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

Another vote for proper emotional support and an easy to follow (easy to buy and cook) meal plan.

I don't think 'how to eat healthy on a budget' is a big problem. Portion control when you're fat and snacking IS a problem.

And if any smart bugger tries with my user name, I am hormonal, dieting and supposedly studying!

General exercise rather than diet is what my DM needed (she was once a perfectly reasonable swimmer).

However, how do you get a proper old fashioned, self sacrificing, house wife to spend time walking or money swimming, when they go without new clothes to treat their DCs.

Not that their was a public swimming pool for 30 miles when we were children.

Best thing would be to pay for some gastric bands

Petula I didn't say free gym sessions, i said tailor made programmes for each individual.

Agree to go with evidence, but evidence results in what programme is the most likely to succeed as an average. The health messages in the past havent worked for that reason.

A prize is a daft idea, but it might work brilliantly for the right person.

This is why a series of in depth consultations initially would be good to ensure each person finds the approach that works for them.

Elephants,if your Mum had had a decent consultation to get to the bottom of why she put everyone else first and why she did not value her own health perhaps that would have helped. I think that is a very common mindset for mothers. This is often completely missed by people who are self motivated,

i know you didn't - i was agreeing with you

not a bloody prize, anyway!
And why is this in aibu..when it isn't one?

Sorry my mistake Petula.

Another thought, as I was assessing my environment, even a simple thing like the home environment should be assessed as it makes a massive difference - where you live, how you live.

Kitchens - simple equipment for cooking more veg, banishing frying or deep fat frying, they may want some decent cookery books or show them some websites.

Home - If people watch a lot of TV, to stop using the remote, sitting on a high stool at home so you are more likely to get up and not sit for hours, putting the computer on a shelf on the wall, having a dining table. Using stairs etc.

Local facilities - Where are your parks, showing someone the most convenient way to exercise.

Routines - helping people deal with clutter, having a fresh kitchen to cook in, a clear floor to exercise on.

Work - once you are overweight it's hard to get work, people associate it with laziness and dysfunction. Helping with that might also be good.

The thing is you can't bombard people with this stuff they might need coaxing through it a bit, which is why I think support will help. Most people know what they should be doing, they just can't for some reason. I don't think anyone wants to die an early death on purpose.

This is the one chance the NHS have to make a difference by offering a holistic approach, I just hope they do that and don't offer another one size fits all solution that most people can't work with.

Hindsight is a wonderful thing. Unfortunately weight is gained slowly, arthritic knees develop slowly.

There isn't a point in time to stop and say you need to get some exercise.

Perhaps now, with much better knee replacements available, a really clued up GP could have said something at the right time. Back when DMs knee got really painful originally there wasn't a lot to offer except pain killers.

Unfortunately DM is very bloody minded about those as she'd had everything under the sun for her shoulder when I was a child. (That was never properly diagnosed).

Doing everything for everyone else was her job. Sending her swimming or walking would have just taken the time she used for cooking, which she enjoyed and was brilliant at, reading the paper and sewing.

She'd still have had to cook something less satisfying, clean and do laundry and iron, but she'd have resented them more.

We live in a different world. At least those of us fortunate enough to have money and the luxury of time do. We can step back and consider taking some exercise or walking instead of taking the car. We know the risks of today's life style my DMs generation didn't.

My DMIL was 17 years older (she'd be 94), she refused to have a washing machine, never learnt to drive and walked everywhere, for necessity and pleasure.

She was far fitter than me the day she had a stroke and died.

Thank you, everyone, for the replies. I promise this is a genuine question! I posted in AIBU as there doesn't seem much traffic anywhere else.

In response to a few questions:

There is about £16000-20000 for the year, not a fortune really, but enough for one part time person, or 2 less qualified people

Yes, a GP really does have to ask this! If massive government think tanks can't figure out the answer I think it's unfair to assume a single GP practice will solve it without asking for help.

The prize idea was in response to asking some of his patients what would help. They suggested being paid for every pound they lost.

I'll definitely tell him to have a look at the counterweight programme, thanks

Twice a week evening babysitter and a swimming pool season ticket for me please. Not sending a referral for an exercise class that runs mid morning for someone who works full time. Or offering a helpful leaflet on healthy portion sizes to someone who is struggling to get their eating under control. Or actively refusing to sign the medical forms for Lighterlife and telling me I was being 'silly and just needed to eat less' (I wasn't asking for a referral or funding, just confirmation that I didn't have any of the contra-indicating conditions) These are examples of the 'help' I have had from my GP surgery over the last decade.

Seriously, an approach that says 'we know the reasons why people are overweight are different, how can we best help you?' rather than the approach that says, 'we're providing xyz, here's a prescription for it' The solutions that may work for someone who has gradually got a bit lardy because they're bored, lonely and inactive (walking group and weightwatchers?) are very different to what someone may need if they have a compulsive eating problem (specialist counselling?).

missmay you sum up my long irate rant perfectly.

People get over weight for different reasons not all over weight people over eat.

Many people become less and less active for many many reasons. Work commitments, lack of time, lack of money, lack of babysitting, lack of facilities, cost of travel and minor health problems.

If you have ashma, a bad back or a dodgy knee, the gym or even walking to the shops may not appeal.

If the doctor starts on at you about your weight, rather than listening to your concerns, your not going to bother going back!

Jesus. Are there not far better things to spend money on than coercing those who don't want to, lose weight???? Makes me not want to pay taxes.

I would avoid the prize idea like the plague. I think counselling and support is the only thing to help.

I have just read an article about how positive emotions are far stronger than willpower and why are alcoholism (via AA) and drug addiction using counselling and programmes using these while obesity, despite being the largest problem, is still just expected to be conquered by will

My local NHS obesity support group thing to help you lose weight is atrocious. It destroyed my self esteem and basically made me suicidal. Long story short - I use a wheelchair at all times and have done from birth, they were asked specifically about my disability before I was referred and said their set up was accessible. They couldn't weigh me, kept putting pressure on me to stand on the scales. Kept telling me I'd be much more mobile if I lost weight and need less meds (none of which, according to my neuro was true). I pointed out the nature of my condition meaning they were wrong which combined with what they saw as my "refusal" (actual inability) to be weighed on a stand on scale led to them accusing me of letting my disability stop me.

If this is a real thread the money should be used to provide individualised support to those most in need and most willing to participate.

Creampie the point is that everyone needs different support. Some might want a prize.

If you employ anyone it should be a counsellor who can help the individual make do it their way. Perhaps people with motivation type skills like a personal trainer. Allocate some money to individuals if it helps, but a really good look at their daily routines and at access to facilities, including cooking and dining, budget, local parks etc. someone upthread offered her services, it shouldn't be someone who is an expert in one aspect of health, it is more a matter of motivation and really good listening. They need to be able to gain the client's trust and work with them. Facilitating people to join up with buddies or doing small groups would also be useful.

But please don't get anyone who is paid loads because they have some kind of specialism.

Surely there is scientific research available into what actually tends to work, rather than GPs being asked to just have a guess? What studies have been done into programmes which have led to successful long term weight loss? What were they key findings?

Cats a one size fits all approach won't work.

GPs should exactly be having a guess, on an individual case by case basis. People aren't obese because they haven't followed x y z magic programme, they are obese because they don't know how to control their weight.

Look at what the five a day message has done, nothing but dishearten and make people lose faith in the medical profession.

5 a day is a farce, what on earth was wrong with simply 'Eat, more fruit and veg!'

Due to illness I put on a lot of weight over the last year, resulting in me tipping over to 40 on the bmi chart.

Due to surgery etc in was unable to exercise and I have been advised by my consultant to eat as low fibre as possible, so white everything with no wholemeal; I have low gluten tolerance and fruit makes me react badly, my eating has become very disordered.

As a result of tipping over bmi of 40 I was offered the chance to join the NHS funded weight management scheme; it is 20 group meetings (one each week) and we will get nutrition advice, help to identify individual triggers etc and exercise advice.

I exercise anyway, but my eating is crap at the mo - this initiative is like a gift to me and I am feeling very positive and excited about getting back to being 'me'.

That sort of thing is where your money is best spent imo - personalise things. Identify the individual's fall-down and deal with the cause, the rest will follow (imo).