Following a full assessment of the patient’s health risk, dietary and physical activity habits, as well as expectations, decisions need to be taken about how the primary care team can progress with treatment.

In the first instance there should be mutual agreement about entering a weight management programme that will consist clearly of a weight loss phase followed by a weight maintenance phase. Secondly, the responsibilities of the patient and the practitioner need to be agreed. This does not imply that a formal contract should be drawn up but rather there should be a mutual understanding and respect about how the treatment will proceed.

The practitioner should undertake to:

• Offer support advice and guidance
• Have available the appropriate equipment and tools for assessing and monitoring progress e.g. weighing scales, BMI charts, large blood pressure cuffs etc.
• Examine their own expectations of the treatment of overweight and obesity
• Make arrangements for referral to other healthcare professionals/support agencies as appropriate
• Review the patients progress and make arrangements for an appropriate level of follow-up

The patient should undertake to: 

• Accept responsibility for making agreed changes to diet and activity
• Review their expectations and set realistic goals for what they want to achieve
• Make reasonable attempts to attend follow-up appointments

Support

Support is recognised as a crucial component of achieving successful behaviour change. It is therefore worth spending time discussing where that support might come from and what type of support would be most helpful. The health professional can be clear about what support can be offered from the surgery. For some, it may only mean an encouraging few words at regular intervals, for others more support may be required.