Running a weight-management programme with a psychological focus within a lymphoedema service
Weight management and psychological health are intertwined. Patients in this context are often mindful of how to eat healthily and what they need to do to lose weight, but frequently self-sabotage, with external influences often impact any attempted weight-loss approach. Consequently, any form of lymphoedema management is also thwarted and vicious cycles between success and rebound occur. This article describes a 6-week weight-management programme that took place before the COVID-19 pandemic. The programme focused exclusively on the expectation that, if a patient's psychological health could be improved, weight reduction would occur as a result, and, in turn, any positive effects on adherence with lymphoedema treatments could be observed.
Lymphoedema services often support patients who are overweight or obese (Provan, 2019). Being overweight or obese are risk factors for the development of lymphoedema and can also be a complication in its management (Provan, 2019). In the UK, clinical efforts to help patients lose weight and keep this weight off have been found to be ineffective (Moffatt et al, 2019; Nymo et al, 2019; Busetto et al, 2021). Studies have indicated that a variety of strategies and approaches successfully lead to weight loss, but evidence shows that the majority of these patients then regain weight (Kouvelioti et al, 2014; Shantavasinkul et al, 2016; van Baak and Mariman, 2019). A common pattern for patients in the author's lymphoedema service is ‘yo-yo’ dieting—moving from one diet to the next, or one approach to the next, losing and then regaining weight. As a result, patients typically become highly demoralised, and this emotional state then sabotages possible future attempts to lose weight. In psychological terms, the experience of repeated failure, ie weight regain, has a serious negative impact on feelings of personal control, to say nothing of the adverse impact on self-esteem (Quinn et al, 2020).
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