Obesity is a major public health issue in the UK. Nearly two-thirds of adults in England are overweight or obese [1]. As part of the 2019 Long Term Plan, the NHS developed an obesity action plan to tackle preventable health issues, such as type 2 diabetes and coronary heart disease.
These issues place pressure on the NHS, and the NHS has identified actions it will take to tackle obesity. The NHS will:
- Improve access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30+
- Commit to fund a doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option
- Test an NHS programme supporting very low calorie diets for obese people with type 2 diabetes.
- Continue to take action on healthy NHS premises.
- Together with professional bodies and universities the NHS will ensure nutrition has a greater place in professional education training.
A common treatment plan for obesity is for the clinician to offer the patient a referral to a weight management programme.
What is a Weight Management Programme?
A weight management programme is a 12-week behavioural and lifestyle programme designed to support the overweight and obese with weight loss. Healthcare professionals can either refer the patient to local weight loss groups or to a 12-week digital weight management programme.[2]
Research conducted by the Nuffield Department of Primary Care Health Sciences shows that although clinicians have been making referrals to weight management programmes for years, they are often reluctant to do so. This is due to:
- Misunderstandings – A lack of confidence in their ability to discuss the programme as the clinician is unsure of what to say.
- Misinterpretations – The clinician’s relationship with the patient could be tarnished if they misunderstand why the referral is being presented.
With the right tools, conflict with the patient can be avoided and clinicians can confidently recommend weight management referrals. Communication is crucial, building clinician confidence in delivering interventions generates a more positive reaction from patients.
In a study carried out by Nuffield, a series of Weight management referrals were analysed to identify trends in successful weight management referrals. Dr Charlotte Albury, a communications scientist specialising in weight management referrals at the University of Oxford, discussed what they found through this research [3].
Weight Management Referrals in Context
Weight management referrals are part of the wider NHS system and are the same as referrals clinicians may offer for different long-term health conditions. The only difference with weight management referrals is that clinicians need to take care when approaching the topic as it can be a delicate matter. The conversation surrounding referral can have a positive outcome when handled correctly. However, if not they can contribute to the everyday stigmas obese people face.
5 Steps to Offering a Weight Management Referral
The team at Oxford identified 5 clear steps to when offering a referral. They increase the likelihood that the referral will be understood and positively received by the patient.
• Raise – Raise the topic of referral with the patient and show them the available programmes
• Establish – Establish that referrals are effective and that the 12-week plan can work for the patient
• Offer – Make the offer of the referral and clearly tell them that it is a free service
• Listen – The intervention is a conversation and the clinician needs to listen to the patient’s response or any reservations they may have.
• Outline – Outline the next steps in the process and work with the patient to make a plan addressing the actions being made.
These steps outline the course of a brief interaction a clinician can have with patients following a consultation. Brief conversations on referrals have seen the most positive feedback from patients when carried out correctly. This shows the importance of confident communication when discussing referrals.
Strategies to ensure the success of the 5 step approach
Language is key when having positive conversations with patients about weight management referrals. Clinicians need to choose the right words to help the patient understand what is being offered.
By using branded examples such as Slimming World, the type of weight management strategy being offered to the patient is more easily understood.
To avoid misconceptions, state clearly that the referral is a free 12-week programme as often patients assume only the first session is free with the NHS.
It is often believed that referrals are going to be in hospitals and places the patient will struggle to get to. By stating the referral is local, the patient is reassured it is nearby.
Being clear with the patient is key to helping them understand why the service is being referred and what is actually being offered. While it is important to think about what to say to the patient, it is equally important to avoid common misconceptions and communications in the referral.
Common Miscommunications
Previously clinicians associated weight loss with an existing health concern or condition, this has resulted in a negative response to the referral. The link drawn between the condition and the referral can imply that they have caused the health issue through their obesity.
Offering superficial advice is also harmful to the referral. By oversimplifying the causes of obesity and focusing on the eat less and exercise more approach, clinicians add to the stigma people can face in healthcare.
Negative and Positive Referrals
Negative Referrals
A negative delivery in the referral outlines the immediate need for a person to lose weight. The delivery focuses on the potential risks associated with obesity and the consequences a person could face if they don’t lose weight.
This referral is time-consuming and focuses on the burdens associated with obesity, both on the patient and on the NHS in the long term.
Positive Referrals
A positive referral asserts the course of action by suggesting the referral in passing. It is framed as an opportunity for the patient, giving them more of an active choice in the treatment plan.
This referral is far shorter to deliver than the negative referral.
Summary
It is important to communicate effectively with the patient about weight management referrals. Communicating effectively means both speaking and actively listening to the patient’s response. If a patient doesn’t want to go through with the referral, clinicians should respect that decision. By trying to convince them to say yes, it is being implied that their decision was wrong.
After the referral, it is important for clinicians to immediately link the patient into support as with any other referral. Quickly starting this process for the patient increases the likelihood of them continuing with the referral.
[1] NHS England, NHS Long Term Plan, (2019)
[2] Public Health England, Let’s Talk about Weight, (2017)
[3] Dr Charlotte Albury, Nuffield Department of Primary Care Health Sciences, University of Oxford, (2021)
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