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English weight loss guidelines: 'lose a little, keep it off'

Guidelines direct GPs to identify people eligible for state-funded slimming classes, with obese adults given priority
Participants in programmes should lose 3% of their body weight on average

New weight loss guidelines for the NHS in England advises people to "lose a little and keep it off", according to a report from the National Institute for Health and Care Excellence (NICE) states. The guidelines direct GPs to identify people eligible for state-funded slimming classes run by companies such as Weight Watchers, with obese adults given priority.

The report, ‘Managing overweight and obesity in adults – lifestyle weight’, makes recommendations on the provision of effective multi-component lifestyle weight management services for adults who are overweight or obese (aged 18 and over), and  covers weight management programmes, courses, clubs or groups that "aim to change someone's behaviour to reduce their energy intake and encourage them to be physically active".

The guidelines said such programmes may particularly benefit adults who are obese, and where there is capacity, overweight patients which equates to two-thirds of the adult population.

“Lifestyle programmes are one part of the solution,” said Professor Mike Kelly, director of the Centre for Public Health at NICE. “An environment that makes it easier for people to be active and eat well is also crucial, as are services for people with other issues that affect their health and wellbeing. The guidance isn't about quick fixes. There is no ‘magic bullet'. It is about ensuring effective services are there to support people in the long term.”

GPs and other health professions have been instructed by NICE to raise the issue of weight loss in a "respectful and non-judgmental" way and identify people who are eligible for referral for lifestyle weight management services by measuring their BMI.

“Obesity is one of the biggest health issues facing the UK. It's a complex problem with no single solution, but programmes which aim to help people manage their weight can make a difference,” said Gill Fine, independent public health nutritionist and Chair of the group which developed the NICE guidance. “What we have done in this new guidance is to identify the key components that need to be included in these programmes for them to be effective. We hope that these practical recommendations will help people make life-long lifestyle changes so they lose weight and most importantly help prevent those pounds from coming back.”

NICE also said that providers of lifestyle weight management programmes should demonstrate that participants maintain their weight loss and their programmes are effective at 12 months or beyond.

It said participants in such programmes lose 3% of their body weight on average, which if sustained would be enough to lower the risk of type 2 diabetes and high blood pressure. The NHS currently recommends that obese people should aim to lose 5%-10% of their weight, and NICE emphasised it was not replacing that guidance.

"A 3% reduction may well have some health benefit - every little helps - but if the patient is obese at the beginning of the course he or she will probably still be obese by its end,” Tam Fry, from the National Obesity Forum, told the BBC. “At least a 5% weight loss, and preferably one of 10%, have been weight reduction targets in past years and they still should be today. NICE should be going for the clinical excellence that it's proud of and not the compromise it has suggested."

The guidance for the NHS in England said weight-management programmes should:

  • Tackle diet, physical activity and change behaviour
  • Be focused on lifelong change not short-term gains
  • Last at least three months, but set target weights for the end of the programme and after one year
  • Plan to reduce calorie intake, but not ban specific foods or food groups
  • Introduce physical activity into daily life such as walking
  • Be respectful and non-judgemental

In addition to publishing the guidelines, NICE also said a national database for lifestyle weight management programmes that have achieved positive long-term results should be established to help tackle obesity rates.

"The fact remains that significant weight loss is hard to achieve and even harder to sustain, even with the help of health professionals," said Mr Richard Welbourn, president of the British Obesity and Metabolic Surgery Society. "We promote the safe and effective use of surgical strategies as part of a coordinated pathway of care for people who are obese. There is compelling evidence that weight-loss surgery is clinically effective, safe and cost-effective. The second National Bariatric Surgery Register (NBSR) is due out in summer and will re-affirm that bariatric surgery is a cost-effective solution for many people."

NICE is also reviewing its guidance on bariatric surgery, which it currently recommends for adults with a BMI of more than 40 who have tried but failed to lose weight using non-surgical techniques. The revised guidance is due to be published in November 2014.

To view the report, please click here

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