Discuss prevention strategies and treatments for overeating and obesity
· Obesity rates in adults are very high in many countries and it is difficult to reduce excessive weight once it has become established. Therefore many prevention strategies aim to prevent children from becoming obese (e.g. targeting schools and after-school services as natural settings for promoting physical activity and learning about healthy eating.
· The promotion of healthy eating and regular physical activity is essential for both the prevention of future obesity (primary prevention) and for treating those who are already overweight and obese or just preventing them from gaining more weight (secondary prevention).
Examples of prevention strategies
· Michelle Obama’s Let’s Move
· NFL PLAY 60 Challenge
Fat and sugar tax
· Some countries (e.g. Denmark) have introduced taxes on unhealthy food such as fat and sugar in order to encourage a more healthy diet and reduce the costs of obesity. When the price of a food increases, the consumption of that food normally decreases. The fat and sugar tax is a way for governments to control people’s diets and encourage them to eat more healthily (just like taxing cigarettes and alcohol to decrease consumption of these substances). This is called social engineering.
Treatment
Dieting
Obesity treatments always involves dieting in one form or another. It seems to be somewhat ineffective.
Wadden (1993) Meta-analysis of studies on effectiveness of dieting
· The study reviewed randomized control studies on the effectiveness of either moderate or severe calorie restriction on weight loss.
· The results showed that patients stayed in treatment for 20 weeks and that 50% lost around 9 (20 pounds) kg or more. Modern approaches to diet with counseling were more effective in the short term compared to previous methods, which mainly focused on dieting and weight loss. The majority of obese patients in research trials tended to regain their lost weight.
· Wadden’s findings are supported by data from a meta-analysis of 92 studies of interventions for the treatment and prevention of obesity (NHS Centre for Reviews and Dissemination 1997). The conclusion of that study was that weight gain after treatment is the norm.
· Weight loss is not quick and this fact may result in many negative emotions and giving in to eat more than allowed. Many dieters are guided by all-or-nothing thinking. The belief that one little transgression (e.g. eating an ice cream) ruins the overall attempt to lose weight could make them stop the diet and indulge in food. This is described as the “what the hell effect” and it has been repeatedly demonstrated in chronic dieters.
Surgical treatments
Surgical treatments are used with severe obesity. The two most common are:
· Gastric bypass: a surgical procedure that cuts off part of the stomach to prevent overeating by limiting the ability to absorb food
· Gastric banding: a surgical procedure where a band is tied around the upper part of the stomach to reduce food intake and help the patient to feel full earlier.
Maggard et al. (2005) Meta-analysis of effectiveness of surgical treatments of obesity
· The study reviewed the results of 147 studies.
· The results showed that gastric surgery resulted in weight loss of 20 to 30 kg. The results were maintained for up to 10 years and patients reported an overall improvement in health. Gastric bypass was overall more effective than gastric banding.
Drug treatments
The National Institute of Health in the USA considers obesity to be a chronic disease. Two sorts of drugs are used:
· Appetite-suppressant drugs: decrease appetite or increase the feeling of being full because they act on neurotransmitters that affect mood and appetite (e.g. serotonin and adrenaline levels). There is some evidence for the effectiveness of these drugs although they have some side effects such as nausea, constipation, and dry mouth.
· Lipase inhibitors: reduce fat absorption. The drug has some unpleasant side effects, especially after eating fat. This may have a preventive effect since eating fat becomes associated with unpleasant consequences such as diarrhea.
Few studies have evaluated the safety and long-term effectiveness of drugs and some are concerned that they may be over-prescribed. Sibutramine has now been taken off the market in many countries because of its serious health risks (e.g. heart failure and sudden death).