Lifestyle in NICE guidance – Part 2a – preventing excess weight gain

This week’s NICE guidance is going to be ‘Preventing excess weight gain’  (NICE guidance NG7)

I realise this is an emotive subject, but I think it is important to talk about it and empower people with the information and tools they can use to maintain or improve their health and wellbeing.

The aim of this guidance is to:

“prevent a range of diseases and conditions including cardiovascular disease and type 2 diabetes and improve mental wellbeing.”

The full guidance is quite extensive. I’ve tried to cut it down and include practical tips/places to signpost that I’ve found useful in practice. Despite this, I have split this guidance into two blog posts to avoid it being a deterrently long read! Please be aware, however, that this does not therefore represent the full guidance, a link to this is given at the end of the blog.

Recommendations:

Encourage people to make changes in line with existing advice

  • Follow existing advice on the recommended level of physical activity because it is likely to help increase energy expenditure and reduce the risk of diseases associated with excess weight.
  • Follow existing advice on healthy eating because it will make it easier to have an appropriate energy intake.

eatwell_lge.gif

Source for picture: https://www.gov.uk/government/publications/the-eatwell-guide
  • Avoid extreme physical activity or dietary behaviours, because these are difficult to sustain and may not be accompanied by wider improvements in health. This includes:
    • Excessive exercise
    • Dietary restriction of entire food groups
  • Identify perceptions, habits or situations that may undermine efforts to maintain a healthy weight or prevent excess weight gain in the long term, and offer practical examples of helpful alternatives. These may include:
    • drinking water instead of drinks containing free sugars (including sports drinks) while being physically active
    • not overestimating how much physical activity is being done
    • avoiding overeating after being physically active
    • maintaining healthier physical activity and dietary habits most days (including at weekends) and during holidays.
    • avoiding giving ‘sweet treats’ as a reward or giving them regularly as gifts.
      • This is important especially in children and establishing food behaviours.
    • checking food and drink labels as a guide to appropriate portion sizes.
      • I realise in the time restraints of a GP consultation, or any other speciality, this can be a challenge. I often use diabetes.org.uk – which has some great resources of how to read food labels and portion sizes. It also has healthy swaps and meal plans to guide patients into making healthier food choices which are satiating meals suitable for family cooking. I use this as an educational resource for patients who are what I call ‘pre-pre-diabetic’, those with raised HbA1c, but not pre-diabetic as yet, with risk factors both genetic and lifestyle which predispose them to this number rising further.
      • You can also see the dedicated work of Dr Punam Krishan – recently featured in the news talking about her ‘Lidl walks’ with patients in her community in Glasgow, educating them about food choices. Screenshot_20190914_154519
        Source for picture: https://www.heraldscotland.com/news/17800808.dr-punam-krishan-reality-life-scottish-gp/
      • being aware that even food and drinks perceived as ‘healthy’ (such as olive oil and nuts) can contribute to weight gain if large amounts are consumed.

Encourage physical activity habits to avoid low energy expenditure

Again, please see my blog from last week discussing the guidance Physical activity: brief advice for adults in primary care’ : https://thelifestylepill.org/2019/09/08/lifestyle-in-nice-guidelines-part-1/

  • Encourage people to build activity into daily life, developing routines and habits that gradually increase the amount and intensity of activity they do. This may include:
    • Increasing regular walking, particularly brisk walking, or cycling as a form of active travel (to school, work or other local destinations).
    • Increasing activities during leisure time and breaks at work or school.
    • Increasing activity as part of daily routines (such as taking regular breaks from sitting at home or work, and taking the stairs instead of the lift).
    • Reducing TV viewing and other screen time. Advise people that any strategy that reduces TV viewing and other leisure screen time may be helpful (such as TV‑free days or setting a limit to watch TV for no more than 2 hours a day).

Encourage dietary habits that reduce the risk of excess energy intake

Encourage everyone to follow a dietary pattern that is mainly based on vegetables, fruits, beans and pulses, wholegrains and fish. In addition, everyone should be encouraged to:

  • Reduce the overall energy density of the diet. Practical ways to achieve this may include:
    • reducing how often energy dense foods and drinks (such as fried foods, biscuits, savoury snacks, confectionery and drinks made with full fat milk or cream) are eaten
    • substituting energy dense items with foods and drinks with a lower energy density (such as fruit and vegetables or water)
    • using food and drink labels to choose options lower in fat and sugar – see above Diabetes UK resource on this.
    • choosing smaller portions or avoiding additional servings of energy dense foods.
      • I often discuss portion sizes with patients. An easy way of reducing portion sizes subconsciously is to buy smaller crockery. For example, when on all-inclusive holidays I often go for the large side plates they have instead of the massive main plates to avoid over-eating. At home I eat desserts in ramekin dishes. This might be too much for some patients to start at, but plates on the whole have got bigger, and sicking to the small ones still makes you feel you’re eating a full plate and is psychologically then appealing.
      • It’s also important to make patients aware of this issue with glasses. Wine glasses are getting bigger, to the point it’s easy to pour a third or even half a bottle into one glass. Being aware of this makes it easier not to fall into the trap of mistakenly over consuming alcohol.
  • Limit consumption of energy dense food and drinks prepared outside the home, particularly ‘fast’ or ‘takeaway’ foods.
  • Avoid sugary drinks (including carbonated drinks, sports drinks, squashes). Everyone should be encouraged to choose water or other drinks that do not contain free sugars.
    • A tip if a patient doesn’t like water is to cut up fresh fruit or veg into water to make it more palatable. Such as a slice of lemon, cucumber or even some strawberries.
  • Increase the proportion of high fibre or wholegrain foods eaten. Practical ways to do this may include:
    • choosing wholemeal bread and pasta and wholegrain rice instead of ‘white’ versions
    • opting for higher-fibre foods (such as oats, fruit and vegetables, beans, peas and lentils) in place of food and drinks high in fat or sugar.
  • Limit intake of meat and meat products. Follow existing advice from NHS Choices to eat no more than 70 g of red and processed meat a day on average. Practical ways to do this may include reducing the portion size of meat or how often meals including meat are eaten.

 

This is where part 1 ends, come back next week for part 2 where I finish off discussing this guidance.

Emma x

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