GPs, more than most, are well used to the lines: ‘all my family were big-boned’; ‘it’s in my genes’; ‘you see, I have the wrong metabolism’; etc. It’s fair to say that men have ducked and dodged around what is increasingly being described as an emerging obesity epidemic in Ireland. As men’s waistlines have been steadily expanding, women have led the way on most weight-loss initiatives – although this has begun to change more recently. 

 (click to enlarge)

Introduction

So how much of a problem is male obesity in Ireland? What are the key (sex) differences in the way that women and men gain weight and are there additional (gender) differences in men’s and women’s attitudes to their weight and in their approaches to weight loss? 

More importantly, what are the key factors to take into account when tailoring lifestyle interventions directed at overweight/obese male patients? 

These are some of the questions that this article poses and they will be discussed in the context of the key findings from a recent postgraduate study conducted in the south-east that informed the design of a resource booklet for health practitioners.¹

Why men?

Unhealthy diets and physical inactivity are among the leading causes of the major non-communicable diseases including cardiovascular disease, type 2 diabetes and certain types of cancer, and contribute substantially to the burden of disease, death and disability.²

Obesity levels in men have more than tripled since 1990 (up from 7.8% in 1990 to 25.8% in 2011). The greatest increase has been observed in 51-64-year-old men, with the rate quadrupling from 10.7% to 42.1% during the same period.³ Central (or visceral) obesity is more prevalent among men than women and is associated with an increased risk of hypertension, diabetes and metabolic syndrome.¹ 

A study conducted in the HSE South revealed that, despite overweight/obesity levels being much higher in men, the majority of referrals (62%, n = 6,224) to the HSE South Community and Nutrition Dietician Service for the year 2008 were for women.¹

What is different about men?

Underpinning these worrying male obesity statistics are a number of important gendered aspects of male obesity: 

• Men’s diets are less healthy than women’s diets, with men eating more fried foods and high-caloric items and less fruit and vegetables than women⁴

• Men who are overweight/obese tend not to see their (excess) weight as a cause for concern. Indeed, men tend to become concerned about their weight only when their weight has reached obesity proportions or becomes associated with obesity-related comorbidities⁵

• Men tend to lack control over their diets and are less knowledgeable than women about the health benefits of particular foodstuffs.^6,7 Men are also less likely than women to read food labels⁸ and tend to rely on women for advice and support on food and dietary matters⁹

• Previous studies have shown that men working shift hours and commuting long distances tend to have an increased reliance on convenience foods, snacking and eating out^10,3

• Men’s approach to food is often pleasure-oriented, with healthy food often being seen as insubstantial or being associated with ‘hassle’, ‘self-denial’ and ‘blandness’⁹

• ‘Bigness’ is associated with more dominant notions of masculinity, leading many men to strive for a large body frame as opposed to a ‘normal’ body weight.¹¹ For men, meat-based diets and bulk items remain privileged within discussions of food, particularly with reference to fitness rather than health¹²

• Men can often be resistant to healthy-eating messages or to being ‘told’ what to eat 

• Previous qualitative studies^9,12-13 reported scepticism and cynicism among men who were interviewed toward healthy-eating messages filtered through the media. Some men view such information as misleading and as an affront to their freedom of individual choice in terms of what they eat 

• Men are much less likely than women to consider dieting as a means of weight loss 

• Men tend to view exercise and sport as a more acceptable means of trying to lose or maintain weight 

• Men are more open to dietary change or to losing weight when prompted to do so by their GP.⁹ This highlights the potency of appropriate medical advice in altering the dietary behaviours of men.

Men are more likely to manage their weight by exercise than by dieting(click to enlarge)

Best practice approaches to tackling male obesity in the primary care setting¹

Utilise your professional status to prompt male patients to address overweight or obesity

GPs in particular have a crucial role to play in raising obesity as an issue (or as a potentially serious health problem) with their male patients. Indeed, men are more likely to take weight loss seriously when prompted to do so by their GP.

Adopt a ‘shared investment’ approach to lifestyle change 

Support and empower men to take responsibility for lifestyle changes that can bring about long-term and sustained weight loss. Men like to be consulted and to feel as equal partners in negotiating lifestyle changes aimed at reducing weight.

Recognise the potential role of obesity as a confounding factor in mental health and addiction problems among men⁸

Examine the potential for multidisciplinary approaches in working with mental health and addiction services.

Build trust and rapport in supporting men to lose weight

Trust, humour and rapport are necessary characteristics when working with obese men to help instil confidence towards weight loss and to build an effective working relationship. 

Recognise key ‘transitional’ periods in men’s lives 

These are periods where men are more likely to gain excess weight – for example, after they get married, when they retire from competitive sport, if they lose their job or if they stop smoking – and are periods when support is particularly needed. 

Conversely, the onset of a health problem may be the catalyst for increased motivation and commitment towards losing weight.

Account for and anticipate likely problems or barriers to weight loss

Tailor advice to meet potential barriers that can occur in the context of men’s lives, ie. work or family commitments, food affordability, etc. There is also a need to counter perceptions of healthy food as bland or unappetising.

Use support tools when working with men

A good incentive when working with men is to describe processes in terms of bodily mechanics or the use of visual aids. Men tend to like gadgets, eg. pedometers, measurements (BMI, waist circumference etc), scores/results and the identification of goals. 

Place a strong focus on physical activity as a means to weight loss for men

Men tend to see physical activity as more relevant than nutrition to weight loss, therefore are more likely to seek to manage their weight by means of exercise than by dieting. Prescription of exercise may be a better starting point for men who wish to lose weight, with appropriate dietary advice being offered as soon as some success has been achieved.

Develop a network of supports for obese men to help maintain behaviour change

For example, follow-up texts or telephone calls can be used if one-to-one consultations are not feasible. Refer to the GP Exercise Referral Programme/Green Prescription. 

Tailor the approach to the individual 

Services need to account for the significant differences between men and not just between men and women. Particular focus should be placed upon men who are older (aged 45-64), unemployed, live alone, are less educated or who work as shift workers, eg. truck drivers, security men and taxi drivers.

Conclusion

To effectively implement these effective practice guidelines in lifelong healthy weight management of men, all members of the primary care team should adopt the following ethos:

• Ensure that discussions on weight are a natural part of consultations with overweight/obese men. Carry out height, weight and BMI measurements for all patients as part of a routine health check 

• Increase men’s awareness of the potential ill effects of excess weight 

• Avail of opportunistic brief interventions with men in relation to their weight that can fit appropriately within a typical consultation 

• Adopt a client-centred approach to weight loss, emphasising personal choice and responsibility with regard to lifestyle behaviour change 

• Encourage men to reflect on the importance of both healthy nutrition and physical activity/sport as a means to healthy weight management 

• Create an association between health foods and substance/satiation to counter perceptions of healthy food as bland or unappetising

• Fully utilise all expertise and supports available through multidisciplinary team working.  

References

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2. Irish Universities Nutrition Alliance. National Adult Nutrition Survey: Summary Report. Available at: http://www.iuna.net/wp-content/uploads/2010/12/National-Adult-Nutrition-Survey-Summary-Report-March-2011.pdf 
3. World Health Organization. On behalf of the European Observatory on Health Systems and Policies. Health in the European Union: trends and analysis. WHO Regional Office: Copenhagen, 2009
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10. Department of Health and Children. Obesity: The Policy Challenges. The 
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13. Watson JM. Male Bodies: Health, Culture and Identity. Buckingham: Open University Press, 2000
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