Management: Part I—Behaviour change, diet, and activity

In the United Kingdom over 22% of the adult population is now obese, with multiple health problems related to a body mass index—weight (in kilograms) divided by height (in metres) squared—of 30 or higher. In England the national service frameworks for diabetes and coronary heart disease highlight the importance of helping patients who are obese. People continue to gain weight until their 50s and 60s, so 30-40% of older people will be obese, with chronic disease, mobility problems, and depression aggravated by obesity.

Obesity needs to be managed like any other chronic disease—with empathy and a non-judgmental professional attitude. Helping people to manage their weight is difficult and can be discouraging and time consuming for health professionals.

High relapse rates, apparent lack of effectiveness, and lack of training and resources are major obstacles. However, an increasing evidence base exists for the effective management of obesity. And resources for health professionals are also now available.

For people who are obese, long term low fat diets—together with increased physical activity and strategies to help modify their lifestyle—may prevent type 2 diabetes in those with impaired glucose tolerance and improve the control of hypertension and type 2 diabetes. These health benefits are seen with surprisingly small weight losses—5-10% sustained over a year or more, well within achievable goals for weight loss and despite some weight regain over subsequent years.

General strategies for helping a patient with a weight problem include agreeing an individual, realistic, weight loss goal, such as 5-10% over three to six months. Achieving this goal can help motivate success. Aim for weight loss initially, followed by a distinct strategy for weight maintenance. Provide ongoing support …