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Managing one or more long-term conditions will usually mean contact with specialist services within the NHS. We asked people about their experiences of this in relation to their weight.
Diabetes UK advises that when a person is diagnosed with diabetes, they should see a registered dietitian to discuss what they usually eat, how this relates to their diabetes, and what other information and support would help them to eat healthily with diabetes.
The people we spoke to who were seeing a specialist diabetes team had many positive things to say. Janet has been going to the diabetic centre for her care for 20 years where she sees the same people and is known by name. She has felt listened to and was particularly well supported by her diabetes nurse before and after the gastric band surgery.
Sue Y was relatively newly diagnosed, but she too, was impressed with the level of support she received from the specialist diabetes team to manage her diabetes with diet; she said ‘everybody has been brilliant’.
A common theme among those with positive experiences of specialist diabetes care was their relationship with the diabetes nurse. Stuart was critical of general advice from health professionals to lose a few kilos, but said he had an excellent diabetes nurse who ‘has covered all bases’ in terms of weight. Hilary said she swore by her diabetes nurse, who was very supportive and had referred her to a course on diabetes and weight management at her local hospital. Myra said, ‘They understand that it’s not always easy when you’ve always had a weight problem, but they’re encouraging’. Sue Y and William both commented on how knowledgeable and experienced their nurses were. Sue Y said, ‘They’re fabulous, they have so much knowledge and obviously I think the more experienced they are the better because they’ve gone through the gamut of everybody’s worries and questions and so on. So that they know an awful lot’. Not everyone felt so positive about their experiences of diabetes care. When she was first diagnosed with diabetes, Julie says she was told it was inevitable she would go onto insulin. Eleven years later, she is still controlling her diabetes through diet and thinks that the NHS doesn’t necessarily give the right advice about diet.Dietitians are qualified health professionals who assess, diagnose and treat dietary and nutritional problems. They provide practical guidance to help people make appropriate lifestyle and food choices. A GP may refer a patient to the dietician for a range of conditions, including diabetes, high blood pressure, cardiovascular disease or those who need to lose weight safely.
The people we spoke with had mixed experiences of seeing a dietician. Some, like Maxine Mary, Janet and Lina found their advice really useful. Maxine Mary’s dietician told her that ‘We’ve evolved to need different quantities of food and what is the right amount of food for some people is too much for you,’ and she found this advice made total sense to her. Janet found their advice on what to eat after her gastric band very helpful, ‘she give me recipes, she give me ideas’. Lina’s dietician helped her adapt her diet to manage her blood sugar. But Ellie waited four months for an appointment with the dietician, who she then felt didn’t give her suitable advice. Alan had found his visits to the dietician less successful. He felt that the differences in age, gender and size made it difficult for dieticians to relate to him and his weight problems. He would have preferred more practical, evidence-based guidance.
Variable advice on weight loss within specialist careThere were a range of other experiences of specialist NHS care from oncology to rheumatology and cardiology. The extent to which weight was a topic of discussion varied. For example, Liz was found to have osteoarthritis while in hospital with sepsis. She said there had been no discussion of her weight, because the doctors were more concerned with keeping her alive.
When John X was diagnosed with sleep apnoea, he said he wasn’t given any information about changing his diet, but when he was later diagnosed with prostate cancer, his weight was one of the first things that came up. Sue Y said her heart consultant told her she was ‘rather stout’ ‘but that was it’. John Y sees the consultant cardiologist every year and explained: ‘I make a rash assumption that as a consultant cardiologist, if he was bothered about my weight, he would say something about it And similarly any of the other consultants I see, they are not saying, ‘Oh you’d better get some weight off.’ They don’t seem to be bothered about it.’ For those people who had received advice, this was sometimes too general. David said he had received advice and encouragement from his pacemaker reviews, ‘but it’s all at a quite general level and the most useful advice I’ve had has been off the websites’. Stuart said he’d been told he would feel better if he lost a few kilos, and had been given some leaflets ‘which really are a waste of paper they’ve got just basic recommendations’. Lesley said she would like more targeted information about the interaction between her medications with her weight. People whose specialist healthcare professional had discussed their weight with them directly, and not just given them what Alan referred to as the ‘standard mantra’, tended to appreciate this. Joan and David had both been motivated to lose weight after frank discussions, while Paul Y said that he would find some ‘hard targets’ from the diabetes nurse helpful. Moreover, he would like it if a specialist would go through his more than ten year history of living with type 2 diabetes and say ‘Let’s have a look at that long term record of when you were doing well and when you were doing less well’, so pointing out the effects of weight gain, weight loss and exercise on the management of his condition. Managing weight in the context of co-morbidities is a complex issue that requires considerable support from specialist teams. For example, Colin had a heart attack and was diagnosed with heart failure. He got some dietary advice from the cardiac team but was not seen by a dietician. At the same time, he explained that his cardiologist’s main concern was to find the right medication to reduce water retention that didn’t clash with his epilepsy medication. Colin’s unmet need was to find exercise options that took into account his osteoarthritis, lung and heart conditions. He has had mixed experiences with consultants but said that, in general, specialist nurses are better. Lina’s asthma attacks are severe and life-threatening and each attack is followed by a high dose of steroid therapy. Lina thinks that steroids have contributed to her weight gain. Her consultant would like her to have a treatment called Bronchial thermoplasty, which she hopes will lessen her severe asthma attacks and the need for high dose steroids.Google is a wonderful thing. It's like having, you know the Encyclopaedia Britannica on speed in your pocket, because you can literally ask any question...
A GP or practice nurse can help people lose weight by: assessing their general health, helping identify the cause of a person's weight gain, understanding...