Overweight people told losing just 3% and keeping it off can have significant beneficial effects in new NHS guidance
New NHS guidelines have directed GPs to identify people eligible for state-funded slimming classes run by companies such as Weight Watchers, with obese adults given priority.
GPs and other health professions have been told by the National Institute for Health and Clinical Excellence (Nice) to raise the issue of weight loss in a "respectful and non-judgmental" way and identify people who are eligible for referral for lifestyle weight management services by measuring their body mass index (BMI).
The guidelines said such programmes may particularly benefit adults who are obese – those with a BMI of 30 and above – although they also state that those who are overweight should also be considered for funded referrals where there is capacity, meaning two-thirds of the population come within their scope.
Public Health England and other agencies should be a national source of information on effective lifestyle weight management programmes suitable for commissioning, according to Nice.
It said providers of lifestyle weight management programmes should demonstrate that participants maintain their weight loss and their programmes are effective at 12 months or beyond. The watchdog acknowledged the difficulties many people face losing weight and maintaining the weight loss, saying there was "no magic bullet" for the complex problem.
As well as publishing the guidelines on best practice for programmes, including ensuring the tone and content of all communications, Nice also said a national database for lifestyle weight management programmes that have achieved positive long-term results should be set up to help tackle obesity rates.
It said participants in such programmes – which focus on cutting calories consumed and increasing physical activity – lose 3% of their body weight on average, which if sustained would be enough to lower the risk of type 2 diabetes and high blood pressure.
Carol Weir, guidance developer for Nice and head of service for nutrition and dietetics at Leeds Community Healthcare NHS Trust, said: "Obviously, if you need to lose weight, the more weight you lose the better, and the health benefits derive from that, but even a 3% loss, kept up long-term, is beneficial and that is why we are recommending sensible changes that can be sustained lifelong."
The NHS recommends that obese people should aim to lose 5%-10% of their weight, and Nice emphasised it was not replacing that guidance. But it said people needed encouragement and achievable goals.
It found that Rosemary Conley, Slimming World and Weight Watchers had been shown to be effective at 12-18 months, and said lifestyle weight management programmes were "one part of the solution", but robust data was not available for many of them.
Gill Fine, chair of the Nice guidance group, said: "The issue is the variation in the types of programme available, and this is a real challenge for local authorities who have limited resources available when commissioning programmes. If there was a central resource that local providers could go in and see those programmes which are effective, it would help them to commission."
Dr Alison Tedstone, chief nutritionist at Public Health England, said: "Elements of PHE's work to support effective commissioning are already contributing to delivering some of the recommendations that Nice has developed. PHE is currently developing its future obesity work plan, which includes supporting local public health teams to deliver lifestyle and weight management services that meet local needs."
Richard Welbourn, president of the British Obesity and Metabolic Surgery Society, welcomed the Nice guidance but stressed the benefits of surgical interventions. "The fact remains that significant weight loss is hard to achieve and even harder to sustain, even with the help of health professionals," he said. "We promote the safe and effective use of surgical strategies as part of a coordinated pathway of care for people who are obese. There is compelling evidence that weight-loss surgery is clinically effective, safe and cost-effective."
Nice is also reviewing its guidance on bariatric surgery, which it currently recommends for adults with a BMI of more than 40 who have tried but failed to lose weight using non-surgical techniques. The revised guidance is due to be published in November.
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