Raising the issue

In Practice

Obesity is an important health concern that needs to be raised in a sensitive, open and empathetic manner:

 

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Lack of Patient Interest - brief intervention

Do not always expect patients to express an interest in entering a weight management programme. The level of knowledge, concern for health, confidence and ability to overcome difficulties will vary among individual patients and some may justifiably decide that attempting to lose weight at this time is not practicable.

The most suitable strategy at this point is to ensure that the door is left open to revisit this discussion at some point in the future. Increase understanding of the health risks associated with obesity and encourage the patient to minimise any further weight gain. Make a record of the discussion about weight management in the patients' notes to prompt a review of this and to ensure that other members of the team are aware that this has been broached with a patient. The approach should at all times be supportive.

Patient Interested - brief intervention

If the patient expresses interest in proceeding with a weight management programme, a number of options can be explored which could include:

  • exercise referral, 
  • a self-help programme, 
  • a commercial slimming club or other group programme.

Regardless of option chosen, it is important that baseline data (such as: BMI, height and weight measurements, waist circumference, blood pressure, blood glucose, blood lipid levels) are recorded for future monitoring, audit and evaluation purposes. If a decision to treat within the practice is taken, it is important to have in place a protocol, which clearly outlines the management process. The first step should be a thorough and detailed assessment, so that the intervention can be matched to individual needs.

 

Non-NHS Routes

Commercial slimming clubs

The content and structure of slimming clubs vary, but in general they offer support in the form of a weekly group meeting, they follow a particular food plan and have a membership and/or attendance fee. Typically, group leaders are previous members who have personal experience of using the plan to lose weight. The most well known UK commercial slimming clubs include:

 

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Internet-based Programmes

The internet is a popular medium of communication and source of information on all aspects of health, including obesity. Access to the worldwide web has increased and as such has created new potential in terms of delivering patient healthcare.10 Several research centres have evaluated the potential of using an internet-based weight management programme 11-13 with mixed findings in relation to the use of the internet as a medium for facilitating long-term weight maintenance.14, 15 Research in this area is relatively limited at present, but the possibilities for healthcare professionals to use this as a medium for delivering structured programmes and supporting patients has enormous future potential.

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Monitoring Patients who follow a Non-NHS Route

Patients who are following a non-NHS programme for weight management will feel more supported and possibly more motivated to continue with a programme if they feel that their healthcare providers are taking an active interest in their progress. This does not necessarily mean that a formal review appointment has to be arranged as this could be discussed with the patient when attending other routine appointments. Some practices do offer brief drop-in sessions for patients to enable them to update their healthcare professionals. This also allows practitioners to carry out a more comprehensive assessment of progress e.g. blood pressure changes or blood lipid changes. As the management of obesity is a lifelong process it is likely that some patients will chose to dip in and out of non-NHS programmes. The primary healthcare team can therefore provide consistency in terms of support and monitoring and can continue to guide people through the options for weight management in a patient-centred way.

The Assessment and Treatment modules provide a comprehensive review of the assessment procedure and treatment options for patients for whom it is more appropriate to treat via the practice or another NHS route.

References

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