Weight loss is an uphill battle, which is why a few helpful pieces of advice can matter, writes Ben Basger

Here are six reasons why weight management is so hard: the nature of the disorder means it must be treated for life; the treatment is more painful than the disease; there are lots of treatments (diets, complementary, drugs, psychotherapies, exercise programs); we live in an obesogenic environment; the causes are multifactorial (socioeconomic, laziness, time-poor, apathetic etc.); and our patients are not fat detectives.

There are some big problems in dealing with people who are overweight or obese. This is because a significant number of them do not actually believe they are overweight.

In people who are obese, it has been shown that around 12% of them do not think they are obese. So no advice will be sought or heeded by these people.

It has also been shown that most overweight and obese people who wish to do something about it first try diet and exercise (the most successful methods) followed by advice from their GP, a weight loss program (the second most effective method) and a meal plan.

If they have not reached their goals, they may then come into the pharmacy to look for a solution in a bottle. Should we provide some form of OTC medication, for which there is no evidence of efficacy? What about information on prescription medicines?

Or are the three “R”s better ─ rational information, reinforcement and reassurance about finding ways and means to make evidence-based methods work?

Then there is the optimism we must possess in counselling people, given that around 27% of overweight and obese people have been reported to never find a successful method.

Anyway, what “stage of change” are they at? Are they ready for action, or are they just thinking about it and not really committed? Should we spend time with people who think it’s a good idea to lose weight because somebody else told them so?

Dealing with unrealistic expectations appears common, but there are actually large benefits from a weight loss of just 5-10%a realistic goal if stated in the patient’s kilograms.

There is also the pervasive power of our obesogenic environment for our patients to deal with. What advice can we give about that?

We know for example that quitting smoking is not really helped by other smokers in close proximity. Lack of knowledge about food labels and caloric food content can be fought on the patient’s behalf by a visit to a dietician to put them on the right track.

Here are three counselling messages you might find useful.

  1. It’s is all about portion size (or the amount of balanced calories ─ balanced meaning not just fat or carbohydrate or protein). Take your usual meal and push one third of it aside.
  2. There are two sorts of foods – everyday food and sometimes food. It’s perfectly alright to have sometimes food sometimes, but not sometimes food every day. Good behaviour that is habitual will always lead you in the right direction.
  3. The amount of weight you lose does not matter as time goes by, as long as you are heading in the right direction.

This is what provides a successful result.

Dr Ben Basger PhD MSc BPharm DipHPharm FPS AACPA is a clinical pharmacist and educator at Wolper Jewish Hospital and The University of Sydney, NSW.