Time to Abandon the Notion of Personal Choice in Dietary Counseling for Obesity?
Time to Abandon the Notion of Personal Choice in Dietary Counseling for Obesity?
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DOI：
10.1016/j.jada.2011.05.014
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发表时间：
2011-08-01
影响因子：
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通讯作者：
Pagoto, Sherry L.
中科院分区：
文献类型：
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作者：
Appelhans, Bradley M.;Whited, Matthew C.;Pagoto, Sherry L.
目前的肥胖症饮食咨询方法在很大程度上植根于“个人选择”的概念。通常，患者接受有关饮食对能量平衡的贡献的教育，然后鼓励他们做出与减肥一致的饮食选择（例如，食物选择，份量大小）。然而，即使是高度积极性和营养信息丰富的患者也常常难以避免现代环境中提供的高美味，高能量的食物，最终，只有一小部分人通过饮食调整实现持续减肥（1-4）。体重控制的失败尝试对患者和供应商都是令人沮丧的。研究表明，双方经常将肥胖归因于患者的“个人选择”或“意志力”不足（5，6）。例如，英国营养师的一个样本将“缺乏意志力”列为比遗传因素更重要的肥胖发展（7），即使成年人的体重是55-75%遗传（8，9）。由于不健康的个人选择或缺乏做出健康选择的意志力，个人变得或保持肥胖的建议对患者来说是耻辱的，不太可能激励患者减肥（10）。在肥胖症的饮食咨询中，不强调个人选择的作用将减少耻辱感，但这样做有可能破坏患者对自己饮食的控制感。
Current approaches to dietary counseling for obesity are heavily rooted in the notion of “personal choice” Typically, patients receive education about dietary contributions to energy balance and are then encouraged to make dietary choices (eg, food selections, portion sizes) consistent with weight loss. Yet even highly motivated and nutritionally-informed patients often struggle to refrain from highly palatable, energy-dense foods available in the modern environment, and ultimately, only a small percentage of individuals achieve sustained weight loss through dietary modification (1–4). Failed attempts at weight control are frustrating to patients and providers alike. Studies show that both parties frequently attribute obesity to poor “personal choices” or insufficient “willpower” on the part of the patient (5, 6). For example, a sample of British dietitians ranked “lack of willpower” as more important to the development of obesity than genetic factors (7), even though adult body mass is 55–75% heritable (8, 9). The suggestion that individuals become or remain obese due to their unhealthy personal choices, or a lack of willpower to make healthy choices, is stigmatizing to patients and unlikely to motivate patients to lose weight (10). Deemphasizing the role of personal choice in dietary counseling for obesity would reduce stigma, but doing so carries the risk of undermining patients’ perceived control over their