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| NICE – Healthcare professional interventions How1 #369929 Interventions by healthcare professional to address obesity. | Assess lifestyle, comorbidities and willingness to change - Make an initial assessment, then use clinical judgement to investigate comorbidities and other factors to an appropriate level of detail, depending on the person, the timing of the assessment, the degree of overweight or obesity, and the results of previous assessments.
- Manage comorbidities when they are identified; do not wait until the person has lost weight.
- Offer people who are not yet ready to change the chance to return for further consultations when they are ready to discuss their weight again and willing or able to make lifestyle changes. Give them information on the benefits of losing weight, healthy eating and increased physical activity.
- Recognise that surprise, anger, denial or disbelief about their health situation may diminish people's ability or willingness to change. Stress that obesity is a clinical term with specific health implications, rather than a question of how people look; this may reduce any negative feelings.
During the consultation - Assess the person's view of their weight and the diagnosis, and possible reasons for weight gain.
- Explore eating patterns and physical activity levels.
- Explore any beliefs about eating and physical activity and weight gain that are unhelpful if the person wants to lose weight.
- Be aware that people from certain ethnic and socioeconomic backgrounds may be at greater risk of obesity, and may have different beliefs about what is a healthy weight and different attitudes towards weight management.
- Find out what the person has already tried and how successful this has been, and what they learned from the experience.Assess the person's readiness to adopt changes.Assess the person's confidence in making changes.
- Give people and their families and/or carers information on the reasons for tests, how the tests are done and their results and meaning. If necessary, offer another consultation to fully explore the options for treatment or discuss test results.
- Take measurements (see identifying people who are overweight or obese in this pathway) to determine degree of overweight or obesity and discuss the implications of the person's weight.
- any presenting symptoms
- any underlying causes of being overweight or obese
eating behaviours - any comorbidities (for example type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia and sleep apnoea)
- any risk factors assessed using lipid profile (preferably done when fasting), blood
- pressure measurement and HbA1c measurement
- the person's lifestyle (diet and physical activity)
- any psychosocial distress
- any environmental, social and family factors, including family history of overweight and obesity and comorbidities
- the person's willingness and motivation to change lifestyle
- the potential of weight loss to improve health
- any psychological problems
- any medical problems and medication
- the role of family and care workers in supporting individuals with learning disabilities to make lifestyle changes.
Consider referral to tier 3 (specialist) services Consider referral to tier 3 services if: - the underlying causes of being overweight or obese need to be assessed]
- the person has complex disease states and/or needs that cannot be managed adequately
- in tier 2 (for example, the additional support needs of individuals with learning disabilities)
- conventional treatment has been unsuccessful
- drug treatment is being considered for a person with a BMI more than50 kg/m2
- specialist interventions (such as a very low-calorie diet) may be needed or
- surgery is being considered.
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+Citations (3) - CitationsAdd new citationList by: CiterankMapLink[1] Obesity: identification, assessment and management of overweight and obesity in children, young people and adults
Author: NICE - CG189
Cited by: David Price 5:08 PM 19 December 2014 GMT
Citerank: (14) 369907NICE Guidance on Diet, Nutrition and ObesityNote: extended excerpts from National Institute for Health and Care Excellence are included and cross-linked here to help explore and understand their intersection with the policy space and their implications. Those seeking specific guidance should refer to the full Guidelines and Pathways directly.565CA4D9, 369908NICE – DietHaving a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This pathway covers recommendations for everyone about diet and lifestyle, and recommendations for health professionals on interventions to encourage people to follow a healthy diet.565CA4D9, 369912NICE – ObesityGuidelines on preventing and managing obesity.565CA4D9, 370012Assessing health risk and interventionThe latest guidance from the National Institute for Health and Care Excellence on the assessment of the health risk arising from obesity and associated interventions. 125F66EBE, 370041NICE – Increasing physical activity565CA4D9, 370042NICE – Changing diet565CA4D9, 370046NICE – Interventions with drug treatment Consider pharmacological treatment only after dietary, exercise and behavioural approaches have been started and evaluated.565CA4D9, 370047NICE – Interventions to change behaviour565CA4D9, 370048NICE – Interventions to increase physical activityEncourage adults to increase their physical activity even if they do not lose weight as a result, because of the other health benefits physical activity can bring (for example, reduced risk of type 2 diabetes and cardiovascular disease). Encourage adults to do at least 30 minutes of moderate or greater intensity physical activity on 5 or more days a week. The activity can be in 1 session or several sessions lasting 10 minutes or more.565CA4D9, 370049NICE – Interventions to change diet565CA4D9, 370050NICE – Surgical interventions for obese adults565CA4D9, 370057Reduce calorie intake for adults who are obese565CA4D9, 371177NICE – Preventing cardiovascular disease565CA4D9, 399912Assessing health risk and interventionThe latest guidance from the National Institute for Health and Care Excellence on the assessment of the health risk arising from obesity and associated interventions. 82AECCD8 URL: |
Link[2] Obesity: Guidance on the prevention of overweight and obesity in adults and children
Author: NICE - CG43
Cited by: David Price 5:09 PM 19 December 2014 GMT
Citerank: (31) 352351Increased risk of Type 2 diabetes Obesity substantially raises the risk of Type 2 diabetes—with excess body fat estimated to underlie almost two-thirds of cases of diabetes in men and three quarters of cases in women—and people at risk of diabetes can cut their chances of getting diabetes by 60% if they lose between 5% and 7% of their body weight. Worldwide, the number of people with diabetes has tripled since 1985. [2]57DE7179, 352718Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 369907NICE Guidance on Diet, Nutrition and ObesityNote: extended excerpts from National Institute for Health and Care Excellence are included and cross-linked here to help explore and understand their intersection with the policy space and their implications. Those seeking specific guidance should refer to the full Guidelines and Pathways directly.565CA4D9, 369908NICE – DietHaving a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This pathway covers recommendations for everyone about diet and lifestyle, and recommendations for health professionals on interventions to encourage people to follow a healthy diet.565CA4D9, 369909NICE – Lifestyle weight management for overweight or obese adultsLocal authorities, working with other local service providers, clinical commissioning groups and health and wellbeing boards, should ensure there is an integrated approach to preventing and managing obesity and its associated conditions.565CA4D9, 369912NICE – ObesityGuidelines on preventing and managing obesity.565CA4D9, 369913NICE – Obesity working with local communitiesThis pathway focuses on an overarching approach to overweight and obese adults and overweight and obese children in local communities. It focuses on the importance of integrating action on obesity in other local agendas (such as initiatives to prevent type 2 diabetes, cardiovascular disease and cancers, or initiatives to improve the environment and promote sustainability), and provides an organisational framework for the relevant community-based or individual interventions.565CA4D9, 369921NICE – Keeping track of weightEveryone should aim to maintain or achieve a healthy weight, to improve their health and reduce the risk of diseases associated with being overweight and obese, such as coronary heart disease, type 2 diabetes, osteoarthritis and some cancers. Periodically check your weight, waist measurement or a simple alternative, such as the fit of your clothes.565CA4D9, 369923NICE – Diet to maintain a healthy weightBalancing 'calories in' (from food and drink) and 'calories out' (from being physically active) may help to maintain a healthy weight.565CA4D9, 369924NICE – Activity to maintain a healthy weightBalancing 'calories in' (from food and drink) and 'calories out' (from being physically active) may help to maintain a healthy weight.565CA4D9, 369925 NICE – Additional advice for parents and carersIn addition to the general recommendations on behaviours to maintain a healthy weight, the advice below will help children establish healthy behaviours and maintain or work towards a healthy weight. These strategies may have other benefits – for example, monitoring the amount of time children spend watching television may help reduce their exposure to inappropriate programmes or advertisements.565CA4D9, 369926NICE – Advice for adults who wish to lose weightSee also the NICE guidance on diet and activity to maintain a healthy weight.565CA4D9, 369928NICE – Local authority environmental interventions565CA4D9, 369931NICE – Interventions to support smoking cessation All interventions to support smoking cessation should: ensure people are given information on services that provide advice on prevention and management of obesity if appropriate?, and give people who are concerned about their weight general advice on long-term weight management, in particular encouraging increased physical activity.565CA4D9, 369934NICE – Workplace interventionsAll workplaces, particularly large organisations such as the NHS and local authorities should address the prevention and management of obesity, because of the considerable impact on the health of the workforce and associated costs to industry. 565CA4D9, 369937Local authorities and the NHS as employersLocal authorities and the NHS as employers should set an example in developing public health policies to prevent and manage obesity by following existing guidance and (in England) the local obesity strategy.565CA4D9, 369941NICE – School interventions565CA4D9, 370053Standards for take-aways and other food outletsFood from take-aways and other outlets (the 'informal eating out sector') comprises a significant part of many people's diet. Local planning authorities have powers to control fast-food outlets565CA4D9, 370058Supporting people who are stopping smokingAll interventions to support smoking cessation should: (1) ensure people are given information on services that provide advice on prevention and management of obesity, and (2) if appropriate give people who are concerned about their weight general advice on long-term weight management, in particular encouraging increased physical activity.565CA4D9, 370062Lifestyle advice on diet & physical activity for families and children565CA4D9, 370063Diet in early years education and childcareHelp children and young people to have a healthy diet and lifestyle. This includes helping them to develop positive, life-long habits in relation to food. This can be achieved by ensuring the messages conveyed about food, the food and drink available – and where it is consumed – is conducive to a healthy diet.565CA4D9, 370074Training for programme for lifestyle weight management services staff 565CA4D9, 370163Primary Care565CA4D9, 370164Community based programmes and interventions565CA4D9, 370177Training for health and other professionals565CA4D9, 370560Clinical Commissioning GroupsClinical commissioning groups (CCGs) are responsible for commissioning a range of healthcare services for children and adults. This includes specialist obesity services (sometimes called tier 3 services). The groups do not directly commission lifestyle weight management services (sometimes called tier 2 services). Rather, they work with local authorities to coordinate and integrate planning and commissioning through the health and wellbeing board.58D3ABAB, 370918NICE – Interventions to increase physical activity565CA4D9, 370963NICE – Preschool Interventions565CA4D9, 371184NICE – Physical activity in the workplacePhysical activity programmes in the workplace including active travel.565CA4D9, 399548Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 399987Increased risk of Type 2 diabetes Obesity substantially raises the risk of Type 2 diabetes—with excess body fat estimated to underly almost two-thirds of cases of diabetes in men and three quarters of cases in women—and people at risk of diabetes can cut their chances of getting diabetes by 60% if they lose between 5% and 7% of their body weight. Worldwide, the number of people with diabetes has tripled since 1985.57DE7179 URL: |
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