Obesity: Update on Nutrition and Behavioral Strategies

The global rise in obesity has generated interest in nutrition and behavioral therapies as care processes for managing obesity and related co-morbidities. Growing evidence supports the use of nutritional consultation and intensive behavioral therapy to reduce risk factors associated with obesity. The World Health Organization recommends that the delivery of interventions should be of appropriate intensity and sustained over extended periods of time while noting that even modest changes in risk factor levels may achieve substantial public health benefits. Obesity guidelines provide recommended steps for identifying risk status, matching treatment to risk assessment, and implementing weight loss intervention strategies. A highly collaborative process of care, which focuses on the nutritional and lifestyle management of obesity and selected co-morbidities, is known as medical nutrition therapy (MNT), when provided by a registered dietitian, or as nutrition therapy when provided by other disciplines. Behavioral therapy approaches that focus on collaborative decision making include motivational interviewing and the 5 A’s behavioral counseling steps. Motivational interviewing, which includes open-ended questions, reflective listening, affirmation and summarization, helps individuals address their concerns about making lifestyle changes. The 5 A’s steps generally include: Ask/Assess: ask about/assess behavior and health risk(s); Advise: personalize behavior change advice; Agree: collaboratively select goals, Assist: use behavioral techniques to aid in achieving agreed-upon goals and Arrange: schedule follow-up. Training programs can help health professionals develop nutrition and behavioral therapy skills and address bias and discrimination. Weight management approaches and priorities will vary by the risk status and health care settings.

Keywords: 5A’s, behavior, diabetes, diet, dietitian, global health, intensive behavioral therapy, medical nutrition therapy, MNT, motivational interviewing, nutrition therapy, obesity, overweight, wellness.