1. Role of the Dietitian in Obesity Management Jane Critchley Nutrition & Dietetic Services Manager

2. Evidence - Adults Prevention Community-based interventions (3) Treatment Low-calorie diets, low fat diets, VLCD Behavioural therapy GP interventions In-patient treatments Training for HPs and self-help group leaders

3. Evidence - Children Prevention School-based multi-faceted interventions Treatment Family-based interventions Behaviour-modification programmes Exercise

4. Current Service - Adults Referral BMI>30 BMI>28 + co-morbidity (eg. CHD, DM) Appointment by Opting-in 6-10 weeks

5. Current Service - Adults Assessment and follow up Dietary advice to restrict calorie intake by 500kcal/day, practical and achievable targets Protocol-based ‘Xenical clinic’ (NICE guidelines) Advice to increase exercise 1-3month review

6. Current Service – Children Referral BMI>98 th Centile Assessment and Follow up Modest weight loss/weight maintenance during growth Non-sedentary activities Whole family approach

7. Limitations Time/resources Lack of MDT support Un-coordinated service across Primary and Secondary care No identified Health Promotion time No referral pathway for bariatric surgery (gastric banding)

8. Possible Solutions Education & support to Primary care CNA project Pilot a MDT children’s clinic Increase in dietetic resources