Description and preliminary results from a structured specialist behavioural weight management group intervention:Specialist Lifestyle Management (SLiM) programme

Background -  Specialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach. The groups are patient-centred incorporating educational, motivational, behavioural and cognitive elements. The theoretical background, programme structure and preliminary results of SLiM are presented. Subjects/methods - The study was a pragmatic service evaluation of obese patients with a body mass index (BMI) ≥35 kg/m2 with comorbidity or ≥40 kg/m2 without comorbidity referred to a specialist weight management service in the West Midlands, UK. 828 patients were enrolled within SLiM over a 48-month period. Trained facilitators delivered the programme. Preliminary anonymised data were analysed using the intention-to-treat principle. The primary outcome measure was weight loss at 3 and 6 months with comparisons between completers and non-completers performed. The last observation carried forward was used for missing data. Results - Of the 828 enrolled within SLiM, 464 completed the programme (56%). The mean baseline weight was 135 kg (BMI=49.1 kg/m2) with 87.2% of patients having a BMI≥40 kg/m2 and 12.4% with BMI≥60 kg/m2. The mean weight change of all patients enrolled was −4.1 kg (95% CI −3.6 to −4.6 kg, p=0.0001) at the end of SLiM, with completers (n=464) achieving −5.5 kg (95% CI −4.2 to −6.2 kg, p=0.0001) and non-completers achieving −2.3 kg (p=0.0001). The majority (78.6%) who attended the 6-month programme achieved weight loss with 32.3% achieving a ≥5% weight loss. Conclusions - The SLiM programme is an effective group intervention for the management of severe and complex obesity

Validity of claims made in weight management research: a narrative review of dietetic articles

<p>Abstract</p> <p>Background</p> <p>The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored.</p> <p>Methods</p> <p>A narrative literature review of journal articles in <it>The Journal of Human Nutrition and Dietetics </it>from 2004 to 2008.</p> <p>Results</p> <p>Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence.</p> <p>Conclusions</p> <p>Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.</p

Does hypoglycaemic avoidance behaviour contribute to increased HbA1c levels in physically active people with type 1 diabetes?

The aim of this study was to assess the relationship between glycaemic control (HbA1c), self-reported vigorous activity, aerobic capacity and hypoglycaemic avoidance behaviour in people with type 1 diabetes. We studied 50 patients with type 1 diabetes, attending a routine diabetic clinic (30 male, mean age 36 years, mean duration of diabetes 18 years, mean HbA1c 9.1%), Aerobic fitness was assessed using a multistage sub-maximal 20cm step test (Chester Step Test) and self-reported physical activity, exercise related hypoglycaemia and hypoglycaemic avoidance behaviour was assessed using a simple 'in-house' questionnaire. Thirty patients (60%) reported participating in regular vigorous physical activity (sport or gym session &gt;1 hour/week) and glycaemic control was significantly worse in this group compared to those who did not report vigorous activity on a regular basis (HbA1c 9.5% vs 8.5%, p&lt;0.02). Of the vigorously active group, 83% reported taking some action to prevent hypoglycaemia during physical activity compared to 70% of the group who were not vigorously active. Significantly more patients in the vigorously active group reported purposely aiming for higher than normal blood glucose levels during activity than those who were not vigorously active (8 vs 0, p&lt;0.03). In this study, regular vigorous physical activity was associated with poorer diabetic control which may be due to hypoglycaemic avoidance behaviour. Health care professionals should be trained in the management of exercise in type 1 diabetes</p