they want to eat healthier seems likehalf an effort, given the enormous burden to society ofobesity.

What is missing from the report is a way to resolvethis apparent impasse and get restaurants engaged inhelping reduce the societal burden of obesity. There area number of things that restaurants can do to offerhealthier choices and to make them more attractive tocustomers. They could benefit by looking at how thefood industry is dealing with this issue. We might bemore successful in helping restaurants to help changethe food environment if we give them a realistic timelineand if we help drive customer demand for healthierproducts. These are your patients we are talking about,and you have the ability to help educate and motivatethem to make better choices when they eat away fromhome.

Several of the largest foodcompanies have made

significant efforts to improvethe nutritional quality of the

foods they offer.

Suggested Reading“Keystone Forum on Away-From-Home Foods: Opportunities for

Preventing Weight Gain and Obesity,” The Keystone Center, May 2006.The report is available in PDF format for free download at:<www.keystone.org/spp/documents/Forum_Report_FINAL_5-30-06.pdf>.

Page 3: How Can Healthcare Professionals Help Patients Deal with the Obesigenic Environment?

A big problem for restaurants is portion size, buttoday’s ou t -of -cont ro l por t ions d id no t happenovernight — they increased gradually over time. Mak-

ing large reductions in portion size will not likely bepopular with customers who would feel that such achange is not a “good deal.” However, it may be possi-ble to reduce portion sizes in the gradual way that theyincreased initially.

Rather than fight for several years about the issue,let’s encourage restaurants to begin to make gradualreductions in portion size over these years. Similarly,let’s encourage restaurants to make small changes inexisting products to make them a little healthier with-out changing them so much that customers stop select-ing them.

It seems to me that the best way to move forward is tofind common ground with restaurants and engage them inbeing a part of the solution to the obesity epidemic. Ifrestaurants truly commit to change, we should be able togive them a reasonable time for change and allow them todo it gradually.

Other Candidates for ChangeThere are other industries we need to engage as well,

including the physical inactivity industries. These areindustries, such as automobiles, computers, televisions,and video games that make profits from people beingsedentary. How can these industries help to change thephysical activity environment?

The bottom line is that the obesigenic environment is thebiggest barrier to your patients being able to keep weightoff. Be aware of the positive changes in the food and phys-ical activity environments and encourage your patients totake advantage of them. Obesity cannot be solved in theclinic alone, and healthcare professionals must developbetter connections to the community where the action isoccurring in environmental change. Maybe it is time totake a tour of your local grocery stores and restaurants tolook for tips that you can pass along to your patients. ■

—James O. Hill, Ph.D.Editor-in-Chief

Obesity Management

December 2006 Obesity Management 213

More effort should be madeto educate medical students,

residents, and practicing clinicians in the evaluation and

management of obesity.