“Dietitians must be prepared to lead the charge”, believes Joyce Thompson, who was involved in the development of the latest national obesity management guideline.
Published in February by the Scottish Intercollegiate Guidelines Network (SIGN), SIGN 115 states that lifestyle change – diet, physical activity and behaviour change – supported by medication and/or bariatric surgery where necessary, is the appropriate way to prevent and treat obesity in children, young people and adults.
Joyce, a British Dietetic Association (BDA) member and co-chair of the SIGN115 Guideline Development Group (GDG), said that dietitians should be leading on implementation of the guideline:
“Dietitians have come a long way since the formation of Dietitians in Obesity Management (DOM UK) in developing specialist expertise in the management of obesity. Dietitians have established an advanced knowledge base and skills set that is central to the prevention and treatment of obesity and are therefore vital to the successful implementation of this guideline.
“It may also be part of their role to support others to deliver some components; for example, utilising support workers more in order to deliver lifestyle management interventions. It is vital that dietitians ensure their practice is evidence based and of best value, also that they audit practice and apply a continuous improvement approach,” she added.
Although Joyce strongly believes that dietitians are crucial in leading the campaign against obesity, that is only part of the battle:
“One of the challenges is getting weight management higher up on the NHS agenda”, she said; yet figures show that in Scotland almost two-thirds of men, more than half of women, a third of boys and a quarter of girls are overweight or obese, and this is on the rise, costing NHS Scotland £175m in 2007/08. 1
So will this new guideline put obesity more firmly on the NHS agenda, and is it making any new recommendations?
“We hope that the guideline will actively assist and enable health care professionals to improve the quality of weight management services in their area, to help them make rational clinical decisions and strengthen the position of the patient in the process.
“The guideline builds on the earlier work, but with greater emphasis on some areas and new recommendations – particularly looking at referral and service provision in adults,” explains Joyce.
Paediatric dietitian Laura Stewart, also a BDA member and on the GDG, was involved in the 2003 SIGN69 guideline on childhood obesity and was asked to join the SIGN115 GDG as a result of her earlier involvement:
‘For me the most important recommendations for dietitians working in childhood obesity are the use of BMI charts in diagnosis. Added to this is the inclusion of behavioural change tools/techniques in any weight management programme.’
The new guideline has influenced the development of the clinical pathways/intervention for weight management locally where Joyce works for NHS Tayside. The new Paediatric Overweight Service in Tayside (POST), lead by Laura, also reflects the guideline by using an evidence based programme as their clinical intervention for children and young people.
For full recommendations visit: www.sign.ac.uk/guidelines/fulltext/115/index.html
Additional reading: Joyce Thompson (2010) Management of Obesity in Scotland. Proceedings of the Nutrition Society, 69, 195-198 http://journals.cambridge.org/repo_A76i5zPZ
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