Obesity and nutrition: what dietitians need to know

Dietitians play a large role in helping people overcome obesity. Here’s how you can help improve your obese clients’ relationship with food and enhance their quality of life. 

Good nutrition and physical activity play an important role in achieving and maintaining a healthy weight, and can decrease the risk of chronic health conditions. 

But what if your client has a BMI that indicates obesity? This scenario can be more difficult to manage, but with proper nutritional care, you can guide your client towards a positive health outcome and improve their relationship with food. But before diving into how dietitians can provide individualized care, let’s discuss what obesity is, and the health complications surrounding it.

What is obesity?

Obesity is a complex disease that is defined as the increase in size and amount of fat cells in the body [1]. It can adversely affect health, as it directly contributes to cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders [2,3].

At what weight is a person considered obese?

Obesity is classified through measuring a client’s body mass index (BMI). A BMI over 25 is considered overweight, and over 30 is obese [4]. 

Obesity can also be subdivided into the following categories [5]:

• Class 1: BMI of 30 - 35
• Class 2: BMI of 35 - 40
• Class 3: BMI of 40 or higher (also known as severe obesity)

Currently, nearly 1 in 3 adults (30.7%) are overweight, more than 2 in 5 adults (42.4%) have obesity, and about 1 in 11 adults (9.2%) have severe obesity [6].

Causes of obesity

Generally speaking, obesity is caused by an energy imbalance, such as eating too much and moving too little. A diet rich in highly processed foods can contribute to excess calories and weight gain, and when combined with a lack of exercise, it can be easier to accumulate body fat and increase the risk of chronic disease [7,8]. 

Obesity can also be the result of genetics, some medical conditions (such as hyperthyroidism) and certain medications [9]. 

Risk factors

Some risk factors of obesity can stem from unhealthy lifestyle habits. These can include not getting enough physical activity and/or eating high-calorie, low-nutrient foods and beverages [1].

Symptoms of obesity

Some common symptoms of obesity in adults include [10]:

• Excess body fat, particularly around the waist
• Shortness of breath
• Sweating more than usual
• Snoring
• Trouble sleeping
• Fatigue
• Back and joint pain, especially in the back and joints
• Negative self-esteem, depression, shame, and social isolation

What complications can obesity cause?

Obesity can wreak havoc on your client’s body. Here are some common health complications associated with obesity [11]:

• All-causes of death
• Hypertension
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Osteoarthritis
• Certain cancers
• Sleep apnea and breathing problems

TIP: Obesity during pregnancy raises many risks for both mother and child. Learn more about how to help your nutrition client who is dealing with obesity and pregnancy.

How can you help clients with obesity improve their relationship with food?

Intuitive eating is a non-diet approach used by dietitians to help nutrition clients trust their bodies to make food choices that feel good for them, without judgment or the influence of diet culture [12]. But is intuitive eating (IE) is recommended for those who are obese?

Science says yes, as this non-prescriptive approach may help with the treatment of obesity and eating disorders [13]. IE is also associated with a lower BMI, and can significantly improve psychological health, both of which can prove beneficial for overweight or obese clients [14,15]. 

However, the main focus of intuitive eating isn’t weight loss. Rather, the main premise is to improve your client’s relationship with food and become more in-tune with the body’s hunger cues.

You can help an obese man or obese woman implement some of these strategies by:

• Changing their mindset around food. Instead of demonizing select food groups, you should focus on making sure your clients feel nourished and satiated. When your clients feel satiated, they are less likely to feel deprived or restricted. This can lead to a better relationship with food. 
• Establishing healthier habits. When working to establish healthier habits, be sure to start small and increase progress over time. For example, if your client wants to exercise more, you can work with them to incorporate more walking into their daily routine. This could include parking farther away from the front door or taking the steps instead of the elevator. 
• Utilizing the hunger-fullness scale. To help your clients further get in touch with their body, you can use the hunger-fullness scale. The hunger fullness scale in intuitive eating is a tool that’s used to better understand different levels of hunger and fullness, and how to appropriately respond to those levels [16]. Learn more about how this scale works here.

Tip: check out this article for other ways to repair your client’s relationship with food.

What other recommendations can you give your obese clients?

While diet plays a major role in working with obese clients, sometimes it’s necessary to look at other aspects. Here are some other recommendations you can provide.

Psychology treatment

Psychologists play an integral role in the treatment of obesity [17]. These professionals can further work with your clients to help with stress management, stimulus control, cognitive restructuring, and social support.

Join a support group

Support groups can be helpful, as people can gain insight from others, listen to their challenges, understand different perspectives, and not feel as alone in their journey. Interestingly, studies have found that group intervention can be at least as effective as one-to-one care and may offer significant wider therapeutic benefits [18]. 

Add more movement

Notable research shows that physical activity can be beneficial to many critical health markers, independent of weight loss or changes in BMI [19]. 

Whether it’s walking or taking a yoga class, you can encourage your clients to move a bit more throughout the day by doing something that they find enjoyable. 

TIP: As a dietitian, you can also help obese children achieve a healthier weight by making certain lifestyle and nutrition recommendations. Understand what childhood obesity is, and the health implications associated with it in this article. 

Summary

Dietitians play a large role in helping people overcome obesity. While this chronic condition can be difficult to manage, nutrition professionals can utilize intuitive eating concepts to help improve their client’s relationship with food. Some benefits of IE include changing mindsets around food, building healthier habits, and becoming more in-tune with hunger and fullness cues. You can also encourage clients to incorporate more daily movement or seek out a support group.

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References

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6. Overweight & obesity statistics. Retrieved September 8, 2022 from https://www.niddk.nih.gov

    

7. Eating highly processed foods linked to weight gain. Retrieved September 8, 2022 from https://www.nih.gov

    

8. Lack of exercise is a major cause of chronic diseases. Retrieved September 8, 2022 from https://www.ncbi.nlm.nih.gov

    

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11. Health effects of overweight and obesity. Retrieved September 8, 2022 from https://www.cdc.gov

     

12. What is intuitive eating? A nutritionist explains. Retrieved September 8, 2022 from https://www.cedars-sinai.org

     

13. Intuitive eating in general aspects of eating behaviors in individuals with obesity. Retrieved September 8, 2022 from https://clinicalnutritionespen.com

     

14. Intuitive eating mediates the relationship between self-regulation and BMI - Results from a cross-sectional study in a community sample. Retrieved September 8, 2022 from https://pubmed.ncbi.nlm.nih.gov

     

15. Intuitive Eating Longitudinally Predicts Better Psychological Health and Lower Use of Disordered Eating Behaviors: Findings from EAT 2010–2018. Retrieved September 8, 2022 from https://www.ncbi.nlm.nih.gov

     

16. How to use the hunger fullness scale in intuitive eating. Retrieved September 8, 2022 from https://www.rachaelhartleynutrition.com

     

17. Briefing Series on the Role of Psychology in Health Care for Adult Obesity. Retrieved September 8, 2022 from https://www.apa.org

     

18. How Group-Based Interventions Can Improve Services for People with Severe Obesity. Retrieved September 8, 2022 from https://www.ncbi.nlm.nih.gov/

     

19. The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review. Retrieved September 8, 2022 from  https://www.ncbi.nlm.nih.gov