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The Editorial and two articles1,2,3 in the September issue of the Journal highlight the current difficulties in encouraging and supporting patients with obesity to reduce weight and maintain the achieved weight. One paper highlighted the effectiveness of a ‘fourth level’ of support, comparing it to other less supportive levels which were ineffective, but recorded only four out of 28 patients receiving this support.
‘Fourth level’ support had the characteristics:
The Thakur practice is an urban practice with a list size of approximately 3500. For the last 2 years patients with BMI>30 or BMI>27 with comorbidity have been offered during consultations with the GP or practice nurse or by publicity in the practice leaflet, free attendance at an evening support group led by a non-clinical member of the practice staff (SH) who has previous experience in the conduct and process of self-help groups and personal experience of successful weight reduction. During the initial half of each session the patient is weighed alone by the therapist and given individual feedback and advice. During the second session there is a group interactive discussion referring to a relevant topic. Each cycle lasts 12 weeks and we have completed three cycles.
Patient questionnaires indicated a high level of patient satisfaction. Throughout the 12 weeks there is a minimal regular attendance of 76%. The age–sex distribution was 16–29 years = 1 female; 30–39 years = 10 females; 40–49 years = 12 females; 50–59 years = 1 male, 9 females; and ≥60 years = four males, 17 females.
At the end of the three 12-week cycles the total weight loss was 207.5kg with an average weight loss of 4.0kg for those starting and 9.1kg for those completing the 12 weeks. The maximum weight loss was 11kg (9%) and the minimum was 2 kg (4%).
Participation in this group removes responsibility from the healthcare professional referring the patient and encourages patients in their belief that reducing their obesity is their responsibility. We believe this type of group offers effective support and encouragement to obese patients, which may reduce the frustration described by everyone in their management, and also that a more detailed evaluation is indicated, ideally taking into account the recorded difficulties of such evaluation.3
On behalf of the patients, we acknowlege the support given by the Leeds NW PCT.