Evidence-based practice framing an occupational therapy-based weight loss programme for the Danish municipalities

Introduction
Obesity seems to increase all over the world, and it has therefore been labelled ‘the greatest public health challenge in our century’ as obesity is associated with a number of severe diseases. Besides becoming ill, citizens with obesity experience challenges engaging in occupations and experience fear of prejudiced.
In Denmark weight loss programmes are conducted in the municipalities as the municipalities holds the responsibility of health promotion and prevention. These programmes are developed and conducted differently in every municipalities in Denmark. Weight loss programmes placed in municipalities worldwide seem heterogenic which might be the same in Denmark. There is strong evidence for including the components diet, physical activity and behavioral therapy in weight loss programmes. However, weight loss maintenance is still a problem as citizens who lose weight seems to regain it after one to five years maybe partly because of a reductionistic approach. Occupational therapists are recommended to be part of weight loss programmes in the Danish municipalities and a recent scoping review has shown potential for occupational therapists in weight loss programmes because of a more holistic and occupational perspective. Weight loss within occupational therapy is still sparsely described and need to be further evolved. One way is by taking an occupational science perspective based on occupational engagement and health.
There seems to be a potential to develop an occupational therapy weight loss programme for the municipality context.
Objective
The overarching aim of this thesis was to develop knowledge about “best practice” to develop an occupational therapy weight loss programme for the Danish municipalities. “Best practice” was understood through the concepts of evidence-based practice: evidence, experiences from clinics and clients and context.
Design
To answer the overarching aim, four studies were made based on evidence-based practice. The concepts in evidence-based practice point at different epistemological understandings as it holds the ideas about evidence and perspectives. To integrate these differences in understanding a pragmatic eclectic approach situated this thesis. The benefit of this approach is that it provides possibilities of combining understandings and methods best suited for every specific aim with each study and thereby provide the possibility to enable knowledge from the different perspectives in evidence-based practice.
Study I: To examine Danish municipal weight loss programmes to identify and describe programme content and structure (i.e. dose, delivery format), the intended programme recipients, and the involvement of occupational therapists and other health professionals in programme delivery.
Study II: To understand what citizens with obesity who have not sought out municipal weight loss services would want in a weight loss programme.
Study III: To explore health professionals’ views of what an ideal, holistic weight loss programme should include.
Study IV: To obtain a description of what strategies could support the components of diet, physical activity, habits, social relations and occupational balance in a weight loss maintenance programme in Danish municipalities.
Results
In study I: Various health professionals conducted the programmes, and five involved occupational
therapists. Programmes targeted children, adolescent and adults. Dose, structure and content
were heterogeneous.

In study II: Three themes emerged from the analysis: “Creating structure for success”, “Needing support for making up for gaps in willpower”, “Changing to doing something with positive meaning”.

In study III: Three themes emerged from the analysis: “Support from the social network are important both during and after a weight loss”, “Changing the self-belief by positive discussions and doing activities”, “Maintaining changes through daily life”.
In study IV: Five themes presenting each component arose: 1) Diet – Find the line between either or, 2) Physical activity – Break the comfort zone, 3) Social relations - Stand strong together, 4) Habits – Focus on possibilities instead of bad habits, and 5) Occupational balance – Handling life´s bumps.
Conclusion
In this PhD project five components was found important in a weight loss programme: Diet, physical activity, social relations, habits and occupational balance. These components could be supported by taking an occupational perspective on weight loss by focusing on competence and wellbeing and by focusing on finding common meaning by engaging in co-occupations for weight loss maintenance.