“An important part of advancing weight loss interventions is to understand how to improve adherence to weight loss behaviors. In any health behavior, nonadherence is a problem,” notes research published in the journal Patient Preference and Adherence.
With supporting adherence the obvious imperative, it begs the question: What barriers do weight loss patients face, and how can dietitians help them overcome them? Let’s take a closer look at four common patient adherence issues.
In the most basic sense, obesity is caused by “eating too much and moving too little.” However, dietitians know that obesity is actually a complex, multi-factored disease. In fact, Psychology Today goes so far as to declare, “Fat is an emotional issue.”
This proposition is backed by a growing body of evidence. Explains Dr. Colin Waine, who chairs the UK’s National Obesity Forum: “It is a vicious circle. Individuals eat because they are unhappy, and unhappiness makes them eat. Until people have dealt with their emotional problems, they won’t lose weight, but many health and government professionals are happier to treat the end results, rather than the cause.”
Stress, in particular, is a major factor in triggering unhealthy eating behaviors. According to research published in the academic journal Minerva Endocrinologica: “Stress is an important factor in the development of addiction and in addiction relapse, and may contribute to an increased risk for obesity and other metabolic diseases. Uncontrollable stress changes eating patterns and the salience and consumption of hyperpalatable foods; over time, this could lead to changes in allostatic load and trigger neurobiological adaptations that promote increasingly compulsively behavior.”
In short, bariatric surgery is unlikely to succeed if patients don’t acknowledge the aspects of emotional eating which led them to gain the weight in the first place. Helping patients understand this pattern is important, and keeping an “emotional food diet” is an effective way for post-op patients to learn more about hunger and eating.
It’s also valuable to enforce mindful eating techniques, such as taking the time to thoroughly enjoy meals and eating without distractions.
According to Dr. Nora Volkow, director of the NIH’s Institute on Drug Abuse: “Childhood and teen years are ideal times to develop healthy habits. Healthy eating habits will help protect them in the future against the diseases associated with obesity.”
But what happens if you don’t develop healthy eating habits in these pivotal years? The reality is that many people develop unhealthy habits that require active effort to overcome.
“Our long-time habits when it comes to food and eating — or any other behavior — often run so deep that cues in the environment will trigger us to automatically perform them despite our best intentions,” explains wellness coach Doreen Lerner, PhD.
This doesn’t mean that the continuation of bad habits is inevitable, or that people are ultimately at the mercy of their bad habits. However, it does mean that building awareness is critical. After all, in order for patients to cease bad habits, they must first understand them.
Dietitians can help by working with patients to identify their unhealthy food-related habits as well as to brainstorm strategies for adopting healthy new habits. For example, if you’re working with a client who has spent a lifetime buttering his bread and vegetables, pointing him in the direction of healthy yet tasty alternatives, such as olive oil, is a seemingly small yet significant modification.
We all know that diet and exercise are two major pieces of the weight loss puzzle. And some research indicates that inactivity is driving the obesity epidemic, not overeating. This is a big problem when it comes to weight loss and weight management, according to Julia Karlstad, MEd, CSCS for Obesity Action Coalition.
“A lifelong exercise program is critical to a weight-loss surgery patient’s long-term success,” she says. “Bariatric surgery is a valuable tool for rapid weight-loss; however, in two to three years, if a physically active lifestyle has not been adopted, the weight returns. Exercise is insurance for long-term weight-loss.”
For some people, aversion to exercise may run deeper than simply “hating” to do it. They may think exercise means running hours on the treadmill, or be afraid of being judged at the gym. The good news: Research published in the Journal of Obesity & Weight Loss Therapy suggests that the mere act of getting bariatric surgery can make post-op patients more open to exercising.
In other words, there’s no better time than following bariatric surgery for dietitians to work with patients to find appealing, practical and sustainable ways to incorporate physical activity into their lives.
We are all products of our environments. This absolutely applies when it comes to unhealthy eating habits. According to the Obesity Prevention Source at Harvard:
“What we choose to eat plays a large role in determining our risk of gaining too much weight. But our choices are shaped by the complex world in which we live, by the kinds of food our parents make available at home, by how far we live from the nearest supermarket or fast food restaurant, even by the ways that governments support farmers. In the U.S. and many parts of the world, the so-called food environment, the physical and social surroundings that influence what we eat, makes it far too hard to choose healthy foods, and all too easy to choose unhealthy foods. Some even call this food environment ‘toxic’ because of the way it corrodes healthy lifestyles and promotes obesity.”
It’s not just the places — it’s the people, too. Says wellness coach Doreen Lerner, “So much of our unhealthy eating or overeating is done in a social setting, and we tend to unconsciously match other people’s eating behaviors.”
Again, overcoming this obstacle largely comes down to awareness. Dietitians can play an important role in helping post-op patients identify social settings (and people) that act as triggers for overeating.
For example, if holiday meals with extended family always result in the binge eating of unhealthy foods, proactive measures like eating in advance for appetite control and bringing along healthy alternatives can help clients avoid repeating past mistakes.
No one stumbles into weight loss surgery. Rather, it’s a decision made with the best and most hopeful of intentions. And yet “the best and most hopeful of intentions” won’t help bariatric patients succeed with their weight loss goals.
So what will? Information, awareness, understanding and active planning — all of which can be facilitated by dietitians in both pre-op and post-op contexts.