The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in The Netherlands.

BACKGROUND: Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem. OBJECTIVE: To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype. METHODS: Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight. RESULTS: The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements. CONCLUSION: The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.

Determinants of salt use in cooked meals in The Netherlands: attitudes and practices of food preparers.

OBJECTIVE: To assess current habits of using salt and other seasonings in food preparation, and to investigate the psychosocial determinants of salt use. In addition we examined differences in salt consumption and psychosocial determinants with respect to stages of change and socio-economic classes. SUBJECTS AND METHODS: 400 adults were interviewed to determine: 1) use of salt and other seasonings in food preparation; 2) added table salt; 3) consumption of foods with high salt content; and 4) psychosocial determinants of salt consumption. Subjects were divided into 5 stages of change for salt content of the cooked meal: precontemplation, contemplation, decision, action and maintenance. RESULTS: Salt appeared to be the type of seasoning mostly added in food preparation. Frequently used seasonings containing no added salt were pepper, onion, nutmeg, garlic, curry, sweet pepper powder, parsley, and bay-leaf. Spearman correlation coefficients between added cooking salt and taste attitude, health attitude, social influence and self-efficacy were 0.51, 0.14, 0.36, and 0.32 respectively. Correlations between consumption of foods with high salt content and convenience attitude, taste attitude, health attitude and self-efficacy were 0.41, 0.27, 0.18 and 0.21 respectively. Subjects in maintenance of low salt consumption, used less salt than subjects in precontemplation. Socio-economic status only showed an effect on the use of foods with high salt content. CONCLUSION AND PRACTICAL IMPLICATIONS: Health aspects did not play a major role in salt intake, whereas taste attitude was an important predictor of added cooking salt. Attempts to reduce cooking salt should be directed at satisfying taste. Nutrition education tailored to stages of change may be very helpful in decreasing salt consumption.