Healthcare professionals have an important role to play in helping patients make sense of all the ‘hype’ which surrounds dieting in today’s society. Surveys show that many patients trust the advice from their primary care practitioners⁵ and that when obesity management is raised by a health professional, patients are more likely to attempt a treatment.^6,7 However, the frequency with which weight management is raised with patients in primary care is thought to be low^6,8,9 and some studies have indicated that overweight patients have fewer expectations of receiving help with weight management from their primary care team.¹⁰ As the recognition of obesity as a serious health problem continues to rise, this perception may of course change and the unique position that health professionals occupy – not only in terms of patient access but also how their expertise is regarded – means that there is good opportunity within primary care to provide patients with sound and supportive advice.

Information gathered in the assessment phase will allow both patient and practitioner to understand more about current eating habits – developing the practice of recording food intake is invaluable. It is useful to record information about the types of food eaten as well as the circumstances of eating.

The frequency and timing of meals is important as many obese patients describe very erratic or poorly structured diets.¹⁴ A common practice is to skip meals or restrain eating in the earlier part of the day, making it difficult to avoid overeating in the latter part of the day. Patients should be assured that having a regular pattern of eating is one of the key strategies people use to help them gain more control over their body weight.^15-17 It is interesting to note that in a registry maintained by researchers in America, the majority (78%) of those that have been successful in maintaining a lower body weight for at least one year describe eating breakfast every day or most days.¹⁸

In advising about diet it is important to ensure that dietary change does not compromise other aspects of health. The inclusion of fruits, vegetables and wholegrain cereals is of particular importance as these are nutrient dense but low energy foods that have been shown to be protective to health.^19–23 In addition, it is important to consider reducing the risk of conditions such as anaemia and osteoporosis.

In order to lose weight the body has to be in a state of negative energy balance. Treatments for obesity therefore need to focus on helping individuals to reduce their intake of energy dense foods and to increase their levels of physical activity.

Availability of local dietetic support will vary across the country, but most PCTs now employ dietitians, who can offer additional support to the team with respect to:

Practical resources are provided in the patient material section of this education package.

Guidance on suitable resources can often be obtained from local dietetic services. In addition, the British Dietetic Association is a respected source of information on all aspects of nutrition including obesity (www.bda.uk.com).

A very practical resource is also available from the British Heart Foundation entitled, “So you want to lose weight…for good”.

The booklet provides guidance and suggestions of how to adjust dietary intake in order to achieve weight loss. Details are given about appropriate portion sizes as well as examples of eating plans. The booklet can be provided to patients and acts as a source of information about diet to all health professionals. Details are available on the British Heart Foundation website (www.bhf.org.uk).

Very low calorie diets (VLCDs) are designed to completely replace usual food intake. By definition a diet is described as very low calorie if it provides less than 800 kcal per day.³³ It is important that VLCDs provide sufficient protein and meet the daily requirements for vitamins, minerals, electrolytes and fatty acids. VLCDs are usually provided in the form of liquid supplements. Small amounts of low calorie foods such as vegetables may be incorporated into a VLCD. Due to the severe calorie restriction and the potential side effects, VLCDs should not be followed for periods greater than 12–16 weeks. Patients could expect to lose 1.0–2.5 kg per week when strictly adhering to a VLCD.

Physical activity is an important factor in the regulation of human energy metabolism. In terms of weight management the most important role of physical activity appears to be in the prevention of weight gain/regain. In other words, the benefits achieved by a moderate (30 min/day) level of physical activity on weight loss over and above that achieved by dietary restriction is modest, but in the case of maintaining a weight loss the inclusion of physical activity appears crucial.

The current government recommendation for ensuring good health is that a minimum of 30 min of moderate intensity physical activity is taken on at least five and preferably all days of the week. In addition to planned activity, increasing the activities of daily living may also make a valuable contribution e.g. using the stairs instead of the lift. It is interesting to note that those that ‘fidget’ can expend anything from 150–850 kcal extra per day as a result of this ‘spontaneous activity’.¹

Just over a third of men (37%) and a quarter of women (25%) in England take the recommended 30 min of physical activity per day.⁴⁵ Many environmental, cultural and social factors have contributed to the decline in population activity levels.

A pedometer is a simple tool that can be used to provide a measure of activity levels. These devices can be worn on a waistband and are designed to record the number of steps taken. They are relatively inexpensive and easily obtainable through a catalogue or sports shop.

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