Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Research has focused on diet, exercise, and cognitive–behavioral therapy as the core components of weight loss programs. However, a sustainable weight loss is still challenging, maybe because of an individual perspective. Our long-term aim is to develop a holistic evidence- and OT-based weight loss program. Our studies show that the three usual components should be extended with habit, social relations, and occupational balance integrated into everyday life.
Primary Author and Speaker: Christina Jessen-Winge
Additional Authors and Speakers: Anette Enemark Larsen, Svetlana Solgaard Nielsen, and Jeanette Reffstrup Christensen
PURPOSE/BACKGROUND: The purpose with this study was to understand what people with obesity and occupational therapists find feasible in an evidence- and occupational-based weight loss program. This study is part of the developing of an evidence-based occupational therapy program to reduce overweight and enhance wellbeing implemented in the Danish municipalities. The program is called Danish Obesity Intervention Trial (DO:IT). In 2016 1.9 billion people were overweight and of these 650 million were obese worldwide. This is a challenge because living with overweight or obesity effect a great spectrum of life. Not only is it associated with health consequences, but it affects everyday life because of physical and psychosocial barriers. Therefor weight loss programs are offered, however a challenge often mentioned in the literature is to sustain the lost weight. One critic is the focus on weight loss as an individual problem as seen in components diet, exercise and behavioral therapy. The components are often linked narrow to sport and calories instead of the everyday life of people struggling to lose weight. A scoping review by Nielsen et al, 2019 showed that occupational therapy has a role to play in weight loss programs and sustainability because of their holistic approach by focusing on person, environment and occupations. This goes in tandem with earlier results in our developing phase of DO:IT. Sixty-six interviews were conducted with health professionals and people with obesity about their wishes for a weight loss program (Jessen-Winge et al, 2020a, Jessen-Winge et al, 2020b) The results showed the importance of working with integrating the changes in everyday life and that the components diet and exercise should be supplemented with three more components: habits, occupational balance and social relations (Jessen-Winge, 2020a, Jessen-Winge 2020b).
DESIGN: This study took a participatory design by using research circle (RC) methodology.
METHOD: RC builds on a democratic tradition as the knowledge are generated on equal terms between the participants. The participants were people with obesity, occupational therapists and researchers. All in all, 14 participants were included in this study. We had two groups and conducted four research circle meetings with each group. The meeting lasted two hours and was conducted every third week in a meeting room at the University. Based on the 66 interviews from earlier studies in DO:IT the aim of the RC was to discuss the five components to reach a detailed description of how to include these in a weight loss program. The data were analyzed using qualitative content analysis on a manifest level between the first three meetings. All data up to the fourth meeting was analyzed separately for each circle forming preliminary categories. The categories were validated in the last meeting. After the last circles the comments from the circles was discussed between the researchers in order to refine and modify them until the five themes emerged there seemed to fit the data in the best possible way.
RESULTS: Preliminary data showed five themes: Theme 1: ‘Diet – Find the line between either or’; theme 2: ‘Physical activity - Breaking the comfort zone by finding a positive meaning with physical activity’; theme 3: ‘Social relations – Learn to stand strong together’; theme 4: ‘Habits - Make habits not vices’; theme 5: ‘Occupational balance - Handling the bumps in life with adaptability’.
CONCLUSION: Findings suggest that participants believe it is possible to include the five components in a weight loss program and that they should be integrated in everyday life by focusing on both person and environment in a changeable life to support a sustainable weight loss and wellbeing.
References
Nielsen SS, Christensen JR. (2019). Occupational Therapy for Adults with Overweight and Obesity: Mapping Interventions Involving Occupational Therapist. Occupational Therapy International. Vol 2018, Article ID 7412686, 17 pages https://doi.org/10.1155/2018/7412686
Jessen-Winge C, Ilvig PM, Fritz H, Brandt CJ, Lee K, Christensen JR. What a weight loss programme should contain if people with obesity were asked – A qualitative analysis within the DO:IT study. BMC Public Health. Manuscript number: PUBH-D-19-03811
Jessen-Winge C, Ilvig PM, Fritz H, Thilsing T, Lee K, Christensen JR. How a weight loss program should be if experienced health professionals were asked: a qualitative interview study. BMJ Open. Manuscript number: Draft.
