NICE: 'Obese should be prescribed slimming clubs'

“GPs told to prescribe £100 slimming courses for millions of obese patients,” the Daily Mail reports.

The news is based on new guidelines from the National Institute for Health and Care Excellence (NICE) that aim to encourage sustainable weight loss in the obese; “lose a little, and keep it off”.

The guidance is mainly aimed at commissioners (who plan and agree which services will be provided in the NHS and monitor them), health professionals and groups who provide lifestyle weight management programmes. The recommendations may also be of interest to members of the public, including people who are overweight or obese.

The guidance has been issued because being overweight or obese is a common and important health problem in the UK. In 2012 about a quarter of men and women aged 16 and over in England had a body mass index (BMI) over 30, classified as obese.

In addition, 42% of men and 32% of women were categorised as overweight (BMI of 25 to 30). Life expectancy is estimated to be reduced by an average of two to four years for people with a BMI of 30 to 35, and eight to 10 years for a BMI of 40 to 50.

The cost of obesity to society was estimated to be almost £16 billion in 2007, which is predicted to rise to £50 billion by 2050 if obesity levels continue to rise.

NICE has estimated that across the population, a 12-week weight management program me costing £100 or less for people who are overweight or obese would be cost-effective if they were to lose at least 1kg and keep the weight off for life.

What are the main recommendations?

NICE recommends that local authorities and clinical commissioning groups should provide access for people to be referred to a range of lifestyle weight management schemes.

GPs, practice nurses, health visitors, pharmacists and the local adult population should be informed of what services are available locally. And they are advised to use informed advice from the NHS Choices website on weight management.

GPs, health and social care professionals are advised to raise the issue of weight loss for overweight and obese adults in a non-judgemental way. They should consider referring adults of any age to local programmes. They should take the person’s preferences into account. but choose group programmes where possible as they provide better value for money. The programmes should be able to show that at least 60% of people are likely to complete them and that they are likely to lead to an average loss of at least 3% of body weight, with a minimum of 30% of people losing 5% of their initial weight.

People should be referred who have:

• BMI over 30 (or lower for people from black and minority ethnic groups as they have a higher risk of type 2 diabetes), or people with other risk factors such as already having diabetes
• BMI between 25 to 30 if there is enough local resource

GPs, health and social care professionals and providers of lifestyle weight management services should be trained to deliver multicomponent programmes, tailored to the individual needs of the person. The programmes should have been developed by a multidisciplinary team including a registered dietician, registered psychologist and qualified physical activity instructor. The programme should be collaborative, and cover:

• dietary habits
• safe physical activity
• strategies to achieve behaviour change
• prevention of weight regain

Commissioners and local authorities should regularly monitor the provision of services and how effective they have been in helping people to lose weight to ensure that the measures are working and are providing good value for money (are cost effective). This includes collecting outcomes such as:

• the percentage of people losing more than 3% or 5% of their baseline weight
• how the weight changes in the 12 months after the programme is completed
• changes in other outcomes such as blood pressure

What are the main benefits of weight loss?

The more weight that is lost, the greater the benefits – especially if a person is able to lose 5% to 10% of their body weight, and maintain it. However, even losing just 3% body weight if obese or overweight can be beneficial.

Weight loss reduces the risk of:

• diabetes – obese women are 13 times more likely and obese men are five times more likely to develop type 2 diabetes
• high blood pressure – obese women are four times more likely and obese men are more than twice as likely to have hypertension
• mental health problems such as depression – often due to stigma and bullying or discrimination
• difficulties in conceiving
• certain types of cancer
• heart disease
• stroke
• osteoarthritis
• back pain  

What are the dangers of rapid weight loss?

Setting realistic goals for weight loss is an important part of the NICE recommendations. This is to ensure a steady rate of weight loss within safe limits, and to increase chances that the weight loss can be maintained, rather than having weight regain.

The dangers of rapid weight loss include feeling tired and unwell, as well as the potential for more serious complications such as malnutrition and gallstones. The recommended safe level of weight loss to aim for is between 0.5kg and 1kg per week.

The NHS weight loss plan

• promotes safe and sustainable weight loss
• helps you learn how to make healthier food choices
• provides support from our online community
• offers a weekly progress chart 
• presents an exercise plan to help you lose weight
• hopefully allows you to learn skills to prevent regaining weight

http://www.nhs.uk/news/2014/05May/Pages/NICE-Obese-should-be-prescribed-slimming-clubs.aspx

Is portion control the secret to a healthy diet?

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They say it’s best to have everything in moderation—can cutting down your portion sizes finally help you banish fad diets for good?

Whether it’s low carb schemes like Atkin’s and Paleo, or crazes like the master cleanse, eating according to blood type or blending everything into ‘baby food’, we’re continually inundated with the latest, greatest fad diet.

But despite the growth of these so-called solutions, one overarching truth remains: we’re fatter than ever before. A recent study revealed that more Brits are either obese or overweight than at any other time in the past three decades.

Clearly, trendy diets designed for quick results haven’t made us any healthier in the long term. Maybe it’s time to get back to basics.

Health vs. vanity

In order to approach weight loss logically, it helps to remember the main reason you’re trying to lose weight: your health! You may be dying to squeeze back into your favourite jeans, but your biggest concern should be how obesity puts you at a greater risk of heart disease, diabetes, cancer, liver disease and many more life-threatening conditions. Fad diets are a quick fix for superficial insecurities, but it’s time to get serious.

The science of portion control

Why does portion awareness matter? At a basic level, when you overeat, you consume more calories than your body needs. Those excess calories lead to weight gain. That’s the cold, hard truth.

As Cornell University food psychologist Brian Wansink explains, our careless eating habits cause us to regularly eat 100-200 calories more than we need at each meal. If you pay attention to your body, it will naturally tell you when enough’s enough. But too often we ignore our what our bodies are telling us and eat “mindlessly”.

Our subconscious decision to overeat is driven by our brain’s limbic system—the part that supports emotion, motivation and behaviour. Too often, our limbic impulses win against our brain’s ability to make conscious, analytical decisions. Why? Because we don’t think, we just eat. Being more intentional with your meals and considering long-term consequences of overeating is the first step towards achieving a healthier weight.

Snacks aren’t the enemy

Although snacking mindlessly is an obvious no-no, you don’t have to write snacking off completely. If you’re hungry between meals, don’t be afraid to grab an apple or snack on a handful of almonds. You may have been raised in a strict no-snacking household, but experts now say that a light snack may actually stop you from overeating at mealtime. 

OK, so what are the proper portion sizes?

In order to visualise what a healthy portion size looks like, Guard Your Health recommends comparing food items to certain parts of your hand. For example:

• Meat: 3 ounces (about the size of your palm) = one portion
• Butter for your toast: 1 teaspoon (about the size of your fingertip) = one portion
• Ice cream: 1 cup (about the size of a clinched fist) = one portion

Additionally, this comprehensive portion guide covers wide range of foods and the number of portions for each food group you should eat each day. For example:

• - Cereal: 9 tablespoons (about the size of a tennis ball) = three portions
• - Bread: 2 slices = two portions
• - Hard cheese: 30g (size of a small matchbox) = one portion

Reading up on what constitutes a portion, and how many portions of different foods you should eat a day, will give you the information you need to keep your portion sizes in check.

http://www.silversurfers.com/health/diet-exercise/portion-control-secret-healthy-diet/

Cut down on your calories

Many of us are eating too much, and not being active enough. That’s why nearly two thirds of the adult population in England is overweight or obese.

Find out how much you should be eating, and how to cut the calories.

• How much should you eat?
• How much are you eating?
• How you can eat less

The latest figures show that in England 65% of men and 58% of women are overweight or obese. That means many of us are eating more than we need, and need to eat less.

Over time, consuming more calories than we need leads to weight gain, and carrying excess weight puts us at greater risk of a whole range of serious health problems.

And it’s not just food we need to cut down on: some drinks can also be high in calories.

When we eat and drink more calories than we need, our bodies store the excess as body fat. If this continues over time we become overweight, and can become obese. Being overweight or obese causes an increased risk of type 2 diabetes, heart disease, stroke and some cancers.

Most adults in the UK need to lose weight, and to do this they need to eat and drink fewer calories. Combining these changes with increased physical activity is the best way to achieve a healthier weight.

How much should you eat?

The amount that you need to eat to maintain your body weight depends on a range of factors, including your size and how physically active you are.

The term calorie is commonly used shorthand for kilocalorie. On food packets you will find this written as kcal. Kilojoules (kJ) are the metric measurement of calories, and you’ll see both kJ and kcal on nutrition labels – 4.2kJ is equivalent to approximately 1kcal.

An important part of a healthy diet is eating the right amount of calories, so that you balance the energy you put into your body with the energy you use.

As a guide, men need around 2,500kcal (10,500kJ) a day to maintain a healthy body weight, and women need around 2,000kcal a day (8,400kJ).

If you need to lose weight, aim to lose about 0.5-1kg (1lb-2Ib) a week until you reach a healthy weight for your height. You should be able to lose this amount if you eat and drink about 500kcal to 600kcal fewer a day than you need.

You can find out whether you are a healthy weight by using the BMI calculator on this page. If you are overweight, the healthy weight calculator will give you a personalised suggested calorie range.

If you are very physically active because of your job, or you do a lot of exercise, you may need more calories to maintain a healthy weight. If you do very little physical activity – for example, you are housebound – or if you are overweight or obese, you may need fewer calories.

A healthy diet is not only about eating the right amount. It also means eating a wide range of foods, to ensure you get all the nutrients you need. You can still eat less when following a balanced diet. Learn more about a balanced diet in The eatwell plate.

How much are you eating?

Most of us are eating and drinking more than we need, and we often think we are more active than we actually are, too.

It is estimated that the average person eats around 10% more calories than they need every day. This might not sound much, but over time it will cause significant weight gain. 

Foods and drinks that are high in fat or sugar can contain lots of calories, and eating or drinking these often or in large amounts can make it easy to have more calories than you need.

If you are overweight or obese, you could be eating over 500kcal more than a person of a healthy weight does every day. So it’s time to think about where your extra calories are coming from, and to make changes to your diet to reduce the number of calories you consume. 

It is likely that it’s not just one snack, meal or drink that you need to change: you are likely to be having more calories than you need across the whole day.

In England in 2011:

• 65% of men and 58% of women were overweight or obese.
• The average (mean) height for men was 175.3cm (5ft 9in) tall while the average height for women was 161.6cm (5ft 3in) tall.
• The average (mean) weight for men was 83.9kg, while the average weight for women was 71kg.

Use the BMI calculator on this page to see if you're a healthy weight for your height.

How you can eat less

You can reduce the number of calories you eat by making healthier choices when it comes to food and drink.

Often, that will mean swapping high-fat or high-sugar foods for alternatives that contain fewer calories, or eating these foods in smaller portions or less often.

And it’s not just foods: drinks can be high in calories, too. To consume fewer calories you should choose drinks that are lower in fat and sugar or consume high-calorie drinks less often. Don't forget alcohol is also high in calories.

As well as choosing foods and drinks lower in fat and sugars, also think about reducing the size of your portions. Research suggests that we tend to eat more when we are served more, even when we don’t need the extra calories.

When serving yourself food at home, resist filling your plate, and think about if you are really hungry before having an extra helping. When eating out, avoid supersizing or choosing large portions of food or drink.

Knowing the calorie content of different foods and drinks can be useful when it comes to achieving or maintaining a healthy weight. It can help us to keep track of the amount of energy we put into our bodies, and ensure that we are not eating too much.

The calorie content of many foods and drinks is provided on the packaging as part of the nutrition label. You can look at the calorie figure to assess how a particular food or drink fits into your daily intake. Find out more in Understanding calories.

These tips can help you to get started:

• Swap sugary fizzy drinks for diet versions with low or no calories. Even better, swap some soft drinks for sparkling water with a slice of lemon.
• Swap the frying pan for the grill when cooking meat; you don’t need to add any oil.
• Swap creamy or cheesy sauces for tomato or vegetable-based sauces on your pasta, or meat and fish dishes.
• Choose wholegrains, including wholemeal and wholegrain bread, or wholegrain breakfast cereals. Wholegrain foods contain more fibre and other nutrients, and we digest wholegrain foods more slowly so they can help make us feel fuller for longer.
• Swap a cake or biscuits for a currant bun, or some malt loaf, plain or with reduced-fat spread.
• Read food labels: they can help you choose foods that are lower in calories, as well as lower in saturated fat and sugars.
• Alcohol is also high in calories, so cutting down could help you control your weight
• http://www.nhs.uk/Livewell/Goodfood/Pages/eat-less.aspx

Height/weight chart

You can use this chart to check if you're the right weight for your height. Alternatively, you can use the BMI healthy weight calculator.

This height/weight chart is only suitable for adult men and women. It isn't suitable for children or young people under 18.

If you want to check if your child is a healthy weight for their height, or if you are under 18 yourself, use the BMI healthy weight calculator, which is suitable for both adults and children.

Growth charts specifically for children are included in the red book (Personal Child Health Record) given to parents in most areas of England just before or after the birth of their child. 

Interpreting the height/weight chart

Remember that this chart is only suitable for people aged 18 and over.

Underweight

If you're in the underweight range, there are a number of possible reasons for this. Your GP can help you find out more and give you help and advice. 

Healthy weight

If you're in this range, it means you're a healthy weight for your height. However, to stay in good health, it's still important to eat abalanced diet and include physical activity in your daily life. Adults should be active for at least 150 minutes (2 hours and 30 minutes) every week. Find out more in Benefits of exercise.

Overweight, obese or very obese

If you're in any of these ranges, you're heavier than is healthy for someone of your height. Excess weight puts you at increased risk of heart disease, stroke and type 2 diabetes. It's time to take action. There's lots of information, advice and support on NHS Choices that can help you.

• Lose weight has information and advice on achieving a healthy weight.
• Food and diet contains information and advice on healthy eating.
• Health and fitness gives you information on physical activity, including advice on how much exercise to do and how to get fit for free.

You can also talk to your GP or practice nurse. They can offer advice on lifestyle changes, and may refer you to a weight loss group or discuss other treatments. Find out more in How your GP can help.

Is this chart suitable for all adults?

This chart is suitable for most people aged 18 and over. However, if you have a very muscular build it may not be suitable. This is because having lots of muscle may put you in the overweight or obese categories, even if you have little body fat. For example, professional rugby players can fall into the 'obese' category despite having very little body fat. However, this will not apply to most people.

In addition to BMI, your waist circumference can provide information about your health. You can learn more in Why body shape matters.

Check your BMI

BMI (Body Mass Index) is another measure of whether you're a healthy weight for your height. You can see if you are a healthy weight for your height and receive tailored advice by checking your BMI using our BMI healthy weight calculator.

http://www.nhs.uk/Livewell/healthy-living/Pages/height-weight-chart.aspx

A balanced diet

Despite what you see in some diet books and TV programmes, healthy eating can be really straightforward.

A diet based on starchy foods such as potatoes, bread, rice and pasta; with plenty of fruit and vegetables; some protein-rich foods such as meat, fish and lentils; some milk and dairy foods; and not too much fat, salt or sugar, will give you all the nutrients you need.

When it comes to a healthy diet, balance is the key to getting it right. This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight.

Most adults in England are overweight or obese. That means many of us are eating more than we need, and should eat less. And it's not just food: some drinks can also be high in calories. Most adults need to eat and drink fewer calories in order to lose weight, even if they already eat a balanced diet.

Food groups in our diet

The eatwell plate

• To help you get the right balance of the five main food groups, take a look at our eatwell plate (PDF, 1.6Mb)
• To maintain a healthy diet, the eatwell plate shows you how much of what you eat should come from each food group

The eatwell plate shows that to have a healthy, balanced diet, people should try to eat:

• plenty of fruit and vegetables
• plenty of starchy foods, such as bread, rice, potatoes and pasta
• some meat, fish, eggs, beans and other non-dairy sources of protein
• some milk and dairy foods
• just a small amount of food and drinks that are high in fat and/or sugar

Try to choose a variety of different foods from the four main food groups.

Most people in the UK eat and drink too many calories, too much fat, sugar and salt, and not enough fruit, vegetables, oily fish and fibre. Read our page on understanding calories. 

It's important to have some fat in your diet, but you don't need to eat any foods from the "foods and drinks high in fat and/or sugar" group as part of a healthy diet.

Fruit and vegetables: are you getting your 5 a day?

Fruit and vegetables are a vital source of vitamins and minerals. It's advised that we eat at least five portions of a variety of fruit and vegetables each day.

There's evidence that people who eat at least five portions a day have a lower risk of heart disease, stroke and some cancers.

What's more, eating five portions is not as hard as it sounds. Just one apple, banana, pear or similar-sized fruit is one portion. A slice of pineapple or melon is one portion. Three heaped tablespoons of vegetables is another portion.

Having a sliced banana with your morning cereal is a quick way to get one portion. Swap your mid-morning biscuit for a tangerine, and add a side salad to your lunch. Have a portion of vegetables with dinner, and snack on dried fruit in the evening to reach your five a day. 

Read our 5 A DAY page for more tips on how to get your five portions of fruit and veg.

Starchy foods in your diet

Starchy foods should make up around one third of everything we eat. This means we should base our meals on these foods.

Potatoes are an excellent choice and a great source of fibre. Leave the skins on where possible to keep in more of the fibre and vitamins. For example, when having boiled potatoes or a jacket potato, eat the skin too.

Try to choose wholegrain or wholemeal varieties of starchy foods, such as brown rice, wholewheat pasta and brown, wholemeal or higher fibre white bread. They contain more fibre (often referred to as "roughage"), and usually more vitamins and minerals than white varieties.

Learn more from our starchy foods page.

Meat, fish, eggs and beans: all good sources of protein

These foods are all good sources of protein, which is essential for the body to grow and repair itself. They are also good sources of a range of vitamins and minerals.

Meat is a good source of protein, vitamins and minerals, including iron, zinc and B vitamins. It is also one of the main sources of vitamin B12. Try to eat lean cuts of meat and skinless poultry whenever possible to cut down on fat. Always cook meat thoroughly. Learn more by reading our page on meat.

Fish is another important source of protein, and contains many vitamins and minerals. Oily fish is particularly rich in omega-3 fatty acids.

Aim for at least two portions of fish a week, including one portion of oily fish. You can choose from fresh, frozen or canned, but remember that canned and smoked fish can often be high in salt.

Eggs and pulses (including beans, nuts and seeds) are also great sources of protein. Nuts are high in fibre and a good alternative to snacks high in saturated fat, but they do still contain high levels of fat, so eat them in moderation. Learn more from our pages on eggs and pulses and beans.

Milk and dairy foods: avoid full fat varieties

Milk and dairy foods such as cheese and yoghurt are good sources of protein. They also contain calcium, which helps keep your bones healthy.

To enjoy the health benefits of dairy without eating too much fat, use semi-skimmed, 1% fat or skimmed milk, as well as lower-fat hard cheeses or cottage cheese, and lower-fat yoghurt.

Learn more by reading our page on milk and dairy foods.

Eat less fat and sugar

Most people in the UK eat too much fat and sugar.

Fats and sugar are both sources of energy for the body, but when we eat too much of them we consume more energy than we burn, and this can mean that we put on weight. This can lead to obesity, which increases our risk of type 2 diabetes, certain cancers, heart disease and stroke.

But did you know that there are different types of fat?

Saturated fat is found in foods such as cheese, sausages, butter, cakes, biscuits and pies. Most people in the UK eat too much saturated fat, which can raise our cholesterol, putting us at increased risk of heart disease.

Unsaturated fats, on the other hand, can help to lower cholesterol and provide us with the essential fatty acids needed to help us stay healthy. Oily fish, nuts and seeds, avocados, olive oils and vegetable oils are sources of unsaturated fat.

Try to cut down on foods that are high in saturated fat and have smaller amounts of foods that are rich in unsaturated fat instead. For a healthy choice, use just a small amount of vegetable oil or reduced fat spread instead of butter, lard or ghee. When having meat, choose lean cuts and cut off any visible fat. Read on to find out how to eat less saturated fat.

For more information on fat and how to reduce the amount we consume in our diets, read fat: the facts.

Sugar occurs naturally in foods such as fruit and milk, but we don't need to cut down on these types of foods. Sugar is also added to lots of foods and drinks such as sugary fizzy drinks, cakes, biscuits, chocolate, pastries, ice cream and jam. It's also contained in some ready-made savoury foods such as pasta sauces and baked beans.

Most of us need to cut down on foods high in added sugars. Instead of a fizzy drink, for example, try sparkling water. Have a currant bun as a snack instead of a pastry. Learn more from our page on sugars.

Find out more about healthy eating in our food and diet section.

http://www.nhs.uk/Livewell/Goodfood/Pages/Healthyeating.aspx