The UK’s National Institute for Health and Care Excellence (NICE) has begun a consultation on draft guidance on lifestyle weight management services available to help overweight and obese people to achieve and maintain a healthier weight.
The guidance is intended primarily for commissioners, health professionals and providers of lifestyle weight management programmes, but may also be of interest to overweight and obese adults, their families and other members of the public.
Obesity not only increases the risk of serious conditions such as type 2 diabetes, heart disease and some cancers, but dealing with the long term consequences of obesity costs the NHS an estimated £5.1 billion each year, placing a huge strain on the health service.
Lifestyle weight management programmes are formed of a number of components that aim to help overweight or obese adults reduce their calorie intake and help them to be more physically active by changing their behaviour.
The programmes can accept adults through self-referral or referral from a health practitioner and are provided by the public, private or voluntary sector.
Professor Mike Kelly, Director of the Centre for Public Health at NICE said: “Being overweight or obese can have serious consequences for an individual’s health, not only physically with increased risk of high blood pressure and type 2 diabetes, but it can also affect their mental health as a result of stigma and bullying or discrimination. Levels of obesity in England are rising, with a little over a quarter of adults classified as obese and a further 41% of men and 33% of women overweight. This is a huge proportion of our population.
“This new draft guidance focuses on the provision of effective lifestyle weight management services and makes a number of recommendations to ensure that the providers of programmes whether from the private, public, or voluntary sector follow good, evidence-based practice. This draft guidance isn’t about quick fixes, it is about ensuring lifestyle weight management services support people in the long term. Programmes that address diet, activity and behaviour change can help people who are obese lose weight but they are only cost effective if the weight is kept off.”
The draft guidance does not cover preventing obesity or pharmacological or surgical treatments for obesity. It is aimed at commissioners, local authority managers, directors of public health and their teams, those providing weight management services. Draft recommendations include:
Minimising harm: Health professionals and providers should ensure the tone and content of all communications or dialogue is respectful and non-blaming. They should ensure equipment and facilities meet the needs of most adults who are overweight or obese.
Addressing adults’ expectations of a lifestyle weight management programme: GPs and providers of weight management programmes should explain to adults who are considering a lifestyle weight management programme: how much motivation and commitment is needed to lose weight and maintain weight loss; that no programme holds the ‘magic bullet’. They should also explain how much weight they might realistically expect to lose if they adhere to the programme and the benefits of losing even relatively small amounts of weight or preventing any further weight gain in the long term.
Core components of lifestyle weight management services for weight loss and maintenance: Lifestyle weight management programmes should only recommend or be commissioned if they are in line with core components for weight loss and weight maintenance, such as:
- Focus on long-term lifestyle change (weight loss that is maintained over the long term or prevention of further weight gain), rather than temporary weight loss.
- Set achievable goals for weight loss over the course of the programme
- Ensure staff are trained by a multidisciplinary team, including input from a dietitian, clinical psychologist and a qualified physical activity instructor.
- Provide information or opportunities for ongoing support once the programme has ended and stress the impact of both healthy eating and physical activity on long-term weight loss maintenance.
Referrals to lifestyle weight management programmes: GPs and other health professionals advising about, or referring people to, lifestyle weight management programmes should focus mainly on adults with a BMI over 30 kg/m² and on people identified as overweight or obese through the NHS Health Check or other services.
The use of lower BMI or waist thresholds, as a trigger to reduce the risk of conditions such as type 2 diabetes, have previously been recommended for black African, African-Caribbean and Asian groups (see BMI and waist circumference – black, Asian and minority ethnic groups).
People’s preferences should be taken into account along with their previous experience of such programmes and their motivation to change. Refer people who have no preference to a group programme because, on average, these tend to be more cost effective.
Commissioning lifestyle weight management services: Commissioners should ensure lifestyle weight management programmes complement activities that address the wider determinants of health and ensure contracts state who will undertake routine evaluation and what measures will be collected.
Services should also make adequate provision for disadvantaged groups and provide a range of local services support people who need to maintain their weight or weight loss.