Barns Medical Practice Service Specification for Weight Management

Barns Medical Practice Service Specification for Weight Management

DEVELOPED March 2015 REVIEW DATE March 2017

Introduction

Obesity in Scotland has reached epidemic proportions and its prevalence is increasing. The impact on physical and mental well-being is now recognised at a national level. The ideal body mass index (BMI) is anywhere between 18.5 and 24.9, and those over a BMI of 25 are classed as overweight. NHS information showed that up to 6.4% of adults displayed signs of an eating disorder (Adult Psychiatric Morbidity Survey, 2007). This survey also showed that a quarter of those showing signs of an eating disorder were male. It is estimated that of those with eating disorders:

• 10% of sufferers are anorexic,
• 40% are bulimic, and
• the rest fall into the Eating Disorders Not Otherwise Specified (EDNOS) category, including those with binge eating disorder.

Clinical staff in Barns Medical Practice are acutely aware of the difficulties experienced by individuals challenged by weight management. This service specification attempts to inform patients of the services available. It may be used at induction of new staff or as an ongoing reference document where indicated. It may relevant to individuals who have a clinical diagnosis but equally relevant to those attempting to engage in a lifestyle for general health and wellbeing.

Diagnosis

Healthcare professionals should discuss willingness to change with patients and then target weight loss/gain interventions according to patient willingness around each component of behaviour required for weight loss/gain, eg specific dietary and/or activity changes.

The Healthy Living Readiness Ruler is recommended to facilitate discussions with patients contemplating weight loss behaviours (see appendix 1). Patients should be encouraged to make sustainable lifestyle changes and given support to avoid weight cycling. Weight history, including previous weight loss/gain attempts, should be part of the assessment of patients with obesity or disordered eating.Healthcare professionals should be aware of the possibility of binge-eating disorder in patients who have difficulty losing weight and maintaining weight loss. Weight management programmes should not exclude patients with binge-eating disorder.

Management

Barns Medical Practice supports the Healthy working lives programme (NHS Scotland, 2012). All administrative and clinical staff have an awareness of the benefits of a healthy lifestyle and make attempts to promote this. The practitioners delivering weight management services should be appropriately trained and qualified to deliver the specific interventions and have ongoing specialist supervision where relevant. There is an attached dietician and referrals can be made to this service via the staff at the surgery.

Delivery of evidence based weight management programmes through the internet should be considered as part of a range of options for patients with obesity. Self management should be encouraged wherever possible and patients may benefit from information leaflets to support the consultation such as the one that can be found at this web page . Use of mobile phone apps and electronic devices may be considered when addressing motivation issues.Reducing inactivity should be a component of weight management programmes. Dietary interventions for weight loss should be calculated to produce a 600 kcal/day energy deficit. Programmes should be tailored to the dietary preferences of the individual patient. When discussing dietary change with patients, healthcare professionals should emphasise achievable and sustainable healthy options (SIGN, 2010).

Overweight or obese individuals should be supported to undertake increased physical activity as part of a weight management programme. Goals should be set and individuals should be encouraged to use relevant support mechanisms in order to increase their chances of maintaining their activity on a long term basis (eg regular interactions with appropriately trained professionals, the opportunity to participate in group sessions, and support from family members and others undertaking the exercise programme).Overweight and obese individuals should be made aware of the significant health benefits associated with an active lifestyle, many of which are independent of weight loss (eg decreased risk of cardiovascular disease, enhanced social opportunities, improved self-efficacy and confidence).Overweight and obese individuals should be prescribed a volume of physical activity equal to approximately 1,800-2,500 kcal/week. This corresponds to approximately 225-300 min/week of moderate intensity physical activity (which may be achieved through five sessions

of 45-60 minutes per week. To this end referrals can be made to the Activity for health, invigorate or weigh to go programmes. These are coordinated via South Ayrshire Council in partnership with Ayrshire and Arran NHS. (See appendix 2 ).

Drug intervention such as Orlistat should only be used where diet, physical activity and behavioural changes are supported. Therapy with orlistat should be continued beyond 12 weeks only if the patient has lost at least 5% of their initial body weight since starting drug treatment. Therapy should then be continued for as long as there are clinical benefits (eg prevention of significant weight re-gain). This may involve medication use outside current licence. Ongoing risks and benefits should be discussed with patients.

Bariatric surgery should be included as part of an overall clinical pathway for adult weight management. Referral by the GP for bariatric surgery is an option in Ayrshire and Arran NHS if you suffer from diabetes or sleep apnoea. This should be part of a programme of care that is delivered by a multidisciplinary team including, surgeons, dieticians, nurses, psychologists and physicians. There should be close communication between health professionals for effective management of patients’ comorbidities as weight loss occurs.

Resources for Staff and or Patients

1. SIGN Guideline Management of obesity - [online] accessed 17/2/15

2 . NHS Scotland Healthy Living [online] accessed 17/2/15

3. NHS Scotland Healthy Working Lives [online ] accessed 17/2/15

4. South Ayrshire Council .Weigh to go {online] accessed 17/2/15

5.South Ayrshire Council. Activity for Health. [online] accessed 17/2/15

6. How to Lose Weight [online] accessed 17/2/15

Staff involved and training required

This service specification is relevant to all Barns Medical Practice staff. Training will be discussed as part of the clinician’s personal development plan depending on past experience etc.

Advertising of service to patients

Via Barnsnet