Jane Diggle and Dr Pam Brown offer 10 top tips on initiating conversations about weight and motivating people to make healthy changes

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Figure 2: Example bubble diagram

Bubble diagrams can be used to help patients decide which aspects of their lifestyle they want to discuss. the blank bubbles allow people to tailor the discussion to their own needs so that they do not feel it is being driven solely by the healthcare professional.

Many people believe that drugs are an easy route to weight loss. Orlistat is the only drug available on NHS prescription that is licensed for treatment of obesity. Treatment with orlistat should be discontinued after 12 weeks if patients have been unable to lose at least 5% of the body weight as measured at the start of therapy.17 Liraglutide 3 mg and other drugs have demonstrated efficacy but are not currently (February 2019) available on the NHS for treatment of obesity.18–22

8. Help people understand the benefits of physical activity

Physical inactivity and prolonged sitting are modifiable risk factors for mortality and morbidity.23 Being active improves cardiometabolic risk, so people without contraindications should be encouraged to aim for 150 minutes of moderate activity every week (or 75 minutes of vigorous activity), as well as strength exercise on at least 2 days per week.24

Help the patient to identify activities they enjoy, encourage walking, and discuss ways of building activity into daily life to help people become more active. Record activity level using a validated tool such as the General Practice Physical Activity Questionnaire.25 Refer to Exercise on Prescription and ‘Green Gym’ schemes to help motivated people to adopt active habits. Some practices partner with initiatives like Walking for health (www.walkingforhealth.org.uk) or parkrun (www.rcgp.org.uk/clinical-and-research/our-programmes/clinical-priorities/parkrun-practice.aspx) to provide additional options for ‘prescribing’ exercise.

Many people believe that inability to exercise (through lack of time or musculoskeletal problems) makes weight loss impossible. However, physical activity is less effective as a sole weight loss strategy than diet, although it can reduce visceral fat and insulin resistance,26–28 and in combination with diet only increases loss by around 1.5 kg compared with diet alone.29

9. Help people set realistic goals and support progress

People often have unrealistic weight loss goals and set themselves up for certain failure. Discussing realistic goals (including hidden health benefits) encourages people to feel successful and avoid disappointment and demotivation. Encourage SMART—Specific, Measurable, Achievable, Realistic, and Time‐sensitive—goals, which may be used to create meaningful action plans.

Regular weighing by healthcare professionals or in commercial programmes can support weight loss, so keep weighing scales and tape measures readily accessible. Recording weight and waist circumference helps track, and provide feedback on, progress. Slow, steady or rapid weight loss are both beneficial; speed of loss does not significantly influence weight regain as was previously believed.30

Achieving and maintaining weight loss of 3–5 kg (or 5% body weight) has significant health benefits, whereas attaining ideal weight or BMI is unrealistic for most. The recent DiRECT study demonstrated that losing 10–15 kg can result in remission of type 2 diabetes at 1 year.31

10. Signpost to help and support and know your local pathways

Healthcare professionals are often put off starting a conversation about weight due to lack of confidence in weight management, but most of the time the main role is in signposting people to other information, organisations, and resources. Commercial weight loss organisations may be more effective at helping people lose weight and maintain loss than practice teams.32 Check if you can refer patients at preferential rates to services in your local area.

Learn about your local obesity care pathway and Tier 2 and 3 services, so you can refer appropriate patients.

Discuss bariatric surgery with those who meet local criteria. The conversation should include the types of surgery and significant weight loss and health benefits. People often believe that they can continue to eat normally after surgery, and sharing the restrictions and potential side-effects often motivates re-engagement with medical management.

Sources of further information for healthcare professionals can be found in Box 1.

Jane Diggle

Specialist Practitioner Practice Nurse, South Kirkby, West Yorkshire

Dr Pam Brown

GP with special interest in diabetes, obesity, and lifestyle medicine,Swansea

Box 1: Sources of information about managing overweight and obesity in primary care

NICE Clinical Guideline (CG) 189 on Obesity: identification, assessment and management (www.nice.org.uk/cg189)

NICE Public health guideline (PH) 53 on Weight management: lifestyle services for overweight or obese adults  (www.nice.org.uk/ph53)

Stop Obesity Alliance (stopobesityalliance.org)

Diabetes UK. Meal plans and diabetes. www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/meal-plans-

Diabetes UK. Evidence-based nutrition guidelines for the prevention and management of diabetes.www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/evidence-based-nutrition-guidelines-for-the-prevention-and-management-of-diabetes

References

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