Advising patients on a healthy diet

In light of a National Obesity Forum (NOF) report on reversing obesity, Professor David Haslam and Dr Rachel Pryke discuss how to advise patients on eating a healthy diet.

Professor David Haslam

The epidemic of obesity and type 2 diabetes is reducing life expectancy and costing healthcare systems dearly. Current policies and interventions have not worked and international dietary guidelines are being scrutinised in the light of the growing problem. It is futile to repeat the same ineffective advice over and over again.

The National Obesity Forum (NOF) Eat Fat, Cut The Carbs and Avoid Snacking to Reverse Obesity and Type 2 Diabetes recommends that people should eat less processed food and refined starchy carbohydrate, and more healthy, natural food.1

In 2015 the Scientific Advisory Committee on Nutrition called for a reduction in sugar intake.2 There is a growing body of evidence demonstrating the benefit of a low carbohydrate diet – for weight loss and for improving cardiometabolic risk factors – compared with low-fat diet approaches.

Foods such as oily fish or avocado contain a wide variety of vitamins, minerals, protein, and saturated and unsaturated fats. We must treat fat with caution because many fats – notably trans fats and heated vegetable oils – are deleterious to health.

Furthermore, fats often turn up alongside processed foods, salt, preservatives and additives.

But fat can be beneficial and should not be demonised. Healthy, natural fats are necessary in the diet, for example, to enable absorption of fat-soluble vitamins.

  • Professor David Haslam, GP with a special interest in obesity and cardiometabolic disease in Hertfordshire, Chairman of the National Obesity Forum, UK

Dr Rachel Pryke

The NOF report suggesting that fat is our friend, and displacing sugar into ‘chief toxin’ position, has done a disservice to health professionals and patients alike. The report fails to address the concerns that many families struggle with.1

Healthy food – however we define it – is not as palatable, cheap, readily prepared or well promoted as unhealthy food. People develop strong food preferences that are hard to change.

Demonising one food does not magically unlock a liking for a healthier alternative, but does risk generating increased guilt.

We have to consider the context in which food is eaten – the strong connection that ‘feast’ foods, treats and rewards have with pleasure.

Unless we understand how eating behaviours develop and can be influenced, scare messages will continue to confuse people, while having no impact on behaviour change. Fat and sugar can both fit in a healthy diet – just not too often and not too much.

Swapping chaotic grazing for structured meals and planned nutrient-rich snacks can help families rebuild a positive relationship with food.

We should be helping patients to focus on putting good food into their diet, rather than banning ‘bad’ foods. Save treats for special occasions and use non-food rewards when celebrating success or showing love and affection.

Teach families to talk to children about exercising restraint and developing a liking for healthy food. Anyone can develop a taste for a new food by repeated, calm, non-forced exposure.

A useful information leaflet for parents can be downloaded from the RCGP website.3

Policy measures promoting reformulation to lower sugar in drinks and (hopefully in future) in commonplace foods are vital.

Avoid burdening your patients with complex messages that have little impact on their food preferences (see box).

Instead, use motivational interviewing approaches to guide and empower them to set their own goals and achieve a healthy, active lifestyle.

  • Dr Rachel Pryke, GP in Worcestershire, Chairwoman of GPs Interested in Nutrition Group, UK

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References

  1. NOF/PHC. Eat Fat, Cut The Carbs
  2. SACN. Carbohydrates and Health. London, TSO, 2015
  3. Mealtime Magic!

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