NICE: 'Obese should be prescribed slimming clubs'

“GPs told to prescribe £100 slimming courses for millions of obese patients,” the Daily Mail reports.

The news is based on new guidelines from the National Institute for Health and Care Excellence (NICE) that aim to encourage sustainable weight loss in the obese; “lose a little, and keep it off”.

The guidance is mainly aimed at commissioners (who plan and agree which services will be provided in the NHS and monitor them), health professionals and groups who provide lifestyle weight management programmes. The recommendations may also be of interest to members of the public, including people who are overweight or obese.

The guidance has been issued because being overweight or obese is a common and important health problem in the UK. In 2012 about a quarter of men and women aged 16 and over in England had a body mass index (BMI) over 30, classified as obese.

In addition, 42% of men and 32% of women were categorised as overweight (BMI of 25 to 30). Life expectancy is estimated to be reduced by an average of two to four years for people with a BMI of 30 to 35, and eight to 10 years for a BMI of 40 to 50.

The cost of obesity to society was estimated to be almost £16 billion in 2007, which is predicted to rise to £50 billion by 2050 if obesity levels continue to rise.

NICE has estimated that across the population, a 12-week weight management programme costing £100 or less for people who are overweight or obese would be cost-effective if they were to lose at least 1kg and keep the weight off for life.

What are the main recommendations?

NICE recommends that local authorities and clinical commissioning groups should provide access for people to be referred to a range of lifestyle weight management schemes.

GPs, practice nurses, health visitors, pharmacists and the local adult population should be informed of what services are available locally. And they are advised to use informed advice from the NHS Choices website on weight management.

GPs, health and social care professionals are advised to raise the issue of weight loss for overweight and obese adults in a non-judgemental way. They should consider referring adults of any age to local programmes. They should take the person’s preferences into account. but choose group programmes where possible as they provide better value for money. The programmes should be able to show that at least 60% of people are likely to complete them and that they are likely to lead to an average loss of at least 3% of body weight, with a minimum of 30% of people losing 5% of their initial weight.

People should be referred who have:

• BMI over 30 (or lower for people from black and minority ethnic groups as they have a higher risk of type 2 diabetes), or people with other risk factors such as already having diabetes
• BMI between 25 to 30 if there is enough local resource

GPs, health and social care professionals and providers of lifestyle weight management services should be trained to deliver multicomponent programmes, tailored to the individual needs of the person. The programmes should have been developed by a multidisciplinary team including a registered dietician, registered psychologist and qualified physical activity instructor. The programme should be collaborative, and cover:

• dietary habits
• safe physical activity
• strategies to achieve behaviour change
• prevention of weight regain

Commissioners and local authorities should regularly monitor the provision of services and how effective they have been in helping people to lose weight to ensure that the measures are working and are providing good value for money (are cost effective). This includes collecting outcomes such as:

• the percentage of people losing more than 3% or 5% of their baseline weight
• how the weight changes in the 12 months after the programme is completed
• changes in other outcomes such as blood pressure

What are the main benefits of weight loss?

The more weight that is lost, the greater the benefits – especially if a person is able to lose 5% to 10% of their body weight, and maintain it. However, even losing just 3% body weight if obese or overweight can be beneficial.

Weight loss reduces the risk of:

• diabetes – obese women are 13 times more likely and obese men are five times more likely to develop type 2 diabetes
• high blood pressure – obese women are four times more likely and obese men are more than twice as likely to have hypertension
• mental health problems such as depression – often due to stigma and bullying or discrimination
• difficulties in conceiving
• certain types of cancer
• heart disease
• stroke
• osteoarthritis
• back pain

Read more about the complications of obesity.

What are the dangers of rapid weight loss?

Setting realistic goals for weight loss is an important part of the NICE recommendations. This is to ensure a steady rate of weight loss within safe limits, and to increase chances that the weight loss can be maintained, rather than having weight regain.

The dangers of rapid weight loss include feeling tired and unwell, as well as the potential for more serious complications such as malnutrition and gallstones. The recommended safe level of weight loss to aim for is between 0.5kg and 1kg per week.

How accurate and balanced is the media’s reporting of the guidelines?

The media have accurately described the extent of people being overweight and obese in the UK, and the cost of treating obesity-related illnesses. They have also highlighted the risks of obesity and the benefits of long term weight loss.

Arguably some of the papers have missed the point of NICE’s main arguments. That is while funding weight-loss programmes may cost the NHS money in the short-term (the Daily Mail quotes a figure of a £100 million a year, but it is unclear how it came up with the figure), it could potentially save the NHS billions of pounds in the long-term. This remains to be proven. 

The NHS weight loss plan

NHS Choices provides a downloadable 12 week weight loss plan that:

• promotes safe and sustainable weight loss
• helps you learn how to make healthier food choices
• provides support from our online community
• offers a weekly progress chart 
• presents an exercise plan to help you lose weight
• hopefully allows you to learn skills to prevent regaining weight