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At the heart of general practice since 1960

Deanery cuts cost GPs £5k

five

kilos

in six months

One in five people in our practice is clinically obese and more than half our patients are overweight. This mirrors national statistics. The number of patients with diabetes has doubled in the last five years. I identified a real need to tackle obesity and it was clear the practice population were keen.

We decided to set up a nine-session obesity clinic course (see panel, right) and have now successfully run three separate courses.

It has cost us around £1,000 to run each clinic (nine sessions) and this is to pay for dietitian, nurse, photocopying, admin and doctor time.

The first clinic we ran was paid for by a Roche grant, so it was free for patients. The second we received some prize money and asked each of the patients for a one-off £20 donation. The third was paid for entirely by patient donations (one-off fee of £50).

Each clinic has catered for 25 patients and we managed to recruit very easily each time.

Recruitment criteria included a BMI over 27 with co-morbidities, such as type 2 diabetes, hyperlipidaemia, hypertension, CHD, joint problems and sleep apnoea.

Patients were recruited mainly through diabetic clinics, but also opportunistically through consultations. We also advertised the clinic in our quarterly practice newsletter.

What we have achieved so far

The average drop-out rate was about 30 per cent. In the first clinic, those who completed the six-month course had an average weight loss of 4.9kg at six months, and this was sustained at 4.5kg at one year's follow-up. We also saw a mean drop in blood pressure.

The average weight loss for each group has been similar ­ 4.5kg over six months.

Approximately one in eight patients was on weight loss medication but often did

not take it for long (either they started

late or stopped because they developed side-effects).

Patient questionnaires suggested patients were satisfied with the clinic and felt much better for losing weight.

Interestingly outcomes (and drop-out rates) were no different for patients who had paid for the sessions compared with those for whom it was free.

With new contract pressures and sweeping changes in general practice, it is difficult to commit time to clinics that may not be seen to be directly helping the practice achieve QOF targets.

But with possible new quality targets on obesity management, and the fact that obesity is contributing to so many different illnesses, setting up clinics has proved a worthwhile and fulfilling experience.

I am a GPwSI in weight loss management and diabetes. I organised funding, set up the team, and selected patients. I also attended most of the patient sessions in a supportive role, and actively encouraged them, which included a telephone ring-round of all patients halfway through the course.

I measured pre- and post-clinic blood pressure, and prescribed when appropriate, following National Obesity Forum guidelines.

We had a state-registered dietitian, who provided evening lectures and group sessions over six months.

We also had a weight loss adviser sponsored by Roche, who provided monthly daytime sessions (one-to-one appointments) and teaching in-house. Our primary care team nurse is going to run future weight loss management clinics.

Our phlebotomist and nurse has shown a keen interest in weight loss manage-

ment and has attended PCT-led obesity workshops as well as local educational

meetings. She helps with weigh-ins and data collection.

·Local gym ­ reduced rates and individual training

·Sonning Common Health Walks Scheme ­ an existing initiative that encourages walking for health

·Evening cycling club

·The Green Gym ­ local working parties that sustain environmental development

·Availability of exercise machines in the practice ­ receptionists organised appointments/exercise times

·Restaurants ­ six local restaurants volunteered menus for scrutiny and sessions on eating out

patients' Welcome pack

Welcome to the Sonning Common Weight Loss programme

The weight loss programme is a series of nine sessions run by a state registered dietitian. Over the next six months we will be looking at how you can adopt a healthier lifestyle to help you lose weight.

The main objectives of the course are:

·to enable you to identify current eating habits that prevent you from losing weight successfully

·to help you to understand the benefits of healthy eating

·to help you to understand the benefits of increased activity

·to provide you with skills, knowledge and resources that will help you to lose weight

Session 1 Introduction

Link between nutrition and health, nutrition questionnaire, weight measurement, BMI, target setting and objectives

Session 2 What is healthy eating?

Making plans for change, healthy eating guidelines and the balance of good health

Session 3 The ideal diet

Sample menus, calorie swaps, portion sizes, food diaries, and the average diet versus the ideal diet

Session 4 The importance of exercise

Creating an energy deficit, calculating energy expenditure and successful weight control

Session 5 Emotions and eating

Motivation, barriers to change and coping with relapse

Session 6 Eating out

How to cope with social eating plus menu suggestions

Session 7 Understanding food labels

­ a practical session at the local supermarket

Identifying high-fat and high-sugar foods, misleading food claims and true low-fat alternatives

Session 8 Fad diets ­ why they don't work

A synopsis of current popular commercial diets

Session 9 Evaluation

Final weight check, evaluation of progress and next steps

Please note:

·You will be weighed at each session and target weights will be discussed

·The dietitian will be available at each evening session and handouts will be provided for each of the topics covered

·Do not hesitate to ask if you have any questions or queries

There is no real money from PCTs for weight loss projects, as trusts don't see obesity management as saving costs by shifting work or money from secondary care. Pharmaceutical companies (in our clinics Roche and Novartis) can be very helpful with set-up and running costs. But we had to charge patients a minimal fee depending on set-up costs for the second and third clinics ­ ranging from £20 to £50 per patient for the nine-session course ­ to enable the project to break even.

It is difficult to find dietitians who can provide the time and commitment to help run a weight loss programme. We provided an enthusiastic team, good pay and a pleasant working environment and have had an exceptionally high quality of dietetic advice for our patients. Wokingham dietetic department has also been helpful.

The project involved a lot of time commitment from the whole team. You need to be very enthusiastic to make the project work but it is very rewarding.

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