Obesity Abstracts

The National Institute for Health and Care Excellence recommend that weight management programmes should include behaviour change strategies to increase patient physical activity (PA) and decrease physical inactivity (PI). This is advocated as part of a multicomponent interventional approach, alongside dietary, pharmacological and surgical interventions. (NICE 2023). Combined dietary and PA interventions have demonstrated widespread health benefits over dietary interventions alone. These include physiological benefits such as favourable lipid profiles (Gobbo 2019, Clark 2015 & Schwingshackl 2014) and reduced insulin resistance (Battista 2021), in addition to physical benefits such as reduced overall body weight (Ramage 2014), waist circumference (O’Donoghue 2021) and visceral adiposity (Rao 2019), with increases in lean body mass (Chu 2021). Greater functional improvements are also seen in combined interventions compared to PA or dietary changes alone for overall cardiovascular fitness (Miller 2013) and quality of life (Batsis 2017). The Barts Health Weight Management Service (BHWMS) champions a multidisciplinary team (MDT) approach to patient care. Weekly clinics provide specialist assessment, investigation and management from a diabetes nurse, dietician, psychologist and doctors. Patient lists run simultaneously before a collaborative MDT meeting for complex case reviews. After considering training requirements and clinical governance, training programme director approval allowed incorporation of Sport and Exercise Medicine (SEM) Specialty Registrars within the MDT. Subsequently, an Exercise Medicine (EM) branch was introduced to BHWMS, with PA focused consultations. Using Moving Medicine for a framework, these consultations explore patient motivation and readiness to change, promoting increased PA and reduced PI through motivational interviewing (Moving Medicine 2022). Where appropriate, patient specific PA prescriptions are provided, applying frequency, intensity, type and time principles. Baseline patient PA levels are collected prior to initial consultations using the global physical activity questionnaire, which will be repeated at 12 weeks to gauge consultation efficacy. Whilst the EM branch of the BHWMS remains in its infancy, early qualitative patient feedback has been positive, indicating high levels of patient satisfaction and improvements in readiness to change. Further analysis and reflective practice will guide service development, but there is optimism for a new SEM legacy in the context of the BHWMS.