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Obesity is a patient problem you should be preparing for
The National Audit Office report in 2001 showed that over half of women and about two thirds of men are overweight or obese. The House of Commons Select Committee on Obesity in May 2004 reported that obesity was rising at an even quicker rate than expected and the costs of the disease in UK are £3.3-3.7 billion per year with obesity plus overweight at £6.6-7.4 billion.
The Government’s White Paper on Public Health published in 2004 marked a significant shift towards the concept of Primary Care Trusts working in partnership with reputable commercial sector companies in tackling obesity.
The White Paper called for the creation of a strategy to develop innovative clinical models that will help support evaluation of different approaches to delivery of obesity services at local level including using quality assured, commercial diet providers.
The Cambridge PriSec programmes
Cambridge has been delivering flexible weight care programmes to people in the UK for more than 20 years. The foundation for each of these programmes is the Cambridge Diet - a nutritionally balanced formula food.
Everyone using the PriSec programmes follows four phases of weight management: preparation, weight loss, stabilisation and weight maintenance (including long term weight care). Within the PriSec programme are several flexible weight management options ranging from 415-1,500+kcal.
The programmes are:
Programmes comply with all relevant UK/EU legislation and government guidance. The four phases of the Weight Care programme incorporate:
NB. During and following the VLCD programmes, Health Professionals may need to reduce or discontinue the following medications: antihypertensives, diuretics, oral hypoglycaemic agents and insulin therapies.
Flexible Delivery
Primary Care
Delivery and implementation of the weight care programmes are flexible. Patients can attend a weekly Cambridge PriSec Clinic at the practice, or visit the PSC at their home. Each practice can select their preferred method to suit a patient’s particular requirements and circumstances.
CHWP also provides specific training days for health professionals (who can also be accredited as a PSC) thereby promoting better understanding of the options available from Cambridge.
Secondary Care
Delivery and implementation of the weight care programmes can be adapted to meet the hospital’s requirements. Patients can be seen on a weekly basis by the PSC in a hospital outpatient clinic room (such as a diabetes centre outpatients’ department).
Alternatively, the role of the Counsellor (including the support element) can be undertaken by the health care professionals themselves following full training and accreditation on the PriSec programmes. The patients access Cambridge products via the hospital pharmacy.
The PriSec Counsellor
- Professional, Caring and Committed
Cambridge PSCs are skilled, trained and proficient in weight management as well as in the use of all Cambridge programmes. They provide the necessary empathy and encouragement to ensure optimum results. GPs, Practice Nurses, Hospital Consultants, Diabetes Specialist Nurses, Dietitians professionals can refer patients to the PSC, who sees them weekly, either in a group, or one-to-one, if preferred.
The PSC liaises with the health professionals, keeping them informed via a monthly report of the patient’s progress, including BMI and waist measurements. Following a referral from a healthcare professional the PSC instigates an initial consultation with the patient to explain the PriSec programme. After deciding together which is the most suitable option, the patient is informed as to what is required from them and given an outline of cost. Funding can be met either by the patients themselves or directly through PCT or hospital budgets
From the onset eating habits, lifestyle, food groups and the importance of increased activity are discussed. This re-education process forms the basis for long-term weight maintenance.
During the initial screening interview, the patient’s medical profile is carefully considered by all involved when selecting the appropriate weight-loss programme and adjustments made to medication. For patients with diabetes, blood glucose levels fall significantly from day one of a VLCD/LCD.
How medication is adjusted by the health professional is dependant upon the type of diabetes, the medication being used and the current status of blood glucose control. After the stabilisation and weight maintenance phases, the PSC continues to provide long-term care and support. This involves regular contact and the patient is encouraged to continue their new eating habits, and to maintain an increased level of activity. The patient and PSC arrange a mutually suitable care pattern - ie every month or two months - for the continuation of long-term weight care.
A partnership that will benefit your patients and your practice.
Cambridge programmes provide health professionals in primary and secondary care with a multifaceted intervention for overweight and obese patients.
Compliance with stringent legislation and standards ensure the product can be used confidently; providing complete balanced nutrition. Scientific research, spanning 25 years confirms credibility and efficacy.
Long-term weight maintenance findings indicate a favourable response when combined with behaviour modification. Patients are provided with proven weight loss programmes and the support and advice of the PriSec Counsellor.
Tried, Tested, Trusted. The science behind very low calorie diets
Listed here are a few of the many clinical papers which demonstrate the health benefits and safety of using very low calorie diets in the treatment of obesity.
VLCD: a useful alternative in the treatment of the obese NIDDM patient.
F Capstick et al. Diabetes Res Clin Pract 1997; 36; 105-111
Conclusion: The short-term use of a VLCD is very effective in rapidly improving glycaemic control and promoting substantial weight loss in obese patients with Type 2 diabetes. Moreover, a VLCD increases insulin secretion and reduces substrate for gluconeogenesis. Thus VLCD treatment may improve glycaemic control by factors more than caloric restriction alone.
An intensive weight loss programme in established type 2 diabetes and controls: effects on weight and atherosclerosis risk factors at 1 year.
P B Paisley et al. South Devon Healthcare, Torbay Hospital. Diabetic Medicine 1998
Conclusion: Substantial weight loss and improvement in cardiovascular risk factors could be maintained for 1 year in Type 2 diabetic patients by the use of a very low calorie diet.
Very low energy diets in the treatment of obesity. P Mustajoki & T Pekkarinen. Peijas Hospital, Dept Medicine, Vantaa, Finland. Obesity Reviews 2001
Conclusion: VLEDs accomplish maximum initial loss and can be conducted safely in patients with obesity associated diseases – diabetes, hypertension, or other chronic diseases.
Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. C Ayyad & T Andersen. Roskile County Hospital, Denmark
Conclusion: VLCD was most efficacious if combined with behaviour modification and active follow-up. The literature on long-term follow-up of dietary treatment of obesity points to an overall median success rate of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow-up.
Efficacy of very low-energy diets and meal replacements in the treatment of obesity. S A Jebb & G R Goldberg. MRC Dunn Clinical Nutrition Centre, Cambridge. J Human Nutrition and Dietetics 1998
Conclusion: VLEDs are a proven success in achieving significant short-term reduction in body weight. There is evidence to suggest that meal replacements may make a contribution to the maintenance of weight loss in some individuals.
Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance. A Astrup & S Rossner. Obesity Reviews 2000
Conclusion: Greater initial weight loss as the first step of weight management may result in improved weight maintenance.
Use of very low-calorie diet in preoperative weight loss: efficacy and safety. T Pekkarinen & P Mustajoki. Dept of Med. Helsinki University Hospital. Obesity Research, 1997
Conclusion: A VLCD program is suitable for preoperative weight reduction in morbid obesity and seems not to compromise the immune system.
Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women: one-year follow-up study including ambulatory blood pressure monitoring. T Pekkarinen et al. Dept of Med. Helsinki University Hospital. Int .J Obesity 1998
Conclusion: This weight loss programme with a VLCD enabled obese subjects to lose weight and decrease cardiovascular risks. Despite some regain in weight during follow-up, the beneficial effects were overall maintained over the year.
No evidence of excessive losses of protein during acute weight loss. S A Jebb et al. MRC Dunn Clinical Nutrition Centre, Cambridge. Poster presented at 8th International Congress on Obesity, Paris, September 1998
Conclusion: This four-compartment analysis of changes in body composition provides no evidence of any significant loss of protein in this treatment programme. However if two-compartment models are used to assess changes in body composition during acute weight loss the very significant loss of water will appear as losses of lean tissue.
Very low calorie diets and sustained weight loss. W H M Saris. Maastricht University. Obesity Research 9, Supp 4 Nov 2001
Conclusion: VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long term weight maintenance success.
An eight-year experience with a very low calorie formula diet for control of major obesity. M A Kirschner et al. Newark Beth Israel Medical Centre, New Jersey. IJO 1988 12(1) pp 69-80
Conclusion: Our 8-year experience strongly suggests that the VLCD approach using high quality protein supplement and multi-disciplinary counselling provides a reasonable success rate for achieving and maintaining weight loss in the morbidly obese population.
Long term weight loss maintenance: a meta-analysis of US studies. Anderson, Konz, Frederich and Wood. American Society for Clinical Nutrition, 2001
Conclusion: Five years after completing structured weight-loss programme, the average individual maintained a weight loss of more than 3kg and a reduced weight of more than 3% of initial body weight. After VLEDs, or weight loss of more than 20kg, individuals maintained significantly more weight loss than after HBDs or weight losses of less than 10kg.