肥胖症的最新心理学观点报告：解决之道、实践和研究重点.pdf

July 2019Psychological perspectives on obesity: Addressing policy, practice and research priorities 2019 The British Psychological Society ISBN: 978-1-85433-776-4All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage retrieval system, without permission in writing from the publisher.Psychological perspectives on obesity: Addressing policy, practice and research priorities3ContentsAcknowledgements 4Executive summary 5Introduction and overview 91. The causes of obesity A complex interaction 122. Weight bias, stigma and discrimination 223. Changing behaviour 294. Preventive and community-based obesity services 365. Weight management service 44Further information 52Appendix A 53References 55Psychological perspectives on obesity: Addressing policy, practice and research priorities4AcknowledgementsThis document was written by the BPS Obesity Task and Finish Group. Chapters were led by Paul Chadwick, Angel Chater, Fiona Gillison, Clare Llewllyn, Helen Moffat, Lisa Newson, Marie Reid, Sinead Singh, and Vanessa Snowden-Carr with contributions from Anna Chisholm, Jacqueline Doyle, Colin Greaves, Ian McKenna and Ross Shearer.It was edited by Kathryn Scott (Director of Policy and Communications), Saskia Perriard-Abdoh (Policy Advisor) and Joseph Liardet (Policy Administrator).The authors would like to thank all the members of the British Psychological Society who contributed to the consultation on this reportEXECUTIVESUMMARYExecutive summaryPsychological perspectives on obesity: Addressing policy, practice and research priorities6EXECUTIVE SUMMARYExecutive summaryObesity has received much attention from politicians, policymakers, healthcare professionals, the media and the public over the past few decades. Indeed, since the formal recognition from the UK government in 1991 that obesity was a sufficient threat to the health of the nation to warrant a targeted response, addressing the issue has been a policy priority for almost thirty years. A wide range of policies are now in place, including the establishment of nutritional standards in schools, programmes aimed to boost physical activity, and weight management services. However, while some interventions and services have been successful at the individual and community level, there has been little impact at population level.This report looks at what psychological evidence and perspectives can add to help improve our combined response to obesity. It seeks to guide professionals and policy-makers who are working with individuals, groups and populations that are impacted by obesity to take an approach that is guided by psychology. We have sought to produce guidance that recognises and builds on existing services, while identifying areas where further resources, standards, training and staff are required. Summary of recommendationsREDUCING WEIGHT-RELATED STIGMA Journalists, policy makers, service providers and anyone who produces media about weight management should use language and imagery that does not stigmatise, for example using World Obesitys online image bank. There are still gaps in the evidence base. To develop the evidence base around emerging psychological approaches, public health research funders should incentivise research that seeks to answer questions around what language to use and how best to frame messaging about healthy weight, nutrition and physical activity to avoid stigma and promote healthy behaviours. This should include specific research to understand how to tackle the stigma that prevents people from using services and projects. Public health campaigns targeting weight management could be more effective by avoiding framing obesity as a simple choice and using psychological evidence and expertise to design campaigns. Managers and commissioners of weight management services should ensure that their premises and equipment provided minimise the risk of increasing stigma. GOVERNMENT Building on Public Health Englands Improving Peoples Health strategy, the government should explicitly adopt a psychological framework using evidence from behavioural and social sciences and proven behaviour change frameworks to organise a cross-departmental response. All new government statements, policy papers and strategies aimed at promoting healthy weight must demonstrate an understanding of the causes of obesity from a perspective that is informed by psychological evidence as well as consideration of the biological and social/environmental factors. Psychological perspectives on obesity: Addressing policy, practice and research priorities7EXECUTIVE SUMMARYSTANDARDS AND GUIDELINES Commissioners should incorporate quality standards around the full implementation of evidence-based weight management programmes. NICE guidelines for the treatment of obesity should provide clearer, more detailed examples of how evidence based services can be implemented most effectively in different settings. The guidelines should be updated with the inclusion of psychological evidence and the input of psychologists to guide the design of services. Clinical guidelines should incorporate evidence on the role that psychological factors can play in obesity, for example addressing past trauma, unhelpful attitudes and behaviours towards food and physical activity and dealing with stigma, emotional regulation, and managing setbacks for long-term maintenance. The NICE and SIGN guidelines for the prevention of obesity should be updated with the input of psychologists with expertise in behaviour change and weight management. Clearer examples should be included on the application of behavioural science in different settings.TRAINING AND SUPERVISION A nationwide training and supervision programme in the provision of psychologically informed behavioural support for weight management should be made available to all those working with people to help them to lose weight and maintain weight loss. Evidence-based training, aimed at health care professionals and people working in the fitness and nutrition industries, which covers the impact of weight stigma and outlines best practice, would improve clinical practice and service delivery. This should be provided by health education bodies as part of undergraduate training as well as being offered by professional bodies as part of continuing professional development (CPD) and vocational training. All health professionals delivering weight management initiatives should have regular supervision sessions with a practitioner psychologist to increase their awareness of how mental health conditions and psychological factors can contribute to obesity and the success of treatment. This supervision would also help professionals to understand and address their own unconscious biases within their practice, language and behaviour.WEIGHT MANAGEMENT SERVICES For weight management interventions to work most effectively, they need to be implemented properly and be able to cater for everyone who is an unhealthy weight, including those with a BMI over 50. Service providers, such as local authorities or CCGs, must ensure they commission evidence-based interventions and that they are fully implemented, fully resourced and are designed and delivered by people with appropriate psychological knowledge, skills and training. Weight management services are best delivered by integrated multidisciplinary teams (MDTs) that include psychologists who can support and train other team members to provide psychologically informed practice. All members of these MDTs should have an appropriate level of training in the underlying principles of how to change behaviour using psychological approaches. Health education bodies should invest in ensuring both psychological awareness for MDTs and more psychologists to support them.Psychological perspectives on obesity: Addressing policy, practice and research priorities8EXECUTIVE SUMMARY Services for children should be designed in the context of engaging parents in the context of stigma, concern about the development of eating disorders and parents understanding of childrens health and wellbeing. TALKING ABOUT OBESITY: A NOTE ON LANGUAGEThere is considerable debate about the most appropriate language to describe weight and this poses a real challenge for those working with people who are classified as overweight or obese. There is a lack of evidence about the impact that language can have on the effectiveness of responses to manage obesity. This report will predominantly use first-person language that considers people in a more holistic way, rather than by a characteristic1for example a person with obesity or living with obesity rather than an obese person. Where possible, we strive to use person-centred language and a strengths-based approach.INTRODUCTIONIntroduction and overviewPsychological perspectives on obesity: Addressing policy, practice and research priorities10INTRODUCTIONIntroduction and overviewObesity is not a choice. People become overweight or obese as a result of a complex combination of biological and psychological factors combined with environmental and social influences. Obesity is not simply down to an individuals lack of willpower. The people who are most likely to be an unhealthy weight are those who have a high genetic risk of developing obesity and whose lives are also shaped by work, school and social environments that promote overeating and inactivity. People who live in deprived areas often experience high levels of stress, including major life challenges and trauma, often their neighbourhoods offer few opportunities and incentives for physical activity and options for accessing affordable healthy food are limited. Psychological experiences also play a big role up to half of adults attending specialist obesity services have experienced childhood adversity.2This report looks at what psychological evidence and perspectives can add to help improve our combined response to obesity. It seeks to guide professionals and policy-makers who are working with individuals, groups and populations that are impacted by obesity to take an approach that is guided by psychology. Chapter 1 seeks to broaden our understanding of the influences that can lead to individuals and whole populations becoming and remaining overweight and obese.Next, Chapter 2 looks at evidence around stigma and shows how the common view that the cause of obesity resides within an individual has created negative stereotypes that have allowed weight bias and discrimination to go unchallenged. This has an impact not only on individual experiences but also on the way that policies and support services are designed. Since both services and service uptake can be compromised as a result, the importance of addressing weight stigma must be integrated as a central component of weight management services. Behaviour change is central to the prevention, management and treatment of obesity for individuals, groups and entire populations. Reversing the trend of increasing obesity rates over the past decades requires an integrated, evidence-based approach that recognises behaviours are influenced by a combination of biological, psychological and social factors. The report outlines how psychologists working in behaviour change science have designed interventions that work for individuals, groups, communities and whole populations.Chapter 3 outlines some of the policy frameworks and interventions that can bring about some of the large-scale population level behaviour change that is needed. It sets out how all these different elements and different levels of approach are connected, and why they are all needed as part of a joined-up response to obesity. While prevention activity can reduce demand, and community interventions can ease pressure on health services, the need for specialised services will not be eradicated and maintaining progress after an initial weight-management intervention is not guaranteed. A psychological understanding of obesity will add new evidence -based effective tools to policy-makers and practitioners toolkits. Chapter 4 examines community level interventions that have proven successful to change the behaviour of groups and communities. The final chapter looks at specialised services, demonstrating that, while clinical guidance is available, there is a challenge to ensure that it is followed, that recommendations are fully implemented and that specialist obesity services are able to provide holistic care.Policy and practice is already informed by evidence on biology, nutrition and some awareness of social context, but to be most effective it needs to become better informed by psychological knowledge and practice. Psychological evidence, expertise and experience from the frontline in weight