Educational strategies address obesity epidemic of Americans

Taking weight off slowly and keeping it off

Americans are growing fatter in spite of media coverage about diet and exercise. According to a survey conducted by the Atlanta-based Centers for Disease Control and Prevention a few years ago, an estimated 64 percent of adults are overweight or obese.

The overweight category includes individuals with a body mass index (BMI) of 25 to 29.9, while individuals with a BMI of 30 or more are considered obese. People who are overweight or obese are more at risk for diabetes, high blood pressure, high cholesterol, asthma, and arthritis, according to the CDC.

Can the health care community make a difference? Patient Education Management talked to a few health care professionals with expertise in weight management to find out what America needs to know.

One problem is that most people misunderstand the word "diet." They think that it is something you do to lose weight. "It is so unfortunate that the word diet has been misused. It is really a Greek word that means lifestyle. It was the perfect word, but we have turned it into a bad word," says Shirley Kindrick, PhD, RD, LD, a team leader for Comprehensive Weight Management at the Center for Wellness & Prevention at The Ohio State University Medical Center in Columbus.

Diet should not be thought of as a moment in time, agrees Andrea Dmitruk, RD, MA, clinical coordinator of Food and Clinical Nutrition Services at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City. "Diet is the nutrition that you take in to maintain a healthful lifestyle," she says.

Following the right diet is not only the restriction of calories but selecting the right balance of nutritional foods. Many people go on a weight-loss diet and, once they reach their goal, they go back to their normal eating pattern. More people can lose the required weight than maintain it, says Dmitruk. "Lifelong lifestyle change is the key," she says.

Everyone says that as soon as they reach their goal weight they will never gain the weight back, but that is not true if they haven’t changed their eating habits, says Kindrick. The weight is a symptom, and they need to discover the root cause for being overweight. "Most people have no idea what they are eating — they just think they know," she says.

A lot of people Kindrick works with fall into one of two groups. There are those who like to eat meat and foods that are high in fat, and those who like their carbohydrates, such as sweets or crunchy, salty foods.

Kindrick often tells people to keep a journal of the food they are eating, their exercise, and also how they interact with food at different points. For example, if they went to a buffet, they would note how they made choices and what was a stumbling block. In this way they can learn what they are doing right and evaluate the things that are challenging.

Some people find that the best way to avoid overeating at a buffet is to look at their choices and then sit down and think about what they want before they go through the line. Others may divide their plates into sections and put foods that are higher in fat and calories in one of the sections.

If people don’t have a plan, they will have a problem, and the best way of creating a plan is to track eating habits by journaling, says Kindrick.

Journaling triggers behavior change

People need to be aware of their eating habits to make lasting changes, says Dmitruk. Often people form the habit of snacking while watching television, and this causes them to overeat. Or they may not be overeating in volume, but they may be selecting foods that are high in calories and fat. For example, they will choose a burger with lots of cheese and sauce rather than the plain hamburger.

"People need to be aware of the behaviors that they need to change, and a journal is very helpful," says Dmitruk. Many who say they know what foods they have to decrease will drink a 16-ounce glass of orange juice because it is healthy without noting the amount of calories in the beverage, she says.

One of the best permanent weight loss strategies is to make small changes over a long period of time that really become a part of a person’s life, says Kindrick. Everyone wants an instant fix, but it takes time to put on weight, and it takes time to take it off. Health professionals should help individuals learn how to determine a realistic goal.

According to the Department of Health and Human Services in Washington, DC, a healthy weight loss goal is ½ to 2 pounds per week. An overweight or obese person can improve their health by simply losing 10% of their body weight.

People need to determine a realistic goal weight that is right for them, says Kindrick. "Often I ask the question, what is the lowest weight in your adult life you have been able to maintain for at least a year?’ That is at least a starting point. If someone wants to weigh 120 pounds but they have never been under 175 pounds in their adult life, that weight goal is not very realistic," she explains.

Another stumbling block is exercise. Many people think that they have to exercise at least 30 minutes a day at their target heart range in order for it to be beneficial. Yet, if they are exercising more than they were the previous day, they are burning calories, and as people lose weight their heart does not have to work as hard, says Kindrick. Soon they are able to exercise at their target heart range. People should set small goals and attain those first so that they are not overwhelmed. Exercise is as simple as getting out the door and walking, she says.

Americans are on overload, says Kindrick. Many have heavy workloads and a hectic family life, which leaves little energy and time to create a plan of care for themselves. Good eating habits need to become a priority in people’s lives to prevent weight gain, she says.


For more information about education pertaining to the prevention of obesity, contact:

Andrea Dmitruk, RD, MA, Clinical Coordinator, Food and Clinical Nutrition Services, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th St., New York, NY 10028. Telephone: (212) 746-0851.

Shirley Kindrick, PhD, RD, LD, Team Leader, Comprehensive Weight Management, Center for Wellness & Prevention, The Ohio State University Medical Center, 2050 Kenny Road, Suite 1010, Columbus, OH 43221. Telephone: (614) 293-2810.