Improving obesity treatment how to offer personalised advice and support

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Improving obesity treatment (how to offer
personalised advice and support)

• Jane Ogden
• Professor of Health Psychology
• University of Surrey

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Overview

• The psychology of eating
• Obesity treatment
• Dietary interventions
• Medication
• Surgery
• What doesnt work?
• What works?
• What lessons can we learn?

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Obesogenic environment

• Sedentary lifestyle
• Less manual labour
• More car use
• Town planning
• Remote controls
• Mobile phones
• More fast food
• Less cooking
• More eating out
• More snacking

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A role for behaviour

• Physical activity
• Eating behaviour
• Why we eat what we eat?
• How to change eating behaviour?

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Why do we eat what we eat?

• Hunger?

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The function of food

• Habit
• Emotional regulation
• Social interaction

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Habit

• Eating learned in childhood
• Familiarity
• Food preferences
• Low effort
• Not having to think
• Breakfast?

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Emotional regulation

• Comfort
• Boredom
• Pleasure
• Control
• Guilt

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Social interaction

• Celebration
• Treat
• Sexuality
• Family love
• Power
• Religion

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Why do we eat what we eat?

• For ALL people eating is complex
• Habit
• Emotional regulation
• Social interaction
• forum for communication

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As communication

• Who am I?
• How am I feeling?
• What do I feel about you?
• How do you make me feel?

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Basically ..

• We eat because at the time the benefits of eating
  out weigh the costs

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• How to change behaviour?
• And what can we learn?

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Dietary interventions

• Traditional programmes
• Eat less
• Lost weight
• but 99 regained weight
• Multidimensional packages
• Lifestyles changes, cognitive restructuring,
  reasonable weights, nutritional information, self
  monitoring, relapse prevention, screening
  patients, follow ups
• 60 lose weight
• Up to 95 regain weight in longer term

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• Why dont they work?

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Dieting

• Trying to eat less
• But.
• Most dieters show episodes of overeating
• The what the hell effect

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Why dont dietary interventions work?

• Trying to change embedded habit
• Rebound back to old habit
• High effort
• Restriction takes away function
• Emotional regulation
• Social interaction
• Communication
• AND imposes denial
• Creates preoccupation with food
• Lowers mood
• Exacerbates benefits of eating
• Offers no costs of eating

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Potential risks

• Weight loss
• Overeating
• Weight regain
• Weight cycling
• Depression
• Low self esteem
• Etc etc etc

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What can we learn?

• Behaviour is difficult to change
• Habits
• Function of food
• Social
• Emotional regulation
• Communication
• Benefits out weigh costs
• Dieting exacerbates benefits
• Denial

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• Alternatives?...............

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Medication

• Orlistat (Xenical)
• Prevents fat absorption
• Causes unpleasant side effects
• Qualitative study
• The experience of taking Orlistat as a window
  into
• Successful behaviour change
• (Ogden and Sidhu, 2006)

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Method

• In depth interviews
• 12 patients taking Orlistat
• 2 main themes
• Causes of obesity
• Experiences of side effects

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Causes of obesity

• Medical
• Im not a big eater, sometimes I dont even want
  to eat but I just eat coz I have to eat coz Im
  diabetic (Frances).
• Behavioural
• I ate too much. I ate all the wrong foods. I
  did a static job.. And the bigger I got the more
  I ate. And thats about it really. I used to
  eat a colossal amount..it was bacon, eggs,
  sausages, chips I used to eat loads and loads of
  meat. Beef, pork. I could eat two French
  sticks in one sitting (Matthew).

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Experiences of side effects

• I had near misses I dont break wind unless Im
  sitting on the loo. Its a fear thing I have
  had situations where Ive had to discard a pair
  of boxer shorts (David).
• messy, disgusting, horrible, unsafe, near
  misses, accidents, personal oil slick.

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Behaviour change?

• Showed behaviour change if
• Behavioural model of causes
• Visual side effects act as an education

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What can we learn?

• Drugs work by
• Encouraging a behavioural model of obesity
• See diet as the cause
• Create match between cause and solution
• Create short term costs of overeating

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Surgery

• Surgery
• Reduces stomach size
• Reduces food intake
• Can cause dramatic weight loss
• But has unpleasant side effects

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Gastric bypass
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Gastric banding
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Qualitative study

• In depth interviews
• 15 people who had had surgery
• (Ogden et al, 2005 2006)

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Weight since operation (kg)
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Role of food

• I used to think about food all the time..before
  I got married Id sit in bed reading recipe books
  thinking cor I fancy thatnow I think that would
  be good and that wouldnt

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Hunger

• The most incredible thing that has happened is
  lack of appetite the hunger pangs have gone Im
  sated when I eat

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Control over food

• If someone or something didnt stop me I would
  just continue. What the operation has done for
  me is that physically because my stomach is
  smaller I can only eat smaller mealsbecause I
  know I cant I dont

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What can we learn?

• Surgery works by
• Reduces function of food
• Changes habit
• Emotional regulation
• Social interaction
• Communication
• Provides short term costs to overeating
• Taking away control from individual
• Relies upon stomach size NOT denial

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Therefore

• Obesity on the increase
• Obesogenic environment
• Behaviour
• Behaviour difficult to change
• Treatment alternatives
• Have psychological implications

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• How can we improve obesity treatment?

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Need to change behaviour

• Things to avoid doing
• Avoid consequences of dieting
• Avoid denial
• Avoid making food more pleasurable
• Avoid exacerbating benefits of eating

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Things TO DO.(personalised advice)

• Make small low effort changes to habits
• Explore the function of eating
• Reduce function of eating
• Find substitutes for eating
• Create costs of overeating
• Create new benefits of healthy eating
• Create new habits
• Encourage behavioural model of obesity
• Empower people to make changes
• OR
• Take away their choice / control
• AND / OR change environment