Conference report: multidisciplinary approach to obesity

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Obesity requires an intensive multidisciplinary approach. During the National Obesity Congress, which was held in Amersfoort on March 8, a diverse group of stakeholders in obesity care came together. The program was interesting and diverse and highlighted different treatment strategies.

Treatment is tailor-made

An unhealthy lifestyle is often seen as the sole cause of overweight or obesity. Lifestyle plays a role according to Prof. Dr. Liesbeth van Rossum, intexpert-endocrinologist, professor of Obesity and Stress Erasmus MC and chairman of the Overweight Partnership Netherlands, often an important role, but is certainly not the only cause. ‘Socio-economic or psychological problems, medication use such as weight-increasing drugs, hormonal causes and sometimes medical diseases are all important causes that contribute to obesity or maintain obesity. That is why tailor-made solutions and a better connection between the existing range of care or assistance within both the medical and paramedical domain and the social domain are needed.’ In the new guideline on overweight and obesity, which was published in July 2023, provides guidelines for this customization. Van Rossum: ‘The guideline consists of various steps for optimal treatment of overweight and obese adults. Step 1 is to ask permission to talk about weight. The guideline contains new insights, such as determining the weight-related health risk, also abbreviated as GGR. The GGR is leading and step 2 in the treatment plan. Fat mass and specifically belly fat are examined. Belly fat is an organ from which inflammatory substances can travel throughout the body. This means that obesity is not only a disease itself, but also a gateway disease that causes or worsens more than 200 other chronic diseases.’ Customized treatment is also provided by patients or clients who complete the digital questionnaire prior to the consultation to be filled in. “Among other things, people are asked about medical conditions and medications that can increase weight, lifestyle factors such as nutrition, exercise and stress, but also about social factors such as money problems and loneliness, psychological factors such as trauma or binge eating disorder,” says Van Rossum. ‘As a professional, you can specifically create a tailor-made treatment plan together with overweight people and initiate, monitor and evaluate the treatment.’

Exercise as medicine

Dr. Thijs Eijsvogels is an exercise physiologist and associate professor at Radboudumc in Nijmegen. He said that it is already detrimental to your health if you sit for more than 30 minutes at a time. ‘And mePeople who sit for more than 9.5 hours a day have a greater risk of death, especially from cardiovascular disease. In addition, heart patients sit on average an hour longer per day than the rest of the population. There is therefore much to be gained from this group. We wanted “from sitting to fit in practice” and invited 212 heart patients from 2 hospitals to participate in a normal cardiac rehabilitation program or a cardiac rehabilitation program combined with “SIT LESS”. In this intervention group, specific attention was paid to sitting less. These patients were informed about the risks of sitting too much and, together with the rehabilitation nurse, they set concrete goals to sit less. They also received a smart exercise meter to take home that was linked to their smartphone. The movement meter provided insight, but also vibrated when the patient had been sitting for half an hour.’ Eijsvogels says that all this resulted in a greater reduction in sitting time in the intervention group, bringing the total sitting time to less than 9.5 hours. ‘After 3 months it turned out that sitting less was difficult to maintain. That is why, 2 years later, we looked at whether we could give the participants a short exercise booster. It worked. And within 3 weeks there was an effect on sitting behavior again via a remote intervention.’ Eijsvogels also showed that the often recommended 10,000 steps per day are not sacred. Getting and keeping someone moving is already effective. ‘A meta-analysis of number of steps and health outcomes shows that the risk of premature death drops by 8 percent if someone goes from 2,000 steps per day to 2,5,000 steps. Those 500-700 extra steps already result in a huge risk reduction of cardiovascular disease, regardless of your starting level.’

This is what obesity does to you

Surprising during the conference was the appearance of a lifestyle coach in a fattening costume. She left home in the suit and then walked around in the suit for the entire conference day. She shared her findings with the audience present and started practically by reporting that she was hot, could not close her shoes, climbing the stairs was already difficult and she would prefer to sit down for a while. However, the chair that was suggested turned out to be too narrow for her and so she remained standing. But besides those practical things that stood out, her different appearance meant more to her. She said that she normally likes to make contact with people, but now it is less easy for her to look at people. She didn’t dare take a cookie when she came in; afraid that others would think something of it. In the busy conference hall it was more difficult to move between people and when she heard others laughing behind her she was afraid it might be about her, while those conference participants might have had a completely different topic of conversation. Being overweight affects you in all kinds of ways, that was her message.
This lifestyle coach was able to take off the suit at the end of the day. For overweight people, changing lifestyle is difficult due to, for example, stress, psychological problems, impulsiveness, ingrained habits and dysfunctional thoughts. Prof. Dr. Anita Jansen, professor of Experimental Clinical Psychology of the Eating Disorders and Obesity section at Maastricht University, indicated that it is less easy to eat healthily if you also have psychological problems. Jansen: ‘On average, 1 in 4 people has a mental illness at some point in their lives. This number doubles if you are overweight. Try to tackle the sabotaging psychological processes and work with patients, for example, on dealing with temptations and a negative self-image. People who have a positive and happy outlook on life can more easily change their lifestyle.’

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