1. Counterweight in Manchester A Primary Care Weight Management Program Frances Wilkinson Tel: 0161 861 2348 Frances.Wilkinson@cmft.nhs.uk Community Dietitian 16/06/2014

2. What I will talk about today?  The scale of the problem.  What is Counterweight?  The story in Manchester so far.  Case Study: Mr B  The nurses’ views.

3. The Scale of the Problem in Manchester 90,000 adults currently obese (JSNA,2008.Healthy weight, healthy lives: A toolkit for developing local strategies. 2008). By 2015 this figure is expected to increase to: 137,000 obese adults (Greater Manchester Public Health Network, 2009)

4. Manchester’s Healthy Weight Strategy 2010-2013 Aimed to: ‘ Create an environment and culture where all adults and children in Manchester have an opportunity to maintain a healthy weight.’

6. Counterweight Aims 5 - 10% decrease from starting weight Change in eating behaviour and physical activity levels Maintenance of weight loss long-term To improve health status Aims Are Not  To achieve an unrealistic ‘ideal weight’  To lose weight for short-term goals

7. -6 -5 -4 -3 -2 0 1 2 3 3m3m 6m12m 24 m Weight Change kg -2.3 - 4.2 -3.3 -3.0 One in 6 achieve >5% weight loss at 12 or 24 months Counterweight mean weight change n (12m) = 642 attending from total possible 1419 (45%) n (24m) = 357 attending from total possible 825 Expected weight change without intervention Heitmann BL & Garby L (1999) Int J Obes Br J Gen Pract. 2008; 58: 548-554 Mean Counterweight effect size: 4 kg below expected weight at 12-24 months Weight Change in Attenders

8. Percentage of attending patient who lost>= 5% body weight

10. Manchester Weight Management Services BMI> 35kg/m2 ABL Health BMI> 25kg/m2 Counterweight

11. Treatment Pathway Discuss weight loss target: ≥ 5-10% weight loss First Line – Lifestyle Intervention Group Programme or 1:1 Goal setting or 1:1 Calorie deficit plan with exercise referral scheme, if available Second Line – Additional Interventions Pharmacotherapy Dietitian referral Psychology referral Secondary Care referral Weight Maintenance

12. Counterweight Resources

13. Centralised Nurse Training  Causes of obesity  Healthy eating and physical activity  Energy Balance  Weight loss expectations  Behaviour change strategies  Pharmacotherapy  Weight loss maintenance  Counterweight pathway  Individual and group programmes

14. Roles GPPractice nurse/HCA Local Counterweight advisor Understanding and awareness of Counterweight Screening for Counterweight 2 half-day training sessions Refer patients onto Counterweight Delivering Counterweight Mentoring for up to 6 months Ongoing support

15. Example from session 1 My Dream weight A Happy Weight An Acceptable Weight A Disappointing weight 31% 25% 16%

16. Cathy’s chain of events Buys Biscuits Leaves biscuits on kitchen table where they are visible She experience being home alone on Saturday afternoon is a high- risk time for overeating Feels tired and bored She feels the urge to eat She goes to the kitchen She takes the biscuit to the living room Eats the biscuits while watching TV She eats rapidly until she feels full She now feels guilty This weakens her resolve She eats more biscuits

17. Breaking the chain LinkBreaking the Link Buys biscuits Shop from a list and on a full stomach Shop with a partner or friend who helps to keep you motivated Avoid the biscuit aisle Buy something that needs preparation Biscuits on Kitchen table Store in opaque container Freeze biscuits in plastic container Store out of sight and reach

18. Story So Far in Manchester  Total of 24 practices trained (25%) 11 North 9 central 4 South  43 staff trained  Data collected on 724 patients

19. Nurses’ views ‘Reduced Orlistat prescribing by the end of the first 6 appointments. ‘Gives an end point to discharge patients’ ‘Easy to understand booklets’ ‘Structured way of delivering weight management information that you already do in everyday practice (knowledge you may already have)’ ‘Well supported throughout the training and afterwards’ ‘Improved the background knowledge I already had’

20. Percentage of eligible patients who attended Counterweight VisitEstablishe d practices 2006- 2010 Original evaluation 2000- 2005 Manchester 2011-2012 3 months55 54.6 6 months39 64 12 months45 62

21. Mr B  BMI: 38.5kg/m2, weight 139kg  Age: 42 years  Sex: Male  Medical history: Knee and back problems leading to poor mobility, High cholesterol and high blood pressure  Medication: orlistat

22. Mr B  Patients Goals: better quality of life lessen the risk of health complications, to be around for his family.  Approach Personal Weight loss plan, NHS physical activity services (Pars)  Weight loss goal for 3 months: 132kg (5% reduction )

23. Mr B

24.  Week 10: Weight 128kg, BMI 35.8kg/m2  Total weight loss: 7.9%  Blood pressure: dropped 150/95 to 138/84.  Patient noticed an improvement in his mobility.

25. How to Book onto training  Leave your contact details with me  Discuss the program with your practice.

26. Thank you for Listening Tel: 0161 861 2348 Frances.Wilkinson@cmft.nhs.uk

27. References DoH.,2008. Healthy Weight, Healthy Lives: A toolkit for developing local strategies. Greater Manchester Public Health Network.,2009. Obesity Indicators report - Greater Manchester. Accessed at www.nwph.net. GD. et al.,2001. ‘Obese patients’ perceptions of treatment outcomes and factors that influence them’. Archive of Intern Medicine, 161,2133-39. The Counterweight Project Team and Trueman,P.,2010. Long-Term Cost Effectiveness of Weight Management in Primary Care.International Journal of Clinical Practice,64(6),775-783. The Counterweight Project Team.,2008.Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care,Journal of Health Services Research & Policy,13(3),158-166. The Counterweight Project Team.,2004 A new evidenced-based for weight management in primary care: the Counterweight Programme, Journal of Human Nutrition and Dietetics,17,191-208.