GPs should advise obese and overweight patients they will be much healthier even if they lose relatively small amounts of weight, according to new draft guidance from NICE on lifestyle weight management programmes for adults.
NICE says that as well as stressing to patients the ‘substantial health benefits’ of losing at least 5% to 10% of their weight and maintaining that weight loss, GPs should also advise patients that even losing and keeping off a relatively small amount, for example around 3% of weight, is beneficial.
The guidance also says GPs need to explain to patients that no programme holds a ‘magic bullet’ and that they need to be committed to it, but should offer patients ongoing support to help them to .
The draft public health guidance is principally aimed at helping commissioners choose providers of lifestyle weight management services – whether from the private, public or voluntary sector – that are effective and follow best evidence-based practice.
It says evidence so far favours commercial over GP- or practice nurse-led services, although ‘local NHS programmes or services may be established to address the needs of people living in particular geographic areas, or from lower income groups, if those needs are not being met by commercial programmes’.
GPs are told to focus on referring people with BMIs over 30 kg/m2 (or BMIs above 27.5 kg/m2 in black, Asian and minority ethnic groups) and those identified as overweight (BMIs 25–30 kg/m2 or 23–27.5 kg/m2 for black and ethnic minorities) or obese through the NHS Health Checks programme, or other services such as postnatal or smoking cessation services.
Unless they have a preference, all patients should be referred to group programmes as these ‘tend to be more cost-effective’.
The guidance also calls for better training of GPs in how to approach discussions about weight in the consultation and how to assess patients’ motivation to make lifestyle changes, as well on providing ongoing support.
Professor Mike Kelly, director of the centre for public health at NICE, said: ‘Being overweight or obese can have serious consequences for an individual’s health, not only physically with increased risk of high blood pressure and type 2 diabetes, but it can also affect their mental health as a result of stigma and bullying or discrimination.
He added: ‘This draft guidance isn’t about quick fixes, it is about ensuring lifestyle weight management services support people in the long term. Programmes that address diet, activity and behaviour change can help people who are obese lose weight but they are only cost effective if the weight is kept off.’
According to recent estimates just over a quarter of adults in England (24% of men and 26% of women) are obese and a further 41% of men and 33% of women are overweight, NICE says, and dealing with long-term consequences of obesity costs the NHS £5.1 billion each year.