Local and national NHS/charity support for weight management specifically for people with chronic conditions

Groups and programmes provided by the NHS

The NHS offers a range of support group services, including weight management programmes for people with multiple health conditions and courses which aim to help people with long-term conditions manage their health better. These vary across the UK, but may include group-based support with specialist nurses, dieticians and psychologists. Individuals are usually referred through their GP, although some programmes may be via self-referral. One example is DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed), a group course for people with type 2 diabetes. Another is the Expert Patients’ Programme (EPP), a free self-management course for people living with any long-term health condition, such as heart disease, diabetes, asthma, arthritis, multiple sclerosis, or depression. The course explores issues such as how to manage common symptoms, nutrition and exercise, medication management and dealing with difficult emotions.

Among the people we spoke with there were mixed experiences of attending these kinds of groups.

Positive experiences

Sue Y attended a six week X-PERT Diabetes programme after being referred by her local medical centre. She was impressed with how good it was and found the information she learned helped her change her life for the better. Hilary also attended an NHS course after being diagnosed with diabetes. She found it useful for reinforcing some of the information she already knew and suggesting alternatives in the kitchen.

Sue Y was impressed with the X-PERT Diabetes programme she attended, which she felt made a positive difference to her health.

Age at interview 69

Gender Female

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What, would you like to tell me more about this course that you did. Who recommended it? Did you have to wait to join it? How long you waited and what it was all about? I mean, can you just tell me a little bit?

I have a computer which I go on a lot and I was having a look at diabetes within [City] and it mentioned about this course, the X-PERT course and I brought it up with the diabetic nurse at the medical centre which I attended, and she said, It was a brilliant course. Would I, I like to go on it? She would put me forward. So, she did, and I got a call within a matter of a week or so to say they had a place on the next course and so got on it very, very quickly after being diagnosed with diabetes.

It all seemed to happen very, very fast indeed and the course was once a week and people sat round a table. They had the booklet and we worked our way through the through the book and talked about it and there were two nurses, really experienced nurses, who’d done this course many times. They knew everything that, that they talked about. It was so pertinent to, to the lifestyle of people and it, it gave so much information it was incredible. Really incredible. I was very, very impressed indeed with how good it was.

There’s not many times that I’ve been so impressed, but I was definitely with this course. It was second to none and it inspired me to start the diet proper again because with being with [partner’s name], he’s always accepted me as I am but then I thought, Well, right, I’ve got to do something about my weight and blah, blah, and, you know, change for the better and get more exercise and, and so on and so forth. So, so that’s, that’s it really. it’s so good, it was just incredible. Very inspiring.

How would you describe the course to someone who was going to look at the website and who is going to be interested in joining something along those lines?

Yeah, if you want to find out information that will change your life for the better and be inspiring at the same time to make you feel better to help your health to improve things for you, then go on this course.

it’s fantastic the, the ladies who were giving the course were so interesting. So down to earth. They kept it simple. There was no pretentious overload of information. It was pertinent to each of us and it did make a difference. That’s what I would tell somebody.

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After being diagnosed with type 2 diabetes, Hilary was referred to a course which helped reinforce information about diabetes and weight management. She attended with a friend from work who was also recently diagnosed.

Age at interview 62

Gender Female

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Now the nurse was very supportive. They sent me on one of these courses where they talk about diabetes and weight management and what you can do at our local hospital and that was very helpful as well because that came round with some of the things which I already knew but reinforced things like don’t assume diabetic chocolate is good for you. it’s not because something, it’s got sorbitol in it and, you know, if you have too much of that you’ll spend the rest of the day on the toilet because it’s just a laxative basically. Those sort of things, and certain things that you could have, you assume sugar free sweets, again there’s no sugar in them. There’s no sugar as such but again there are things like sucrose. Another form of sugar but a different name, so it’s all those sorts of things. So, they were very helpful in that respect and told me the sort of things. I thought, Well, I’m not sure about those and they were able to say, Well, no you can’t

they’re all trained in the diabetes side, so they can help and support. They were able to refer me on to [NHS courses], our local health people our local NHS who had courses that people could go on. They could show you how to cook as well. In fact, I went on one of those initially as well because there was a lady at work that was diagnosed the same time and she came through and said, Look there’s something here So, we went and had a look. Again, it gives you just a reminder of the things you can and can’t do and some alternatives if you say. I suppose it’s like going to Weight Watchers where somebody’s going to say, I can’t do without gravy. I’ve got to have gravy on the mashed potato or whatever, and they’ll come up with a calorie friendly solution. Perhaps not ideal but it will, you know, it will see you over that need to have something like that.

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Stuart attended a six week group-based programme for diabetics which included question and answer sessions and an open forum for discussion. It helped him make sense of what he felt were conflicting health plans that he had received for diabetes and cholesterol. Tommy was referred by his doctor to ABL, or ‘A Better Life’, which offers support services to people who need to lose weight for health reasons. This included group meetings with discussion and an hour’s exercise. Through that, he was introduced to a local physical activity referral service called BUZZ, which helps people living with long term health conditions to safely increase their levels of physical activity.

Stuart attended an NHS course which gave him perspective on how to marry up’ the dietary advice about his type 2 diabetes and cholesterol.

Age at interview 70

Gender Male

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So do you think that was very important for you to become aware of

Yeah, it was, it was a big life change for me because I had this diabetic health plan. I had this cholesterol health plan. But if you look at the information the NHS give you, if you overlap it, it doesn’t, it doesn’t marry up. It, the diabetes health plan doesn’t marry up with the cholesterol one. If you, if you, if you ate as, as, if you ate as on the cholesterol plan and you weren’t diabetic that was fine. But if you’re diabetic and you hadn’t got high cholesterol, that was fine. But if you had both, like me, and, and I was very keen to know everything, like I said to you at the beginning, if you know what it is you can set your stall out and alter things to make yourself better. But I had two conflicting bits of information and I couldn’t make them, I couldn’t see how they could marry up.

This course put that into perspective, in terms of, yes, you’ve got to eat some, you’ve got to eat some fat, you’ve got to absorb some fat but just keep it to a minimum it’s impossible to live without eating but we went off, we made a big change, we use a lot of olive oil, but we also use, very rarely we fry in actual fact, very rare apart from them peppers [laughs].

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Tommy describes the NHS group support he has received, including a home visit, an accompanied shopping trip and personal advice about how to cook healthier versions of the foods he enjoys.

Age at interview 85

Gender Male

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And then the doctor recommended ABL, A Better Life. It meant me attending this, this class every week for two hours. There was about usually ten or twelve in the class and what they did was they described for instance, when you go shopping, what do you sort of buy? Well I have this, that and the next Do you ever look at the labelling, the, the, the orange, the green and the red Well no, I’m afraid I don’t Right, you must start doing that And they teach you then just what things to sort of look for so that you select the right food. The other thing they talked about was, how do you, Say I’m going to a party tonight. Now you go to a party it’s a buffet, all the foods there, it’s very inviting and you dive in.

You eat the meat pies and all the rest of it. They said, Look, before you go have something to eat so that when you get there, you’re not hungry that you want to sort of do this thing and then I, after we had an hour of this sort of talk and each one said what their failings were and all the rest of it. We did an hour’s exercise. Now it wasn’t chair based exercise, but it was similar to that. You sort of did walking round, press ups against the wall and legs and all that sort of, so as well as the talking about how to select foods it also gave you the exercise and from that I was introduced to an organisation called BUZZ – B-U-Z-Z. And what happened there was I had an interview with this health chap and I went through more or less what I’ve gone through with you, background and that sort of thing. So, he said to me, Do you mind if I have a look in your cupboard, what, your, what food have you got Yes, right, I had a look. That’s all right Tommy. don’t have that, that’s all right. don’t have that. That’s all right Then he said, Next week, I’m going to meet you at the supermarket and we’re going to go shopping and I’ll help you selec, all for nothing, you don’t have to pay for this, you know for the advice.

So, I went to the Tesco’s and he said, Now you see Tommy this label saysrdquo; and they introduced me to all that sort of information and then the following week he says to me, What, what’s your favourite dish, what do you like to have Well, spaghetti bolognaise, fish chips and that sort of thing and he said, Right, get these ingredients in and I will show you how to cook it And he did that. Now that went on for twelve weeks and it was abso- not only did I get good advice as to what was the best foods and how to cook them to, to sort of benefit from, from that but he was teaching me how to cook. Now that like all good things come to an end. That finished.

I’m still with ABL, A Better Life. Again, that has to finish, this, this, this weekly visit where you did advice and exercise, that’s now gone to a monthly visit. Just an hour where they keep you on the ball. Have you any problems, Tommy Well yes I went.. Why didn’t you and that sort of thing and I think where as I said earlier, I left Slimming World, that was keeping me tied down, £3 or not, that made me make certain I put weight on. Once I stopped going then it put the weight on. With this, I still feel focused that I must watch what I eat because you need so much help. it’s so easy to fall by the wayside and at the moment, come back to my weight, I’m actually, I was, when I joined this ABL, I was twenty-two stone and now I am nineteen and a half stone.

So that in say twelve months or so, I shed a couple of stone off and that’s where I’m up to today.

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For people who have had a heart attack, heart surgery or a related procedure, the NHS offers a cardiac rehabilitation programme. What happens in cardiac rehabilitation programmes varies throughout the country, but most cover exercise, education, relaxation and emotional support. A key focus is how to protect the heart and manage heart conditions long-term, which includes information and advice on diet, exercise and other lifestyle factors.

Lesley used the BHF website for information and found her local cardiac rehab support group, where weight was just one topic covered, useful. The group physio wrote a letter for her to join an aqua gym.

Age at interview 60

Gender Female

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And where does your information, where have you got information about healthy eating and sort of healthy lifestyle and things like that? What things you have now are part of your routine?

Mostly from the British Heart Foundation website. I think that was really useful. Also the, our local Trust, I was under [Name] Hospital here and the [Name], Foundation Trust. They’d run a cardiac rehab support when you’ve had a heart issue, so you have eight weeks of classes, exercise classes which are carefully monitored. They have information sessions, so every Monday you’d have an information session either on healthy eating, healthy living, exercise, your medication. They’ve just incorporated one which is also for your mindfulness and how you’re stressed and anxiety, so it was really helpful to pick up all those tips. Lots of literature and also, I think most people with a bit of common sense know how to eat healthily, you know. I think it’s, there’s so much publicity around now. There’s so much sort of push towards healthy eating that I think it’s there, but the, the cardiac rehab team were really informative, and they still are. You can go back to any of the sessions
Okay.

and learn about weight management or as well as your tablets, the structure of the heart. Why did you have heart problems? What causes things?

So, you went this and these are group sessions, aren’t they?

they’re group, they’re group sessions, yeah.

And you were, you were okay with those?

I think because we, we all had a common link; we all had heart issues, you know, it wasn’t about weight management. It, one of the information sessions was about weight management, one of them was about all your pills and so all the side effects of pills and things, so then we learnt then about there could be side effects of pills, so it was very informative. They were very good.

Okay, did you have sessions about sort of kind of rehab, rehabilitation sessions, I mean in which you go to a gym or you do

Yeah, we had eight weeks of that.

Eight weeks of that.

Eight weeks of that and that again that was good. That sort of encouraged me to think, Well, actually I can go to the gym,’ because I went to the local gym they wouldn’t touch me, they said, No, you’re not coming in here [Laughs.] And then I said, If I get a letter from the doctor, will you, can I come in Because I just wanted to go to the pool or do aqua gym, something that wasn’t such a strain on my heart, and again they wouldn’t because the doctor wouldn’t give me a letter. The doctor would not sign a letter saying I was, he was happy for me to go to a gym. But the physiotherapist at the cardiac rehab team said, Oh I think you should go, so I’ll write you a letter in the end and they accepted that, so that’s how I joined the local gym and go to aqua gym.

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Joan and June X participated in the same NHS weight management service and both praised it. It is a GP/consultant referral service for morbidly obese people with BMI over 35 or those with a BMI below 30 who have multiple health problems. It is a multi-disciplinary service that includes specialist dietitians, clinical psychologists and specialist physiotherapists. June X had also attended fitness programmes in the USA and commented that the programmes available in her city were just as good.

Joan has lost over 6 stone in eighteen months and thinks this programme worked for her because it had the following ingredients: support, encouragement and specialist care and an exercise class under the supervision of a physiotherapist with knowledge of her different long-term conditions. She added that her own attitude at that time was the right one as she was ‘sick of looking at myself being at twenty stone’. She is attending the monthly maintenance sessions and is conscious of the dangers of ‘slipping back’ into old habits. She knows that if it gets harder, though, she could ask for a referral to the psychology team for support.

June is beyond impressed’ with the combination of psychological support and exercise, with physiotherapists in attendance, at the group she attends.

Age at interview 70

Gender Female

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And for how long has the programme lasted?

Oh, for me?

Yeah.

I think it’s up to as much as a couple of years.

Okay,

Not at the same level obviously. There’s an initially more intensive groups, it’s once every two weeks the group sessions and then it’s one a month I think for another period of time and then it’s even more spaced out, but they keep your eye on you for an extended period of time which is great, you know, sort of and I would imagine if you were in particular trouble you felt or they could help or something like that or, you know, I’m sure that they would.

Okay, okay, so they don’t leave you just when you finish the course.

No, no, no, don’t, don’t appear to.

Okay.

But on the very long term I mean I really, I really don’t know. But certainly I was very impressed at how long it did last anyway.

Okay because I mean the fortnight, the every two weeks sessions, they involve what? A talk?

You come, you are seen individually and that you’re weighed and a brief word and with the emphasis on brief, obviously, can’t spend too much time or there wouldn’t be too much time or there wouldn’t be a session. And yes, there is an agenda for each session and so yes, you will have your talk and a group discussion and yes, you can, you can contribute as and when with questions and things like that, as you wish.

There was a fair bit of work on mindfulness, relaxation and that type of thing, which varying views on that, but I think it’s very helpful. I think just from anything that I’ve experienced in the past encouraging people to be more thoughtful, to perhaps interrupt behaviours and to be able to relax and, and make relaxation or bringing yourself down from anxieties is, is very, very useful and techniques such as slowly down your eating are tremendously helpful. If you eat more slowly, you really do eat half as much [laughs]. it’s really that simple

[Laughs] Yeah.

nd that’s, that’s one thing is, is remembering to do that and remembering to adopt these techniques is very, very important and they’re very helpful.

Okay, so it’s relaxation, techniques to, to help you.

Hm-mm. Hm-mm.

Okay.

And, also, to think about what you’re doing in a more positive light. I think to have a more positive attitude period. Not to be so scared of negative thoughts and negative events. To be able to be mindful and relax more and to slow down.

And at what point do you have the physiotherapy sessions?

They are, generally speaking, the ones that I attended were on a Thursday afternoon/ and those are straightforward getting back into movement classes with two physiotherapists in attendance and movement to music and good classes actually
Okay.

good classes. They, they give you stations. You have the floor exercises and then you have the stations round the room of, of sort of wall presses and work in a trampoline and work in an arm press and various sort of things, and a step, getting on and off a step, things like that type of thing.

Yes you kind of can do, you can, you can come to your, absolutely, to your group session and you can come to the psychology lecture and you can attend the physio and you can also attend the Live Active programme and get the benefit of, of people, people who are expert in, in various types of exercise and getting you going in that regard. I would say it’s pretty widely supported.

as I say, I’m beyond impressed. There’s a tremendous willingness to help in any way that they actually can.

What have been the most positive aspects of it for you?

I think that the recording and eating regularly and not perhaps stressing too much, getting, not getting too rigid. This rigidity or your feeling profile that I was speaking about. This unrealistic expert, expectation. This over perfectionist attitude really is going to get thoroughly in the way. We’ve had a bit of an exploration of how negative thinking is what happens to the human organism first. That it’s far more part of our evolutionary cycle to think in, in negative terms than it is to think in positive terms and therefore it’s not that strange but challenge it. Wait, wait a while [laughs]. It won’t necessarily stay that way and perhaps challenge it. If, as and when possible

And the number of times since beginning this that I’ve thought, Oh no, no, wait a minute, you know, this isn’t a disaster. This isn’t the universe versus me this is just temporary, this will pass,’ and it’s very true. Everything passes, and I think probably that to, [Name] who’s one of our, our group leaders who’s, who’s psychologist and very good one saying, This is a marathon not a sprint. This is a marathon not a sprint has been probably the most useful thing that has been said to me that makes sense. However, you think this is going to happen whatever, it’s not and the last thing actually he said to me was, Remember to enjoy the benefits of what you’ve achieved so far because since last year I’ve lost 75 pounds, so that again is tremendously, tremendously important.

Exactly, yeah.

You know, and to, to let it slip your mind, to, you can’t become blasé about that.

Yeah.

That’s a big difference from where you were, you know. It may not be where you want to go but it’s a big difference, oh I’ve done it now.

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In summary, people who had positive experiences of attending NHS support groups found the following aspects good:

  • Useful information provided in a relevant and accessible way
  • Inclusive and encouraged participation from everyone
  • Personalised one-to-one advice and support
  • A good, knowledgeable and motivating leader
  • Support from health professionals with specialist knowledge about the relevant health conditions, as well as weight management
  • Long-term support, including psychological support

However, people also found room for improvement. June commented that NHS weight management programmes need some practical changes to make it easier for working-age people to attend, e.g. like evening sessions. This contrasts with community weight management groups/programme which normally operate in the evening. Some programmes offer longer term follow up over several months, but others were packed into 8 consecutive weeks. June said, ‘You can’t undo in eight good sessions, no matter how excellent they were, you can’t undo all the habits’. Colin would prefer to attend a course designed for people living with a similar health condition, not a ‘mixed’ group. [See also ‘Messages to health professionals interested in helping people with weight control‘.

June attended a very good NHS programme where she learnt new ways to tackle her eating and exercise habits over an 8 week course. She would have liked longer-term support.

Age at interview 70

Gender Female

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I went on a very good NHS programme in [City] called Keep it off for good’ and that was fantastic. But it was eight sessions and if you’ve spent thirty or forty years getting bad habits and being overweight, you need prolonged support. You need it to go on and on, whether it’s a group or whatever it’s, it, you can’t undo in eight good sessions no matter how excellent they were, you can’t undo all the habits. So I think it’s a reason to keep going back and the availability of something that you can keep going back to.

Can you tell me a little bit more about that programme, the NHS programme?

Yes, so it was, it was self-referring, so you had to be overweight. It was self, you had to have a BMI over a certain amount and it was a small group which was excellent. There were only eight or ten of us and the, the leader of it, [name], she was she never said what her qualifications were, but she worked in a gym and I think she had qualifications of some kind in nutrition and it’s the first time really that somebody had put all information together. Every week we had a, a strong topic and I learnt some new things because I think overweight people are quite experts in things and you think, I’ve not got much, much I can learn. But actually, she, you know, she used a, a wide range of references and excellent handouts and she emphasised exercise. But I think it would have been improved if it would have been far longer than eight weeks and if it would have been a two-parts thing so that those sessions were one part and actual exercise was another part.

Okay.

Joining the two together.

Okay, so, yeah, sort of, kind of to keep
No, a token amount within the session but a separate session for exercise, I think that would have been great.

Okay, and what about in those sessions that she did, [21:32] she talk about sort of how to change behaviours so what would help to change behaviours?

Yes, so she talked about keeping a food diary, looking at what we were currently doing. Making small changes which, you know, she emphasised all the medical side of things, what it could lead to. She had a week on exercise. She had a week on all the temptations and downfalls and how you could get around those things. So things like, something that’s become prominent like cakes at work on a Friday and eating out and coffee shops and all the things that really contribute to people potentially putting weight on. And, but I just think then she gave us a little bit of homework, so we had to go away and think about whatever the topic was. But I just think it should have been far, far longer course.

Okay, so would have been, for you more, more, a longer term to keep you
Yes, because I think to take a new idea on board and turn it into a new and better habit, they say it takes three weeks minimum and to be doing that every week, obviously you’ve not got enough weeks to, you’ve not even ingrained one good habit before you’re having to try and start another one.

What has stayed with you from that course in terms of habit changing?

I suppose really it’s just that it combined elements of other things that I’ve done all in one place and with a bit more thought and knowledge and it, it’s sort of, you know, it’s, I’ve never really believed in silly crash diets but there was a week where it was all about, you know, debunking the myth of crash diets and why they don’t work and things. But she did sort of really say, you know, at the end of the day the responsibility is with me, nobody, you know, nobody could wave the magic wand for us. It was down to each individual which you know that but if you, if you have this negative feeling that I’ve spent a long time failing and that I’ve got no will power. Self-blame plays a very strong part I think in weight problems or my weight problems.

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Negative experiences

Not everyone was enthusiastic about the groups they had been referred to on the NHS. Ria was referred to an expert patient group by the practice nurse at her GP’s surgery and found the information pitched far below her own level of knowledge about Type 2 diabetes. Christine and Paul Y had a similar experience with diabetes programme DESMOND; Christine said, ‘I found it ridiculous really because they were only telling you what you knew’ and Paul Y was disappointed that it didn’t tackle weight issues ‘it doesn’t appear to be, to revolve around diet’.

Ria thought the diabetes course she was referred to was too basic for her level and she found the trainers patronising.

Age at interview 73

Gender Female

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The other thing I did was I went… they sent me on a course called X-PERT patient.

Oh yes, yes

And it was absolutely dreadful.

Really?

Dreadful. There’s a room full of people, most of whom had Type 2 diabetes, not Type 1.

Oh, you are Type 1?

No, Type 2

Oh OK

Most of whom are older, most of whom were overweight and unlikely to be doing much exercise I would think. During the break they offered us biscuits, and the two people who were the trainers were incredibly patronising, and I just… I went three times and I just could not cope with it anymore. They were holding things up saying, "These are…" something like, "This is pasta. Which of these is carbohydrate?" and somebody would say, "Oh, potatoes," and theyd say, "Brilliant" like that. Well, I have a Masters degree, and I did try to suggest that it was perhaps not being done in the right kind of way but
Yes, it was appalling. But also, I didn’t feel… they were still talking about how having a certain amount of carbohydrate. I mean granted, they were talking about low GI and high GI, so you know, which a lot of people there didn’t know anything about. And I was thinking, you know, if you read that book youd be far better informed than going to those classes.

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Paul did not find the DESMOND programme for diabetes motivating and would have liked a more empathetic approach.

Age at interview 55

Gender Male

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Well I did bring it up, last, last meeting I had with a GP I’d never met before and I just said, you know, he was looking at my latest blood test and, and was saying, Okay blood sugar’s up very slightly again, you know, going to need to put you on two metformin Said, Well, you know, I’m not happy about that. What can I, what can I do Oh, have you heard about this programme called DESMOND I said, No, I haven’t but, you know, if that’s what’s going locally then yeah get me along Right, well it’s a day course Okay, fine I kind of signed up for it without knowing what it’s about. I’ve read through it now. An awful lot of it looks fairly familiar to me and doesn’t necessarily do what I’ve been talking to you about doesn’t, you know, doesn’t tick my boxes as far something particularly motivational but perhaps I’ll meet somebody, or get the chance to meet somebody or talk to somebody who kind of empathises. You know, there’s some empathy there that says, Okay, that’s what, that’s what makes Paul tick. Let’s adapt our approach for him

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Ellie pointed out that the dropout rate may indicate a) whether a programme is working for everyone or b) the level of interest of the people attending it. She said that out of twenty people only six completed the course she attended but the feedback form seemed geared towards providing a positive assessment of the course. There was no room for reflection on why people left the programme.

Some of the people we spoke with had been referred to a gym or exercise class, either by a GP or for example through a cardiac rehabilitation team. Lesley was pleased with the support from the cardiac rehab team but the gyms she was referred to were ‘not near where I am or handy to where I come back from work’ She pointed out that ‘It needs to fit into my life rather than me to fit into the gym life, unfortunately’. Julie accepted a gym referral from her doctor because she is ‘quite into exercise’, but was put off by the cost: ‘the charge is ridiculous really, but I mean I was willing to pay it but then I think, ‘Well I can, I do my own exercise. I can go swimming and I walk”.

As part of cardiac rehabilitation, Colin was referred for exercise sessions in his local leisure centre. He was unable to make use of the referral because of problems with his feet.

Age at interview 72

Gender Male

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They actually, they actually advised in 2015 that I do this cardiac rehabilitation. So this is the second session that I’ve had at that and at the end of it, they, they gave us the option of carrying on with an organisation called physical activity and recreation service I think it is. PARS which was running in city at the time and basically it was, for the first thirteen weeks, it was a similar sort of exercise class to the one, in fact it was in the same place, the gymnasium at the physiotherapy at the hospital and it’s just simple circuit training. After that you, you do a thirteen-week session and after that they pass you on to someone else for thirteen weeks and then to someone else after that for thirteen weeks. I’ve no idea what was to follow the second thirteen weeks because I got to the second thirteen weeks.

And they sent me to one of the local leisure centres, to the gym there and they gave me a free membership. I thought it was great. I thought I’m doing great but at the time I had sore feet and there was like thick hard scaly skin on one foot causing the soreness. Nobody knew what it was.

I hobbled down to the gym at the leisure centre. Mentioned to the young lady there who I saw what the problem was and she said, Well, you’re not really fit to do the exercises that we would plan for you while that’s the case.

Tell you what, go away, keep your membership and get in touch with us when you’re back Well it’s, it’s taken until this year. So, like two and a half years to get my feet right, and about six weeks after the initial visit there, they just, they just wrote me off their books.

Okay.

So, I’ve no idea where it would have gone, where it would have taken us subsequent to that.

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June had mixed feelings about exercise on prescription. For her, it is important to link exercise and food and have a long-term programme of support.

Age at interview 70

Gender Female

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I just think people need to look at every, every single strand. it’s a very, very complicated problem and I think it does need to be more joined up. I mean I have done like an exercise on prescription. We have like an, an arm’s length organisation in city that does sort of weight loss for the terrified, exercise for the terrified and that was good, but I felt that, the training, he was a gym trainer and he was very fit, and I don’t think he under, I think he underestimated how reluctant people feel, frightened even of doing exercise. Some of them a lot more frightened than I was about doing things. Especially the more over weight they are and also, I think they narrow it to just being gym activities and for lots of people, overweight or not, a gym is not the thing that switches them on and keeps them motivated. I like classes, I like groups, I like making a commitment to going to something. So I think it needs to be more joined up thinking between the exercise and, and the food really.

Okay and also to have an exercise programme that is tailor made
Yes.

or people if they haven’t done exercise for a while or ever.

I mean, in fairness this was a very gentle set off and yet I think again, it’s about six or eight weeks and then after that period, you had an induction to the main gym and then you were on your own and it wasn’t so much the being on your own it was the fact that you could go any time then so you didn’t have to be committed and if you felt under the weather you didn’t bother going and if you didn’t particularly like the gym, you didn’t have quite enough motivation to, to carry on with it really.

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Myra attended the same exercise programme twice but said that the second time it ‘wasn’t so good’ and attributed this to funding cuts. She said that the first time she was given a specific plan whereas ‘the second time they just said, ‘Come once a week and see how you get on, sort of thing’. It wasn’t so focused’.

Services offered by local and national charities

In addition to services offered by the NHS, a number of local and national charities provide online information and face-to-face support for patients and carers, as well as local support groups and telephone helplines. John X said he had received very good information about ‘the right kinds of food for cancer sufferers’ from the Prostate Cancer Support Group, where he had also had contact with nurses and advice about weight loss.

After having a heart attack Lesley joined a local charity called Cardiac Rehab Support, for family carers as well as patients. Weight problems were discussed among members.

Age at interview 60

Gender Female

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So you are active in the sort of kind of support group of the cardiac organisations related to heart disease?

That’s right because when I had my event, for my husband I think he had, he obviously had quite a shock. It was quite traumatic for him. He had no support whatsoever. Everything was focused on me and he was sort of left out, had no control over everything and certainly at [Name] Hospital they have a buddy system where people who have had cardiac events are volunteers and would talk to carers/partners and he found them so useful, so supportive to him because that’s what he needed because he was frightened, you know, he’s, he’d had a scare. So that’s why I wanted to become involved. I found that people who’d been through it are very good people to talk to and, you know, again, a couple of people there were talking about their weight problems in a way, What can you do? This sort of thing. A couple of them said, Well I’m just giving up with it. I’m just going to live my life and come what may which is, which is how I felt for a few months.

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John X talks about the dietary advice he has received from a national and a local cancer support centre.

Age at interview 67

Gender Male

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As I say it’s just through the cancer issue. The support group and the support group helped to organise. This may have been happening any way but we were told about a very good dietary seminar at [name’s] Centre which I attended. And that was excellent and we got encouragement about what things to cook and what kinds of foods to avoid and that sort of thing.

So was there anything that they said about food that sort of was new to you, surprised you or?

Well I mean I was pretty naïve about tumours, for example. And of course, the connection with sugar I should have realised before. But I mean this was brought home to me that sugar is not good for tumours because it tends to, it tends to increase growth. And also these other issues like turmeric, green tea, and pomegranate that kind of thing. I don’t know how well established this is but there certainly was encouragement and particularly from other members of the support group.

And I didn’t. I never really considered myself to be sort of hugely overweight but it was obvious to them I needed to lose weight. And then I started to get more information about what is good to eat, what is not good to eat for, for cancer sufferers. And I went to. I had some very, very good information coming for example from the [City] Support Group for Prostate Cancer which, I attend their meetings. And we, we had very good advice from the nurses for example about what we should eat.

But again I got very good advice concerning the right kinds of food for cancer sufferers. And, of course, one of the things that is absolutely top of the list is to cut down on sugar and chocolate and that kind of thing.

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Carole, who has MS, had recently joined Overeaters Anonymous (OA), a national charity for people who want to stop eating compulsively. OA is based on the twelve step recovery programme of Alcoholics Anonymous and involves going to meetings with others who share the same problem. She finds that this offers a space where she can talk about her weight in ways she feels embarrassed to with friends, and get suggestions and tips from others.

Carole has recently joined Overeaters Anonymous. She can talk about her compulsive eating there because the other group members share this experience, you don’t feel a freak.

Age at interview 59

Gender Female

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I’ve just joined three weeks ago now, Overeaters Anonymous, which is like Alcoholics Anonymous but for over eaters and the idea of it is good and but they go through these steps of whatever and what’s good is that they make you realise that it’s not your fault. There is something that’s making you do this. it’s not, I can’t stop it at times so it’s, but I mustn’t beat myself up about it. The problem is they’re all very thin, the women who go to it, because they’ve been going for years and they still go to support each other. So I go along and I’m like this huge thing and I, my issues are different to theirs in in my head. they’re not because they’re still overeaters but they can control it at the moment they’re managing to control it, whereas I’m not and they’re very supportive and they’re very, you know, very kind and sweet but they are all very thin. So I feel it’s difficult for me, difficult for me going there

Overeaters Anonymous, when you go to, to the those meetings, do you feel like talking about it.

I can talk there because I don’t know them. I know them, I’ve met them three weeks, you know, three Saturdays, mornings, but they’re not they’re not like my friends out, in my real life. it’s, they’re friends from there, you know, and they’re very kind and very helpful, so I can talk about it there. But, even with friends who are who are a bit over, who are a bit overweight, I still find it, I can’t talk to them about it because I’m just embarrassed and it’s hard to admit to other people that I’m out of control with my weight.

But in this group that you go and you talk about your weight, does it help? Does it help talking? Does it help getting feedback? And encouragement from other people?

Yeah. And it helps to know you’re not the only one and it helps because they’ve all been, because they’ve all had a lot, I think they’ve, I don’t know how big they were but it sounds like that are complete, it sounds like they’re like me, when they can’t actually stop themselves eating at times and so you don’t feel a freak. You don’t feel because other people, who aren’t like that, it’s, they can stop, you know, they can and they can go on a diet and yes, they might they might need to go on a diet later or, you know, after a few months or whatever but they can control it, whereas I feel, with me, it’s completely out of control and that’s the that’s really, that’s the hardest thing for me. It is that complete, it just takes over, takes over, takes over me, yeah. it’s like, it feels like a disease, in a way. it’s or like, you know, like they say it’s like, it’s based on the Alcoholics Anonymous, the Overeaters Anonymous, and I, I assume it’s the same sort of feeling that alcoholics get when they crave, when they need a drink or drugs or whatever. It feels exactly the same sort of feeling as that I think.

So there are steps, isn’t it.

Yeah.

Yeah. So what are those steps?

I can’t remember really [laughs].

it’s okay. don’t worry, don’t worry.

I think it’s admitting to yourself that it’s not, that there’s something, they say it’s something higher than you that’s causing it. it’s not you that’s causing it yourself and they talk about abstinence, which I’m starting to, I’m starting [sighs] to, well, I’m realising I’m going to have to stop eating bread because it’s my trigger thing, so things like that, so I’m learning things like that from them. Rather than just cutting down, you’re going to have to cut it out completely and the one, they had like a little workshop, at the one I’ve just been to this weekend, and they were talking about how to cope at Christmas time and stuff and they were staying things that helped them. And I was saying things that that will help me, so it’s about putting things in place to help yourself.

Right. Okay.

Getting some suggestions and ideas.

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Weight management groups

Weight management groups provide support to help people lose weight. This usually includes a structured diet plan and behavioural support, in groups or on an...