Page 37 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

VOLUME 9 NUMBER 4 • NOVEMBER 2012

179

SA JOURNAL OF DIABETES & VASCULAR DISEASE

PREVENTION IN PRACTICE

FOLLOW UP AND REFERRAL

Ideally, it should be possible to refer patients for more intensive in-

put from other members of the multidisciplinary weight-management

team. Access to a counsellor or psychologist gives patients the oppor-

tunity to discuss other aspects of their lives. Many patients eat when

they are not hungry, and no diet, magic tablet, or even surgery can

address this. Talking therapies play an essential role in identifying the

underlying causes for comfort or habit eating, and in helping to break

this pattern.

Appointments should be made available with an exercise thera-

pist, who can help to tailor an exercise programme to the individual.

Patients should then be encouraged to engage with any free or subsi-

dised local leisure facilities. RIO has an on-site gym, which is used as

the exercise therapist’s consulting room, as well as partnerships with

local gyms.

It is, however, important that the patient understands that isolated

exercise (which may still be beneficial for other reasons, and should

still be encouraged) is an inefficient way of losing weight. Walking one

mile may only burn up approximately 100 kcal. As a reward, the patient

may then treat herself to a 200 kcal chocolate bar, and the net effect

is weight gain.

The regularity of exercise is also important, and the key is to encour-

age physical activity over the recommended minimum amount that can

easily be incorporated into the patient’s daily routine. Not many patients

can afford the time (let alone the cost, if it is not provided free or heavily

subsidised) to attend the gym five times a week. But we can all walk

more, or incorporate jobs such as housework or gardening into an ex-

ercise regime by performing them at a more vigorous pace.

At RIO, the GPwSI assesses patients who may be suitable for phar-

macotherapy. But there is no reason why a suitably trained and quali-

fied nurse prescriber could not initiate a suitable weight loss agent,

such as orlistat (Xenical).

Finally, it is important that, especially in the obese diabetic patient,

an appropriate healthcare professional assesses co-existing medical

conditions and current medications to review any that may be associ-

ated with weight gain. Medicines can then be changed to more weight-

friendly alternatives.

Professional information

Rotherham Institute for Obesity:

www.rotherhaminstituteforobesity.co.uk

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National Obesity Forum for information on managing obesity in primary

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care

www.nationalobesityforum.org.uk

NICE clinical guidelines

(www.nice.org.uk

): Obesity (CG43); Weight

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management before, during and after pregnancy (PH27)

Patient information on weight loss:

www.nhs.uk

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