The aim of this quiz is to challenge some of the common myths and misconceptions that many people – health professionals and patients alike – believe.
Encourage the group to participate and to give reasons for either true or false responses, so that common misconceptions can be aired.
Ask for show of hands, encourage group responses.
This might explain reported findings of narrower waist circumference despite no change in weight from some lifestyle improvement attempts. However, if a person gains weight from their lifestyle change, then that probably reflects overcompensation for the activity done – whether the weight increase reflects increased muscle or fat.
When following a physical activity (PA) programme, it is better to look for broader health gains rather than focusing exclusively on weight or BMI change.
This is an important concept to convey to patients – weight loss is simply the WRONG measure of PA benefits.
The body will always autoregulate for calories used up in PA by increasing appetite, so the energy gap is made up – unless there is accompanying calorie restriction. Which means feeling a bit hungrier…
Avoid using weight loss as the main measure of benefit from a fitness regime – otherwise, there is a danger that people will give up because of a false impression that PA is having no effect.
You could ask the group to compare likely PA benefits to be gained by someone in their 40s and someone in their 80s. For instance:
40s – reduction in risk of CVD and diabetes, improved self-esteem, motivation.
80s – reduced risk of falls, independence, social engagement, pain control.
Dietary protein content may be relevant to elderly people who increase PA, if their protein intake is currently low, particularly if there is evidence of sarcopenia (loss of skeletal muscle mass and strength as a result of ageing).
High-performance athletes may also need to consume additional protein to match their muscle turnover and muscle repair needs.
Calories in drinks should be included in the total calorie intake when assessing nutritional intake. Children doing high levels of sport could include “energy drinks” as long as these calories are considered alongside total dietary intake.
Children doing average levels of activity do not need energy drinks.
The term “isotonic” has been used as a powerful marketing tool, but it is based largely on pseudoscience. The body is capable of adjusting fluid balance whatever fluid is consumed, by adjusting the sense of thirst.
There is no convincing evidence that consuming calories in sugary drinks improves sporting performance.
Frequent self-monitoring of weight is not recommended for children and young people, because of the need to relate weight to reference ranges and interpret BMI centile changes. Where appropriate, this should be done by a health professional.
It is possible that some slimming clubs may try to discourage regular self-weighing in order to retain their central function of attending for the “weekly weigh-in”.
Daily weighing is an important predictor of weight stability – particularly for people reaching the maintenance phase of a weight loss programme.
Forcing children to “eat their greens” may be one reason why so many children appear reluctant to eat them. The misconception that “children hate vegetables” has become so embedded in Western cultural norms that many “children’s menus” may not feature any green vegetables at all.
These concepts will be discussed in a later workshop in this course.
This is an understandable belief, particularly in patients who have cardiovascular or respiratory problems such as angina or COPD. Graded exercise programmes are recommended for patients beginning an activity programme in response to a recent diagnosis.
Consider a medication review if someone is symptomatic because of inadequate treatment.
Give reassurance that breathlessness is expected and will recede with perseverance.
Explain to delegates that this session will consider any examples of local tools or good practice that they have brought or are aware of.
The aims of the session are to review existing tools, highlight gaps, and share awareness of local resources and good practice. Networking between colleagues can inspire engagement and a sense of a shared agenda.
Use a flip chart or type on screen to record comments and suggestions.
Begin by encouraging reflection over wider service provision across the local/regional health system.
Look for emerging themes and consensus over:
positive examples of provision and ideas that could be shared; gaps in knowledge, confidence, tools or wider service options.
Think about how you will note down comments – see box suggestion on the final slide in the presentation
Move the discussion towards encouraging reflection on personal considerations – e.g. strengths, weaknesses and barriers to discussing lifestyle, activity and weight issues with patients.
Encourage any suggestions or examples of how barriers can be overcome.
Template suggestion for recording or organizing group comments.
You could suggest that a summary of the discussion will be pulled together using this template and circulated once comments have been formatted.
Who else might find this summary of suggestions useful? For example, public health colleagues? Service commissioners?
1. Obesity is a chronic disease much
like diabetes or high blood pressure.
1. True – obesity is a chronic disease that requires
Managing excess body weight (obesity) is
similar to managing high blood pressure or
diabetes – left unmanaged, these conditions
get worse, and when treatments stop, the
problem comes back. This is why weight
management strategies have to be realistic
and sustainable. Short-term “quick fix”
solutions are not sustainable, which is why
weight usually comes back.
2. False – a kilogram is a kilogram!
• A kg is a kg regardless of whether
the kg is fat or muscle. Converting
a kg of fat to a kg of muscle – or
vice versa – will not alter weight.
Muscle is slightly denser than fat
and takes up a smaller amount of
space in the body.
3. Weight loss is the most important
goal of fitness and exercise.
3. False – many benefits arise from PA independently of
• The widespread health benefits from improved
fitness will accrue even if weight does not
change. These include reduced risk of
cardiovascular disease, type 2 diabetes, and
breast and colon cancer, and often an
improvement in mental well-being.
• Weight loss can be an important benefit from a
fitness regime but is only likely if accompanied
by a degree of calorie restriction.
4. Older adults are least likely to benefit
from physical activity.
4. False – regular physical activity can benefit everyone.
• Nobody is too old to enjoy the benefits of regular PA,
although when recommending activities you should
bear in mind a person’s abilities, interests and
• The health benefits gained by an elderly person may
differ from the benefits noticed by a young person
because their health needs and priorities are likely to
• PA is a crucial measure to prevent frailty and
sarcopenia in the elderly.
5. Active people need extra protein or
protein supplements to build muscles.
5. False – muscles develop from training and exercise.
• A person’s muscle make-up reflects their
muscle usage rather than their protein intake.
• Additional protein that is consumed over
normal functional requirements is converted to
energy for storage – it is not stored as
• Although protein supplementation is not
needed to build muscle mass, it is proven to
enhance muscle hypertrophy.
6. Energy drinks are an important way
to achieve improved sporting
performance in children.
6. False – water is the best way to rehydrate the body
• The body is better able to
regulate energy intake from solid
foods than from sugary drinks,
which have been strongly linked
to obesity and tooth decay.
7. Regular daily weighing (self-
monitoring) is a cause of anorexia
7. False – regular weighing (self-monitoring) is an
important predictor of weight stability.
• Anorexia nervosa is a complex psychiatric
disorder relating to a combination of factors
such as body image disorder, low self-
esteem and some environmental factors.
• In the case of a child or young person,
reports of frequent self-weighing should
trigger further exploration of body image
dissatisfaction and/or eating disorder, as
weighing may be a symptom – rather than
a cause – of an eating disorder.
8. Making a child clear the plate is a
good way to ensure the vegetables get
8. False – “clearing the plate” is an outdated concept.
• Forcing food is more likely to
generate a strong dislike of that food
and lead to mealtime battles.
“Generating a liking” for a food
stems from positive associations and
seeing other people enjoy that food.
• Eating to please others teaches
children to ignore their own hunger
9. If a person with overweight or obesity
gets breathless when exercising, they
9. False – building up fitness and stamina takes effort and
• For someone not used to exercising, it is
important to have reassurance that feeling
breathless and minor aches and pains are
a normal part of building up stamina.
• Recommend a gradual programme of
increasing duration and intensity of activity
as stamina and confidence increase.
• However, be careful with children known to
have respiratory diseases such as asthma.
Review of current local
tools and practice
activity and obesity in
• Why discuss
• How to influence
• What to explain
• Which goals and how to measure
• Where to get help
Questions to participants – open discussion
• What are the particular challenges facing health
systems in the region?
• What common barriers to health promotion and
behaviour change have you identified in the area of
nutrition, physical activity and obesity?
• What are the common challenges experienced by
your patients in changing behaviour?
• In which settings and types of consultation would
these issues be raised?
Understanding the local context for you personally
• What are the key factors?
• Which patients are the most engaged?
• What are the barriers and enablers for
integrating lifestyle counselling in your
• Do you have adequate tools?
• Are you able to signpost your patients to
Group discussion summary: addressing barriers
Patient barriers (e.g.
obesity and weight
bias impact on self-
esteem, gender roles
inactivity not high
priority for political or
health system agenda)