New guidelines Available for an important area of health professionals’ work
A consistent message for managing overweight and obese New Zealanders is the aim of new guidelines for health professionals. Released on the eve of the Christmas season last year and just before New Year’s resolutions, the two guidelines are the outcome of an initiative commissioned by the Ministry of Health back in 2008. Approaches ranging from exercises to weight-loss drugs and lifestyle changes to bariatric surgery are included in the comprehensive clinical guidelines.
They are in response to the prevalence of obesity more than doubling in New Zealand adults over the past two decades. The ministry also notes that obesity is more common in Māori, Pacific and South Asian populations compared with other New Zealanders. The guidelines – one for adults and the other for children and young people – are evidence-based and aimed to be used in primary care and community-based health care initiatives.
The 115-page adult guideline and 85-page children and young people’s guideline were developed by the Clinical Trials Research Unit (University of Auckland) with technical advice and guidance from the Guidelines Technical Advisory Group. Development also included key informant interviews, road testing with front line health providers and primary health organisations, consultation with Māori and Pacific caucuses and literature reviews on best practice information for Māori and Pacific. The full guidelines are available from the publications site on the Ministry of Health website: www.moh.govt.nz
A SUMMARY OF THE KEY ADULT WEIGHT MANAGEMENT MESSAGES
Step 1: Engage and raise awareness
- Engage with person.
- Assess BMI and waist measurement to estimate risk.
Step 2: Identify need for action
If high risk, assess person’s “lived realities and clinical need” including their:
- family, culture and values;
- history of weight-related concerns;
- nutrition and activities;
- age, sex and ethnicity;
- smoking status, blood pressure,
lipid levels; - co-morbidities like diabetes;
- psychiatric history.
Discuss risks and motivations or action.
Step 3: Determine options for action
Most effective approach is the three-pronged: changes to food/diet, increased physical activity, and behavioural strategies. The FAB approach. Only effective approach is to get permanent change to how people live their lives. Set realistic target for weight loss aiming for modest weekly loss. Consider referral to professional and community support providers. Action options include:
- Food/diet – low energy, low glycaemic index and modified macronutrient approaches are similarly effective. Do not use fad diets.
- Physical activity: aim for at least 60 minutes a day but start with small achievable goals and build up to target. Reduce screen time.
- Behaviour strategies. Include person’s partner and family/whanau in management to increase weight loss. Identify changes person wishes to work on first using problem-solving and goal-setting strategies.
Other options:
- Weight-loss drugs (consider when BMI over 30 or over 27 with significant co-morbidities like sleep apnoea).
- Surgery (consider referral for bariatric surgery when BMI over 40 or over 35 with significant co-morbidities).
Step 4: Arrange ongoing contact and support once goal weight reached.
