Journal of Human Nutrition and Dietetics (1999), 12, 000±000

# 1999 Blackwell Science Ltd. 01

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Editorial

This supplement brings together two major

themes that currently concern health care practi-

tioners ± obesity and the evaluation of practice.

Once considered an aesthetic rather than a

serious medical problem, obesity, defined as a

body mass index of 30 kg/m2 or greater, is now

recognized as a major public health problem that

generates significant health service costs (West

1994). Despite the setting of national targets and

consideration of strategy options (Department of

Health 1992; Department of Health 1995); the

levels of obesity continue to rise. Helping patients

to lose weight and maintain a new lower weight

is a challenge that is made more difficult by the

limited evidence for effective strategies.

Clearly the aim of treatments, referred to as

weight management services in this supplement,

should be to prevent or reduce the medical

consequences of obesity and ultimately morbidity.

The achievement of `ideal weight' is not necessary

to achieve health benefits. A weight loss of 5±10%

of the initial body weight will result in clinically

useful changes such as lowered blood pressure,

reduction in plasma total cholesterol and triglycer-

ides, an increase in HDL cholesterol and an

improvement in diabetic control (Royal College of

Physicians 1998). Consequently the effectiveness of

a treatment programme should no longer be judged

by the achievement or otherwise of an `ideal

weight' but rather by modest weight loss resulting

in measurable improvements to health and the

maintenance of such weight loss for the long term.

Many weight management services are being

run by health care teams or individuals at local

level but not all are evaluated for effectiveness

and those that are, are rarely disseminated to

help others plan effective programmes. In April

1997, the Department of Heath (DH) allocated

£100 000 to encouraging good practice in the

treatment of obesity. The funds were used to

compile a directory of existing weight manage-

ment services, and additionally to enable the

evaluation of a small selection of the identified

weight management services.

However, the DH recognized that not all

practitioners have the same level of experience

in evaluation and each service may require a

slightly different approach. As part of the project,

expert advice was made available at the start and

throughout the life of the evaluation. This is

described in the paper by Rayner & Ziebland

(p. 9) and is a good starting point for those

needing to evaluate a weight management service.

Ten project evaluations are described in this

supplement and have been assessed to determine

the most effective treatment components includ-

ing factors associated with recruitment and

initiating weight loss, successful weight loss

and maintenance of weight loss. These are

summarized in the paper by Hughes and Martin

(p. 1). Whilst not comprehensive because of the

limited number of services evaluated, this project

will add to the knowledge of the effectiveness of

treatments for obesity and hopefully encourage

others to undertake systematic evaluation of

their work.

References

Department of Health. (1992) Health of the Nation. A

Strategy for Health in England. London, HMSO.

Department of Health. (1995) OBESITY. Reversing

the Increasing Problem of Obesity in England. A

Report from the Nutrition and Physical Activity

Task Forces. London, Department of Health.

Royal College of Physicians. (1998) Clinical

Management of overweight and obese patients.

With Particular Reference to the Use of Drugs.

London: Royal College of Physicians.

West, R. (1994) Obesity. London: Office of Health

Economics, pp. 38±41.

Correspondence: Dr J. Hughes, Elmcroft, Crab Hill

Lane, South Nutfield, Surrey RH1 5NR.

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