Why not what: Etiological approach to obesity management

As obesity levels continue to soar, we need to stop asking WHAT and start focusing on WHY. In this article, we are going to focus on the etiological causes of obesity and how a better understanding can improve the quality of assessment and in turn the management of obesity.  

What do we know about obesity? It’s a serious medical condition that affects the physical, socioeconomic and mental health of an individual. The physical effects of obesity are caused by consuming too many calories and expending too few calories, otherwise known as eating too much and not exercising enough. But looking at obesity from this black and white perspective encourages unfair bias and stigma. The obesity epidemic was not caused because people are lazy or because they eat too much, it was caused by underlying issues due to a range of factors such as environmental, cultural, biological and psychological.

Telling people to eat less and move more does not address the root of the issue, we need to explore what drives people to consistently eat more than they should, what causes them to be sedentary, and most importantly, how we can change their behaviour so that they adopt a healthy and sustainable lifestyle. 

3 questions you need to assess obesity

Obesity is a complex disease that is caused by a wide range of factors. When assessing someone who is obese or overweight, it’s much more useful to focus on why they are exhibiting the behaviour they are participating in, as opposed to focusing on the behaviour itself. 

Practitioners need to think about:

1. Why this person is obese?

2. How obesity is affecting the patient?

Once you have answered these questions you can also consider:

3. What is the best treatment plan? 

The answer to this question should not include a diet or exercise plan (as while this is appropriate during later stages, it is too early to implement, this will come later once you have addressed the underlying issues.)

The four Ms

There is a simple mnemonic created by Sharma (2007) which helps practitioners to assess patients more effectively. 

• Mental – How is their mental health? Mental health is the most important barrier to obesity treatment. Someone must be treated for mental health conditions before or during their diet and exercise plans. 

• Mechanical – Physical/mechanical problems for example osteoarthritis, reflux disease, problems with joints and pain. Consider how this affects the patient’s ability to move. 

• Metabolic –Type 2 diabetes, hypertension, cancer, PCOS. 

• Monetary – Is treatment affordable, can they afford to use a gym, eat well etc? Some groups of people will find it much more difficult to eat healthy, nutritious food and participate in sports and fitness clubs due to the costs, or they may have less time as they need to work extra hours to make ends meet. 

By considering these four areas, you will create an effective treatment plan that will not only help the patient to lose weight, but also to address any underlying issues they have which causes them to become obese in the first place. Taking the time to learn more about the patient will provide you with a long-term behaviour modification, as opposed to a quick fix, to help patients lead a sustainable healthy life. 

Childhood obesity

As the number of obese and overweight children and adolescents rises, practitioners need to be even more careful regarding how they assess and manage effective treatment plans for younger people. 

Children and teens are at a very impressionable age and a negative experience could influence their attitude towards diet and exercise for life. This means treating each child with respect, sensitivity and examining the reason why they are engaging with this behaviour. Discover more about the child’s life before you generate a treatment plan or this behaviour could reappear consistently and encourage a lifetime of yoyo dieting. 

Overweight children will also need the full support of their parents, which may be a challenge as they could be overweight or obese themselves. By changing the behaviour of the family altogether, the child will have a far greater chance of succeeding on their treatment plan. Lifestyle interventions which include the family produce significantly higher weight loss effects compared to non-treatment control or usual care. 

Once you have focused on the etiological factors of obesity, you can administer a treatment plan that tackles the core issues, and focuses on a controlled diet and an exercise program that works for the individual. Amaven creates personalised physical activity plans for people of all ages, find out more about how we can help reduce obesity by emailing info@amaven.co.uk or calling the team on 0161 3009172.