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Specialist Weight Management Services Dr Sheena Bedi ABL Health

Specialist Weight Management Services Dr Sheena Bedi ABL Health. NCMP 2010/11. 23% Reception, 33% Yr 6: overweight or obese 9% Reception, 19% Yr6: Obese 79% obese children  obese adults 2050: two thirds children overweight / obese £50bn/yr direct &indirect £4.2bn/yr direct

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Specialist Weight Management Services Dr Sheena Bedi ABL Health

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  1. Specialist Weight Management Services Dr Sheena Bedi ABL Health

  2. NCMP 2010/11 • 23% Reception, 33% Yr 6: overweight or obese • 9% Reception, 19% Yr6: Obese • 79% obese children  obese adults • 2050: two thirds children overweight / obese • £50bn/yr direct &indirect • £4.2bn/yr direct • £5.1bn/yr consequences

  3. Consequences • Type 2 diabetes • Cancers • Asthma • Sleep apnoea • Mental health • Achievement • Social Status • Self Esteem • Bullying • Stigma

  4. Causality / Approaches • Nature vs nurture • Food addiction / dopamine down regulation • Adolescent brain maturation • Nudge theory • Prioritise young people • Women as influencers • Granular understanding of social structures

  5. AoMRC Measuring up, the medical profession’s prescription for the national obesity crisis • Nutritional standards for food in hospitals • Ban new fast food outlets close to schools / colleges • Pilot duty on sugary soft drinks (20%) • Traffic light food labelling – restaurants / fast food outlets • £100m/yr for 3yrs for  weight management services • Ban advertising foods high in saturated fat, sugar, salt <9pm • Existing mandatory foods: nutrient-based standards

  6. Solutions • NICE Managing overweight and obesity among children and young people; lifestyle weight management services • Expected October 2013

  7. Definitions • UK90 • Population monitoring: 85th / 95th centiles • Clinical: 91st / 98th centiles

  8. Cornerstones • Nutrition, activity, behaviour change • Parents / carers / families • Adult programmes • Effective & cost-effective

  9. Outcomes • Weight maintenance or changes in wt, BMI, waist circumference adjusted for age and gender (eg z-scores / BMI centiles) • Dietary habits / activity • Emotional / psychological / social well being • Satisfaction • QALY’s / ROI

  10. Key concepts • Awareness • Engaging influencers • Family dynamics • Setting • Psychological therapies / MI • Parenting skills / social challenges • Bridging gaps / stakeholders

  11. Stakeholders • Wt mx providers • CAMHS • Healthy schools • NCMP • Community food workers / health improvement service • Family Support workers • Early intervention / prevention teams • Adult services • Dietetics • Physical activity provision • Primary/secondary care • Children’s centres • Social services

  12. Service Model • Multidisciplinary • Family based • Tailored • CBT-E approach • Staged stepping down • Psychological therapies / parenting skills • 6m intervention / 18m support

  13. Stage 1: Assessment • At home • MDA family assessment • LSC / therapist • Story • Barriers / concerns • Motivation / readiness to change

  14. Stage 2: intervention • Month 1: at home, 4-8 sessions • Months 2,3,4: weekly group / 1:1 • Months 5,6: fortnightly group / 1:1 • Celebration

  15. Stage 3: Follow up • 18m • Monthly group / 1:1 • Lifelong change • Continued goal setting • Barriers

  16. Primary Outcomes • BMI / waist circumference (UK90) • Family healthy eating practices • Physical activity levels • Sedentary behaviour / screen time • Self esteem • Perceived body image • Parenting efficacy • Family clinical measures

  17. Secondary Outcomes • Parent / carer BMI • parent /carer waist circumference • Parent /carer clinical measures • Childrens sedentary behaviour • Parent / carer activity levels • Family engagement • Access to other services

  18. MDT ASSESSMENT (within 4 weeks of receipt of referral) Receipt of referral Lifestyle assessment Psychologist assessment Medical assessment Decision and assignment of appropriate intervention, goals set and personal action plan INTERVENTION STAGE (within 8 weeks of the MDA appointment) Group Support 12 x 2 hour sessions Bi-weekly: Nutrition CBT Physical Activity Maternity support Bariatric Specialist Session Domiciliary Support Service Overview Additional options available: 1 : 1 Psychological support 1 : 1 Nutrition support Exercise input from specialist where required MOVING FORWARD FOLLOW UP SUPPORT 18 x 1 hour sessions An incentive scheme to stay engaged and committed Web support

  19. Psychological Clinical Themes • Binge eating 26% • Binge eating + depression 35% • Binge eating + bereavement 3% • Depression 30% • Anxiety and other 6% • (total binge eating 64%) • Serious loss / sexual abuse / domestic abuse

  20. Psychological Therapy Outcomes • 70% complete average 6 sessions • 10% lose 2.5-10% weight through therapy alone • 100% improved well being, self esteem, psychosocial functioning • Overwhelmingly positive feedback • <3% referred back to GP / community teams

  21. Our role as GPs • Honesty • Advocacy • Motivational interviewing

  22. Thank You

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