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Top tips for nurses working with overweight and obese patients

Public Health England's chief nutritionist Alison Tedstone offers advice for nurses working with adults and children who are overweight and obese.
Obesity is a leading cause of morbidity and premature mortality in England and is a major cause of chronic disease; including increasing the risk of type 2 diabetes, cardiovascular disease and some cancers. Overweight and obesity costs the NHS over £5 billion each year and is entirely preventable. Current figures show that 67% of men and 57% of women are obese or overweight and 22% of 4-5 year old children, 33% of 10-11 year old children.
 1. Being overweight should not be seen as the norm
Many people who are overweight and obese don't recognise that they have a weight issue and parents of overweight children are also failing to spot the signs. The Health Survey for England 2012 found that just under a quarter of parents who thought that their child was about the right weight in fact had a child who was overweight or obese. Given that the majority of the adult population are now obese or overweight, this may not be surprising that being overweight is becoming the norm. 
With the prevalence of obesity being so high, the nursing profession plays a vital role in raising awareness and helping patients individually to acknowledge, control, and access appropriate help and support for addressing their own weight and that of their children. We all have a responsibility to strive towards popularising healthy weight as normal.
 2. Raise the issue of overweight and obesity and make every contact with your patient count
It is important to discuss the issue of overweight and obesity confidently and empathetically with your patients.  
You are uniquely placed to help support patients with weight issues and can have a profound impact by helping patients to change their and their families' behaviour, by raising the issue. 
Start conversations with 'Is it ok to ask you about your or your child's weight?' or 'How do you feel about your or your child's weight?' to allow patients and families to set the agenda and offer a choice as to whether the topic is explored or not. 
The key to this approach is respect.  This involves mindfully appreciating that for some patients, who are dealing with 'multiple life challenges', their weight may not feature as a priority, and an individual approach to assessing health and wellbeing needs for each patient is required.
 3. Offer support and be aware of weight management services to refer patients to
Signposting patients and families to suitable long term support to maintain healthier choices and make lifestyle changes is essential.  Speak to your local authority public health team and Director of Public Health to find out what weight management services are available in your area.  
Help patients make an informed decision about the best weight management option for them.
 4. Don't rely on visual judgement, use the appropriate measurement when assessing if a patient is overweight or obese
Body Mass Index (BMI) is currently used as the most accurate and reliable way of assessing the level of excess weight a person may be carrying and although it is not a direct measure of fat mass in the body it provides a good estimate.
To calculate patients BMI you will need to know their height in metres and weight in kilograms and then divide weight (kg) by height (m) squared.
For most adults, a healthy weight is having a BMI of between 18.5-24.9.  A BMI between 25-29.9 is considered overweight and a BMI over 30 is considered obese.
An individual's BMI may vary as a result of factors such as muscle mass and ethnic origin.  
Waist circumference assessed alongside BMI gives a more detailed assessment of an individual's health risk.  For men, a waist circumference of less than 94cm is low risk, 94-102cm is high and more than 102 cm is very high risk.  For women, a waist circumference of less than 80cm is low risk, 80-88cm is high and more than 88cm is very high risk.
It is important when measuring if a child is overweight or obese to use an age and sex appropriate growth chart to interpret BMI in childhood.  For further information on growth charts see the Royal College of Paediatrics and Child Health webpage.
5. Patients should not feel guilt or blame for being overweight or obese 
Obesity is a complex issue, the root causes of which are embedded within our society, the environment we live in, the food supply, our behaviours, psycho-social factors and the impact of health inequalities that exist across the population.
Be aware of the stigma patients who are overweight or obese may feel, and the effort needed to lose weight and avoid further weight gain. Providing the patient with the right information, support and care, can help them to make informed choices about the best option for them to lose weight.
Generally a combination of consuming a calorie controlled, healthy, balanced diet as depicted by the eatwell plate (above) with regular physical activity should help patients, both adults and children, lose weight. You may be interested to look at NHS choices weight loss guide.
Help patients choose physical activities they enjoy as they are more likely to continue doing them. For example the NHS Choices couch to 5K, or community walking schemes.
 6. Online training is available for healthcare professionals
A range of provider's offer online training on obesity and often it is free.    
E-learning for healthcare has a range of online learning for healthcare and other practitioners working to tackle obesity. Additionally the Healthy School Child Programme learning also includes free child measuring and child obesity modules
BMJ Learning has produced audio podcasts on obesity; aimed at NHS and local authority Staff they cover how to raise the issue of weight. 
In June the Royal College of General Practitioners will be launching an Obesity and Malnutrition e-learning module, for GP's and other primary care health professionals, which includes a module on communication skills to help with raising the issue of obesity with patients.
 7. National and local campaigns can help individuals and families who are overweight and obese change their behaviour - get involved!
Public Health England's Change4Life social marketing campaign aims is to inspire a broad coalition of people, including the NHS, local authorities, businesses, charities, schools, families, community leaders - in fact anyone working with families or individuals - to all play a part in improving the nation's health and well-being by encouraging everyone to eat well, move more and live longer. So why not play a more active role and advocate for change at home and in the work place to get everybody eating well and getting active.
Why not sign up as a local supporter and help deliver healthy lifestyle messages to your patients. Change4Life offers free downloadable resources, from leaflets and posters to sponsorship forms, to give individuals the support they need to introduce healthy diet and activity ideas. These materials can help engage families, children and individuals around healthy eating and also provide a useful way to start a conversation. See the Change4Life website for more information.