1 Slimming World’s Approach to Weight Management Paul Sharpe Sue Gibson

2 Overweight & Obesity – scale and cost Raising the issue of weight with patients The Slimming World approach Slimming World on Referral –Accessing the referral scheme in Bracknell Forest –Evidence of Success The link between alcohol and obesity: new research Agenda

3 “People who are overweight or obese have an increased risk of developing Type 2 diabetes, heart disease and certain cancers. There is no silver bullet to reducing obesity. It is an issue that requires action at national, local, family and individual level. Local authorities are ideally placed to develop co-ordinated action across their departments, services and partner organisations to tackle overweight and obesity in the local population.” Diana Grice, Thames Valley Public Health England Centre Director Scale and Cost

4 Public Health England (Feb 2014) Berkshire Districts – levels of overweight and obesity

5 ‘…preventing poor health and promoting healthy living is essential to reduce health inequalities and sustain the NHS for future generations’ Making Every Contact Count

6 Potential Concerns How can I talk about a patient’s weight when I struggle with my own weight? What if they don’t want to talk about their weight? What if I offend the patient?

7 Are you heavier than you’d like to be? How do you feel about your weight? I haven’t checked your height & weight recently, would you mind if…. I wouldn’t be doing my job properly if I didn’t check/let you know that… Suggested questions

8 8 50% of nurses believe they are overweight (Nursing Times) –Fears: no credibility, hypocritical But research shows patients sometimes feel more comfortable with somebody ‘who understands’ Health behaviours can be difficult - acknowledge it Empathy - If it was easy we’d all be a size 12 Self-disclosure – I eat healthily 80% of the time but…! Own weight

9 9 Issue patient with referral letter: –Contains info on Slimming World –Dedicated phone number: 01773 546242 We manage enrolment: –Establish where referral is from –Conversational style –Test readiness to change –Select group and issue joining pack Follow up contact after 2-3 weeks Evaluation questionnaire Follow up weight at 6 months Accessing Slimming World on Referral

10 Support System Facilitate behaviour change Trained consultants who have all lost weight with Slimming World Warm, non-judgemental group environment Empowerment Self-determined behaviour change Set own goals: weight and action targets Share practical skills & strategies, including coping with ‘lapses’ and ‘high risk’ situations Problem solving Praise, recognition, award system

11 Dietary approach Reduces energy intake Balanced approach Normal everyday foods How foods affect appetite Energy density of foods User friendly practical system Feel free and relaxed about food Eliminate distress of guilt, deprivation or loss of control

12 Promotion of Activity Facilitate behaviour change No matter what starting point Why it’s important to me? How can I get started? Foot out of the door strategies Making it a habit Build commitment Support turning of new skills into a routine Recognise commitment with awards

13 13 Free week once 10% weight loss achieved and maintained for 10 weeks Free attendance once personal target achieved (and +/-3lbs) May self-fund after referral, no membership fee, max £4.95pw Website access continues for further 4 weeks Maintaining Weight Loss

14 14 60 patients currently in service Bracknell Forest - results to date FinishedLost ≥5%Lost ≥10% % completers Completers lost ≥5% Completers lost ≥10% Average weeks attended Latest published results 34,27136%5.8%5855%9.7%8.9 Current average (Super Service) 11,21044.5%9.1%65.762.1%13.79.4 Bracknell Forest 4042.5%17.5%65.053.819.29.4

15 Service satisfaction (all schemes) Data for all schemes (Bracknell Forest only 11 questionnaires completed so far)

16 Improved self-esteem Data for all schemes

17 Dean Worrall Referred for 7 x 12 weeks by GP in Dudley Then self-funded Lost 16st 13.5lbs

18 Kim Freshwater Referred for 12 weeks by GP in Hampshire Lost 3st 2lbs Then self-funded Total loss 17st 5lbs

19 19 The UK has the highest prevalence of obesity in Europe 1 It has among the highest proportion of ‘binge drinkers’ in Europe 2 UK’s consumption of alcohol is rising, other countries are reducing 3 These combined issues are placing a huge strain on the NHS: –The cost of treating conditions associated with obesity estimated at £5.1 billion 4 –Treatment costs associated with alcohol estimated at £3.5 billion 5. 1. The Press Association (2010). UK tops European obesity league, Health Service Journal. 2. TNS Opinion and Social (2010). EU citizens’ attitudes towards alcohol. 3. OECD (2011). Health at a Glance 2011. OECD indicators, OECD publishing. 4. The economic burden of ill health due to, diet, physical inactivity, smoking, alcohol and obesity in the UK. Journal of Public Health 33 (4): 527-535 5. Secretary of State for the Home Department (2012). The Government’s Alcohol Strategy. Alcohol and Obesity

20 20 Currently two separate public health campaigns: –Reducing obesity –Raising awareness of the dangers of excessive drinking and in particular ‘binge drinking’ Slimming World’s ‘Tipping Point’ campaign raising awareness of the link between the two. Alcohol and obesity

21 21 Alcohol provides 7 calories per gram, therefore…. alcohol consumption within government guidelines provides up to 2,880 / 3,840 calories a week (women/men) Research has shown that:

22 22 Alcohol Units/Calorie Values Typical UnitsTypical Calories Wine (175ml, 13% ABV)2.1160 Wine (250ml, 13% ABV)3228 Beer/Lager (pint, 3.6% ABV)2180 Beer/Lager (pint, 5.2% ABV)3244 Cider (pint, 4.5% ABV)2.6256 Cider (pint, 7.5% ABV)4.3386 Alcopop (275ml, 5% ABV)1.4192

23 23 Alcohol consumption can lead to an increase in food intake (stimulates appetite, lowers inhibitions) Heavy but less frequent drinkers at greater risk of obesity than low-to-moderate, frequent drinkers Higher alcohol intake associated with greater central obesity (carrying excess fat around the stomach), particularly in men Alcohol reduces the quality and quantity of sleep which may increase the risk of obesity. Research has shown that:

24 24 Tipping Point “The point at which people go on to make unhealthy choices with food and alcohol”

25 25 The average tipping point is 9.3 units of alcohol, equivalent to 3.7 pints of beer or 3.1 large glasses wine 51% of alcohol consumers acknowledge a tipping point with alcohol The average additional energy intake = an estimated 4,305 additional calories 58% who acknowledge a tipping point report they pass this point at least once on an average weekend YouGov Survey, 2042 members of UK population Tipping Point Survey

26 26 63% reported being more likely to eat a larger amount 57% more likely to snack on a family-sized packet of crisps or nuts 58% more likely to order a takeaway 65% more likely to rely on convenience food 34% more likely to go out for an unplanned meal. YouGov Survey, 2042 members of UK population Tipping Point Survey

27 27 People continue to make unhealthy food choices the day after passing their tipping point: average estimated additional intake 2,051 calories Estimated total additional calorie intake therefore around 6,000 The day after passing their tipping point, 50% cancel planned activity Tipping Point

28 28 With a 1lb weight gain said to be the equivalent of 3,500 calories… the reported additional energy intake….. and decreased energy expenditure: potential weight gain of 2lbs Tipping Point

29 29 1.Slimming World calls on Government and health authorities to improve the links between public health campaigns on obesity and alcohol by raising awareness of how drinking too much alcohol can impact on weight- affecting lifestyle behaviours. 2.Slimming World calls on the Government to raise awareness of the calories contained in alcohol by supporting clear labelling on alcoholic drinks. Key Recommendations

30 30 Thank you for listening