Lifestyle programs are extremely popular. People are happy to take the step to try to live a healthier life, but more and more participants drop out prematurely. Still, experts remain enthusiastic. “74 percent completes the first year, which I see as a profit.”
Fabian Hulleman has been kickboxing twice a week since September 2022 with a group of friends. That doesn’t sound special, but in his case it is extraordinary. Fabian weighed 180 kilos last year and he hardly left the house anymore. He and his new friends participate in a so-called ‘combined lifestyle intervention’ (GLi).
‘GLi has been a kind of rescue’
Fabian has opted for a program in Deventer that involves group sports. In the first weeks of the program, all kinds of sports can be tried, from football to Zumba. Fabian eventually chose kickboxing.
“The first 2 months I was completely broken after half an hour, now I can easily continue,” he says. “I have become so fat due to circumstances, but now I have lost 12 kilos in 9 months. That doesn’t seem like much, but for me it is very much. The fact that we train in groups is very important to me. The GLi is been a kind of salvation for me. We do it together, we can talk about it and I have social contacts again.”
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A GLi is a lifestyle program for overweight people. It is usually offered as a group program lasting two years. Participants with a certain BMI are forwarded by their GP or hospital. They receive individual counseling and attend group meetings.
Lifestyle coaches and, if necessary, dieticians, physiotherapists or remedial therapists and psychologists are involved. Since the start of the program in 2019, a total of 33 million euros has been reimbursed by the insurers. A total of 73,000 people participate. According to figures from the RIVM, 26 percent drop out in the first year. In the second year, another 35 percent drop out early. Why people drop out has not been studied.
The participants who complete the program show that the average weight loss is 3.8 kilos. For 70 percent of the participants whose BMI and waist circumference were measured, outcomes improved or at least did not worsen during the treatment phase. Participants say their quality of life increased from 59 to 66.6 on a scale of 0 to 100.
Reducing belly fat
Professor of obesity and internist Liesbeth van Rossum is positive about this form of intervention. “Maybe half will drop out in two years, but 74 percent will complete the first year. I see that as a gain. That is comparable or even less dropout than similar programs abroad. On average, these people improve their lifestyle.”
It is not really about the excess weight, but about the belly fat, emphasizes Van Rossum. “Small inflammations arise in that fat and these can give rise to all kinds of diseases, such as type 2 diabetes, 13 types of cancer including breast and colon cancer, cardiovascular disease, and joint complaints. But that abdominal fat also affects the brain and can lead to to depression or anxiety disorders. In fact, hundreds of conditions are caused or exacerbated by obesity.”
Obesity as a chronic disease
The WHO and the Dutch Health Council have therefore officially defined obesity as a chronic disease. “In people with obesity, the system that regulates appetite is often disrupted,” explains van Rossum. “As a result, many people do not feel that they are full in time.”
“Satiety is a process that involves the gut, the fat hormone and the brain,” she continues. “The satiety hormone system can partially recover, but not 100 percent. That is why coaching towards a healthy lifestyle, which can also be maintained for the rest of life, is so important. Even if a participant would not lose a gram in weight, but would lose 3 kilos Losing belly fat and creating extra muscle tissue, then great gains are already made, both mentally and physically.”
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‘Only diets do not yield anything’
Van Rossum believes that obesity is not the fault of people themselves. “In addition to an unhealthy lifestyle, there are many factors that can contribute to overweight. Medication use, for example. There are medicines such as anti-depressants, diabetes medicines and corticosteroids.ïwhere people can come from.”
“And there are numerous psychological and social factors such as loneliness, traumatic past, stress and poverty. All reasons that people can become overweight. That is why the approach of the GLi is broader than just attention to nutrition and exercise. It is also about stress, sleep and what is going on in people’s lives. Dieting alone does not yield anything in the end. It is about changing behavior, often in small steps”.
Wall between itself and the outside world
Lifestyle coach and exercise broker Meriel Hendriks agrees with Van Rossum. “I guide groups of 15 people who all have their own backpack. Sometimes they weigh 180 or 200 kilos. There is always a story and a lot of sadness behind it.”
“People have literally created a wall between themselves and the outside world. So how can you get them to take care of themselves again? That’s really a huge challenge.”
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Break eating habits
Hendriks sees that people like Fabian make friends by exercising together. “Last week a lesson was canceled and it was spontaneously decided to go for a walk together. I think that’s nice to see.”
In Hendriks’ lessons the word ‘dieting’ is not used either. “But we do keep a food diary. We also discuss that together. In this way we try to break an unhealthy eating pattern together.”
‘We keep each other sharp’
Hendriks thinks it is too simplistic to say that people only lose 3.8 kilos and that therefore the GLi would not work. “When I see people regain self-confidence, their quality of life improves and they get more social contacts, I am proud of each individual participant.”
“I’m not ashamed of my body, but I’m scared when I look at pictures,” says Fabian in the canteen after a workout. “But I’m doing well now. We keep each other sharp and call if you don’t show up. I feel much better, I’m clearer in my head, sleep better and I haven’t ordered anything from Thuisbezorgd for 5 months.”
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2023-07-03 05:00:01
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