Canadian dietitians' approaches to weight-management advice

Nutrition Research Newsletter, Sept, 2005 by Gwen Chapman, Kari Sellaeg, Ryna Levy-Milne

The prevalence of obesity in North America is high and increasing. Concern about associated disease risk has encouraged calls for increased focus on prevention and management, while others argue that fitness has a greater impact than obesity on long-term health. Still others suggest that efforts to prevent and treat obesity may increase weight preoccupation and food obsession and decrease self-esteem. Varied opinions regarding weight-management approaches parallel differing philosophies regarding the obesity problem.

This context of differing philosophies has likely created confusion and diversity of practice among dietetics professionals. However, no documented studies have fully explored dietetics professionals' current practices in this area or how those practices reflect their understanding of the nature of obesity. To attempt to begin to understand this, a recent article described Canadian dietitians' approaches to counseling adults seeking weight management advice, including how dietitians' approaches differ between clients with and without associated risk factors and long histories of dieting. One hundred and four registered dietitians (most currently worked in weight management) were included in this study. Fifteen focus groups were conducted, representing all major regions in Canada. Each focus group was facilitated by two dietitians. The dietitians discussed their approach to specific weight management counseling scenarios, including women clients with and without associated risk factors (impaired glucose tolerance, hypertension, and family history of CVD) and long histories of dieting.

"Being healthy" or "healthy living" emerged as participants' overall goal for clients seeking weight-management counseling. The three subcategories of this goal: behavioral changes, physical outcomes, and psychological well-being; were all perceived as essential for health, but their relative importance varied, depending on the participant and their individual scenario. In contrast to clients' perceived weight loss goals, participants rarely included weight loss as a goal for clients with no additional chronic disease risk factors. However, for clients with risk factors, some registered dietitians (RDs) advocated moderate weight loss, while others aimed for health at any size. Psychological well-being, particularly in relation to feelings about food and body image, were also important factors in the counseling.

Individualized approaches to setting goals, gathering information, and giving advice/education were identified as key counseling strategies. Findings of this study also indicate that while participants were conformable with their role as nutrition education when dealing with weight management, many were not comfortable with the role of nutrition counseling. Further research to evaluate the effectiveness of dietitians' weight-management approaches and additional counseling training for dietitians will enhance practitioners' skills and confidence in this area.

Gwen Chapman, Kari Sellaeg, Ryna Levy-Milne, et al. Canadian dietitians' approaches to counseling adult clients seeking weight-management advice. JADA; 105:1275-1279 (August 2005) [Address correspondence to: Gwen E. Chapman, PhD, RD, Food, Nutrition, & Health, University of British Columbia, 2205 East Mall, Vancouver, BC, Canada V6T 1Z4. E-mail: gec@interchange.ubc.ca]