Obesity is a complex condition and nurses in the community must use various strategies to help patients achieve sustained weight loss
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Tackling obesity in primary care presents a number of challenges. In order to manage this growing problem new approaches to weight management must be explored. We used an evidenced-based strategy, called holistic approach towards self-care in obesity management (HATSOM) to support patients in losing weight. This approach is described in Box 1.
This case study outlines how a patient was encouraged to self-manage her weight loss, thereby reducing co-morbidities and improving her quality of life.
BOX 1. A HOLISTIC APPROACH TO SELF-CARE IN OBESITY MANAGEMENT
- Provides a practical, holistic, person-centred intervention to weight management for those who are obese
- Encourages self-reflection, participation and supported self-management
- Challenges the patient in a non-judgemental way
- Is theoretically underpinned and evidence based
- Provides support and education for nurses
*Moira Carter, a married woman in her thirties with four children, attended her GP surgery requesting a referral for gastric banding, as she was struggling to lose weight after the birth of her fourth child. She weighed 98kg and her BMI was 41.6.
Mrs Carter’s medical history revealed she had been overweight from puberty, and had hypothyroidism and gestational diabetes. During her last two pregnancies she had taken insulin to control the diabetes. At the annual follow-up meeting for gestational diabetes she had an oral glucose tolerance test and was diagnosed with type 2 diabetes. She was devastated by this news and found it difficult to come to terms with.
It was suggested that Mrs Carter attend the weight management clinic as a weight loss of 5-10% could help her to manage her diabetes with diet rather than medication. On attending she appeared motivated and had a positive approach to losing weight. She felt the time was right for her, as no more pregnancies were planned and she was keen to manage her diabetes on diet alone.
Following assessment we set about addressing Mrs Carter’s weight management issues in an empathic manner. As a mother of four, she found it difficult to make time for herself, but with childcare support from her family and friends she was able to go for walks or go swimming in the evening.
Through changes in her eating pattern (smaller portions) and increased activity she started to lose weight and reached her 10% weight loss of 88.5kg in two months. The whole family are now eating healthier diets and being more active.
With further support Mrs Carter has been able to take her weight down to 81kg, giving a total loss of 18kg. Her diabetes has been controlled with diet and her HbA1c is 5.5%. Perhaps with earlier intervention she may have been able to avoid a diagnosis of diabetes altogether.
There is one aspect of weight loss that Mrs Carter finds distressing and may also have been avoided with earlier intervention. She now has an abdominal apron of loose skin for which she has enquired about surgery. Unfortunately, at present she does not meet the stringent criteria for NHS funding.
It is important to continue to support Mrs Carter, to prevent weight regain. In common with weight loss, this often requires the exploration of new coping skills. The amount of support required varies from person to person and, for some, incorporating it into their long-term condition review appointment may be enough.
Although Mrs Carter had initially come to the surgery looking for bariatric surgical intervention, by using HATSOM
she was able to find the confidence to address her weight issues in a holistic manner. This weight management programme has not only helped her lower her HbA1c and blood pressure but only to develop a better understanding of the physical, social and emotional impact of obesity on her life. This understanding led to the implementation of weight management strategies appropriate to her individual needs.
* The patient’s name has been changed
- Nurses in general practice are ideally placed to support patients to self-manage weight loss
- Strategies must address patients’ emotional and behavioural wellbeing, as well as diet and exercise
- The ultimate goal is sustainable weight loss and improved quality of life
- Nurses need to use a variety of tools to motivate patients to continue weight loss programmes
- Early intervention can avoid complications including excess abdominal skin
Christine Goldie is practice nurse, Banff and Gamrie Medical Practice, Aberdeen, and Jenny Brown is honorary clinical research fellow, Centre for Obesity Research and Epidemiology, Robert Gordon University, Aberdeen.
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