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

Following on from last week, I’m discussing NICE guidance is going to be ‘Preventing excess weight gain’  (NICE guidance NG7). I started this discussion last week, so if you haven’t read this yet, I recommend it: https://thelifestylepill.org/2019/09/15/lifestyle-in-nice-guidance-part-2a/

Further advice for parents and carers of children and young people

Encourage parents, carers and everyone in regular contact with children and young people to:

  • Encourage and support them to be active at every opportunity.
  • Eat meals with children and young people.
    • Children often ‘do what I do not what I say’ – by adults demonstrating healthy behaviours children are more likely to engage with them themselves.
    • This often provides time for social interaction and building family relationships.
  • Help children and encourage young people to get enough sleep. Explain to parents and carers that this is because lack of sleep may increase the risk of excess weight gain in children and young people. Provide parents and carers with information on age-specific recommendations on sleep:

Sleep requirements.jpg

Picture source: https://sleepcouncil.org.uk/how-much-sleep-does-my-child-need/

Encourage adults to limit the amount of alcohol they drink

  • Adults should not exceed recommended levels of alcohol consumption.  Alcohol guidelines.jpg

    Picture source: https://www.alcohol-focus-scotland.org.uk/alcohol-information/drinking-too-much/
    • See above my comments on glass size causing it to be easy to subconsciously over consume alcohol.
  • Advise adults that all alcoholic drinks are a source of additional energy.
    • For example, a man drinking 3–4 units will be consuming around 200–325 extra calories a day.
  • Practical ways to limit alcohol consumption may include replacing alcoholic drinks with non‑alcoholic drinks that do not contain free sugars and increasing the number of alcohol‑free days.
    • For more information on the amount of calories in alcohol see this NHS Choices. They do compare alcoholic beverages to food products, I am in two minds about this, especially given the food they chose to compare the drink to, but do think it will be relatable and eye opening for some people.

Encourage self-monitoring

  • Encourage habits that may help people to monitor their weight or associated behaviours.
    • It doesn’t mention this in the guidance, but I think it’s really important before doing this to ensure there is no personal history or risk factors for disordered eating or eating disorders. Self-monitoring such as regular weighing or calorie counting can become detrimental if done to extremes or becomes overly restricted – in terms of both physical and social wellbeing

Clearly communicate the benefits of maintaining a healthy weight

  • Clearly communicate the broad range of benefits of maintaining a healthy weight through being more physically active and improving dietary habits. These should include ‘non health’ benefits as well as improvements to health. For example:
    • The enjoyment gained from shared, social physical activities.
    • The reduced risk of developing diseases associated with excess weight such as coronary heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2 diabetes and some cancers.
    • Improved mental wellbeing.
    • Reduced breathless, improved fitness and other benefits from increased movement that are independent of weight.
    • Lower blood cholesterol, improved oral health and other benefits from improved dietary habits that are independent of weight.

Clearly communicate the benefits of gradual improvements to physical activity and dietary habits

  • Clearly communicate that even small, gradual improvements to physical activity and dietary habits are likely to be helpful. Emphasise that:
    • Improving dietary habits and being physically active are as important for people who are currently a healthy weight as for people who are already overweight.
    • Weight gain in adulthood is not inevitable.
    • No single physical activity, food or drink will maintain a healthy weight – a combination of actions is needed.

Tailor messages for specific groups

  • Tailor messages, for example, for different age, socioeconomic or ethnic groups or for people with disabilities.
  • Ensure all messages are clear, consistent, specific and non-judgemental.

Ensure activities are integrated with the local strategic approach to obesity

  • Ensure that any activities promoting behaviours that may help people maintain a healthy weight or prevent excess weight gain are integrated with the local strategic approach to obesity
    • address both physical activity and diet
    • use effective methods for encouraging and enabling behaviour change.
      • I’m planning on doing post on NICE guidance on individual approaches to behaviour change in this series.
    • target and tailor activities, using local knowledge to meet the needs of the population, recognising that some groups may need more support than others.
      • We have a new social prescriber – here you can use their knowledge and resources to signpost patients to local services and help them attend if necessary. By utilising these services, the demand could drive the development of social prescribing even further, such as providing additional training in motivational interviewing and coaching for those delivering social prescribing.

This is a very extensive list. It is unlikely you will touch the surface of many of these if consulting in a time restricted manner many of us are. It can be all too tempting to provide as much information as possible to patients – yet this risks overwhelming them. I find it’s best to choose 2 or 3, maximum, changes patients can try one at a time and approach each in a SMART manner. See my blogs https://thelifestylepill.org/2019/08/25/bslm-1change-muse-meditation/ and https://thelifestylepill.org/2019/06/02/smart-goals/ for more thoughts on this.

To see the full guidance please go to: https://www.nice.org.uk/guidance/ng7

Emma x

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