Information for Referrers

This page outlines how you can help people you are considering referring to the service;

  • The local specialist obesity service (LSOS) is a tier 3 multi-disciplinary service including dietetics, occupational therapy, psychology and a consultant endocrinologist.
  • The referral criteria is for patients who are willing to engage with lifestyle change who have a BMI>40kg/m2 or BMI>35km/m2 with an obesity related co-morbidity.
  • The LSOS service can provide a route to weight loss surgery for people after fully exploring all  non-surgical methods of weight lossg. Supervised very low calorie diets (VLCD),  pharmacotherapy,  lifestyle and dietary change, behaviour change with respect to self- management.  This may take up to 1 year.
  • Fully exploring these non-surgical methods helps to identify those who will benefit the most from surgery. Surgery is an invasive and non-reversible procedure and does not guarantee long term weight loss and maintenance, therefore identification of the right person is imperative  to get the best possible long-term weight loss outcome. If you want more information about the potential complications of surgery please refer to https://www.nhs.uk/conditions/weight-loss-surgery/risks/
  • LSOS is different to other weight management services in that it is run by a multi-disciplinary team of clinical specialists and offers “intensive and personalised support” for those who are ready to make healthy lifestyle changes to improve their health.
  • There are three “intake sessions” each year where people are invited to attend for a full assessment of their needs. At this sessions a full history will be taken which includes;
    • Full dieting history including weight changes and previous diets tried
    • Complete medical picture and medication taken
    • Assessment of current diet and its adequacy
    • Patients well-being and their expectations of referral to the specialist service
    • Smoking status
    • Screening for depression and anxiety
    • Screening for state of motivation using patient activation measure (PAM)
    • Impact of their weight on current functioning using the Edmonton Obesity Staging System (EOSS)
    • Barriers to changing their lifestyle, activity and eating habits
  • We can offer individual appointments along with group work. The groups offered include;

Eatwell

Patient information group led by Dietitians:
An education and information group on eating well and making informed choices for a healthy lifestyle, 8 weeks of education and self-management direction.

Bariatric Surgery Information Session

Patient group led by Dietitians:
One off information session regarding pre and post-surgery living, what to realistically expect from surgery, information on different types of surgery offered. Attendees are encouraged to reflect on how they would live with the strict dietary changes required post-surgery, including the social impacts this can have on life.

  • As there are many people who may be eligible for the service, referral numbers are high and patients may be on the waiting list for several months.  We therefore recommend that  they engage with Tier 2 or universal providers of weight management services (such as weight watchers or slimming world)  to make the best of the time on the waiting list. Current partners include Y Active in Wyre and Fylde who run activity and nutrition support groups, Active Blackpool for activity schemes and the Healthworks hub in Blackpool for support with eating well.
  • If you would like to discuss with a patient how their weight could affect their health please watch this YouTube clip which will help you have a meaningful conversations with them…

Advice for GPs

Please use opportunities in general practice to record weights on EMIS to help build an accurate picture of a person’s weight history. Listen to the concerns expressed by patients and ask if they would like help.

Advice for Consultants

We do not generally recommend rapid weight loss in order for someone to achieve their ‘target’ weight for surgery as this can be detrimental to their recovery. NICE guidance recommends safe rates of weight loss are 1- 2lbs per week,  so please be realistic with your patients about how quickly they can lose weight sustainably. The aim is to have a good recovery from surgery after which the weight loss they achieved remains. In exceptional circumstances more rapid weight loss can be supported, however this is only if patients are able to tolerate the required severe energy restriction needed.

Advice for Other Health Care Practitioners

You can refer patients currently on your caseload if you have discussed their weight and impact on their health with them. Please ensure you have the consent of the patient before referring them.  A motivated patient changes their behaviour much more readily than one who isn’t. Please see the Motivational Interviewing video links above for more information.

House Bound Patients

Some patients may be confined to their bed and need help with weight reduction so they are able to get out of the house.  The LSOS service will visit the patient at home and provide a nutritional care plan to enable them to get out of bed and into the service. This plan will often be shared with other care providers involved in the patient case. Once no longer housebound, access to the groups can be established.

10 essential facts about obesity that every health professional should know

(Royal College of Physicians (2013)- Action on obesity- comprehensive care for all)

  • In the UK 1 in 4 adults are obese (2012)
  • In the UK 1 in 5 children aged 10-11 are obese (2011)
  • Obesity is strongly heritable (60% of weight variance is attributed to heredity) yet currently known gene mutations and polymorphisms account for <5% of weight variability.
  • Diagnosis by BMI requires measuring height and weight accurately; risk stratification in overweight and modest obesity requires measuring waist circumference and possible use of the clinical staging system (Edmonton Obesity Staging System (EOSS)).
  • Prevention and long-term weight loss maintenance require sustained changes in diet and physical activity habits.
  • Obesity is a major risk factor in diabetes (5 x), cancer ( 3 x the risk of colon cancer), and heart disease (2.5 x).
  • Obesity is a major cause of health inequality and impaired quality of life and costs the NHS £5.0 billion per year (2012).
  • Modest weight loss (~10kg) helps to improve diabetes, improves quality of life and reduces morbidity.
  • An energy deficit of only 100Kcals per day predicts a 0.5kg weight loss in a month.
  • Cost-effective treatment in appropriate adults includes commercial weight loss programmes such as weight watchers, GP schemes such as counterweight, pharmacotherapy such as orlistat, or bariatric surgery.