Getting Started with Weight Management
Is my patient appropriate for the Counterweight Programme ?
Given 60% of men and 65% of women are overweight or obese, it is becoming the norm in society and we are becoming less able to subjectively assess whether a patient is clinically obese. Body Mass Index (BMI) should be used to classify overweight or obesity.1 Patients are eligible for the Counterweight weight management programme if they have a BMI ≥ 30kg/m2 or BMI ≥ 28kg/m2 with an obesity related disease.
Is my patient ready to make changes to help them lose weight?
Many overweight and obese patients desire to be slimmer. Far fewer are ready to put the work in to make changes to their eating and activity habits to create an energy deficit to lose weight. It is important to review a patient’s readiness to embark on a weight management programme.
Discuss the leaflets Thinking About Weight Loss to ensure that the patient knows what to expect from the Counterweight Programme. The leaflet Getting Started Are You Ready provides information and a little quiz that will help to identify those patients who are ready to make lifestyle changes to lose weight. This is a good time to practice your listening skills as the patient may be telling you, often indirectly, whether they are ready to change or not.
How much weight should my patients lose?
Aim for 0.5-1.0kg weight loss per week. The need for a “quick fix” and the relative lack of interest that people show in achieving modest weight losses of 5-10kg contribute to a lack of adherence to most diets in the long term. High attrition rates are common and range from 30-60%.2 Unrealistic expectations leave the majority of people in a position of failure and disappointed. The Making Changes leaflet encourages clinicians to explore weight loss expectations with the patient. Clinicians must have the skills to enable patients to embrace the relatively modest but clinically beneficial weight loss target of approx 5-10kg or 5-10% based on an average patient of 100kg. For patients with BMI ≥ 40kg/m2 or body weight ≥ 120kg, weight losses of ≥ 20kg or more may be necessary for improvements in physical mobility, social function and general quality of life.3 In some cases management may require more intensive support such as dietetic input or secondary care intervention. For further information on the benefits of modest weight loss click here.
How best can I support my patients in weight management?
For patients that are not ready to make lifestyle changes, support should be in the form of advice to enable them to maintain their current weight and avoid further weight gain.
For patients who are ready to make lifestyle changes, there is no evidence as to the effectiveness of ad-hoc advice. It is best to support motivated patients through a structured, evidence based programme of weight management. The Counterweight weight management programme incorporates the components of best practice as recommended by National Institute of Clinical Excellence (NICE) obesity guidelines.4
Components of best practice of a weight management programme.
Recommendation of weight loss target of 5-10kg or 5-10%
- Aim for 0.5-1.0kg weight loss per week
- Focus on long term lifestyle changes
- Address both diet and physical activity
- Recommend a balanced dietary approach
- Include behavioural change techniques
- Provide ongoing support
What results can I expect to see in my patients?
Approximately 70% patients who attended Counterweight and had 12 month data lost weight. The mean weight change at 12 and 24 months was -3.0kg and -2.3kg respectively. 30.7% of the attending population had maintained a clinically significant weight loss of ≥ 5% at 12 months and 31.9% at 24 months, providing evidence that weight loss maintenance is achievable within routine primary care. 5
Why do some of my patients put the weight back on?
Evidence suggests that a weight loss is best for 6 months and then weight loss maintenance should commence. If patients revert back to their previous lifestyles, weight regain will occur. Patients who have managed to maintain their positive changes and avoid weight regain tend to have the following traits in common:
- Increased physical activity
- Low fat energy intake
- Keeping a daily living diary
- Strong social support
For a patient to be suitable for the Counterweight weight management programme they must be accurately weighed, have a BMI ≥30kg/m2 or BMI ≥ 28kg/m2 with an obesity related disease, and ready to make changes in their lifestyle to help them lose weight. The Counterweight treatment pathway will guide patients through the weight management process for optimal clinical benefit long term.
“Counterweight is very simple with fantastic leaflets to keep you on track and the support I have had from the practice nurse Jill has been first class. ....I never feel hungry and am seeing a long term weight loss programme with brilliant results.”
MJ Child, Buckinghamshire PCT.
1. Management of Obesity - A national clinical guideline (.pdf file, accessed Jan 2010)
2. Dansinger M, Gleason J, Griffith J, Selker H, Schaefer E. Comparison of the Atkins, Ornish, Weight Watchers and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005; 293: 43-53
3. The Counterweight Project Team. Patients experience of a UK primary care weight management programme: IASO Obesity Reviews 2007 (Suppl 2) p282.
4. Obesity - guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children (.pdf file, accessed Jan 2010)
5.The Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. British Journal of General Practice 2008; 58: 548-554