A number of approaches have been successful in delivering cost-effective obesity management in the NHS. Ailsa Brotherton and Carol Pinder explain

The demand for cost-effective, evidence-based approaches for treating obesity has never been higher. The prevalence of the condition has reached 21 per cent in men and 23.5 per cent in women and over half the population is overweight.

Securing Good Health for the Whole Population;Delivering Choosing Health; Creating a Patient-Led NHS and Health Challenge England: the next steps for choosing health are just a few of the key drivers identifying the need for innovative obesity management services.There are no simple solutions to halt the rise in obesity, but evidence has clearly identified some successful strategies.

These include:

  • individualised dietary advice;

  • appropriate portion sizes;

  • promoting an active lifestyle;

  • having realistic expectations;

  • setting realistic goals;

  • provision of long-term follow-up.

The challenge is to deliver these cost-effectively, but up to now there has been nothing available to NHS managers that has the potential to reach millions of overweight individuals. A partnership that has brought together senior NHS managerial experience, dietetic research and clinical expertise has resulted in the development of a web-based resource incorporating approaches that have been demonstrated to be successful.

Traditionally, a one-to-one consultation approach has been used in obesity management in the NHS, with limited availability of appointments and long delays before review appointments. This has resulted in low attendance at clinics and poor clinical outcomes. Behavioural change approaches are being used in many trusts with improved success. However, one-to-one consultations are expensive and time consuming, with many services having to restrict access through implementation of strict referral criteria and the provision of minimal, if any, long-term follow-up.

This new computer-based resourcehas been designed to support existing services and NHS obesity care pathways. Users of the resource complete two questionnaires on their current eating habits to receive personalised dietary advice and dietary information leaflets. We know that providing dietary advice alone is unlikely to result in real dietary changes leading to weight loss. The resource therefore incorporates the additional approaches that have been shown to be successful. These include a self-assessment of the person's current motivation levels, setting realistic goals and exploring how beliefs about food affect food choices.

A package of ongoing support, including advice on food labelling, shopping, alcohol intake and healthy food choices for children is also provided. Promoting physical activity is also crucial to successful weight loss interventions and advice and regular updates are provided on the website by a fitness consultant experienced in giving cardiac rehabilitation and pulmonary rehabilitation classes for the NHS. Ongoing support is provided via e-mails, which has been shown to result in significantly greater weight loss in a randomised controlled trial.

The resource also offers a range of patient benefits, including choice, improved access, no waiting list, convenience for users, a service to patients who do not routinely attend clinic appointments and cost-effective new ways of working.Two pilots of the service have been evaluated very positively. People found the personalised advice, motivational questionnaire and portion counter invaluable when setting and monitoring their personal goals. Many people reported they had not known which foods in their diets were contributing the highest levels of fat, as this is affected by not only the fat content of the food but the frequency of consumption.

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Ailsa Brotherton and Carol Pinder are registered dieticians.