1. Healthy Lifestyles Weight Management Services Linda Marklew Healthy Lifestyles Programme Manager Linda.marklew@worcestershire.nhs.uk 01905 733826

2. Estimated annual costs to NHS of diseases related to overweight and obesity (BMI25kg/m2 or more) and obesity alone (BMI 30kg/m2 or more), for Worcestershire. Estimated annual costs to NHS of diseases related to overweight and obesity £ million Estimated annual costs to NHS of diseases related to obesity £ million 200720102015200720102015 Worcestershire PCT 136.6141.8151.670.976.888.1 Source: http://www.fphm.org.uk/resources/AtoZ/toolkit_obesity/2008/full_obesity_toolkit.pdf; Healthy weight healthy lives: TOOL D3 Estimating the local cost of obesity

3. National Institute for Clinical Excellence (NICE) defines BMI risk in NICE Clinical Guidance CG43 Healthy BMI 18.5-24.9 Overweight 25-29.9 Over 30 obese Over 40 morbidly obese Body Mass Index or BMI is calculated by weight in Kg/height in M squared, and is used as a common measure of risk generally accepted as an adequate indicator. Risk increases with weight circumference of over 80cm for women and over 94cm for men and with health status, or co-morbidity e.g. diabetes or hypertension Increased risk at lower BMI where health is already compromised, and in some ethnic and minority groups such as the Asian population where risk is greater at a lower BMI NICE guidance advises action should be taken at a BMI of 30, or 27+ where co-morbidities or other factors increase the risk to health, and recommends a target body weight loss of 5%-10%

4. NICE also recommends that Weight Management Programmes should; Help people to assess their weight and set goals to lose 5-10% original body weight Aim for maximum weekly weight loss of 0.5-1kg per week Focus on long term lifestyle changes, not quick fix Multi-component offering advice on both diet and activity using a variety of approaches Use a balanced healthy eating approach Recommend regular physical activity as part of a daily routine, offering practical advice and support on safe exercise or activity levels Include some behaviour change techniques and support to deal with lapses Recommend and/or provide on going support to maintain motivation

5. Adult Weight Management Programmes in Worcestershire Weight Watchers – started in 2007 Offers 12 weeks of vouchers free to the client on application as a starter incentive following referral to confirm the scheme criteria are met GP/Pharmacy Local Enhanced Agreement – 2007 Offers up to 6 months support free to the client with the GP practice or Pharmacy under a LES agreement, with payments to the provider for referral, 5% weight loss and 10% weight loss achievement points. Rosemary Conley Pilot programme – Nov 2009 Offers 18 weeks including exercise, 6 weeks free and 12 weeks half price to the client, subsidised by Public Health. Available to Wyre Forest GPs as a pilot until April 2010. Criteria for referral for all three programmes are BMI of 30, or 27+ co-morbidity, assessment of health risk, and readiness to change as per NICE guidelines (Dec 2006) Referrals are currently only accepted from GP’s, Practice Nurses and Health Trainers who are competent to assess.

6. Total Starters5% Loss achieved 10% Loss achieved Weight Watchers148241086 GP LES1841270159 Rosemary Conley from Nov 09 only10010 TOTAL3423681245 NICE guidance recommends that a body weight loss of 5% is beneficial to health, but 10% loss greatly reduces the risk of the individual developing diabetes and /or Cardiovascular Disease (CVD) therefore % weight loss achievement is currently being used as a measure to allow comparison between programmes As each programme uses a different model and data is added monthly, a 10 month period of relatively stable data, when all three programmes were fully operational has been used to give a more up to date snapshot for analysis, with more refined data analysis planned for year end. Referrals & Outcomes April 2009-March 2010

7. Weight Watchers January –October 2010 Referred 654, packs sent 573 228 attended 24 x 10% 11% 73 x 5% 32% 97 / 228 lost more than 5% = 42% Coverage for 26 postcode area excluding Wyre Forest

8. Rosemary Conley January – October 2010 Referred 201 106 attended 8 x 10% 7% 31 x 5% 29% 39 /106 lost more than 5%= 37% Coverage for 8 postcode areas- Wyre Forest

9. GP LES 1119 referrals made to in house courses January to October 2010 48 achieved a 10% weight loss = 4% 144 achieved a 5% weight loss = 12% 192 / 1119 lost more than 5% 16% Coverage of 21 postcode areas across 36 GP practices

10. Brief Summary No one model appears to predominate Data from GP schemes requires deeper analysis for comparison as NHS number given only but results indicate poor compliance to outcome Referrals to schemes were predominantly White British with less than 2% Non British where stated. Approximately equal numbers of employed and unemployed attended RC Age groups vary from 18 to 80 with the bulk of attendees between 30-65 Feedback from over 200 attendees of WW and 100 of RC shows there is no particular preference for either programme, and compliance was more relative to liking the course leader, both sets complained that when no longer sessions were no longer free they didn’t attend. Those who attended RC however were more likely to continue exercising after the initial course All programmes experience a large drop out rate from referral to attendance and fewer than 1 in 3 who attend and complete and achieve 5%-10% If clients complete any programme, weight loss of 5-10% is easily achievable,

11. In conclusion For the majority of overweight people there is a strong desire to ‘be less fat’ but is balanced against the effort required to make the changes* It is clear that ‘one size does not fit all’ in weight management Weight is an emotive issue and language used around weight and obesity can be a particularly sensitive, but there are vulnerable points e.g. before and after pregnancy, menopause, stopping smoking, where it would be appropriate to raise the issue ‘weight’ and BMI can lack personal relevance and any assessment should also consider overall health, fitness, size and shape, and personal circumstances There is more involved that just attending a weight loss programme to change behaviour Social marketing research has identified that different population groups find different approaches to ‘appropriate balance of nutritional advice, exercise and support components’ more spontaneously appealing so choice and variety is beneficial * Tailoring support around an individual’s ‘readiness to change’ is important in getting buy-in and sustained engagement for lifestyle change *(taken from key issues identified in ‘Maximising the appeal of weight management services’ A report for the Department of Health and Central Office of Information. ERSO March 2010)

12. Where next? Consider increase opportunities for choice by any willing accredited provider, inviting current providers and others such as leisure centres and the voluntary sector to increase availability, using single point of access for referral. Continue with commercial schemes but provide more than 12 weeks of vouchers for free but insist on payback if not attended Promote more client responsibility with part payments schemes by client and PCT Incentive providers to achieve more 5-10% weight losses using a payment by results only tariff Commission a PCT wide adult weight management service based on a best practice service outline Should the PCT continue to pay for weight loss, or should the responsibility belong to the individual to change their behaviour?

13. But the BIG question is:- Should the PCT be paying for weight loss schemes or is it a lifestyle choice?