Page 577 - Encyclopedia of Nursing Research

544 n WeIGhT MAnAGeMenT

and colon cancers. Insulin resistance syn- Treatments that do not permit individuals to
drome (metabolic syndrome) is positively tailor weight management to their prefer-
W–Z correlated with excess weight and lack of ences and lifestyles cannot be lasting. Weight
physical activity and affects approximately loss treatments fail when program directives
24% of American adults (Ford, Giles, & Dietz, are too stringent for individuals to feel own-
2002; national Institute of Diabetes and ership and acceptance of weight management
Digestive and Kidney Diseases, 2010). The strategies as a way of life (hill et al., 2003).
safest, most effective way to reverse insulin The 2009 ADA position statement defined
resistance and most obesity comorbidities multidimensionality for long-term weight
is through physical activity, dietary intake management. Comprehensive programs
(less glycemic, more fiber), and weight loss should make maximum use of multiple
(national Institute of Diabetes and Digestive cognitive–behavioral strategies (self-moni-
and Kidney Diseases, 2010). toring, stress management, stimulus control,
The challenge that continues to face problem solving, contingency management,
America is not so much achievement of cognitive restructuring, and social support)
weight loss but rather weight loss maintenance. in addition to dietary and physical activity
The most known unidimensional physical strategies to lose and maintain weight loss.
strategies for losing weight have been suc- Successful weight management programs,
cessful, including reduced dietary volume, therefore, are multidimensional, flexible,
calories, fat, and carbohydrates and increased and also focus on internal motivations for
energy expenditure through physical exer- overeating and not exercising regularly.
cise. Medicines to reduce fat metabolism Behavioral strategies have gained rec-
(orlistat) and suppress appetite (sibutramine, ognition as being important to promote
phentermine, and herbal preparations) have long-term weight management, such as the
been found to be effective, especially com- PReMIeR, Diabetes Prevention Program,
bined with lifestyle modifications (American Finnish Diabetes Prevention, and Look
Dietetic Association [ADA], 2009). Bariatric AheAD studies (ADA, 2009). Confusion,
surgical treatments for obese individuals that however, exists in recognizing differences
reduce intake volume (vertical banded gas- between behavioral strategies and cognitive–
troplasty) and reduce food absorption (gas- behavioral strategies. Behavioral strategies
tric bypass) have been found to successfully use behavior modification, which focuses on
reduce comorbidities (Buchwald et al., 2004). changing individuals’ behaviors with little
These unidimensional strategies are consis- or no concern for their underlying reasons
tently based on energy balance theory, as it for overeating, not exercising, and unhealthy
stresses the physiological balance between coping behaviors (Popkess-Vawter, 2008).
energy in and energy out needed for weight Behavioral weight management strategies
loss, maintenance, and gain (hill & Wyatt, emphasize stimulus control of intake and
2005; nhLBI, 2010). output by dieting and weight-related behav-
Few weight management programs use ior modification, which are unidimensional
a holistic, multidimensional approach to life- and focus mainly on calorie reduction. A
style changes with strategies that address and stimulus response mentality (emphasis on
correct underlying overeating, lack of exer- overweight behaviors) without regard for
cise, and poor self-esteem (Popkess-Vawter, individuals’ beliefs, thinking, feelings, and
yoder, & Gajewski, 2005). Often, weight related behaviors (cognitive–behavioral the-
management strategies used in clinical tri- ory) may be partly responsible for continued
als research place greater emphasis on eat- escalation of the overweight–obese epidemic.
ing, exercise, or psychosocial aspects rather Dietary, pharmacological, and surgical treat-
than holistic emphasis on all three dimensions. ments that reduce intake and restrict calories,