I want to ask for your ideas on this (health/obesity)

[creampie]

Husband is a GP. There is money available in the health board to use towards getting those with the largest BMI back into the healthy range.

They can literally propose any ideas they like, including offering it as a cash prize to the person losing the most weight.

What do you think would work best? Offering a prize? Or something like a free weight watchers group? Something entirely different?

Genuinely interested in your ideas as to what would be most useful

I can't quite believe that a GP would have to even ask this question.

I think personal training, rather than gym membership, someone to motivate them.

Overeating is a symptom of something else, so counselling of some kind, whether a monthly catchup to see how it's going.

Community walks for small local groups. One in every park, monitored by a trainer.

Personalising is the way to go.

Prizes are for competetive people, overweight people have given up already and will make those people feel hugely guilty.

the exercise stuff is a red herring i think. it's great for both physical and mental health, especially longterm, but for people who are very overweight i don't think it's the best solution. in terms of money spent, emotional support to address the eating behaviours is going to be much more cost-effective, because that's the part that's difficult. if someone is very overweight, they aren't necessarily going to manage a full fitness session - a 20 minute walk daily will be more than enough. but helping with the eating behaviour - bearing in mind that food is available 24/7 in the areas that most people live in this country (and it's relatively cheap, is the magic combination of carbs+fat that dingdingdings all the pleasure sensors, and doesn't stop you caring for dependents) - that is the thing that is going to help people. the government isn't going to adequately address the food companies, nor the advertising, nor the 24hr supermarkets and takeaways, so people need help putting in place behavioural strategies that will help them avoid this

At mum and dads (ne of England - Tyne and Wear). They were giving out free entry to diet class at the doctors for those with overweight bmi - ww/sw or Rosemary Connelly - you could choose. I can't remember I think you got 12 weeks membership to start, if you lost 10% of your body weight then you got another 12 weeks free.

They also offered exercise on prescription at the local council leisure centre - you got an induction at the gym specially designed for people who hadn't been before and so many weeks free at the gym plus regular reviews in how your programme was going with a personal trainer. They also gave you discount in swimming and exercise classes.

For me the exercise was key in my weight loss - it gives a non scale way you can really see improvement, it provides you with more energy and helps make you feel better about yourself which is vital to ever do well. It also helps you change your mindset towards being healthy.

i agree it's important, i just don't think that exercise classes are the best use of a finite amount of money in this respect. by all means encourage people to take it up, form free fitness clubs etc. being active also helps to relieve boredom-related eating behaviours. but i think that the thing that is most needed is the emotional support and the help with altering eating behaviours in the (frankly) obesogenic environment we live in in particularly the urbanised western world. part of that behavioural support could and should include encouragement to increase activity, but i don't think it should be the focus

as an overweight person, I think it is great to hear that something is being done to help support people with obesity. I don't need cooking advice or lessons, I knows whats healthy and what isn't. I have 3 kids none of whom have weight issues because I feed them the right diet. obesity is a form of self harming for many of us. it is all in the mind. yes there are a very few fat people with genuine medical conditions but for most it isn't they know what they need to do but cant stop. you wouldn't give a heroine addict prizes if they stopped would you? I think there needs to be a real look at the "why" because as with any other addiction that's the key.

It shouldn't be the sole focus but it should be a key focus IMO. I don't think you can ignore the massive positives of exercise on all areas of trying to tackle weight

Great post mummymeister.

OP - why not ask the people themselves what they feel they need?
The reasons why people overeat are as myriad as the reasons why people drink too much or self harm in other ways.
There is no one size fits all.

I'd love someone to address why I eat. I know what to eat, what a healthy diet is. I just have a binge eat mentality and can never he have just one. So for me someone who could help me with the mental and emotional side would have benefit me much more in the the long term as I know what I need to do to loose the weight it's my own sabotage that's the problem

Incentives work for people with a healthy relationship with food that have indulged a bit too much. It won't work for people with food addiction problems, because it's not just about eating too much food.

It's like offering a prize to a cocaine addict for stopping cocaine. They can't do it on their own, they need professional help.

I think setting up a program with a support group would possibly be helpful, like they have with AA. That way they know they aren't alone and they can cheer each other on.

exercise shouldn't be ignored, but it doesn't directly help in weight loss, not in a calories in vs. calories out way anyway. it can be motivational, improve mental and physical health, as sirzy says a good non-scales marker for the positive by-products of weight loss etc

but ultimately it doesn't matter whether someone is exercising or not, if their eating behaviours stay the same then it's unlikely to make any difference

btw, i'm talking about people who are very overweight here, not just a stone or so. i do think that as people who are very overweight lose weight, over time they need different strategies, especially as the time taken to lose weight can be over months and years and it's easy to get disheartened among all the unhelpful messages about food we get in society. as someone gets closer to a "healthy" weight, then introducing more structured exercise activities can be brilliant. but early on, when it all seems so hard and an impossibly long slog, then the focus should be on emotional support, working out if/why/how that person overeats in a very tailored, individual way and working towards strategies for handling the obesogenic environment many of us live in

My DM is now house bound with arthritis due, partly, to the fact that she got so fucked off with the GP bringing her weight into everything, she stopped ask for help.

She doesn't over eat, she's never over eaten, she has the least sweet tooth of any one in the family. She doesn't drink

Likewise my DSIS is way way bigger than me and eats less.

So the patronising health board can stick their money where the sun doesn't shine.

Or better still use it to do some proper research into the genetics of obesity.

not all obese people, sit there stuffing their face

there is that too elephants. it should only be people who actually want to lose weight and have expressed that. and people who are overweight shouldn't be fobbed off with "you need to lose weight" all the time

there was a heartbreaking thread recently where the OP was so ill but didn't want to go to the GP because she was worried they would get at her about her weight

perhaps more funding for screenings for genetic or physiological issues might help? it often tends to be a last resort i think when people have begged the (disbelieving) GP that they ahve tried everything they can to lose weight and it's not working

Petula exercise is vital for mental wellbeing and that supports the person's ability to refuse bad food.

I think people should be able to make their own programme.

I would have

Intensive CBT, maybe an hour a day for two weeks
Then a personal trainer to set up a fitness programme and check on me regularly following a report from the counsellor
I know what to eat and what not to, just not why I make the choices I do.

That would cost about 1000-1500 and save the NHS many more times that.

OP what budget does DH have for this?
Also
How are they going to select people for the programme?

I was referred to a nurse about the Counterweight programme and that helped me massively as it was all about portion size and discussing ways to manage my emotional eating.
I was also referred to a council run programme where I paid £1 a session/class at my local leisure centre for the 1st 3 months, £10 odds for the next 6 months and now I pay 1/2 price for life.
I have lost 4 1/2 stone in the last 2 years, that might be too slow for some people but I know that my lifestyle has changed and the weight will never go back on as long as I am fit enough to workout.

i agree daughterdilemma, and i've said exactly that - but we're talking about the best use of finite money and i don't think free gym sessions is the right use for that

i do like your tailored programme design idea though

Base it on evidence of what works, rather than a bunch of random suggestions on an Internet forum.
I know evidence is a dirty word sometimes on here, but honestly this is ridiculous.
And did your gp husband actually talk about the "health board"? Ccgs everywhere nationwide, not just in certain areas. And public health commissioning, which is what this is, is the responsibility of the local authority.

Counselling services (which are flexible enough to cope with new mums).

Sigh

I've killed the thread with this? Seriously?

What do you want people to say SPB? You've definitely made me think I should probably stop posting

Wales has health boards and so does Scotland

OP - there is an evidence based programme ( assessed for NICE) called Counterweight which is probably worth looking at. It was the only evidence based programme a couple of years ago. I'm not up to date any more but it did have very good outcomes.

Depending on the local criteria, they could reduce the BMI from 30 to 28 for accessing help on the NHS ( I don't know your area but most areas limit help to people with a BMI above 30) - probably worth modelling the impact.

Depending upon the amount and will of the local area, you could look at the design of public spaces - some encourage weight loss while others encourage weight gain. Sweden and Denmark have done quite a bit of research in this area.

I would run an entirely voluntary self referral for cognitive behaviour therapy scheme with an element of a self sustaining community alongside it which could key in with experts by experience.

The building of a recovery community would be the deliverable though NOT the weight loss, excess weight is a symptom of much bigger problems.

I would like to know which CCG your husband is part of, as most of them seem to be accomplishing nothing spectacular (and will continue not to if they insist on effort being expended on non evidence led interventions). I'd prefer my public money spent on schemes that at least have a chance of sucess.