Learning disabilities. Changing behaviours.

Public health nutritional interventions, like clinical treatments in medicine or psychology, should be based on direct evidence of their efficacy relative to prior existing modalities. Yet the contribution of applied human nutrition and the psychology of eating to research into ways of slowing the rise of obesity has been limited to the intake of energy nutrients and investigator-prejudged questions about appetite and food choices. In contrast, it is feasible to get members of the public to describe their patterns of eating in their own words. Self-assessed current frequency of each common potentially less or more fattening eating pattern can then be used to associate weight change with changes in habit frequency. This design has been used to identify the long-term least fattening eating patterns retrospectively and prospectively in several studies in England and Germany. Without using assessments of usual nutrient intake, these studies demonstrate that the least fattening patterns over 1-2 or more years are drinks between meals with no energy intake, cutting back on fat in all foods and replacing as much sitting and riding as feasible each day with walking or cycling. An hypothesis to be tested by this method is that the only known automatic mechanism for eating less dessert is the learnt effect of boosting the readily digested carbohydrate content of high-energy main courses. Such evidence-based advice as well as self-therapy for emotional eating and body-shape distress should be the front line of defence against unhealthy weight gain and re-gain.

Behavior Therapy↗

PubMed1999

Implementing outcome systems: lessons from a test of the BASIS-32 and the SF-36.

With increasing pressure from third-party payers to assess client outcomes, clinical programs want to know how to implement outcome systems. This article focuses on practical and logistic questions involved in implementing an outcome assessment system in ambulatory behavioral healthcare settings. Study questions addressed outcome systems in general and the use of the Behavior and Symptom Identification Scale (BASIS-32) and the Short Form Health Status Profile (SF-36) in particular. General questions focused on obtaining provider buy-in, client consent and confidentiality, data collection methods, sampling, time points, maximizing client participation, clinical utility of outcome data, and resources needed for outcome assessment. Measure-specific questions focused on client acceptability of the instruments and applicability of measures to diverse populations. The article suggests several strategies for enhancing outcome assessment efforts and concludes that there remains a need for further understanding of ways to maximize the utility and value of outcome measurement.

Behavior Therapy↗