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Behaviour change key to successful weight management
By Dr Rick Kausman |
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Dr Rick Kausman is The Jean Hailes Medical Centre weight management and eating behaviour consultant and the Australian pioneer of the non-dieting approach to healthy weight management. Dr Kausman is the Australian Medical Association (AMA) spokesperson on this matter. Principal of the Melbourne Weight Management Clinic, Dr Kausman is also the author of the award-winning book If Not Dieting, Then What? and is the creator of the healthy eating, healthy weight management web site www.ifnotdieting.com |
Many people have tried, or are in the process of trying, to lose weight by following a short-term weight loss diet. World research shows that weight reducing diets and restrictive eating plans do not help people achieve their goal to lose weight and keep it off. The facts are that in controlled settings participants who remain in weight loss programs usually lose 10% of their weight. However, 1/3 to 2/3 of the weight is regained within one year and almost all is regained within five years.
What hope does this give people who want to succeed in their weight loss goals and ultimately succeed in leading healthier lifestyles? Eating behaviour and weight management are complex issues and there are many different factors that can contribute to an individual becoming above their most healthy weight. These variables include genetics, metabolism, age, gender, how well people are able to recognise when they are hungry or full, attitudes, beliefs, habits, self-esteem and the amount of physical activity they are able to do. T
raditionally, the goal for health professionals in managing people who are over their most comfortable weight has been to make weight loss the primary goal and to offer advice about eating less and exercising more. Increasingly, it is obvious from the figures throughout the Western world that this message, given on both an individual and a population level, clearly has not had the desired effect.
In Australia, an estimated 67% of men and 52% of women were classified as above their most healthy weight in 1999-2000. This epidemic is part of a worldwide trend. Currently there are more than 1 billion adults around the world who are above their most healthy weight. Evidence from the USA has shown that the percentage of people who are overweight is increasing at a faster rate than ever before.
Behaviour modification is one approach to healthy eating. The aim is to help people achieve and maintain a healthy weight.
The program is based on behaviour change as the primary goal rather than focusing on weight. It involves working on the reasons why the individual person had come to exceed their most healthy weight. Importantly, it includes working on realistic behaviour change and accepting what cannot be changed.
The methods used are based on a ‘non-dieting’ approach within a model of acceptance and change (an approach known as ‘Dialectical Behavioural Therapy’). This program aims to enable people to adopt and maintain healthy eating behaviours, emotional wellbeing, increased levels of physical activity and increased levels of nutritional knowledge.
During a study into the effectiveness of this program participants were surveyed before, during and 12 months after completing the weight management program. Results showed that the majority of participants lost weight during the program and maintained that weight loss 12 months after completing the program.
Dr Kausman's 10 top tips for healthy weight management
1. |
Focus on achievable, sustainable, behavioural goals
Having the right goals are essential. Even if we are above our most healthy weight and our aim is to lose weight, it is vital to focus on goals to do with our attitudes, habits and behaviours. Allow the change in weight to come as a result of that. |
2. |
Practice a positive attitude towards food
When people eat ‘bad’ food, they often feel guilty. Often this can make people eat more of that type of food, even when they no longer feel like it. Try to look at food as being ‘morally neutral’. Try to think, and talk, about food as ‘everyday’ (rather than ‘good’) and ‘sometimes’ (rather than ‘bad’) food. |
3. |
Do your best to eat slowly and enjoy
While this takes some practice, by slowing down our speed of eating, we often feel far more satisfied with significantly less food. |
4. |
Non-hungry eating
We can all eat food when we are not really feeling physically hungry. It is quite normal to do some nonhungry eating, but when we do too much, it can tip our eating out of balance. Try to check in with your body before you eat to see if you are really physically hungry or not. |
5. |
Do your best to not get too hungry
It is so easy to get caught up in the busy-ness and the business of life, that we can ignore our body signals that are telling us that we are getting progressively hungrier. If this happens, it is very hard to eat slowly, and we can easily eat more food than we really want. |
6. |
Plan ahead to have some food on hand
We sometimes don’t have access to a wide choice of foods. Because we are often very busy, we can leave decisions about what we are going to eat until the last minute. In this situation, it is easy to go for whatever food is most readily available (even when we don’t really feel like this type of food). If you regularly find yourself in this situation, plan ahead to have some food on hand. Take a range of foods that you enjoy eating with you for the day ahead. |
7. |
Fine-tune fat content without deprivation
It is definitely healthy to consume some fat (particularly the ones found in fish and other seafood, olive oil, nuts, seeds and avocado), and it is healthy to have some fat on our bodies. However, many people consume more fat than their bodies need. If this is the case, it is helpful to find some ways of decreasing the overall fat content. You might like to think of this as fine-tuning the fat content in a non-derivational way. |
8. |
Nurture yourself
If we keep giving without looking after our own needs, we may become resentful, frustrated and depressed. As well as giving of ourselves to our families, our friends, our work etc., we need to make sure we are doing things for ourselves. It is very important to nurture ourselves. |
9. |
Don’t confuse the thin ‘ideal’ message with healthy weight messages
Health and vitality come in all shapes and sizes, and it is important to be the healthiest weight we can achieve and maintain, rather than focus on being thin at any cost. By looking after ourselves, and our bodies, in the best way we can, our weight/size will evolve to the healthiest level possible. |
10. |
Look for opportunities to move
Physical activity has long been known to produce beneficial effects. A number of recent research studies are now showing that small amounts of physical activity are cumulative throughout the day, and whatever physical activity we can do is worthwhile. |
Common reasons for non-hungry eating
- We might not be giving ourselves enough time to listen to what our body signals are telling us
- We might be confusing thirst with hunger
- We let ourselves get too hungry
- We aren’t sure when to stop eating
- We’re filling up, but not feeling satisfied
- ‘Just in case I get hungry later’
- The clock says it’s breakfast/lunch/dinner time: ‘meal-time’ eating
- Almost any emotion or feeling can trigger nonhungry eating
- We are meeting certain needs
- The food tastes great
- We’re feeling bored or tired
- We worry we might offend someone if we don’t eat
- Our parents always told us to finish everything on our plate
- We’re bombarded with advertising and marketing
- We eat as a reward
- We eat out of habit
- We eat because it’s there
- It brings back memories
- We eat quickly
- We eat to solve a problem, fill a gap or put off doing something
- Any combination of the above and others
International No Diet Day
May 6, is a day to:
- Accept, enjoy and look after our bodies and ourselves
- Reject diets that endanger our health and stop us from eating well and enjoying life
- Focus on being healthy at any weight rather than thin at any cost
Dr Richard Kausman
Dr Kausman has been part of The Jean Hailes Medical Centre for four years. The following is an insight into his background as well as what motivates and challenges him. Over the years I was struck by how many people were having difficulty with their weight. People were put on strict diets, prescribed appetite suppressants, even given injections. I was determined to find a better way to help people achieve and maintain a healthy weight.
What led to my particular theories on weight loss?
Over the years I was struck by how many people were having difficulty with their weight. People were put on strict diets, prescribed appetite suppressants, even given injections. I was determined to find a better way to help people achieve and maintain a healthy weight.
Common themes about people’s weight struggles that I encountered
I noticed four key factors:
1. People’s days were being influenced, and sometimes completely affected by, their bathroom scales
2. Lots of people were feeling guilty after eating a chocolate biscuit – but ended up eating four more anyway
3. A huge number of people were bombarding their brains with bad body thoughts – with bottoms, bellies, boobs and almost any body part taking the brunt.
4. Most people thought they were weak-willed when they couldn’t sustain getting up at 5.30am in the morning in the middle of winter to go for a swim!
My philosophy on food
Awareness without deprivation. What most people, including some health professionals, forget is that our bodies are actually very good at regulating how much food we need and sending signals to tell us when we are hungry or full. But many people have lost the ability to tune into their bodies and listen to those signals. Saying to yourself, ‘I am allowed to have whatever I really feel like, as long as I do the best I can to listen to whether I really feel like it or not!’
What motivates me
I have been given a wonderful opportunity to make a difference to many people’s lives. My patients continue to inspire me to do the best I can.
What is challenging
The huge number of vested interests wanting to sell a one-size-fits-all product, rather than empowering people with what they need to make a difference.
My message to women
Equip yourself with the knowledge and skills to make your own choices. Focus on the things that you can do, to achieve what you want to achieve. This is an empowering approach, which has a positive flow-on effect. |
Study: Relationship Between Weight and Risk Factors For Diabetes and Heart Disease
Dr Meyer and Dr Teede at the Monash University Department of Medicine, Melbourne are conducting a study into the relationships between body weight risk factors for diabetes and heart disease in women. Women who are overweight are at increased risk developing diabetes, stroke and heart disease later life. Risk factors for these conditions can be detected early and the processes leading to diabetes and disease delayed or prevented with lifestyle change sometimes medication.
We are looking for women who are premenopausal (age range 16-42), overweight, non smokers and pregnant. They must have a regular menstrual cycle, not take the oral contraceptive and not suffer from diabetes.
If eligible, the study Doctor will take a medical history and perform a simple physical examination. Participation will involve 2 visits on consecutive days for 1-2 hours. They will include a comprehensive measure of blood sugar levels called an oral glucose tolerance test (OGTT). In addition blood will be taken measure hormone levels, test for diabetes, cholesterol and blood clotting factors. We will also look at the health of your blood vessels using a painless ultrasound, as well as performing a detailed assessment of your blood pressure by fitting a blood pressure device that you wear at home for 24 hours. These results will be provide to you and your nominated doctor and all tests are completed at no cost.
If you are interested in the study please call either Dimitra Kotsopoulos or Dr Caroline Meyer on (03) 9554 8022
Report On Habits Study: (Feb 2004) Hormone Therapy (HT) After Breast Cancer – Is it Safe?
The management of menopausal symptoms in women after breast cancer is important. Due to improved survival after breast cancer, the number of women who experience menopausal symptoms has increased. Hormone therapy is one of a range of options to manage menopause symptoms.
The study
The HABITS study aimed to evaluate whether hormone therapy (oestrogen and progestin) is safe in women WITH a previous breast cancer. Undertaken in Scandinavia and other parts of Europe, this was an open, randomised, clinical trial with women allocated either to HT or best treatment without hormones.
Planned for 5 years, the study was halted after 2 years. Why?
After 2 years researchers found an ‘unacceptably’ high risk for a new breast cancer event in the HT group. The intention was to recruit 1300 women to the study, but this was not achieved.
These results contrast to those of a comparable study conducted simultaneously in Sweden, involving a similar number of breast cancer survivors. This second study has reported no increase in risk of breast cancer recurrence in women who were randomised to HT versus those randomised to best non hormonal care. At this point we do not know why the results from the two studies are so different.
Conclusion
Based on what we know at this time, recommendations for HT use after breast cancer remain unchanged ie HT use should only be considered by women who have severe symptoms that significantly impair quality of life. Their decision to use HT should be made after a discussion about what is known of their individual risk with their doctor.
The Jean Hailes Foundation magazine is designed to be informative and educational. It is not intended that The Jean Hailes Foundation magazine provide specific medical advice or replace advice from your health professional. The Jean Hailes Foundation does not accept any liability to any person for the information or advice (or the use of information or advice) which is provided in this magazine or incorporated into it by reference. Information is provided on the basis that all persons reading the magazine undertake responsibility for assessing the relevance and accuracy of its content.
© The Jean Hailes Foundation. Apart from fair dealing for the purposes of private study, research, criticism or review, as permitted under copyright legislation, no part may be reproduced or reused for any commercial purposes.
Note: This article is an archive. Whilst the Jean Hailes Foundation for Women’s Health has made every effort to ensure this information was accurate at the time of publication, the article content has not been updated since the date listed below.
Content March 21, 2004
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