NICE guidance demonstrates how lifestyle weight-management programmes can help people to lose weight and more importantly maintain their weight loss
Citation: DeVille-Almond J (2014 ) Overweight and obese adults: lifestyle weight management. Nursing Times; 110: 29, 15.
Author: Jane DeVille-Almond is senior lecturer at University of Wolverhampton and chair of the British Obesity Society.
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Nurses are well placed to ensure the subject of obesity is raised during patient consultations, in line with the concept of “every contact counts”. Therefore it is crucial they are armed with easy-to-digest advice and information to discuss with patients on how best to lose weight or maintain a weight that is healthy. Many people do not recognise that their weight has a negative impact on their health and may not identify themselves as being actually overweight or obese.
A new guideline from the National Institute for Health and Care Excellence (2014) equips nurses with the latest recommendations for evidence-based, multi-component, lifestyle weight-management services that have been proven to be effective. It shows how lifestyle weight-management programmes that focus on a healthy diet and physical activity, and emphasise behaviour change, can help people to lose weight and, more importantly, maintain that weight loss. The guideline also highlights that the health of our patients can improve significantly if they lose as little as 3% of their body weight.
Nurses need to convey this message to patients, as many patients who are obese and need to lose large amounts of weight often feel the challenge is too great and so are reluctant to even try. Nurses also need to understand the difficulties many patients face in both losing weight and preventing regain, and should always ensure communication is respectful and non-judgmental.
Although a weight loss of 3% will have health benefits, nurses should not lose sight of the fact that the more weight an overweight adult loses as part of a lifestyle weight-management programme, the more health benefits they are likely to gain including reduced blood pressure, lower cholesterol and improved blood-glucose levels.
Nurses working in areas where there is a high multicultural mix should be aware that obesity is linked to ethnicity so to avoid ill health, a lower body mass index of 23kg/m2 should be used as a trigger to take action in people of African, Caribbean and Asian descent.
Nurses should be aware of services in their own area to enable them to signpost their patients appropriately or, if they provide services themselves, to ensure they have the appropriate training and knowledge to delivery these effectively.
Commissioned programmes should address dietary intake, physical activity and behaviour change at all levels and need to be developed by a multidisiplinary team, which includes a dietitian, psychologist and a qualified physical-activity instructor. These are usually known as Tier 2 services and are just one part of a comprehensive approach to preventing and treating obesity. Tiers are outlined in Box 1.
Box 1. Tiers of weight management
Different tiers of weight-management services cover different activities.
Definitions vary locally but usually:
- Tier 1 covers universal services (such as health promotion or primary care)
- Tier 2 covers lifestyle interventions
- Tier 3 covers specialist weightmanagement services
- Tier 4 covers bariatric surgery
The programmes should:
- Last at least 12 weeks;
- Be run weekly or fortnightly;
- Include a weigh-in at each session.
Sessions should focus on lifelong lifestyle changes and develop strategies to overcome any difficulties with maintaining new behaviour changes; they should also ensure ongoing support will be in place once the programme has ended.
Everyone should play a part in tackling obesity including general-practice teams, and other health or social care professionals who may give advice or refer people with a weight problem to specialist services. This guideline is not about a quick fix but provides vital guidance on how effective services can be made available to support people in their short- and long-term efforts to reduce weight and maintain a healthy lifestyle.
National Institute for Health and Care Excellence (2014) Managing Overweight and Obesity in Adults: Lifestyle Weight Management Services. London: NICE.