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GPs must urgently refer almost two million overweight people for NHS cooking and exercise classes under official guidelines published today.
Everyone over 40 should have a blood test to identify whether unhealthy eating has damaged their metabolism, the National Institute for Health and Care Excellence (Nice) says.
NHS leaders will have to scale up healthy living programmes to make sure that more people can take part, the guidance adds. Sending people on the taxpayer-funded £435-a-head courses will cost billions but pay for itself within 14 years by preventing thousands of cases of diabetes, Nice estimates.
Obesity is the world’s fastest-growing health risk, with poor diet responsible for one in five deaths. A quarter of British adults are obese and this has fuelled a doubling of diabetes cases in the past 20 years, with more than four million people now estimated to have the condition. Untreated it can lead to amputation, blindness and life-threatening complications.
Last year Simon Stevens, head of NHS England, set up a diabetes prevention programme to stem the tide. So far 50,000 people have been referred to courses — lasting 16 hours — that teach them to cook healthy food and coach them in exercises. He hopes to reach 200,000 people next year with courses covering three quarters of the country.
Classes are a mix of one-to-one and group sessions where patients are taught healthy recipes and the importance of eating fruit and vegetables and controlling portion size. They are also given personal trainers to design activity regimes, which include gym sessions or plans to walk or garden more.
Nice has previously estimated that five million people with high blood sugar could benefit from the voluntary programme, but it now says that GPs must seek out and refer 1.7 million people at the highest risk of developing diabetes. This is defined as having a fasting blood glucose level of 6.5-6.9 millimoles per litre, on the cusp of full-blown diabetes.
Blood tests to check for markers of a damaged metabolism could be carried out during GP appointments or at health checks for the middle-aged.
Mark Baker, director of the centre for guidelines at Nice, said: “We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes. And that this approach is a cost-effective way of managing an illness that costs the NHS around £8.8 billion a year. We need to make sure that the people most at risk have access to the care they need. This is why this updated guidance from Nice is so important.”
The guidance says diabetes checks should be offered to everyone over 40 and younger people who are obese, have high blood pressure or come from south Asian or black backgrounds that are known to be at higher risk.
However, Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “We would advise caution in methods for targeting patients. Blanket checks for all over-40s, for example, have the potential to subject healthy people to unnecessary tests, and this both deflects resources away from delivering patient care to those who need it and could cause unintended harms.”
She added that more formal exercise and cooking programmes would nonetheless help patients to lose weight when GPs did not have time to encourage healthy living. “We are under intense resource pressures, and there is a limit to what we can realistically do within the constraints of the standard ten-minute consultation. Access to these programmes will certainly ease some of this pressure,” she said.
Tam Fry, chairman of the National Obesity Forum, said that family doctors were still flummoxed by obesity and argued that prevention efforts had to begin earlier in life than middle age.
“All these problems start early and by the time people have become obese it’s too late. We have closed the door but the horse has bolted long since,” he said.
Dan Howarth, head of care at Diabetes UK insisted: “We know that globally diabetes prevention programmes do work, and we know that with the right advice and support, people at increased risk of developing type 2 diabetes can take simple but significant steps to prevent the condition developing.”
GPs have often been reluctant to bring up people’s weight, fearing adverse reactions, but a study last year found patients could lose up to 21lb (9.5kg) if doctors took 30 seconds to book them into Weight Watchers or similar schemes. Patients did not feel insulted to be offered slimming classes and lost more weight than those given simple healthy living advice, scientists reported in The Lancet.
Posted with permission from The Times. @thetimes