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Obesity management in adults

Key learning points

  • Practice nurses are well placed to signpost their patients to local weight management services but they need to know what is available
  • No single approach to weight management is going to work for everyone. A patient-centred approach is required
  • Be aware of language as clinical terms such as ‘obese’ can feel stigmatising to patients

Practice nurses have a pivotal role to play in supporting people to lose weight. Many people will present to their clinics with obesity-related multimorbidities, such as: type 2 diabetes; cardiovascular disease; fertility, sleep, breathing or mobility problems; and weight-related impaired mental health. All health professionals have a responsibility to raise the sensitive issue of the importance of weight management, encouraging their patients to adopt healthier eating and drinking habits (including limiting alcohol intake), and to increase their activity levels. The Eatwell guide (see resources) can be used to guide patients on eating more healthily and having a more balanced diet. Like most healthcare professionals, practice nurses have limited time and resources to be able to offer regular support to this patient group. But frequency of contact and regular support are known to improve outcomes. 

It is important to recognise that there is no such thing as ‘simple obesity’. Obesity and being overweight are chronic conditions that result from complex interactions, often with a biopsychosocial basis and environmental influences, which result in people overeating. What works for some obese people doesn’t work for others. Obese patients need a multi-pronged approach that addresses nutrition, physical activity and behavioural issues, with a long-term strategy to improve overall health. No single approach will work for everyone, so we need a ‘toolkit’ with different options. Offering choice can be powerful and gives people with a weight problem some control and ownership over their weight loss journey.

It is helpful for practice nurses and their teams to know what support is available in their area and to have good insight into how these different options operate. It’s a good idea to talk to the CCG, the local dietetic service or the local authority, as since 2013, local councils have been providing tier one and two weight management services in some areas. Different options will be available locally, which are well-placed to offer a first-line approach, many involving support in a group setting.

Group support

Commercial slimming organisations such as Slimming World and Weight Watchers. There are differences in their evidence-based approaches, but both these organisations offer weekly group and additional online support to people with a range of BMIs and co-existing multimorbidities, and encourage people to adopt healthier eating habits and increase their activity levels using behavioural change strategies. There is a cost for the membership and weekly groups, which may prevent patients on low incomes from attending. But offers are often available and, in some areas, healthcare professionals can refer people into these groups at no cost to the patient (usually in 12-week blocks). The Slimming World and Weight Watchers websites give good overviews of the support available, where local groups are held, and who to contact. All facilitators will have undertaken comprehensive training, are supported by a team of psychologists and dietitians, and will have been members of the organisation themselves in the past to manage their weight – so they genuinely understand the struggles that obese people face.

Groups run by MoreLife, Shape-Up or Counterweight. These groups have been commissioned in some areas of the country, and are delivered by trained facilitators. They train local teams to run the well-evaluated programmes and, again, more information can be found on their websites. Counterweight also offers an online weight-loss support programme.

Some patients might fear going to a group for the first time; they will need reassurance that everyone there is facing similar challenges. The facilitators will know how difficult it can be for people to lose weight, but the great advantage of group support is that members can come up with solutions together. Put patients at ease by reminding them that they might actually enjoy it and find it beneficial. Research confirms this is the case.But if the patient is adamant they don’t want to go to a group, then there are also a number of online weight management options offering support on an individual basis.

Individual support

NHS Choices weight loss plan – a 12-week programme that promotes an energy deficit of 500kcal, and encourages healthier eating and physical activity. There is an information pack for each week containing advice and simple tips, and patients can also access a supportive online community, a calorie counter and a weekly progress chart to encourage self-monitoring.

Rosemary Conley – an online support programme that encourages people to increase activity and follow a low-fat diet, with recipes provided.

Some charities help obese people to access local support. They include the Obesity Empowerment Network and Weight Concern.

There are also several smartphone apps that some patients might find helpful. MyFitnessPal includes a digital food diary and calorie counter, which enables people to monitor their food and energy intake and has been reasonably well evaluated, although long-term compliance is an issue.Lose it! is a customised programme that, at an additional cost, incorporates a meal-planning option, and Fitbit tracks eating, drinking, exercise and sleeping habits. This list is not exhaustive. The functions on MyFitnessPal and Fitbit are compatible with each other, providing an even more comprehensive support package.

Some patients may have heard about, or want to try, very low-energy diets. These restrictive plans – either based on the ‘milk diet’ or incorporating special products, such as LighterLife or the Cambridge Weight Plan, to help achieve low energy intake without compromising nutrition – can be effective, but patients should be referred into the local tier three weight management service and seen by a registered dietitian. This is also the case for ‘intermittent energy restriction’, where more specialist support is required in the first instance. It is also important to know the local referral pathway for bariatric surgery and to find out a little more about the patient’s journey once they are referred for surgery.

References

  1. Greaves C, Sheppard K, the IMAGE Study group et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011;11:119 https://doi.org/10.1186/1471-2458-11-119
  2. Jolly K, Daley A, Adab P et al. A randomised controlled trial to compare a range of commercial or primary care led weight reduction programmes with a minimal intervention control for weight loss in obesity: the Lighten Up trial. BMC Public Health 2010;10:439. http://doi.org/10.1186/1471-2458-10-439
  3. Stubbs R, Morris L, Pallister C et al. Weight outcomes audit in 1.3 million adults during their first 3 months’ attendance in a commercial weight management programme. BMC Public Health 2015;15:882. http://doi.org/10.1186/s12889-015-2225-0
  4. Paul-Ebhohimhen, V, Avenell A. A Systematic Review of the Effectiveness of Group versus Individual Treatments for Adult Obesity. Obesity Facts 2009;2:17-24
  5. Laing B, Mangione C, Tseng C et al. Effectiveness of a smartphone application for weight loss compared to usual care in overweight primary care patients: a randomized controlled trial. Annals of Internal Medicine 2014;161:S5–12. http://doi.org/10.7326/M13-3005
  6. Allen J, Cohn S, Ahern A. Experiences of a commercial weight-loss programme after primary care referral: a qualitative study. Br J Gen Pract 2015;65:e248–e255. http://doi.org/10.3399/bjgp15X684409

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