Tackling the root causes of obesity

By Jane Elliott
BBC News health reporter

Kathleen says a diet is finally working

Ever since she can remember, Kathleen Arnold has been larger than she wanted to be - as a teenager her weight was about 14 or 15 stones (88-95 kgs).

Other children teased her and she was reluctant to do sport.

Getting dressed and undressed in front of her classmates became a weekly torture.

Her self-esteem was very low and she over-ate. She tried a number of diets, including attending slimming classes but nothing seemed to work.

Health

As she got older she put on even more weight and, after the birth of her third child, she noticed that the scales had begun to nudge 20 stones (127kg).

"I had always thought I would never get beyond 21 stones and here I was at 20 stones. I knew I had to do something about it.

"My health had started to suffer, I had an arthritic hip and asthma and my breathing was getting worse."

My health had started to suffer, I had an arthritic hip and asthma and my breathing was getting worse Kathleen Arnold

Desperate for help, she went to her GP who referred her to the University Hospitals Coventry and Warwickshire NHS Trust, where they are pioneering an innovative way of tackling obesity.

Rather than just focusing on reducing the weight the team, which includes a psychologist as well as the usual obesity specialists and dietician, try to address any underlying issues which affect why somebody has become obese, or how they feel about themselves during the weight-loss process.

David Kendrick, the psychologist at the clinic, said: "Many people who are overweight experience problems associated with low self-esteem and guilt.

"This is not just because they believe that others think they are greedy or slovenly, but more because they feel out of control in their eating behaviour.

"Eating is often of high functional value to the overweight in the short term - it serves a purpose, even though there are immense negative consequences in the long term.

"Helping people to understand why they are eating too much can eliminate the guilt, raise self esteem and in doing so, give them back the control they need to modify their eating behaviour."

Success

Kathleen, said the clinic's holistic approach had helped her.

"I was asked to keep a diary so I could write about bad days - and good ones.

"It wasn't just about what I ate, it was about how I was feeling as well.

"If you have a problem, you can write about it."

Kathleen said it the diary, as well as regular consultations with the psychologist helped her to keep a perspective on her progress.

"It helps you to recognise that it isn't wasted time, that you can do it."

She has been attending the clinic monthly since last summer and has already lost over a stone.

"This month I lost half a stone, sometimes it has been a few pounds. The important thing is that each time I have been losing weight and it is not going up.

"I had noticed my health was beginning to deteriorate. I am a carer for my mother and one of my son's who has attention deficit disorder. I thought 'who will care for them if I can't."

We discover and tackle the route cause and work with the patient to improve their confidence and self esteem Dr Anesh Anwar

As well as offering Kathleen psychological counselling the team also gave her suggested diet sheets to help her retrain her eating and prescribed her the slimming pill Xenical.

"The support I have been getting has helped me a lot. In t he past when I ate something I shouldn't have I would spend my time torturing myself, but after the counselling I am able to just think I will just start again afresh and move on.

"I know which foods I should and shouldn't eat.

"Without the support I have been given I would have failed. The weight is gradually coming off. It is not a miracle cure, but I am putting the work in and it is showing results."

The clinic is also helping Kathleen's mum, who is also obese and a diabetic.

Rates

Obesity is rising in England faster than in most other European countries and has grown by almost 400% in the last quarter of a century.

In 2001 just over a fifth of males and females aged 16 and over were classed as obese.

Dr Anesh Anwar, consultant in obesity with the trust, said just telling people they should eat less and exercise more was not enough to tackle the problem.

"There are serious health risks associated with obesity including heart disease, diabetes and kidney failure.

"There's also psychological consequences for the patient including low self-esteem, anxiety and clinical depression.

"We discover and tackle the root cause and work with the patient to improve their confidence and self esteem.

Dr David Haslam, clinical director of the Obesity Forum said offering psychological advice in the same clinic as the patient gets dietary advice is unusual. but was the ideal approach to follow.

"It is an approach to be applauded. It is an excellent idea. It is well documented that dealing with the behavioural elements of people's eating problems as well has better results.

"I am not saying that this is the only clinic that offers this approach, but they scarce."

Louise Diss, chairman of the charity Toast (The Obesity Awareness and Solutions Trust) agreed: "Obesity is a multifaceted problem that requires a wide range of solutions.

"It is vital that people whose lives are affected by obesity are able to get the support that they need."