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Commercial weight management solutions – what can you advise your patients? Robert Hobson Public Health Nutritionist.

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Presentation on theme: "Commercial weight management solutions – what can you advise your patients? Robert Hobson Public Health Nutritionist."— Presentation transcript:

1 Commercial weight management solutions – what can you advise your patients? Robert Hobson Public Health Nutritionist

2 Overweight and obese - Current situation 61% UK overweight 24% UK obese Complex disease with many influencing factors Foresight report – 100 variables which directly or indirectly effect energy balance Around 6000 dietitians in the UK to help treat the disease NHS Limited resources Obesity – issues too great for any one organisation

3 Overweight and obese - Current management Primary Care Trust’s and voluntary organisations Weight management groups Drop-in clinics Cookery clubs Exercise clubs BMI 30+ free vouchers for weight watchers Barriers to success Funding/who commissions? Lack of resources Compliance/motivation Lack of innovation/support

4 Commercial slimming groups Policy documents recommending partnership between Commercial slimming groups and NHS Choosing Health 1 Healthy Weight : Healthy Lives 2 GP referral schemes exist Slimming World Weight Watchers Many LA and primary care organisations already commissioning groups Heath and Social Care Bill 2011 – who commissions in future

5 NICE guidance CG43 National institute for Health and Clinical excellence (NICE) guidance CG43 3 Guidance on prevention, Identification, Assessment and management of overweight and obese Adults and children Suggests that primary care organisations and LA recommend commercial weight management programmes which met the standards of best practice

6 NICE guidance CG43 – standards of best practice Help people assess their weight and decide on a realistic healthy target weight - usually a weight loss of 5-10% of the original weight Aim for a maximum weekly weight loss of 0.5-1kg Focus on long term lifestyle changes rather than a short term, quick fix approach Be multi-component, addressing both diet and activity while offering a variety of approaches

7 NICE guidance CG43 – standards of best practice Use a balanced healthy eating approach Recommend regular physical activity, ideally daily activities like walking and gardening, and offer advice about increasing activity safely Include behaviour change techniques, such as keeping food diaries, dealing with lapses and high risk situations Recommend or provide ongoing support

8 Commercial weight management programmes What’s out there? Weight Watchers Slimming World Jenny Craig Lighter Life How do these weight management programmes work? How effective are they?

9 Weight watchers Founded in USA, 1963 Over 1 million members worldwide 50,000 meeting groups Combines diet and physical activity advice with behaviour change techniques Regular support group meetings Membership free if weight goals met - incentive NICE compliant

10 Weight watchers Eating plan based on a point system ‘ProPoints system’ assigns each food with a point and takes into account satiety Points are allocated based on gender, weight, height and activity level Points allocated to achieve 0.5 – 1 kg per week Weight loss target is 10% of original weight Member chooses balance of foods – emphasis on healthy eating and satiety (lean proteins and whole grains)

11 Weight watchers Group support – weekly meetings (critical to success) Group leaders are previous members Groups leaders manage points as weight is lost Interactive online membership available Weight watchers online – support and information Member forums Interactive activity demonstrations Magazine 1000’s of own brand food products – points system

12 Slimming World Founded in UK, 1969 7500 weekly meetings Program combines healthy diet and physical activity advice with support and long-term behaviour change IMAGE therapy (Slimming World technique) Regular support group meetings Members set own realistic targets Membership free if target weight met - incentive NICE compliant

13 Slimming World ‘Food optimising plan’ Promotes low energy dense foods and controls high energy dense foods Unlimited ‘free foods’ – starchy carbs, lean protein, fruit and veg, low fat yoghurts Allocated portions of ‘healthy extras’ – wholegrain cereals, breads, milk, cheese and dried fruit/nuts Daily allowance (optional) of ‘syns’ – confectionary, savoury snacks and alcohol Help members learn – no food banned in healthy lifestyle

14 Slimming World Weight loss target is around 10% of original weight Weight loss target chosen by member Weight loss goal of 0.5 – 1kg per week Groups support - weekly meetings (critical to success) Group leaders – previous members Exchange IMAGE info, recipes, motivation and support from leader/members Interactive website – information and support Magazine, recipe books and email/telephone support

15 Jenny Craig Founded in Australia, 1983 Recently introduced to UK after success overseas Holistic ‘food-mind-body’ approach Members purchased ambient branded food products Home delivered Program combines personally designed eating plans, physical activity advice, telephone support and behaviour change strategies Vitamin and mineral supplementation recommended NICE compliant

16 Jenny Craig Portion controlled and focus on low energy density Menu plans offer 1200 – 2300 kcal daily As well as purchased food members encourage to consume fruit and veg and low fat dairy products Members learn about portion size through food packs Re-introduction to home cooked meals when halfway to goal weight

17 Jenny Craig Member assigned personal weight management coach Target weight loss agreed between member and coach (0.5-1kg weight loss per week) Private, weekly telephone consultation Encouragement Support strategies – eating out, holidays Adjust eating plans Design weekly activity plan Health cooking support via councilor and recipe booklets

18 Lighter Life Founded in UK, 1996 Two eating plans: Very low calorie diet (VLCD) - BMI > 30 Low calorie diet (LCD) - BMI between 25-29.9 Meal replacement powders Single sex group meetings, weekly weigh-in, behaviour change support and physical activity advice Heavily regulated – COMA, SCOOP, CODEX, NICE

19 Lighter Life VLCD – 500-600kcals per day, 12 weeks GP referral, contraindicated medical conditions, 28 day check up (COMA, NICE) Solely meal replacement powders Dietary ketosis Rapid weight loss at start Powders gradually replaced by normal food during ‘phase one management stage’ Normal food based on low energy density Diogenes – foodplate – low GI www.diogenes-eu.org

20 Lighter Life LCD – 800-1200 kcal per day 3 food packs (replacement powders) and one healthy meal (recipes provided) Rapid weight loss Powders replaced by normal food during the ‘phase one management stage’ Normal food based on low energy density Diogenes - foodplate

21 Lighter Life Weekly group meeting (critical to success) Group leaders mostly past members Group leaders have an accredited BTEC certificate or diploma in weight-management consultancy Strong emphasis of CBT therapy during meetings as well as support from other members Membership free if target weight met – incentive Magazine/cookbooks/recipe books Online forum and podcasts

22 Evidence of efficacy Majority of research carried out by Weight Watchers, Slimming World and Lighter Life Research shows that in general commercial weight management programmes work As with any weight loss therapy long-term weight loss is pretty modest – No panacea Compliance with a programme is key to it’s success More research on improving compliance would be very useful

23 Jolly et al (2011) 4 Randomized control trial Assess effectiveness of weight management programmes (WW, RC, SW, NHS) Comparator group received free vouchers to leisure centre 740 overweight and obese individuals from UK Commercial programmes achieved significantly greater weight loss than the primary care programmes At progammes’ end, mean difference of 2.3 kg Primary care programmes more costly

24 Jebb et al (2011) 5 Randomized control trial (12 months) Compared referral to commercial weight loss treatment (Weight Watchers) with standard care 722 overweight and obese individuals from UK, Germany and Australia Those assigned to the commercial weight programme lost twice as much weight compared with standard care at 12 months (5.06kg and 2.25kg respectively) Three times more likely to lose 10% of initial weight on commercial weight management programme Useful early intervention for weight management in overweight and obese people Can be delivered on a large scale

25 Truby et al (2006) 6 Randomized control trial (6 months, multicentre) Compared effectiveness of 4 commercial weight loss diets (including weight watchers and Rosemary Connelly) All produced statistically significant weight loss Intention to treat analysis showed average weight loss of 5.9kg and fat loss of 4.4kg Minimal difference between the groups but greater weight and fat loss than control group Useful weight and fat loss in individuals motivated to follow commercial weight loss diet

26 Heshka et al (2003) 6 Randomized control trial (24 months) Compared standard self-help weight loss (2 sessions with nutritionist) with commercial weight management programme (Weight Watchers) 423 overweight and obese individuals 25% attrition (often not reported in studies) Intention-to -treat analysis showed average weight loss of 2.9kg after 2 yrs in the commercial group compared with 0.2kg in the self-help group Modest weight loss in the commercial group but more than that of the self-help group

27 Bariatric surgery What is it? When is it an appropriate solution? NICE CG43 guidance How easy to access privately e.g. overseas Evidence of efficacy

28 Bariatric surgery – what is it? Generic term for weight loss surgery More effective in achieving weight loss that non- surgical treatment – longer term NHS commissioned procedures increased from 470 in 2003/04 to 6500 in 2009/10 Equivalent to <1% of morbidly obese in UK

29 Bariatric surgery – what is it? Most common procedures: Adjustable gastric banding Gastric bypass Associated risks Requires extensive follow up Waiting list high – lack of funding from PCT

30 Bariatric surgery – when is it appropriate? NICE guidance CG43 BMI ≥ 40 or between BMI 35 and BMI 40 with other significant disease which could be improved Tried all non-surgical treatments – failed weight loss at 6 months Receiving intense management in a specialist obesity service Fit for surgery – anesthesia Commitment to long term follow up First-line option BMI ≥ 50

31 Bariatric surgery – Overseas treatment – risk? In the press over the years Europe and India Cosmetic treatment – BMI<25 Increase risk – would you travel back to country Often no follow up or proper aftercare Diet, supplementation, gastric band adjustments NHS left to ‘pick up the pieces’

32 Bariatric surgery – how effective? Two systematic reviews Effectiveness in relation to obesity Picot J, Jones J, Colquitt J, et al (2009) 7 Colquitt J, Picot J, Loveman E, et al (2009) 8 Both involved 26 studies 3 RCT’s, 3 Cohorts compared surgery vs non-surgery 20 RCT’s compared surgical treatments

33 Bariatric surgery – how effective? Key findings More effective weight loss and long term weight maintenance in people BMI>30 Improve co-morbidities – diabetes and hypertension Improvements in health related quality of life No clear evidence that one type of surgery leads to more weight loss or improvement in co-morbidities Surgery more costly that non-surgical but gave improved outcomes

34 Hallam et al (2010) – not published Retrospective study (8 months) Determine if morbidly obese patient (BMI ≥ 50) could comply with VLCD (Lighter Life) 650 obese individuals, compliance tested using urinary ketone reagent strips (test ketosis) 88.5% participation at 4 weeks, 80.2% participation at 8 weeks and 66.5% participation at 12 weeks Average weight loss at 12 weeks 3 stone 10lb Similar results, low morbidity and lower costs Weekly group meetings – CBT therapy, Healthy lifestyle VLCD – viable replacement to surgical management of obesity? Depends on patient

35 Do different programs suit different people? Lot’s of choice – all offering slightly different methods of weight management Useful to have NICE CG43 guidance to establish which programmes are suitable in the treatment of overweight and obesity List of preferred providers – NICE compliant, descriptions/check list? One size does not fit all – key to successful weight management is keeping positive changes, activity and behaviour going

36 Do different programs suit different people? Discuss patient lifestyle, time commitments, work schedule, family set-up and previous attempts at weight loss Identify client need to change for good Groups motivation? One-to-one support? Convenience? Access to resources Knowledge of programmes can help to match client needs First step to a more permanent weight management success

37 References 1. DOH (2004). Choosing health : making healthier choices easier. London. Department of Health 2. COI (2008). Healthy weight, healthy lives: a cross government strategy for England. London. Department of Health. 3. NICE (2006) Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: NICE 4. Kate Jolly, Amanda Lewis, Jane Beach, John Denley, Peymane Adab, Jonathan J Deeks, Amanda Daley, Paul Aveyard (2011). Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. BMJ 343:d6500 5. Jebb SA, Ahern AL, Olson AD, Aston LM, Holzapfel C, et al (2011). Primary care referral to a commercial provider for weight loss treatment versus standard care: an international randomised controlled trial. Lancet;378:1485-92.

38 References 6. Helen Truby, Sue Baic, Anne deLooy, Kenneth R Fox, M Barbara E Livingstone, Catherine M Logan, Ian A Macdonald, Linda M Morgan, Moira A Taylor, D Joe Millward (2006). Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials”. BMJ 332:1309 7. Heshka S, Anderson JW, Atkinson RL (2003). Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA; 289:1792-8 8. Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database of Systematic Reviews, Issue 2. 9. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost- effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess, 13(41).


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