Norfolk Obesity Network

2015

WINNER OF THE ASSOCIATION FOR THE

STUDY OF OBESITY BEST PRACTICE AWARD 2015

Deanna.alexander@nhs.net

Maintaining a healthy weight;

update on NICE guidance and review of strategies to

help weight loss maintenance after discharge from a weight management

service

Dr Carly Anna Hughes Clinical Lead FWMS

Is it possible to prevent obesity?

Advice for individuals;Maintaining a healthy weight and preventing excess

weight gain (2015) NICE NG 7Population MeasuresTown planningActive TravelIncreased PA‘Fat or sugar taxes’Education

NICE guideline on maintaining a healthy weight and preventing excess weight gain

Thanks to Adrienne CullumAnalyst, Centre for Public Health, NICE

Trustee ASO

NICE NG 7

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice on health and social care in England.

Public Health role since 2005.Guidance is aimed at a wide range of

stakeholders including the NHS, local authorities and the wider health community.

Existing guidance

Obesity CG 43 (2006) and Obesity update CG 189 (2014)

Lifestyle weight management in adults (2014) and children (2013)

BMI and waist circumference – BME groups (2013)

Obesity – working with local communities (2012)

Weight management before, during, after pregnancy (2010)

Updating Obesity (2006)

‘Information for the public’

• Clearer on aims and target audience

• New evidence e.g. sugar sweetened drinks, sleep

• Nuanced recommendations

• Practical examples

Scope

• Aimed at practitioners who need advice on behaviours that help people maintain a healthy weight.

• Focus on individually modifiable behaviours.

• Supports other NICE guidance including e.g. preventing CVD or type 2 diabetes.

• Includes children and adults

• Excludes weaning, pregnancy and management of obesity.

Guideline developmentIndependent committee with range of expertise

Assessment of evidence: Systematic review of reviews on 64 factors Qualitative evidence on communicating advice Consideration of relevant economic models

Stakeholder consultation

Overarching messagesCombination of increased physical activity and healthier

eating – energy balance.

Existing advice on diet and physical activity.

Avoiding extreme behaviours (e.g. excessive exercise or avoiding all carbohydrates).

Identifying perceptions, habits or situations that may undermine efforts to maintain a healthy weight.

Physical activity

• All activity likely to be helpful – range of definitions used in evidence.

• Good evidence for walking (particularly brisk walking) and cycling.

• Good evidence for being active during leisure time, part of daily life, play.

• Limited review level evidence on sedentary behaviours; strong relationship with TV viewing.

Additional adviceAdults • do not exceed recommended amounts of alcohol

Children • active at every opportunity• family meals• enough sleep

General• Self monitoring – e.g. pedometer, regular

weighing• Robust sources of information

Communicating messages

The broad range of benefit including ‘non health’

Even small improvements are likely to be helpful

Important for people currently a healthy weight weight gain not inevitable No single factor

Tailor messages Clear, consistent, specific, non judgemental

References

Maintaining a healthy weight and preventing excess weight gain (2015)

https://www.nice.org.uk/guidance/ng7Obesity: identification, assessment and

management of overweight and obesity in children, young people and adults (2014)

http://www.nice.org.uk/guidance/cg189Obesity Pathway www.nice.org.uk

How can we help people maintain weight loss after a successful intervention?

Scientific evidencePractical solutionsDiscussion

Weight maintenance after weight loss

Difficult challenge

What are realistic expectations?

How do we managing challenges and fluctuations

What help is available?

Does not depend on initial weight lossObes Rev 2010 Dec;11(12):899-906. doi: 10.1111/j.1467-789X.2010.00740.x.Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review.Barte JC et al

Weight Regain Prevention

Data from RCT and Population studies

Consistent and structured eatingSelf monitoringHigh levels PAGroup support and follow-upProblem solving trainingPharmacological

Meal replacements

Christina Garcia Ulen,Mary Margaret Huizinga,Bettina Beech,Tom A. Elasy

doi: 10.2337/diaclin.26.3.100 Clinical Diabetes July 2008 vol. 26 no. 3 100-113

Weight Regain ; is it inevitable?

20% of individuals attempting weight loss are able to achieve and maintain 5% weight reductions for at least 1 year. Among successful weight losers, various studies indicate that more than 60, 35, and 19% of individuals are able to maintain 10% weight reductions for 1, 3, and 5 years, respectively.Maintenance of weight loss for ≥ 2 years is protective against subsequent regain; by 2 years the likelihood of regaining 2.6 kg in the coming year is only 50%; by 5 years the likelihood drops to 27%

Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators

PJ Teixeira et al BMC Medicine 13 2015http://www.biomedcentral.com/1741-7015/13/84

Self regulation mediators (1)

A comprehensive search of peer-reviewed articles, published since 2000

Conducted on electronic databases and journal reference lists.

Experimental studies were eligible if they reported intervention effects on ;hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake).

Self regulation mediators (2)

35 studies,Best predictors;

higher autonomous motivationself-efficacyself-regulation skills

positive body image and flexible eating restraint may additionally improve outcomes.

Long-term weight loss maintenance

Wing R R and Phelan S.Am J Clin Nutr 2005;82 (suppl) 222S-5S 6 key strategies ;1.High levels P A2.Diet low in calories and fat3.Eating breakfast4.Self-monitoring weight regularly5.Maintaining consistent eating pattern6.Catching ‘slips’ before large regains

What should we discuss with clients?

1. Set realistic goals both for target weight and maintenance2. Establish regular eating patterns3. Eat breakfast 4. Avoid high fat/sugar foods5. Alcohol in moderation6. Don’t deviate from healthy eating for more than 3 days7. Plan a strategy to help with relapses-ask for help if needed8. Note what has worked for you in the past and return to it9. Consider a support group (NHS or commercial)10.Maintain high level of PA 11.Aim to maintain your new weight for 2 years if possible

Discharge plan

Consider a written plan drawn up in conjunction with the client

Check they have realistic expectations Encourage self monitoring weight, activity

(pedometer/fitbit/app etc) Consider support group Offer up to date information and reliable long term resources;

ActiveNorfolk, Norfolkslivingwell, NHS choices, British heart foundation

Do they need additional help? Overeaters anonymous http://www.oagb.org.uk/ Man v Fat manvfat.com B-EAT www.b-eat.co.uk NHS support (health trainers, GP/practice nurse, dietitian)

ASO UKCO 2015

Is there a role for protein sparing modified fasts for weight maintenance?

5:2But must be based on a healthy balanced diet

and avoid overconsumption on non-fasting days

Some evidence to support this from meal replacement trials

More research required