"Don't be nasty to fat people," is the front page headline in the Daily Mail. The paper reports on new draft guidelines that encourage doctors to be "respectful and non-blaming" when discussing people's weight problems.
The headlines stem from new draft guidelines published by the National Institute for Health and Care Excellence (NICE) for the management of overweight and obese adults, focusing on lifestyle weight management services.
Despite the media's focus on the commonsense recommendation that obese people should be treated with respect, the draft guidelines offer a host of other useful recommendations.
These include promoting the message that even minimal weight loss can bring significant health benefits, and that there is no "magic bullet" for weight loss. People may have to try a number of approaches before they find what works for them, the guidance says.
The NICE guidelines are in the draft stage, so the recommendations are currently provisional and may undergo some changes after consultation with stakeholders. Final guidance is likely to be published some time next year, when the recommendations come into effect for health professionals.
NICE produces guidance on promoting good health and preventing, diagnosing and treating illness for healthcare professionals and other organisations with a role in healthcare, such as councils.
The organisation aims to ensure that people receive the best quality care possible at the best value for money. It produces its guidance using transparent methods based on the best available evidence.
The current draft guideline, "Managing overweight and obesity and adults: lifestyle weight management services", is public health guidance. NICE public health guidance makes recommendations to the NHS, local authorities and other organisations in the public, private, voluntary and community sectors on how to improve people's health and prevent illness and disease.
The NICE draft guidelines make 14 recommendations, mainly for the organisations that decide how to run local health services.
These recommendations include:
NICE recommends that professionals should be aware of the effort needed to lose weight and avoid further weight gain, as well as the stigma adults who are overweight or obese may feel or experience.
It says professionals should ensure the tone and content of all communication or dialogue is "respectful" and "non-blaming". It also says that equipment and facilities should meet the needs of most adults who are overweight or obese.
NICE says healthcare professionals need to ensure that adults who aim to lose weight are made aware of how much motivation and commitment is needed to lose weight and maintain weight loss, and that there is no "magic bullet" that can guarantee success.
NICE also advises on the need to convey to overweight or obese patients that they should make gradual long-term changes to their eating habits and physical activity, and tell them how much weight they might realistically expect to lose in total and on a weekly basis if they adhere to the programme.
NICE wants healthcare professionals to ensure that adults are fully informed of the pros – such as the benefits of preventing further weight gain – and cons – such as potential financial costs – of lifestyle weight management, if they are considering this.
NICE sets out what it expects lifestyle weight management services should offer for helping people lose weight. For example, this could be done by:
NICE also wants lifestyle weight management services to only be commissioned or recommended if they provide advice and support for the maintenance of weight loss (or continued weight loss), for example by:
NICE says that GPs and other health professionals should:
The media's reporting is generally representative of this guidance. However, some of the headlines, such as "Don't blame patients for being overweight" and "Being fat not your fault", could give a slightly skewed idea of what this draft guidance recommends.
This guidance essentially centres upon ensuring that people who are overweight or obese are referred for the help and support that they need. It is intended to help provide services to meet overweight or obese patients' needs, ensure that they are treated with full respect, and receive all the support they need to achieve their weight loss goals.
The guideline recommendations do not state that being overweight or obese is not your fault. The guidelines do not say, for example, that being overweight or obese has nothing to do with your health behaviour (such as a high calorie diet and low physical activity) and that it is all down to your genetics. These headlines purely reflect the fact that the guidance recommends that people with weight issues should be treated with more respect.
Headlines suggesting that people will no longer be told they are "fat" should not be wrongly interpreted as meaning that people who are overweight or obese will now just be "left to get on with it" and no longer guided towards weight loss advice and support when necessary. Being overweight or obese is associated with many chronic diseases. Therefore, decreasing prevalence rates is key to improving the health of the population.