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Blog: Managing Lifestyles

At the start of a New Year,  maybe after overindulging during Christmas, how many of us are making an effort to take more exercise or improve our dietary habits? Very often it is the combination of eating more than we should, while doing physically very little physically that contributes to each of us gaining a few excess pounds.

Maybe you did not succumb, but I am sure there are lots of patients who will have done and will come in to their GP surgery asking for advice. Small changes are required such as reducing how many potatoes eaten at a main meal or cutting out a sugary or alcoholic drink each day.

Alternatively, perhaps suggesting walking upstairs if only living a few floors up, on the way to work getting off the bus or train a stop earlier to get a little more exercise or obtaining a pedometer, which can be a great incentive for increasing physical activity.

If these small changes are maintained, then individuals should see improvements to both weight and wellbeing - and better blood glucose control.

How many of you have been aware of the update to the NICE Guidelines on Obesity (CG189)?  Now there is now a section which states that surgery may be the best way forward for those who have had Type 2 Diabetes under 10 years, whose BMI is 35 or greater in White Caucasians and much lower in those of South Asian Origins. This is particularly for cases where lifestyle interventions have been tried and may have failed.

There are so many people with Type 2 Diabetes who have weight concerns and need help. I recently attended the National Obesity Annual Conference, where the whole picture surrounding obesity was given, not least the psychological aspect. We need to engage with patients and enable them to receive the support and help to change their eating patterns and improve lifestyles.

You can take look at NICE at to find out what is current in order to give patients the recommended advice and keep yourself up date. NICE provides guidance to help with  practice, not to dictate so sometimes we may have to use our own clinical experience and understanding when patients do not fit the guidelines.

Then what about foot care? When patients attend for their annual review, what do we tell them while doing their foot check? Do we explain to them the risks associated with poor circulation or deteriorating sensation in their legs and feet? Have we kept up to date with the training we need in order to do these checks? Do patients have access to a good Multidisciplinary Foot team, which can help provide the more specialist care and attention some patients may need?

So many, (80% of patients, in fact) who have amputations, actually could have been prevented through better monitoring and advice and care.

Sadly QOF has in the past tempted some in General Practice to use the exercise for ticking boxes, not to improve patient services. Let's make sure that whenever we come into contact with patients, we give them the best possible care, and ensure they get the appropriate and timely referrals when necessary.