How I...set up an evening class to raise obesity awareness
Dr Anita Sharma explains how she encouraged her patients to take an interest in obesity by organising an evening workshop
Having run the health promotional programme for the last five years, I am convinced that educating and encouraging patients about the benefits of self-care is a better way of improving the health of my practice population.
I am a singlehanded GP in Oldham with a list size of 3,200. The fact is that people in this part of the country do not enjoy as good health as people in the South.
Heart disease, diabetes, stroke and some form of cancers are more common in my practice area. This could be due to poor social and economic circumstances, poor housing, poor education, increased obesity, increased smoking and alcohol and drug-related problems.
In August 2001 I set up a patient participation group. I consider myself very lucky in the sense that I had no problems setting up the group and the group is getting stronger. The full credit of my thriving group goes to my practice manager.
Women's health, men's health promotion, breast cancer awareness, managing minor illnesses, managing asthma, eczema in children and myths about hormone replacement therapy are just some of the topics discussed and debated in the evening classes in the last four years.
The problem: weight management
This year we decided to talk about obesity and its management. We were getting increasingly concerned about this growing problem.
• The practice nurse was concerned about increasing BMI and its impact on
controlling BP, diabetes and asthma.
• The district nurses were concerned as they were seeing more and more patients with leg ulcers requiring more attention.
• The health care assistant was seeing increasing numbers of overweight children.
• Some 20 per cent of women and 15 per cent of men aged 16 to 75 had BMI >30.
What we did
The Government bowed to pressures from Jamie Oliver, the celebrity chef. I bowed to pressure from my primary care staff. Jamie Oliver pushed school dinners into the limelight with his TV series. My active patient group pushed the programme like there was no tomorrow.
They advertised the weight management evening class by making posters, displaying them at all key locations, including a local post office, sports club and pub. A message was even put on the prescription slip about the date and time of the event.
We invited an obesity management adviser, who is a nurse by profession, employed by a neighbouring primary care trust to give a talk at the evening class at the surgery.
There are so many health gurus around, often promoting personal and non-sensible opinions, but believe me, she was a true 'guru' who gave advice about healthy and sensible eating. She gave a clear message of 'no quick fix' and gave advice on diet, exercise, behaviour modification and weight checks (see box). Some patients wanted an easy option of taking pills for weight loss. This was discouraged, as the aim was to make lifestyle modifications to be continued indefinitely in order to maintain weight loss.
What we achieved
Feedback from the patients was encouraging. We hope they understood that losing weight saves lives. The majority of the patients went home with all sorts of literature brought in by the adviser.
Since the talk the practice nurse has started measuring the waist circumference of all the patients attending diabetes and CHD reviews. This is on top of BMI.
It is too soon to see the results. I intend to do the audit in three months' time. I am hoping to see a positive outcome; if the outcome is not positive, I am planning to have another meeting, inviting a heart disease nurse and diabetes nurse. The invites will go to patients registered with local practices.
We might invite some of the patients to talk about the benefits of attending the last obesity evening. I am also hoping that our PCT would help us in promoting and advertising the next event.
My advice to those who are still thinking about it is to stop thinking. We as professionals are there to warn and advise – to facilitate changes patients wish to make, ensuring at the same time not to use your position as a weapon to attack the already obese, vulnerable patients.
Anita Sharma is a GP in Oldham
Competing interests None declared
Evening class advice
Advice given to patients on weight management
• The adviser addressed how to make and achieve realistic goals, stressing the importance of lifestyle changes if the weight loss is to be maintained.
• Salt restriction, increasing fibre intake, the difference between saturated and unsaturated fats, eating five portions of fruit and vegetables and what actually made a portion was explained in a simple way.
• Behavioural therapy, avoidance of comfort eating and keeping a full diary was also stressed.
• The role of increasing physical activity at least five times per week, 30 minutes a session, and its impact on weight loss, was made very clear.
• The adviser also gave advice about doing regular weight checks.