Key learning points regarding diet and exercise:
– What are the outcomes of an inadequate diet and physical idleness?
– When to offer advice on healthy eating and exercise
- How to provide structured and effective counsel to encourage positive and sustained behavioral modification
Obesity levels continue to be alarmingly high, with approximately 30% of the global population being overweight or obese. This percentage is predicted to increase to nearly half of the world’s adult population by 2030, as stated by the McKinsey Global Institute.2 The underlying cause of excessive weight and obesity is an imbalance between energy intake and energy expenditure. Globally, the consumption of energy-dense foods that are rich in saturated fat, salt and sugar has gone up. We also consume inadequate quantities of fruit, vegetables, dairy, whole grains and oily fish,3 which has an additional effect on the health impact of a bad diet. Our ways of working remain largely sedentary and we work for the longest hours compared to many other European countries.4 In the UK, we spend more time sitting on public transport, watching television and being indoors.
Obesity is preventable and is the outcome of a complex, multi-faceted integration of environmental and social elements that influence our patterns of diet and physical activity. The absence of supportive policies has resulted in the creation of an environment conducive to obesity, which simply does not facilitate the public to make healthy choices with ease. The UK is now lagging behind many other western industrialized countries in reducing premature mortality rates.8 This escalates the financial burden on local authorities and health resources. Those employed in primary care are obligated to operate much more through a reactive approach to healthcare as opposed to the more desirable proactive approach.
Obesity prevention strategies are starting to gain momentum but to witness substantial progress, positive change must surpass the speed of negative contributors. Prevention policies should aim at a few key behaviors and the role of the primary care nurse is crucial to its implementation:
– Restricting processed foods (refined grains, processed meat and foods high in sugar, saturated fat and salt) and beverages (sugary drinks).
– Enhancing physical activity.
– Reducing “sit time”.
At what point should nurses advocate for healthy eating and exercising?
To fulfill the NHS’s implementation guidance – Making Every Contact Count (MECC)15 – nurses are anticipated to advocate for healthier lifestyle choices from the moment of admission up to discharge. Patient and nutritional assessment, accompanied by appropriate lifestyle advice and an effective referral system, are indispensable in supporting positive long-term behavioral change.
Lifestyle advice ought to be appropriate, personalized, safe and effective17, and also ensure equality, improved outcomes and the best patient experience. Accessing approved documents and resources will enable and furnish nurses with the means to offer clear recommendations on behaviors that will assist service users in maintaining a healthy weight or preventing excessive weight gain.
Regarding the promotion of physical activity, nurses can inspire service users to identify activities they take the greatest pleasure in doing. These could be activities of daily living such as gardening or doing household chores. It is crucial to appreciate the service user’s culture and any obstacles to behavioral change in order to facilitate the increase in physical activity levels. The alternative concept of ‘green exercise’, for instance (exercising in a natural environment), attracts many and has been linked with significant physical and mental benefits.20 To enhance exercise adherence, it is important to take into account the time needed to start adopting new behaviors (typically around 21 days), and that relapses are to be anticipated. The most common circumstances to cause a relapse include travel, holidays, illness, stress, bad weather, and competing family duties. Service users can be taught how to overcome such barriers and substitute negative thoughts with more realistic or positive ones.