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Obesity and exercise: A psychological perspective

Submitting Institution

University of Northampton

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

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Summary of the impact

Obesity in the UK is a growing problem for individuals and for NHS resources.^a,f There is evidence to suggest that the Government's healthy living messages are failing to get through, as figures show obesity levels have almost doubled in 14 years.^a,f More than half the adult population are now overweight or obese.^b The report led by Waumsley that reviews the evidence base for psychological approaches to obesity and provides guidelines for practitioners forms the basis for this impact case. This influential research on secondary data was commissioned by the British Psychological Society (BPS) and remains their position statement on obesity, and features in advice to the general public on obesity in adults. As lead, Waumsley participated in a House of Lords cross-party seminar on behaviour change and obesity, has been an expert discussant on obesity at the BPS Annual Conference, and will lead the BPS's response to the National Institute for Health and Care Excellence (NICE) consultation on Overweight and obese adults: lifestyle weight management.

Underpinning research

In 2008 the BPS commissioned Waumsley to Chair an expert panel to review the evidence for effects of psychological factors upon obesity and to produce a position paper for the Society that would complement NICE clinical guidelines.^b Waumsley was appointed in recognition of her expertise as both a BPS Chartered Sport and Exercise Psychologist and an expert counselling practitioner, and her experience as Parliamentary Officer for the Division of Sport and Exercise Psychology. The analysis of published findings was intended to provide accessible, clear and explicit guidance for applied psychologists and other professionals within multidisciplinary teams who undertake support work with obese individuals by identifying and advising on professional concerns and challenges that they face.

At the time of this report, childhood obesity was increasing with the associated health problems, including a rise in diabetes.^d,g The NICE clinical guidelines^b offer national guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in England and Wales. They suggest a multidimensional approach within existing PCTs and communities that address the issues of lifestyle, diet, exercise, working with adults and children, motivation and behaviour change. However, despite their thoroughness, these guidelines have proved difficult for clinicians and other practitioners to apply, with anecdotal evidence suggesting a lack of confidence in recognising how to implement behaviour change and motivation strategies or to prescribe exercise programmes or dietary advice.^h The BPS report consists of original research on secondary data in order to synthesise those research findings in an accessible form, and so provide such clear and practicable guidance on current understanding of psychological factors affecting the occurrence and treatment of obesity.

To this end, a representative expert cross-disciplinary panel Chaired by Waumsley was convened and met regularly in the British Psychological Offices in London. The panel consisted of members from The Division of Health Psychology (Dr Lisa Newson, NHS Knowsley Public Health Team), The Division of Clinical Psychology (Dr Susan Boyle, Consultant Clinical Psychologist, Glasgow & Clyde Weight Management Service; Dr Beverley Flint, Chartered Clinical Psychologist, Camden Weight management Service), The Division of Counselling Psychology (Professor Julia Buckroyd, Professor Emeritus of Counselling, Hertfordshire University; Dr Jacqui Finnigan, Counselling Psychologist; Emma Kewin, Chartered Counselling Psychologist, Specialist Bariatric Team, North Bristol Trust; Dr Katheryn Roberts, Eating Disorders Northampton) and The Division of Sport and Exercise Psychology (Professor Nanette Mutrie, Professor of Exercise & Sport Psychology, University of Strathclyde; Dr Julie Waumsley, Senior Lecturer Psychology & Counselling, The University of Northampton and Chartered Sport & Exercise Psychologist; and Dr David Marchant, Senior Lecturer in Sport & Exercise Psychology, Edge Hill University) The Division of Education Psychology (Dr Kairen Cullen (Educational Psychologist). Together, this Working Group reviewed current understanding of psychological factors that impact across their range of disciplines, identified intervention strategies and evaluated their efficacy. Individually, each member concentrated on their area of expertise to draw on empirical evidence, Government reports,^a,b,c,e and applied practice to produce a report that showcased the psychological perspectives on Physical Activity and Exercise Psychology; Exercise for morbidly obese individuals; Applied interventions and management of obesity; Weight loss surgery; Pharmacological interventions; Obesity in children; and Psychological interventions for people with BMI>35. As well as authoring one of the chapters of the report, Waumsley served as editor of the other contributions to ensure coherence and was responsible for the report's introduction and conclusion that identify the key lessons and implications.

The report was not intended to undermine the importance of factors identified in the NICE guidelines as contributing to the obesity epidemic, but rather argued for the added value that psychological and therapeutic approaches can make to the treatment of the complex problem of obesity. Recommendations for behavioural change are made in the report; when implemented by clinicians and other practitioners, these guidelines will have clear impact upon the sustainability of healthy practices and benefits for the health and wellbeing of clients and service users.

References

a. Department of Health (2009). Cost of obesity to NHS in England. http://www.dh.gov.uk. Accessed 7th August 2009.

b. NICE (2006). Obesity: guidance on prevention, identification, assessment and management of overweight and obesity in adults and children. London: Nice Clinical Guideline 43, National Institute for Health and Clinical Excellence.

c. Northern Ireland Executive (2008). Obesity time bomb is ticking louder than ever — north and south. http://www.northernireland.gov.uk/news Accessed 12th April 2010.

d. Reilly, John, J. (2009) `Obesity in children and young people' Highlight no.250 National Children's Bureau.

e. Scottish Government (2010). Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight. The Scottish Government, February 2010.

f. Health Survey for England (2008), taken from National Obesity Observatory Adult Data Briefing 2010.

g. (EarlyBird Diabetes Trust, http://www.earlybirddiabetes.org Accessed 2008

h. Waumsley, J., & Mutrie, N. (2011). Physical Activity & Exercise Psychology: Our role in healthy weight management for adults in Obesity in the UK: A psychological perspective, The British Psychological Society Obesity Working Group 2011.

References to the research

• Waumsley, J. (Ed.) (2011). Obesity in the UK: A psychological perspective. Leicester: The British Psychological Society ISBN 978-1-85433-714-6

• Waumsley, J., & Mutrie, N. (2011). Physical Activity and Exercise Psychology: Our Role in Healthy Weight Management for Adults. In J. Waumsley (Ed.) Obesity in the UK: A psychological perspective. pp. 5-15. Leicester: The British Psychological Society ISBN 978-1-85433-714-6

Details of the impact

The report on obesity is still the BPS's position statement in relation to this issue and continues to be available to download from their website [1]. The BPS sent out a press release to all major media outlets [2] and appeared on BPS Facebook and Twitter feeds, and the story was reported by a number of national newspapers, including the Guardian and Daily Telegraph. The report was picked up by various online media including Medical News Today and Obesity Australia [4, 9], and features on websites offering health advice to the general public on obesity in adults because of the importance psychology plays in the treatment of weight issues, thus far neglected as an intervention within treatment programmes [5, 6, 10].

The report was disseminated widely, including to Andrew Langsley, the Secretary of State for Health. In November 2010, when the report was nearing completion, Waumsley was invited to attend a House of Lords cross party seminar on behaviour change interventions to prevent and tackle obesity [3]. This occurred in the context of London preparing for the London 2012 Olympic Games where fitness and health would naturally be promoted and where creating a legacy was important, yet half the population was identified as obese or morbidly obese. The debate acknowledged the power of food companies and their partners in the advertising and marketing sector to influence eating behaviour, and a psychological approach to obesity was welcomed. An outcome from the debate was the recommendation to take the issue to a cross party discussion across Parliament. Further correspondence followed with Professor the Lord McColl [7]. Reducing obesity and improving dietary behaviours is currently an area of government policy [8]

Waumsley was invited to participate as one of three expert discussants for a special panel on obesity at the BPS Annual Conference (10 April 2013). The panel was aimed at practitioners with the intention of advising on evidence-based best practice [9]