Weight Management - Q2 - Jun 2019

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DAVID KERRIGAN: BRITISH OBESITY & METABOLIC SURGERY SOCIETY “Stigma is one of the greatest barriers to overcoming obesity.” » p4

EMMA ELVIN: DIABETES UK “There isn’t a one-size-fits-all way of eating for everyone with diabetes.” » p6

PROFESSOR JONATHAN VALABHJI: NHS ENGLAND “Around two thirds of adults and one third of children are now overweight or obese.” » p6

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Time to introduce enforceable policies to change the food environment In the vast majority of cases, being overweight or obese is not an intentional choice, but a natural consequence of our obesogenic world. Relentless marketing and the availability of processed food, takeaways and huge portions all contribute towards this.

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o what can a cash-strapped government do on a macro-level to get the biggest impact for minimal spend? They need to i nt roduce en forceable policies to change the food environment. This means not shying away from policies that place the burden on the industry that is profiting while the NHS is struggling, even if accused of ’nanny-stateism’.

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Encouragement for healthier foods Rest r ic t i ng adver t i si ng a nd promotion of unhealthy foods will push companies to improve their products so they can still market them. Widely known as ‘reformulation’, foods can be made healthier, and still be enjoyable to consumers.

The Soft Drinks Industry Levy (Sugar Tax) successfully encouraged

wide reformulation, and our drinks now have 11% less sugar. We have been able to demonstrate that there is scope to apply this model to other categories, such as confectionery.

Forcing all food outlets to use clear nutrition labelling (just as the retail sector does with materials in clothing), is essential for customers to make an informed choice. The lack of transparency from many fast

KAWTHER HASHEM Campaign Lead, Action on Sugar

food chains, restaurants, cafes, and takeaway food on apps, means we have no way of knowing what is in our food.

A preventable problem The use of food-tracking apps has the potential to help those manage their food intake and can be beneficial for patients and healthcare professionals, but this is a secondary

means of dealing with a preventable problem.

The cost of obesity and Type 2 diabetes is set to overwhelm the NHS; with better guidance, policies and nutritional education we can remove unnecessary pressure on our health system.

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Research drives insight to tackle childhood obesity Research helps consumers, policy makers and healthcare professionals turn the tide on childhood obesity.

INTERVIEW WITH: DR J BERNADETTE MOORE Associate Professor, School of Food Science and Nutrition, University of Leeds

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he c au s e s of c h i ld ho o d obesity are complex, with genetics, culture, environmental, and socio-economic factors all playing their role. “It requires a concerted effort on behalf of all of us - the food industry, parents, teachers and policy makers - to support our children as they grow up,” says Professor Janet Cade, who leads the Nutritional Epidemiology Group at the University of Leeds. This is no mean feat, and research is crucial in initiating change.

Sugar content of yoghurt exposed The high sugar content of children’s snacks is certainly one contributing factor, and part of the problem is that many so-called ‘healthy options’ simply aren’t healthy.

“Items labelled ‘organic’ are often

thought to be the ‘healthiest’ option, but they may be an unrecognised source of added sugars in many people’s diets,” says Dr J Bernadette Moore, Associate Professor at the University of Leeds and lead author of research into the sugar content of yoghurts.

T h e s t u d y, p u b l i s h e d l a s t September1, found that the average sugar level in most yoghurts was well above the five grams of sugar per 100 grams required to carry a green ‘traffic light’. Most concerning is the fact that only two out of 101 children’s yoghurt products surveyed met the low sugar criteria.

New research into weaning When it comes to encouraging healthy eating, it’s never too young to start. New research, due to be published by the university next

INTERVIEW WITH: PROFESSOR JANET CADE Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds

month, goes right back to weaning.

“The preference for sweet tastes is seen in babies and we’re just about to launch a report providing support for manufacturers of baby food,” says Professor Cade.

With one in ten children being classified as obese when they start primary school and one in five falling into that category by year six, intervention must start early. It will be interesting to see how this new research could help stem the rise of childhood obesity.

Technology enables better monitoring T h e r e s e a r c h h i g h l i g ht s t h e challenge that consumers have, but it’s also a challenge faced by healthcare professionals as they advise patients on nutrition and healthy living.

In response, Professor Cade led a team developing an online dietary monitoring tool.2 “Trying to characterise nutrient intake with our huge variety of foods in an accurate way is difficult, so we developed myfood24,” says Professor Cade.

Previously, researchers and healthcare professionals had little more to rely on than a pencil and paper but now, with apps making monitoring simpler, it could equate to better patient outcomes.

Professor Cade believes that the online tool’s benefits could stretch even further, following successful trials within secondary schools. Research found that, while adolescents are typically reluctant to talk about their eating habits within a class, they were keen to interact with the technology.

Written by: Kate Sharma

myfood24 myfood24, developed by The University of Leeds, and now supported by Dietary Assessment Ltd, reduces the burden of food monitoring for consumers and health care professionals. The online tool provides greater detail on the composition of more than 45,000 different types of food.

Sponsored by

Read more at myfood24.org

1: www.leeds.ac.uk/news/article/4291/sugar_in_yogurt_leaves_a_sour_taste 2: theconversation.com/the-online-tool-that-can-track-monitor-and-analyse-nutritional-intake-73814

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Time to end the stigma of obesity, stop judging and start helping PROFESSOR DAVID KERRIGAN President, British Obesity and Metabolic Surgery Society

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he UK Bariatric Surgery Registry contains data on over 60,000 patients. It clearly demonstrates that modern weight loss operations are highly effective and safe, with the potential to save the health service money by reducing the burden of diseases associated with obesity. However, the annual volume of bariatric surgery in the UK – at under 6,000 operations a year - is five to 10 times less than most European countries.

In France, 50% of the population are obese or overweight (compared to two thirds of UK adults), yet more than 60,000 surgeries are carried out each year. Data from 2012 show Belgians and Swedes go under the knife even more frequently (928 and 761 operations per million citizens respectively), yet the UK performed just 117 bariatric procedures per million at that time and numbers have dwindled since.

Will obesity bankrupt the NHS? The NHS currently spends £1m every hour treating diabetes, a condition strongly linked with obesity. A recent study1 showed that three-quarters of people with Type 2 diabetes treated with gastric bypass surgery, experienced diabetes remission within one year of treatment – a powerful argument for the NHS to invest to save.

People who are seriously obese usually develop other medical conditions too. Worn out knee and hip joints are expensive to replace and there is plenty of evidence that obesity is closely linked to serious conditions such as heart disease, stroke and even cancer.

Obesity is a major preventable cause of cancer There is strong evidence emerging that obesity is also a major, preventable risk factor for a variety of cancers, particularly women’s cancers and colon (large bowel cancer) in men. Even fairly mild obesity (BMI 25-35) can increase the risk of uterine (womb) cancer.

Obesity may also reduce the chances of responding well to cancer treatment.

It is thought that more than one in 20 cancers are directly caused by excess weight. In fact, obesity is now the second biggest preventable cause of cancer in the UK after smoking.

Stigma is one of the greatest barriers to overcoming obesity Stigma persists because some members of the public and even some medical professionals still see obesity as a lifestyle choice.

But this way of thinking has to stop. Obesity might well have roots in unhappiness, psychological trauma, poverty, poor education or even just plain hedonism, but these triggers cause a catastrophic failure of the physiology that regulates the body’s normal energy intake. Surgery re-boots this natural control system, giving patients the chance of a better life. Severe obesity is a disease state and we need to start treating it as such.

Let’s be clear – bariatric surgery isn’t a first-line treatment to aid weight loss (except in the most severe cases), but we should be working hard to remove obstacles to patients accessing effective obesity treatment once all other reasonable and appropriate measures have been tried.

Read more at healthawareness.co.uk

1: Diabetologia (the journal of the European Association for the Study of Diabetes [EASD])

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Specialist approach results in successful weight management DR LAURA STEWART RD Registered Dietitian and member of, British Dietetic Association’s Specialist Obesity Group Committee

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eig ht management is c omple x a nd p e ople living with obesity need differing levels of support at varying times. In the UK, tiered classification of weight management support is used. Tier 3 is best described as a multifaceted specialist weight management service.

A 2014 Public Health England report described tier 3 as a multi-disciplinary team approach, potentially including a specialist dietitian, psychologist, physiotherapist, predominately delivered through the NHS. What that will look like and how you get referred to your local tier 3 will vary across the UK. The majority of people will be referred via their GP or other health professionals.

to consider why they want to change and how they might be able to make those changes in their daily living.

A psychologist will work with those requiring assessment and support for mental health concerns.

There is no quick fix to losing weight and our modern society makes it easy for people to gain weight through taking in excess calories and doing less physical activity.

The dietitian supports people to consider the changes they need to make to decrease overall calorie intake from food and drink, increase levels of physical activity and reduce time spent being inactive.

Typically, a tier 3 patient is someone has tried to manage their weight and needs more specialist support.

Specialist dietitian support leads to changing habits An important member of this team is the specialist dietitian, who will predominately deliver the core weight management programme.

Dietitians working in tier 3 services will offer sound nutritional advice along with support in changing behaviours. They have expertise in guiding people living with obesity

Criteria for tier 3 support varies depending on where you live Eligibility criteria is one of the factors that varies across the UK. It is usually dependent on BMI, which will always be at least a BMI of 30 and above. In some areas, waist measurement or medical complications such as Type 2 diabetes or heart disease will be part of the criteria.

Clear guidance on nutrition to prevent obesity With 27% of adults in the UK having a BMI of 30 or above, the importance of tier 3 services can easily be seen.

The level of obesity in the next generation is worrying. In England, at age 10/11 years, 20% of children are in the ‘higher unhealthy’ weight range.

The Government has recognised the importance of changes the food industry can make to give people guidance and support on healthier choices. Food labelling and the sugar tax on drinks are well-known attempts. Policies around calorie labelling on menus and restricting two-for-one offers on high fat and sugar foods have been out for consultation.

Weight management in the UK has come a long way but more needs to be done through public health initiatives to prevent obesity and support those who are ready to manage their weight.

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What can you eat when you have Type 2 diabetes?

EMMA ELVIN Senior Clinical Advisor, Diabetes UK

One of your first questions if diagnosed with Type 2 diabetes is likely to be: ‘What can I eat?’ With so much to take in at once it can be hard to know what to do, you’ll probably hear myths about what foods you should and shouldn’t eat.

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Going digital improves access and support for patients PROFESSOR JONATHAN VALABHJI National Clinical Director of Diabetes and Obesity, NHS England

ere, we will try to dispel common myths about what people living with a Type 2 diabetes diagnosis can eat.

Myth no 1: The Type 2 diabetes diet There are so many different types of diet out there and lots of people giving advice about nutrition, it can be really difficult to know what is best for your health. There is no such thing as a special diet exclusively for all people with Type 2 diabetes. No two people with diabetes are the same. So there isn’t a one-size-fits-all way of eating for everyone with diabetes.

In the past, people with Type 2 diabetes were sent away after their diagnosis with a list of foods they weren't allowed to eat, or often told to cut out sugar. But Diabetes UK's advice is to make healthier choices more often, and only have treats occasionally and in small portions.

Myth no 2: All carbs are bad for you It is true that all carbs affect blood glucose levels, so it’s important to know which foods contain carbohydrates. But the healthier foods that contain carbs also have important nutrients that are beneficial for health, such as fibre and vitamins. Being aware of portion sizes can also help with weight management and managing blood glucose levels. Some healthy sources of carbohydrate include: • whole grains such as brown rice, buckwheat and whole oats • fruit • vegetables • pulses such as chickpeas, beans and lentils • dairy, such as unsweetened yoghurt and milk.

It’s also important to cut down on foods low in fibre, such as white bread, white rice and highly-processed cereals. Everyone needs a different amount of carbs each day, but this can depend on how active we are, what our weight management goals are, and our age.

Myth no 3: All fats are the same, and all fats are bad We all need fat in our diet because it gives us energy. Healthier fats are in foods such as unsalted nuts, seeds, avocados, oily fish, olive oil, rapeseed oil and sunflower oil.

Some saturated fats can increase the amount of cholesterol in your blood, increasing your risk of heart problems. These are mainly found in animal products and prepared food such as: • Red and processed meat • Ghee • Butter • Lard • Biscuits, cakes, pies and pastries It’s still a good idea to cut down on using oils in general, so try to grill, steam or bake foods instead.

Myth no 4: You can't eat fruit Whole fruit is good for everyone, whether you have diabetes or not.

Fruits do contain sugar, but it’s natural sugar. This is different to the added sugar (also known as free sugars) that are in things like chocolate, biscuits and cakes.

Products like fruit juices also count as added sugar, so go for whole fruit instead. This can be fresh, frozen, dried or tinned (in juice, not in syrup). And it’s best to eat it throughout the day instead of a bigger portion all in one go.

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Wearable tech devices and apps are allowing more thorough and frequent patient access to healthy lifestyle advice, with great success already being seen.

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iabetes and its complications costs over £10 billion ever y year to treat and one in six patients in hospital has diabetes. Around nine out of ten people with diabetes have Type 2, which is closely linked to obesity and there is strong evidence that, for many, it is preventable.

Recent projections show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke.

Education, motivation and bespoke programmes may help prevent Type 2 A lack of exercise, poor diet and b ei ng over weig ht a re a l l r i sk factors for developing the disease.

But there is help designed in the form of the Healthier You: NHS Diabetes Prevention Programme to stop or delay onset of Type 2 diabetes through a range of personalised lifestyle interventions.

These includes education on lifestyle choices, advice on how to reduce weight through healthier eating and motivations to move with bespoke physical activity programmes.

From August this year, a digital version of the programme will be available; including wearable technologies and apps that have been launched to help those at risk of Type 2 diabetes. This tech is designed to help those who find it difficult to attend face-to-face sessions because of work or family commitments; widening access to the Healthier You service.

Recent projections show that the growing number of people with diabetes could result in nearly

39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke.

Professor Jonathan Valabhji, NHS England national clinical director of diabetes and obesity says: “Around two thirds of adults and one third of children are now overweight or obese, driving higher and higher rates of Type 2 diabetes. We are now focusing huge efforts to address, as outlined in the NHS Long Term Plan.

“I’m delighted that our work so far in this area has been producing really positive results. The weight loss achieved and the programme’s ability to reach groups most at risk – including men and those from black, Asian and minority ethnic communities - is very promising. We hope to help many more of those who are at risk of Type 2 diabetes to not get it in the first place.”

Harry’s story: “I’ve gone from a waist 42 to a 28” Harry Matharu was referred onto his local Healthier You service at the age of 56, following an NHS Health Check. The check-up revealed he

I’m 56 now and my next big goal is to get a sixpack by 60.”

was borderline obese and that his blood sugar levels were in the pre-diabetic range.

Harry decided to take action. He reviewed his sedentary, slow-paced lifestyle, and lost over three stone after joining the programme.

Har r y says: “ The prevent ion programme has changed my life.

I’ve gone through at least three different clothing sizes and from a waist 42 to a 28. Above and beyond the weight loss, I’m healthier and I’m happier. I’ve learnt so much; the programme has revolutionised the way I think about food and exercise.

I’m 56 now and my next big goal is to get a six-pack by 60.”

Check your risk of Type 2 diabetes Finding out your risk of Type 2 diabetes only takes a few minutes using the Diabetes UK Know Your Risk score at riskscore.diabetes.org. uk. If you are at risk, then you may be eligible to join your local Healthier You service. Ask at your local GP practice for more information.

The Healthier You NHS Diabetes Prevention Programme is specifically for people at high risk of Type 2 diabetes. To date, over 250,000 people have been referred onto the scheme to get help to live healthier lives and reduce their risk of the condition.

The programme, which gives advice on dieting, exercise and healthy lifestyle, will double in size over the next few years to treat around 200,000 people annually as part of the NHS Long Term Plan’s focus on prevention.

So far, participants that have completed the programme have individually lost just over half a stone (3.5kg).

Harry Matharu - Healthier You NHS Diabetes Prevention Programme patient

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Changing the path for Type 2 diabetes

INTERVIEW WITH: DR CLAIRE MARRIOTT Medical Affairs Lead, Roche Diabetes Care

Coaching could give people the right help at the right time to make the healthy lifestyle choices that count. Could this be a game changer for Type 2 diabetes?

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diagnosis of Type 2 diabetes can leave people feeling guilty and ashamed. The condition is often unfairly associated with an inactive, gluttonous lifestyle and this stigma can have a huge impact at an already difficult time.

This stigma can carr y on far beyond diagnosis and can have a significant impact on mental health. Assumptions are made about someone’s food choices or sedentary lifestyle, and people can feel judged if they are having a tough time managing their blood glucose.

But rather than labelling someone who is struggling, or presuming they are not following medical advice, we need to look into ways to provide better support. Expecting someone to navigate the complex plethora of ‘dietary advice’ is tricky enough. To know and to change are two very different things; providing extra support and really understanding the

challenges that an individual faces can be the key difference in helping people make a change.

Motivation, understanding and support for healthier behaviours Adopting healthier behaviours can be beneficial for us all, but people living with Type 2 diabetes may have additional motivations. This can include reducing the risk of developing diabetes-related complications and for some, reduction of medication or even remission of Type 2 diabetes could be achievable.

Even with this powerful incentive, it isn’t always so easy in practice.

Living with a long-term condition and all the ‘rules’ that go along with it can make it seem as though you are not the one in control.

Understanding what can be changed, being supported to make that change and, importantly, not feeling responsible for what can’t be changed - such

To know and to change are two very different things. Providing extra support and really understanding the challenges that an individual faces can be the key difference in helping people make a change.” as your genetics or ethnicity - could be pivotal in taking charge.

Mentoring encourages positive lifestyle changes Behavioural coaching is an appealing way to enable people with Type 2 diabetes to make a change. It offers a tailored level of support that understands where someone is on their journey to making positive lifestyle changes. It provides the information, advice and mentoring appropriate for them to manage their condition, in the ways that work best for them.

Dr Claire Marriott, Medical Affairs L ead for Roche Diabetes Care, believes this is a crucial element in successful care: “It’s about understanding what makes people ‘tick’.

It’s not just the message that’s important, it’s how it is conveyed – the language, the tone. Behavioural coaching can support an individual to find their personal motivation and help them to start enjoying the food they love in a healthier way.”

Written with: Ailsa Colquhoun

Sponsored by

Read more at roche.co.uk/en/roche-in-theuk/our-role-in-diabetes-care

OurPath: Roche Diabetes Care, one of the longest standing players in diabetes management has partnered with a start-up company, OurPath, to scale up their popular coaching-based lifestyle change programme. OurPath is one of five digital providers commissioned by the NHS to support lifestyle change in diabetes as part of the NHS Diabetes Prevention Programme.

Over a 12-week period, coaches help people to eat well, increase activity levels and understand how to manage negative thought patterns, setbacks, and challenges such as social situations and eating out. All interventions are designed to support sustainable and meaningful, healthy lifestyle changes.

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