“I Can’t Make You Lose Weight” — A New Paradigm for Weight Control
By Carol M. Meerschaert, RD
Today’s Dietitian
Vol. 7 No. 9 P. 56

Maybe you can’t offer clients a simple, one-size-fits-all solution to overweight and obesity. But you can certainly guide them on the path to weight loss.

You may be familiar with the quote attributed to Albert Einstein: “The definition of insanity is doing the same thing over and over again and expecting different results.” We have been counseling people on sensible diets for weight reduction, and clients are not losing the amount of weight they desire. Those who do drop pounds are not maintaining their weight loss. Are we insane to keep trying?

No, we are not insane. Yes, we need to use our nutrition expertise to help people lose weight and, more importantly, consume a more nutritious diet and live as healthy a life as possible. But we can’t make anyone lose weight. We need a new approach to weight loss.

The lessons come from leadership literature, not just dietetics journals.1 Ronald Heifetz and Marty Linsky from Harvard University’s Kennedy School of Government Center for Public Leadership are leadership authorities who train corporate CEOs how to lead workers. They offer us many lessons in how to lead clients during their lifelong quest for weight control.

According to Heifetz and Linsky, two major types of problems exist: technical and adaptive. A technical problem has a clear definition, solution, and way to implement the solution. The problem can be solved with the tools already available without any additional learning needed. The primary responsibility for the work lies with the authority.

Treating an ear infection is a technical problem. The patient sees a doctor (the authority), who diagnoses the problem and offers the solution. All the patient must do is implement the solution—taking the prescribed antibiotics in the correct number of doses—and the problem is solved.

Weight Loss: No Easy Solution
If weight control were a technical problem, the solution would be clear. It would be easy to identify the problem with just a step on the scale. We, as the diet authorities, would be in charge of the solution and we would use the tools we already have, namely a standard weight reduction diet of the appropriate calorie level, to solve the problem. All the client would need to do is implement our solution. Sadly, to the chagrin of those hoping for a magic bullet, weight loss is not a simple technical problem—it’s an adaptive problem.

Unlike technical problems, adaptive problems are not so easily solved. They require learning to define both the problem and appropriate solutions. Adaptive problems must be solved by the person with the problem, not by the authority. But a client seeking to lose weight can consult with a diet authority, and the two can work on the problem together.

This adaptive problem-solving method has three major requirements: valid data, free choice, and commitment to change. The person with the problem is given valid data. For our weight-loss clients, this can be objective data such as their body mass index and cholesterol level. We can also offer data on our assessment of their current dietary habits.

The next step is free choice. The client must have a choice of possible solutions to the problem. Our job is not to choose the correct solution for the client but to help the client discover the solution that will work for him or her. Because weight management is an adaptive problem, the most common solution is a custom combination of many small changes, such as choosing healthy, satisfying food, increasing physical activity, seeing a therapist, and learning stress control techniques. Once the custom solution is established, the client must be committed to change for the solution to have a chance to succeed.

Another feature to the adaptive work approach to problem solving is that quite often the presenting problem is not the true underlying issue. In a business setting, the presenting problem might be trouble with staff learning a new computer system, when underneath lies the true problem of their fear of being laid off as technology makes their jobs obsolete. The same thing is true of most people and their weight issues. A person who is greatly overweight may have many issues he or she needs assistance with, such as self-esteem, stress, health issues such as high blood pressure, fear of ridicule in public places, and a plethora of concerns associated with weight problems. If we only address calories, we miss the root of the problem.

Weight Management by the Book
This business-based concept does mesh with the current science on weight reduction. For those trying to assist adults in managing their weight, the American Dietetic Association’s (ADA) state-of-the-art guidebook for practitioners, Adult Weight Management Evidence-Based Practice Guidelines, is the first place to gain scientific consensus on weight management research.2

The first recommendation seems almost intuitive at this point: Weight loss and weight maintenance therapy should be based on a comprehensive weight management program including diet, physical activity, and behavior therapy. Perhaps part of the major frustration in the quest for weight management is that offering a client only the nutritional counseling piece without the physical activity and behavior therapy components is setting them up for failure. Offering just a “diet” without the other components is a technical solution to an adaptive problem.

Our clients need all components to be successful. Dietitians must ensure that their institutions make a comprehensive approach to weight management policy. The days of “dietitian to instruct patient on 1,200-calorie ADA diet” on the way out the hospital door should be long over. To cooperate in a one-session weight-loss effort is not fair to the client, as we know the chance for success is dismal.

Some dietitians are also personal trainers or licensed therapists. Those who are not need to team up with these professionals to offer clients the total tool kit they need to be successful. H. Theresa Wright, MS, RD, CDE, LDN, of Renaissance Nutrition Center, Inc. in East Norriton, Pa., offers her clients a long-term therapeutic approach to weight control. In fact, Wright’s first client from 16 years ago still has one 30-minute session with Wright every three months to support her weight maintenance. Wright’s clients see psychological therapists to work on behavior and other issues in their life that either contribute to overeating or impede weight-loss efforts.

The second recommendation in the ADA guidelines is that the weight-loss program should last at least six months and offer frequent contact with the nutritionist. We cannot in good conscience offer a client a written diet and only one or two diet instruction visits. We should decline clients who cannot commit to a program that is long enough to work. We can suggest to those clients who cannot truly commit to six months of professionally supervised weight management that perhaps they should wait until a later point in their life.

To encourage this long-term approach, dietetics practitioners can offer discounts for multiple sessions. Incentives, such as a rebate at the end of six months if all sessions are attended, could motivate clients to keep this long-term commitment. Nutritionists can pair with groups such as TOPS (Take Off Pounds Sensibly) Club, Inc. or Overeaters Anonymous so clients have professional meal plans but yet get peer support and camaraderie from these nonprofit groups.

Weight maintenance is also critical to stop weight cycling for many of our clients. Wright offers intensive, multiday workshops to her weight maintenance clients to continue support and help them tweak their diet plans so they can maintain their weight loss and continue to eat in a healthy manner. She not only discusses food and nutrition topics but also brings in expert speakers on subjects such as spirituality to offer a truly holistic approach to the complex issues of maintaining a healthy weight.

According to the ADA guidelines, much more research needs to be conducted before a consensus can be reached that one particular diet approach (such as cutting fat vs. cutting carbs) is the superior weight-loss method. However, the ADA did note that a low glycemic index diet has not been shown to be an effective weight management tool.

Another lesson from the business world is that successful products and ideas are those that are marketed well. Brian Wansink, PhD, John Dyson professor of marketing and nutritional science at Cornell University, has developed a manual on this subject appropriately titled Marketing Nutrition: Soy, Functional Foods, Biotechnology, and Obesity (see Today’s Dietitian September 2005 for a review of this book). Wansink reviews the research about motivating people to accept new healthy foods. A 1945 study examining how to get people to eat unfamiliar vegetables found that new foods are better accepted if they are prepared in a familiar manner. Witness the success of sweet potato fries. Familiar appearance also influences acceptance. If a new healthy food looks like a food people already eat, they will probably think it tastes better than if it looks “weird.” Witness the success of soy-based burgers and “chick” patties.

Another lesson is that people were much more likely to accept a new food if it was positioned as an addition to their diet and not something that would substitute for familiar favorites. This evidence supports the approach of offering clients new foods to add to their diet as better than the food police approach of “don’t eat this or drink that.”

Wansink’s book reviews research from the nutrition realm that confirms the adaptive problem-solving approach of free choice. Famous anthropologist Margaret Mead found that people who perceived a change in their diet as voluntary rather than forced were much more likely to adopt that change. She also found that compared with lectures, interactive group discussions led to five times the number of people trying a new food. This discussion method also led to children making better choices at lunch. When the children were only lectured on foods to choose, they initially chose a more nutritionally adequate lunch. But the children who participated in a discussion not only initially changed their food choices but those choices also became long-lasting habits. Active participation leads to better choices more than passive lectures.

Marketing professionals know they must segment the market. That means that not everyone is the right recipient for their message. This is true for weight management messages as well. There is a segment of consumers who are highly taste-conscious. Those consumers are not the audience for our “eat it, it’s good for you” message. They need messages about good food that tastes good. When surveyed, these taste-motivated consumers were more likely to believe they live with a great cook, are less traditional and more adventurous, and consider themselves opinion leaders. The good news is that people who adopt foods for taste reasons are more likely to continue eating these foods than people motivated only by health.

Strategies for Success
So far, this article has focused only on the individual. But in the complex issue of weight management, public strategies can assist every individual in the quest for health and a healthy weight. Lori A. Kaley, MS, RD, LD, MSB, of the Muskie School of Public Service at the University of Southern Maine, says, “We need to approach this from all levels. We need dietitians who can counsel individuals and conduct weigh-loss classes for small groups. We also need public policy and healthy environments that support individuals’ weight-loss efforts.”

Let’s use the state of Maine to illustrate the point. Maine residents can visit www.healthymainewalks.org and enter the part of the state in which they wish to take a walk, choose between indoor and outdoor, and find a nice walking route. The site also lists the length of the route so people can match the route with their time and fitness level. One walking path, the Eastern Trail, starts in Maine and has a path that reaches all the way to Florida. Safe Routes To School (www.saferoutesinfo.org) is gaining momentum in a state where rural children must share a road with a logging truck and sometimes even a moose. The point is, everyone must work together to help people become more active and achieve healthier dietary patterns.

— Carol M. Meerschaert, RD, is a freelance writer, a corporate consultant, and a lecturer in Falmouth, Me. She can be reached at carol@nutritionresource.com.

References
1. Heifetz R, Linsky M. Leadership on the Line. Boston: Harvard Business School Press, 2002.

2. ADA Evidence Analysis Library: Adult Weight Management Major Recommendations 2006. Available at: http://www.adaevidencelibrary.com

3. Wansink B. Marketing Nutrition: Soy, Functional Foods, Biotechnology, and Obesity. Urbana, Ill.: University of Illinois Press, 2005.