Manchester’s Healthy Weight Resource Pack 2012: overweight and obese patients

Transcription

Manchester’s Healthy
Weight Resource Pack 2012:
A directory of services to help support
overweight and obese patients
Contents Page
Introduction
01
Healthy Eating Services
02
Physical Activity Services
05
Weight Management Services
16
Combined Healthy Eating and Physical Activity Services
24
Services which support a Healthy Weight
31
Healthy Eating, Physical Activity and
Weight Management Training
42
Training which supports a Healthy Weight
45
Resources: what’s available and where
48
Care Pathways
52
Physical Activity, Healthy Eating and
Weight Management Guidelines
59
Other Important Information
69
Appendix
79
Introduction
Welcome to Manchester’s Healthy Weight Resource Pack:
A directory of services to help support overweight and obese patients
This resource aims to outline to front line workers the different services that are currently available in Manchester to support
people to maintain a healthy weight, including all healthy eating, physical activity and weight management services. This
resource pack contains information about services for all age groups and abilities. In addition the resource also contains
information about services and interventions that contribute to a healthy weight, such as the stop smoking service and
alcohol identification and brief advice. As well as outlining the services available the resource also aims to clarify how to refer
to the services included.
This document supports Manchester’s Healthy Weight Strategy: Tackling Overweight and Obesity (2010-2013) and this
resource pack is focused on services that help people to maintain a healthy lifestyle. It does not include services for
malnutrition or eating disorders.
To enable you to quickly find the services available the resource has been split into several categories - please see contents
page. Where possible, referral forms have been included in the appendix to enable you to refer to the service without delay.
Also included in this resource are useful guidelines, information and websites for further information. Access to websites is
available at every public library.
Additional downloadable copies of this resource pack are available from the following websites:
www.manchesterpublichealthdevelopment.org
www.manchester.nhs.uk
The resource pack will be updated regularly on these websites.
If you want more information about this resource pack please contact
Amy Ashton, Public Health Manager - Healthy Weight (NHS Manchester)
Tel: 0161 234 3651
Email: [email protected]
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Community Food Co-ordinators
Introduction to this service
There are 3 Community Food Co-ordinators based across Manchester, one in each district (South, North, Central). The
Community Food Co-ordinators provide a variety of courses and support around healthy eating and weight management.
What to expect from this service
The Community Food Co-ordinators provide 8 week weight management courses including weekly taster exercise sessions
and healthy eating topics and 6 week cooking courses for adults. All of the courses are free and are run in local schools,
community centres and children’s centres across Manchester.
Referral criteria
This service accepts self-referral to all of its courses. There isn’t a referral form for this service so please contact the relevant
co-ordinator directly.
Contact details
For more information or to obtain details of the courses please contact
Eleanor Murphy
Community Food Co-ordinator (South)
Healthy Living Network
Withington Community Hospital
Nell Lane
M20 2LR
Tel: 0161 217 3951 or 07971331540
Bernie Murphy
Community Food Co-ordinator (Central)
Manchester Public Health Development Service
Fallowfield Library - 1st Floor
Platt Lane
Fallowfield
M14 7FB
Tel: 0161 48 1767 or 07971331537
Rose Boyd
Community Food Co-ordinator (North)
Zest Project
North Manchester Regeneration
4th Floor, Hexagon Tower
Delaunays Road
Blackley Village
M9 8GQ
Tel: 0161 655 7887 or 07971331539
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Community Food Workers
Community Food Workers aim to raise awareness of food and health within the community. They encourage people to
experience new ways of cooking, shopping, budgeting and eating healthily and help people to apply their new skills and
healthy eating behaviour to their everyday life.
Community Food Workers support groups by giving nutritional information and advice, facilitating cook and taste sessions
and developing recipes and skills.
This service is citywide. It does not provide sessions on a 1:1 basis
Referral Criteria
This service does not have a referral system. However the service targets people who
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Lack skills and confidence
Struggle on a budget
Are unable to make healthy food choices
Lack understanding of food portion sizes, food labels. etc
People who find it difficult to eat well
and groups of
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Young people
Young parents
The elderly
People in supported housing
Refugees and asylum seekers etc
Contact details
For further information about this service please contact
Nandy Cousins
Community Food Worker
Levenshulme Health Centre
Dunstable st
Manchester
M19 3BX
Tel: 0161 861 2333/6
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Food Futures
Food Futures is a partnership that embraces a wide range of individuals and organisations with an interest in improving food
in the city.
Its ambitious goal is to create a culture of good food in the city, based on the belief that good food is enjoyable, safe,
nutritious, environmentally sustainable, and produced ethically and fairly; and that everyone in Manchester has a right to
good food – no-one should have this right denied because of where they live, their income or their background.
The Food Futures strategy embraces the whole food agenda for the city – from improving health, tackling health inequalities
and reducing the environmental impact of food, to building sustainable communities and strengthening the local economy.
Food Futures can provide policy advice and support to services, organisations and groups who want to do food related work.
Food Futures also produces an e-bulletin - a monthly update featuring brief articles on local and national news, events and
developments that relate to food.
Contact details:
If you would like to receive any of the resources or would like more information about Food Futures please
contact the team
Food Futures
Public Health Manchester
Room 4042
Town Hall Extension
Manchester M60 2LA
Tel: 0161 234 4268
Email: [email protected].
Website: www.foodfutures.info
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City in the Community
Manchester City Football Club’s community scheme, City in the Community (CITC) has been working with the people of
Manchester since 1986.
CITC, which is made up of 25 full time members of staff and 20 part time members of staff, works with over 200,000 people
a year across four main programme areas: Football and Multi-Sport; Skills and Enterprise, Community Cohesion, and Health
and Activity.
CITC organises free football and sport activities for the community throughout the year.
These include; healthy school programmes for primary schools, free after school and half term football courses for young
people, weekly disability sports clubs across the city and football activities for unemployed men in East Manchester.
Through its Community Cohesion Project, Kickz, CITC provides constructive and positive activities for young people between
12 and 19 years on Thursday, Friday and Saturday nights in the Fallowfield and East Manchester areas of Manchester.
The community programme also runs a range of Enterprise programmes in schools designed to give young people the
opportunity to gain nationally recognised qualifications in Business and Enterprise whilst learning about the various
departments within the Football club.
Referral criteria
To refer to this service please contact the team directly.
Contact Details
For more information about the programme or to find out what activities are offer, when and where please
contact the team
City in The Community,
City Of Manchester Stadium,
Sportcity,
Manchester,
M11 3FF.
Tel: 0161 438 7711
E-mail: [email protected]
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Strike a Balance: MCFC Healthy Schools Project
City in the Community (CITC) launched its new Healthy Schools Programme Strike a Balance in September 2010.
The five week programme is aimed at young people in year 5 in Manchester primary schools and is a partnership between
CITC and Manchester Healthy Schools.
It aims to raise awareness of the importance of eating healthier food amongst young people by using the diet of footballers
to teach young people that healthy food does not have to be boring food.
Since it was launched, over 80 primary schools have taken part in the project and CITC is now working with Manchester
Healthy Schools to develop new initiatives for secondary schools in Manchester.
Using examples of Premier League footballers such as Joe Hart and Gareth Barry, each session covers a different area of
healthy eating and is followed by a football session. Topics covered include:
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The balance of good health
Why we eat what we eat
The importance of physical activity
Cooking healthy, balanced meals
Participants take part in a fun cookery session which reinforces these lessons and they are encouraged to take home
affordable healthy recipes for all the family.
They are also taught the importance of making physical activity part of their everyday life, whether simply walking to school
or taking part in organised sport.
Every young person receives their own educational folder and MCFC apron, and schools who take part are invited to enter
a football competition against other schools.
Referral criteria
The Strike a Balance project is free for all primary schools within Manchester.
Contact Details
For more information about the programme or to find out what activities are offer, when and where please
contact the team
Lisa Kimpton
Healthy Schools Project Manager
City in the Community
City of Manchester Stadium
SportCity
Manchester
M11 3FF
Tel: 0161 438 7711
E-mail: [email protected]
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Disability Sports in Manchester
Manchester Sports Development deliver sporting opportunities for disabled children that are adapted to meet individuals
needs These range form recreation ‘Come & Play’ activities to competitive sports clubs.
Sports on offer are: swimming, athletics, cycling, football, multi sports clubs.
Sports Development offer an inclusive school holiday programme that delivers activities to ALL children regardless of ability,
our ethos is ‘Sport can be played by all’
Referral criteria
For information on the referral process contact 0161 220 3856 or email: [email protected]
Contact details
To find out more information about the clubs which are on offer as well as venues etc please contact
Nicky Boothroyd,
Disability Sport Manager,
Regional Athletics Arena,
Gate 13 Sportcity,
Rowsley Street,
Manchester,
M11 3FF.
Tel: 0161 220 3856
Fax: 0161 274 7372
Website: www.manchester.gov.uk
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Fighting Fit
Manchester Learning Disability Partnership (MLDP)
Fighting Fit (FF) is MLDP’s initiative to encourage and support adults who are learning disabled to lead more physically active
lifestyles and to achieve or maintain a healthy weight. The aim is for people to experience the significant health benefits and
sense of well-being that stem from this.
The FF project has been co-ordinated by the physiotherapy team. This team raises awareness of health issues and provides
training for staff and carers. It endeavours to provide initial opportunities for sport and exercise to encourage people to
either independently or in groups access public facilities. This service has access to a dietitian one day per week, to work with
overweight and obese adults with learning disabilities that live at home with their family. Referrals must be made through
Fighting Fit.
Referral process
Referrals can be accepted:
• Externally via contact centre (this would be G.P.s, people themselves or carers)
• Internally via other health or social care staff
• Directly from G.P.
Step 1
Step 2
Step 3
Step 4
Referral is received
Letter is sent to the person with a request fro further information
Home visit is arranged
Plan is drawn up with the person with clear goals and expected outcomes
People and their carers will be asked to consent for information to be shared with their G.P. and others as necessary.
Contact details
For more information please contact
Emma Clegg
Community Learning Disability Team
Moss Side District Office
Bold Street
Manchester
M16 7AD
Tel: 0161 226 8131
Fax: 0161 274 7373
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Getting Active Through Exercise (GATE)
The Getting Active Through Exercise (GATE) team promote the benefits of exercise in the over-65’s to improve health and
prevent falls.
The GATE team work closely with other health professionals, statutory agencies and the voluntary sector. This partnership
approach has brought together a wide range of expertise to ensure that the older population benefit from an integrated
range of services and resources.
Exercise classes have been established across Manchester and to assist those who cannot get to a class, home based
programmes are available, free of charge. The project offers exercise opportunities to all Manchester residents over the age
of 65 from the most frail to the more active. Physiotherapists, occupational therapist, other health professionals and nonclinical staff can refer people to classes.
Contact details
For more information or to obtain details of the exercise classes please contact
Manchester Public Health Development Service,
Victoria Mill,
10 Lower Vicker’s St,
Miles Platting,
Manchester,
M40 7LJ
Tel: 0161 861 2585
Fax: 0161 203 5817
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Get Walking Keep Walking Manchester
Get Walking Keep Walking is a FREE urban walking project developed by The Ramblers to increase regular independent
walking among previously inactive or insufficiently active people in Manchester. It is especially targeted at people from lowincome groups and black and minority ethnic backgrounds, and people with physical and mental health issues.
The aim of the project is to change peoples’ behaviour, to get them walking more as part of their everyday lives, thereby
making a big contribution to physical & mental well-being.
Front line workers can contact Get Walking Keep Walking to set up Get Walking programmes for their clients. There are
three easy, cost-free options for getting involved.
OPTION 1: Get Walking Keep Walking one-off walk
Includes: Short, fun workshop with a quiz or competition, free motivational materials (including a step counter), local circular
led walk (approx one hour) and refreshments – all tailored to your requirements.
OPTION 2: Get Walking Keep Walking four week programme
Includes: Short, fun workshop and refreshments, free motivational materials including step counters, four local circular 3060 minute led walks which are different each week. Each participant will receive the routes to walk again in their own time
and will receive encouragement in the weeks after the walks. There is also a celebration two months later to encourage
people to keep walking. All tailored to your requirements.
Ideal Group size for options 1 & 2: 10 – 30 people
OPTION 3: DIY packs
For those who are unable to get to an organised one-off walk or programme, or who prefer walking in their own time,
we offer a DIY walking pack which includes: Get Walking Keep Walking booklet with hints & tips to increase independent
walking, log book to keep track of walking progress, step counter and local walking information.
Get Walking Keep Walking also offers volunteering opportunities with their walking programmes or to design walking
routes. For more information please contact Annette Crane.
Referral Criteria
Get Walking Keep Walking programmes are open to any Manchester resident. Led walks range from 30 minutes to 11/2
hours so participants need to be able to walk the minimum of 30 minutes at a comfortable pace for them.
Contact details
For more information about this service please contact
Jen Green, Project Co-ordinator.
Tel: 0161 232 3106
Annette Bell, Outreach Officer
Tel: 0161 232 3101
Website: www.getwalking.org.uk
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Manchester City Council – Active Lifestyles
Active Lifestyles is a city wide Physical Activity and Wellness Programme. Active Lifestyles is part of Manchester City Council’s
Community and Cultural Services and sits within the Neighbourhood Services Directorate. We want all Manchester residents
to have the opportunity to lead an active, healthy and happier life. Active Lifestyles is committed to the people we serve,
we deliver at the place you choose, and we take pride in all that we do.
Our Commitment
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Innovative…we will create new and inspiring ways to help you get active
Reliable… we will deliver the highest standard of service provision
Trustworthy… we will give you accurate information and deliver on our promises
Cost efficient… we will show that resources have been used wisely
Professional… we are serious in all that we do and strive for excellence
Our commitment to excellence
We pride ourselves on service delivery and ensure that you, the customer comes first. All Active Lifestyles instructors have nationally
recognised qualifications and meet all of our minimum standards for service delivery. Our instructors are highly experienced and
knowledgeable in their field of expertise. They are there for you, and will provide support and guidance along your journey.
Innovation and Motivation
We will help you track your progress; using the latest technology you will be able to see how much activity you are doing, and
what that actually means for your health. We will help to keep you motivated ensuring you reach your goals, and keep active.
What to expect from this service:
Active Lifestyles programme guarantees to help people lose weight, get active and feel better through either an individual
or family-based programme.
With over 200 fun-packed activity sessions across Manchester every week for people aged 0 to 100.
Whatever your age and ability, there will be something to suit.
Our sessions are located in facilities that are best suited to you – we deliver in primary schools, church halls, dance studios,
community centres, resource centres, leisure centres, youth centres, local parks and outdoor places – ensuring convenience
and easy access.
The Programmes
Tots on the Move - 6 weeks – 5 yrs
Get active with your little one with our range of indoor, outdoor and aqua programmes specially designed for babies,
toddlers and children aged 6 weeks to 5 years. This is coupled with a pre and post natal programme of activity.
Kidzone – Guideline Age 5 to 8 years.
A wide range of activities and adventure that will help your child be active and stay active.
Club Active – Guideline Age 5 - 10 years / 11 – 16 years
New and exciting activity clubs in Dance, Gamezone (non traditional sports such as Ultimate Frisbee, Tri-Golf and
Handball), Active Fit and Dodgeball – no experience necessary.
Urban Mania – Guideline Age 11 – 16 years
Fitness sessions just for teenagers.
Active Choices – Guideline Age 16+
Tone, tighten, burn, build, relax and refresh with this range of activities just for adults.
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Easy Rhythms
A range of gentle physical activities programmes designed for older adults and people new to exercise.
Commit 2 It! - Guideline Age 16+
Ever wanted to run a 5K or 10K or even a marathon? Then join our weekly running sessions and we will get you
from walking to running in no time – perfect for absolute beginners.
Weight No More! – Children, Family and Adults
Structured and supported weight loss programmes for adults. Easy to follow diet plans, calorie burning exercise
sessions, guaranteed results.
Aquativity – Open to All
With our great range of aqua activities we have something for everyone, whatever your age. Mother and Daughter
5+, Learn 2 Swim, Funquatics, Aqua natal, Aquacise plus much, much more.
Fit Families
Fit
A brand new fitness programme aimed at helping families get healthier, lose weight and get active; with a
Families
bespoke 12 week ‘kick start plan’ we will help you with healthy eating topics, easy to follow food plans, personal
development, motivation and lots, lots more. Follow the plan and we guarantee results.
Active Lifestyles Community Support
Active Lifestyles can also help local community groups that are new and/or existing. We can assist with set up, constitution,
which includes support with completing appropriate documentation, applying and writing bids for external funding, sourcing
local venues and instructors, providing the opportunity for greater independence. For those groups that do not have the
capacity to be independent, that is they do not want to undertake any financial workings, or bid writing, Active Lifestyles
can try to identify funding and apply directly on the groups behalf or work with partners to support in funding.
We also have a vast amount of experience in working with groups and communities who may need additional requirements
in order to be able to access our programmes – we work hard to ensure that all within our communities can participate,
providing female only sessions, which guarantee privacy and female instructors, specialist support for vulnerable participants,
and we do whatever else we can to remove any barriers people may face, ensuring that we provide the opportunity for all
to lead an active lifestyle.
Specialist Provision
Active Lifestyles also provides specialist physical activity provision, supporting people who have or are experiencing ill health.
We work directly with NHS Manchester’s Physical Activity Referral Service (PARS) which provides a specialist service for people
who have serious clinical conditions, and delivers programmes such as cardiac and pulmonary rehabilitation. Active Lifestyles
provides the after service for PARS ensuring that we support the long term recovery into an independent active lifestyle.
Active Lifestyles provides weight management programmes, for adults, children and the family. Working closely with GPs,
NHS Manchester, School Nurses, District Nurses and other health professionals, our bespoke programmes help those most
in need of losing weight. If you are worried about your weight or your child’s weight, please contact us and we can help
you with the right programme.
We work closely with other services across Manchester such as Manchester’s Public Health Development Service, The Christie,
and Mental Health Services to provide specialist care and support for those who may not yet be able or ready to attend our
general activity programme.
We provide dedicated support for young people, and deliver bespoke programmes catering for the various issues that young
people face when trying to access mainstream services and programmes.
Our aim is to provide the right support and care to ensure that everyone can eventually lead an active lifestyle.
Referral Criteria
Active Lifestyles is open to all.
Contact Details
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The Active Lifestyles Centre
Tel: 0161 232 3100
Website: www.manchester.gov.uk/activelifestyles
Manchester Amputee Fitness Initiative (MANFIT)
Manchester Amputee Fitness Initiative (MANFIT) is funded by the Joint Health Unit and Manchester Leisure. The project is
evolving as we discover people’s wants and needs. The aim of the project is to give the participants confidence to get/keep
fit and ultimately to integrate into “normal” sports centres. This follows on from the strength, stamina and flexibility that
lead to better operation of the prosthesis. The social interaction during exercise and after during a free lunch, together with
exercise induced endorphin release gives people the confidence to move on to integrated gym sessions or another place of
their choice.
This service offers:
•gym sessions which take place at The Manchester College (Openshaw Campus) fitness suite in the daytime and at
Nicholls Campus in the evening for people who are not available during the day.
•A weekly exclusive swimming group also takes place at Manchester Aquatics Centre. A personal plan is given to each
participant by pool staff.
All sessions are FREE.
•Weekly, non-contact boxers sessions at Moss Side Fire Station (small participant fee).
Referral criteria
The inclusion criterion is people have to have been discharged from the DSC physiotherapists unless permission is gained
from the DSC. The age limit is over 18 years of age unless accompanied by an adult. Referral to this service can include
self-referral or referral from a health care professional. There is not a referral form for this service so please contact MANFIT
directly on the details below.
Questionnaires are distributed to all new members and feedback questionnaires are used to assess satisfaction. Both include
personal and health/fitness related data. Fitness is also assessed periodically by gym trainers (BP, weight, BMI, aerobic capacity etc).
Contact details
To find out more information, to refer to the service or to enquire about the timetable of the sessions please
contact
Website: www.manfit.org
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Manchester MENCAP
Manchester Mencap offers an Advocacy and Sport and Physical Activity service for adults with learning disabilities in
Manchester. Manchester Mencap is an organisation, affiliated to Royal Mencap.
Manchester Mencap offers many sport and physical activities opportunities including Boccia, Football, Yoga, Dancing and
Walking. These activities are offered throughout Manchester and are either free or of minimal cost.
Manchester MENCAP offers free training for the Physical Activity and Citizen Advocacy volunteers.
Referral criteria
This service is available for adults with learning disabilities of the age 18+. To refer to the sport and physical activity groups,
the person or professional should email the service.
Contact details
For further information please contact
Website: www.manchestermencap.cswebsites.org
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Physical Activity Referral Scheme (PARS)
The Physical Activity Referral Service work across Manchester, helping members of the community to increase their levels of
physical activity.
The aim of the Team is to:
Improve the health and wellbeing of the people of Manchester through increased physical activity (i.e. getting more people
more active more often) - specifically targeting those with existing, or at high risk of developing, long term health problems
like COPD, Heart Disease, Diabetes etc. This is done in two ways through one-to-one referrals and community activities,
which include the following:
• Cardiac rehabilitation, pulmonary rehabilitation.
• Swimming lessons.
• Weight management classes (with a dietitian).
• Cycling.
• Health Walking groups (indoor and Outdoor)
• Low cost gym sessions
These activities may vary across the city. Health Walks are free and exercise classes cost £1.
Patients referred to PARS are seen by a fully qualified Physical Activity Referral Officer. A full assessment of the patient’s past
medical history and current lifestyle will be completed. The assessment will include:
• A discussion about past/current activity levels
• A discussion about past and present medical history.
• Physiological and psychological measurements
•A discussion about what the individual wants to achieve from attending PARS activities both in the short and longer
term and goal setting.
•Advice on what types of activities are available and those that are most suitable and safe for the individual.
•Specialist advice relating to specific conditions for example heart disease, angina, diabetes, asthma and many more
specific conditions
Everyone referred to PARS will be asked to come back for follow up at:
• 12 weeks in clinic
• 6 months in clinic
• 12 months in clinic
Feedback will be sent to G.P.s and referrer (if different) after the patient’s initial appointment and after three and twelve months.
Referral criteria
The project is for anyone over 18 years old with long term health conditions or with risk factors for developing heart disease
or diabetes in the future especially where increased activity will improve the condition or is a treatment option. For condition
inclusion and exclusion criteria please see referral form.
Referrals can come from the following people; General Practitioners/Practice Nurses, Physiotherapists, Health visitors/ Cardiac
nurses/ Practice nurses AND Other health professionals.
To refer to this service please complete a referral form and return to the relevant team. Please see appendix 1.
Contact details
Please contact the team at
Clayton Health Centre, 89 North Road, Clayton, Manchester, M11 4EJ
Tel: 0161 230 1857
Fax: 0161 230 1820
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Fit
Families
Fit Families (Family Weight Management Programme)
Introduction to this programme
This new programme developed and run by Active Lifestyles is a family based healthy lifestyle programme targeting
overweight and obese families.
The programme aims to increase physical activity levels whilst educating families on how to achieve a healthy balanced diet
and maintain their weight through behaviour modification.
What to expect from this programme
•Sessions run twice per week; one early evening session and one weekend session.
•Participants can attend the programme for 12 months.
•The first 12-weeks provide personal development sessions and physical activity. The second 12-weeks provide healthy
eating sessions and physical activity followed by a maintenance programme of physical activity sessions for 6 months.
•Sessions are split into ages 5 – 10 years and 11 – 16 years and parents/ guardian.
•Fun physical activity sessions
•The whole family can attend
Referral criteria
Inclusion criteria
•Children must be accompanied by at least one parent/ carer at each session, other family members can attend also.
•Children aged 5 – 16 years
•Children must be over the 91st centile on the UK 1990 BMI centile charts (Child Growth Foundation) or above the
International Obesity Task Force overweight cut-off point.
Exclusion criteria
•Children with Diabetes
•Children with any other medical diagnosis will be reviewed on a case by case basis.
•Children with moderate/ severe behavioural and/ or educational problems.
The physical activity sessions have been designed for children with no physical disabilities. The exercise sessions rely on group
participation and assume all children are fully mobile.
Families can self refer to the programme or be referred by any health professional. To refer either;
• Complete the referral form – see appendix 2
• Self register by contacting the team below.
Contact Details
For more information or to refer a patient to this programme please contact
Anne-Marie Keating
Active Lifestyles Centre,
Denmark Road
Hulme
Manchester
M15 6FG
Tel: 0161 232 3127/07931546227
Website:www.manchester.gov.uk/activelifestyles
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Weight Management Service - Child and Family
The Child and Family Weight Management Service aims to help overweight children and their families to achieve and maintain a healthy
weight. Aimed primarily at children, the service offers a programme of advice and support to families who are committed to making
healthy lifestyle changes. Adult family members who seek personal weight management support may be signposted to appropriate local
services.
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Informal telephone assessment
Tailored resources
Healthy lifestyle days
Face to face contacts
Ongoing support and advice
Signposting to local services
The first stage of the programme consists of an informal telephone assessment whereby the child’s named carer has the opportunity
to discuss any concerns with a member of the team. Initial personalised goals will be agreed and resources provided to support the
proposed lifestyle changes. The carer shall be invited to contact the service after an agreed timescale to discuss the level of progress and
to engage with the service further if necessary.
Referral criteria
Any overweight or obese child aged between 2-17 years, with a Manchester GP, can be referred into the service for initial assessment
and advice using the service referral form Please see appendix 3
Contact details
Sarah Vince-Cain, Community Paediatric Dietitian
Lorraine Leonard, Public Health Nutritionist
Dina Pieri, Public Health Nutritionist
Levenshulme Health Centre,
Dunstable Street,
Levenshulme,
Manchester,
M19 3BX.
Tel: 0161 861 2329
Fax: 0161 248 0389
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Weight Management in Primary Care – Counterweight
The Counterweight Programme is an evidence based weight management programme for adults. It is the only fully evaluated,
cost-effective, evidence based primary care weight management programme being used in the UK, showing sustained
weight loss at 2 years.
The aim of the counterweight programme is:
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To achieve and maintain medically valuable weight loss of 5-10% or 5-10kgs
To make sustainable changes to eating and physical activity behaviours
Maintenance of weight loss long term
To improve health status
The Counterweight model is based on Counterweight Specialists (registered dietitian and nutritionists specialising in
obesity management), working with Primary Care Trusts and Health Boards to train and support healthcare staff to put the
Counterweight Programme into practice.
It is anticipated that each trained practitioner can enrol at least 25 patients in one year. (Counterweight aims to train 2
practitioners per practice and each practice therefore should enrol 50 patients in one year).
Counterweight promotes behavioural strategies which seek to change eating habits, activity levels, sedentary behaviours
and thinking processes that contribute to a person being overweight or obese. The programme provides a range of options
which promote active weight loss for 3 to 6 months followed by long term weight loss maintenance.
Referral criteria
Counterweight is recommended for an adult population:
• 18 to 75 years old
• BMI≥ 30 kg/m2 or BMI ≥28 kg/m2 with co-morbidities
• Assessed as at the right stage of behaviour change to be receptive to the programme
A number of Manchester General Practices are participating in the Counterweight Programme - further details from Frances
Wilkinson (contact details below)
Contact details
If your practice is interested in delivering Counterweight or for further information please contact
Frances Wilkinson
Counterweight Dietician,
Dunstable Street,
Levenshulme,
Manchester,
M19 3BX
Tel: 0161 861 2348
Website: www.counterweight.org
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Weight Management Service - Central Manchester
Community Nutrition Service
This service provides evidenced based advice and support for weight management for adults, which is tailored to the
individual’s needs. They also provide a service for people with other food related health problems.
This service can give one to one advice to adults on weight management at various health centres across Central Manchester.
They can also visit people in their own homes.
Referral criteria
This service accepts referrals for adults over the age of 18, from NHS, hospital and community staff and from other social
care and community workers, using the referral form. Please see appendix 14.
Contact details
For more information about the programme or to send referrals please contact:
Hazel Andrews (Community Dietitian)
Central Community Nutrition Service,
Dunstable Street,
Manchester,
M19 3BX
Tel: 0161 861 2333
Fax: 0161 248 0389
19
Weight Management Programme - ‘Your Choice’
Organised and run by the Community Nutrition Service in order to offer overweight patients more support to lose weight.
Your Choice provides practical support, dietary advice, activities and health checks. Self motivation is also a key factor and
the regular health checks encourage this as well as the opportunity for more help with other professionals in this area.
There are 3 key areas;
1.Nutrition - Delivered by Dietitians and Nutrition Assistants. Practical help. Group sessions. Further 1-1 help to make
changes to diet that will reduce calorie intake. As well as providing a regular 3 monthly health check for patients to
review their progress.
2.Activity - Delivered by P.A.R.S. (Physical Activity Referral Scheme for those with co-morbidities) and the Active lifestyle
service (for those without co-morbidities). Patients can be referred to either of these services as part of their weight
loss programme.
3.Motivation - Patients are involved in breaking down barriers and developing their own goals to achieve weight loss.
Sometimes there are behavioural or psychological issues which prevent people from achieving their aims. We work
closely with the Mental Health Team to help patients that need this extra support.
‘Your Choice’ was started in South Manchester where it is currently provided by experienced dietitians and nutrition assistants.
Changes to NHS Manchester mean that a citywide weight management programme will be developed to provide a service
for all Manchester residents. The program will include elements of the following;
• E
ducation Morning – A group session to discuss food, eating and energy intake we also look at activity and motivation
to make these lifestyle changes to lose weight.
•Activity - with help from P.A.R.S. (Physical Activity Referral Scheme) and the Active lifestyles service qualified instructors
can work on helping the patient increase their activity. Activities to suit all levels of ability are available.
•Health checks - The patient will be offered health checks to monitor their weight, BMI, body fat, blood pressure and
waist circumference.
•Drop-in – The patient can come along anytime during the half hour to have a chat and get weighed if they wish.
Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre
•1 to 1 – An appointment with a Registered Dietitian
Referral criteria
The service accepts self referrals from people aged 16+ with a BMI of 30+. Please see appendix 4. The service will contact
the patient directly following referral and provide them with an appointment that is closest to their home address.
Contact details
For more information about the programme or to send referrals please contact:
Ray Green (Community Dietitian)
Wythenshawe Offices
Stancliffe Road
Sharston
M22 4PJ
Tel: 0161 946 8210
Fax: 0161 946 8209
20
Weight Management Service - Community Nutrition Assistants
(South Manchester)
The role of the Community Nutrition Assistant (CNA) is to support the dietetic service delivery to clients. Community
Nutrition Service CNAs have recognised nutrition qualifications and specific skills such as communication and community or
group work skills, which provide motivational and practical support to clients.
Currently CNAs participate in regular weight management sessions in South localities only, for example they complete:
•
•
•
•
Twice monthly group sessions in different venues
Follow up and health check one to one sessions weekly in different venues
Drop in weight monitoring sessions face to face, and telephone support
Exercise programme on referral
Referral criteria
Any adult (>16 years) with a BMI over 30 or over 28 with co-morbidities can self refer to the ‘Your choice’ program using
the referral form. GPs or health care professional can also refer patients to this service, using the referral form. Please see
appendix 2.
Contact details
For further details about the CNA role or the ‘Your Choice Programme’ please contact
Ray Green (Community Dietitian)
Wythenshawe Offices
Stancliffe Road
Sharston
M22 4PJ
Tel: 0161 946 8210
Fax: 0161 946 8209
21
Level 3 - Adult Specialist Weight Management Service Choose to Change
This service is focused on inspiring positive and lifelong behavioural change. The service balances psychological, physical
and nutritional support and advice, and is designed to empower individuals to make healthier lifestyle choices. In order to
make a real difference, the service sets realistic targets and celebrates successes at every stage of a patient’s journey with the
message that ‘small changes are good changes’.
All clients will receive an initial multi-disciplinary assessment including a psychological assessment. All clients referred into
the service are made aware of the level of commitment required and their readiness to change. Clients will be supported
to develop an individual action plan that can consist of a 6 month group based lifestyle programme, 1:1 Psychological
programme or 1:1 nutrition programme.
Referral criteria
Adults over 18 registered with an NHS Salford, Manchester or Oldham GP with a:
• BMI over 35
• BMI over 30 and pregnant
• Eligible for bariatric surgery and requires 6 month lifestyle intervention
can be referred to this service, using the referral form. Please see appendix 15.
Contact details
For further information about the service or to make a referral please contact
Melanie Taylor – Stakeholder Engagement Lead
Shelley Evans – Programme Manager
ABL Health Ltd
71 Redgate Way
The Royal Bolton Hospital
BL4 0JL
Tel: 01204 570999
22
Weight No More, Active Lifestyles
Developed and run by Active Lifestyles, Weight No More is a city-wide weight management programme for adult residents
who are overweight and obese.
The sessions are arranged to provide support including confidential weigh-ins, physical activity sessions, goal-setting,
nutritional advice and lots of support and encouragement.
•Fun physical activity sessions
•Nutritional advice (if required). This can be omitted if a client is receiving nutritional advice from another weight
management programme.
•Ongoing support, guidance and advice.
•Regular health checks
•Encouragement and motivation and personal development workshops
•Sessions run at various times in the daytime and evening, there are always two sessions at the same venue per week.
Referral criteria
To join Weight No More, residents can turn up to the advertised sessions, alternatively if you feel a resident needs more
support then please refer them and we will contact them and go through the options available to them.
•
•
•
•
Suitable for ages 16 – 65 years approx.
No co-morbidities
Sessions are suitable for those with a BMI over 25.00
Everyone referred to WNM will be contacted.
Please see appendix 5.
Contact details
For more information or to refer a patient to this programme please contact
Anne-Marie Keating
Active Lifestyles Centre,
Denmark Road
Hulme
Manchester
M15 6FG
Tel: 0161 232 3127/07931546227
Website:www.manchester.gov.uk/activelifestyles
23
Community Health Trainer Programme
Health Trainers are drawn from local communities and aim to reach people who want to adopt healthier lifestyles. The
programme aims to:
•
•
•
•
Improve public and patient access to information and services
Target vulnerable and marginalised individuals
Address the major lifestyle determinants of health
Support clients to achieve and maintain positive lifestyle changes
Health Trainers are based within different settings across the city. They encourage increased levels of physical activity and
improve access to information and one-to-one support around food, diet and nutrition. The introduction of a more holistic
health and well being assessment means Health Trainers work more broadly. They can now therefore offer assistance around
alcohol consumption, smoking, stress and anxiety.
The Health Trainers role is not to give advice, it is to structure a series of discussions to empower the client to develop and
use skills to regulate their own behaviour. This brief intervention aims to assist clients in moving towards specific goals.
A Health Trainer will usually see a client on a maximum of 6 separate occasions. The first session includes a health and well
being assessment in order to assess the person’s opinion of their current general health, well-being and health goals.
Referral criteria
Any adult (>18 years) can access the Health Trainer service by self referral or referral from a third party, using the referral
form. Please see appendix 6.
Contact details
For further information about the service or to make a referral please contact
Aurora Robb,
Manchester Mental Health and Social Care Trust,
Victoria Mill,
Lower Vickers St,
Miles Platting,
Manchester,
M40 7LJ
Tel: 0161 861 2548
Fax: 0161 203 5817
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Healthy Living Network South Manchester
SMHLN is a service which works with people and local organisations to bring them together to improve health and wellbeing.
SMHLN consists of the following projects:
Volunteer project - supports local involvement in the NHS, volunteers are trained in smoking cessation, chair based exercise
and outreach work. They support local focus groups, map gaps in existing health provision and act as sign posters for local
NHS services.
Partnership health project - supports local organisations and groups to improve health and wellbeing. The project builds
capacity and helps towards sustainable community work.
Community Food Project - Supports local individuals and community groups in weight management courses, healthy
eating and food growing projects (see community food co-ordinators page for more details).
Referral criteria
Most sessions are open to all, and are free or very low cost. Some sessions are for specific target groups and ages. This service
accepts self referral by contacting the SMHLN directly.
Contact details
For more information or to obtain a full list of healthy activities contact
Health Improvement Manager
Withington Community Hospital
Nell Lane
Manchester
M20 2LR
Tel: 0161 217 3667
25
Healthy Living Network Zest
Zest is an established healthy living network in North and East Manchester. Zest works in partnership with local people,
communities and organisations from all sectors to increase choices and opportunities to improve health and well-being. Zest
links in to the public health agendas of Manchester City Council and the NHS.
The service currently delivers over 40 regular healthy living activities in local, accessible venues, which are free or low cost
and are mainly open to everyone. Zest works closely with individual communities and residents to ensure these activities
reflect local need. Examples of the range of activities include: Yoga, Tai Chi, massage and relaxation, craft, dance, chair-based
exercise, walking, Fun and Games.
Food related activities include: cook and taste, cooking skills and weight management classes. (These are provided by the
Zest Community Food Co-ordinator – see their page for more details)
Other wellbeing programmes / workshops are delivered throughout the year in response to identified needs and in partnership
with local groups and organisations.
There is a Zest Co-ordinator for each of the following areas:
•
•
•
•
•
Charlestown / Higher Blackley
Cheetham / Crumpsall
Harpurhey / Moston
MPAC ( Miles Platting, Ancoats and Collyhurst) / Newton Heath
Beacons (Beswick, Clayton and Openshaw)
Health Forums are supported in each area, where local health and well-being issues and solutions can be discussed, and
information shared. These are open to all residents, partners and organisations.
Referral criteria
Most sessions are open to all and anyone can be directed to these. Some sessions are for specific target groups and ages.
Contact Zest directly for further details.
Contact details
For more information or to obtain a full list of activities contact
Debra Pearson,
Zest Project Manager,
North Manchester Regeneration,
7th Floor, Hexagon Tower,
Delaunays Road,
Blackley Village,
M9 8GQ.
Tel: 0161 655 7889
Fax: 0161 655 7801
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Manchester’s Healthy Schools Service
Manchester Healthy Schools Service consists of three teams who provide support and resources to schools in Manchester,
on health related issues:
1. The Safer Choices Team – Includes Sex and Relationship Education and Drug Education
2. The Healthy Lifestyles Team – Includes Healthy Eating and Physical Activity
3. The Well-Being Team – Includes Mental Health in Schools, Anti-Bullying and Pupil Voice
The Healthy Schools approach is based on the holistic child, supporting good health and happiness inside and out. Healthy
School involves the whole school and local community – children and young people, school staff and parents and governors
are all supported to improve health and wellbeing, making the most of life and learning.
All three teams offer a range of targeted and universal training programmes and resources suitable for school staff to
support children, young people, governors, parents, carers and families.
The training and resources aim to support and skill professionals working with children and young people to tackle the
specific health inequalities evident within Manchester. These include healthy eating and physical activity to help tackle
obesity, poor mental health, sex and relationships and alcohol and substance misuse.
Referral criteria
All Local Authority Primary, Secondary and Special Schools in Manchester can access the training and resources offered by
this service.
Contact details
Tel: 0161 946 8270
website: www.manchesterhealthyschools.nhs.uk
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Health Visiting Service
Health Visitors are qualified registered nurses with specialist qualifications in community health which includes child health,
health promotion and education. They lead teams comprised of community staff nurses and nursery nurses. They provide
a universal service to all families with children under four and a half years of age in a number of settings including in the
home, at baby clinics, in Children’s Centres and can also give telephone advice. Their focus is on the prevention of ill-health
and on the early identification of health problems.
Advice and support for parents around:
•
•
•
•
•
•
Breast feeding
Infant feeding and healthy weaning for babies
Healthy eating for children and families
Weight and growth monitoring
Children’s development and behaviour
Sign-posting/referral to local services such as healthy eating/cooking groups and exercise activities for toddlers
Referral criteria
Clients can access the health visiting service by self-referral or can be referred by any agency by phone or letter.
Contact details
Clients can find their Health Visitors contact details in their Personal Child Health Record (red book).Health Visitors can be
contacted by phone, by calling in at their base/health centre or at the community baby clinic.
You can access all children’s community health services via our website www.younghealthymanchester.nhs.uk
Alternatively clients can locate their Health Visitor through their GP or local Children’s Centre who all have link Health
Visitors. They will ensure a clients referral/request for Health Visitor contact is passed onto the Health Visitor for the family.
28
School Nursing Service
School Nurses are qualified registered Nurses with specialist qualifications in Community Health which includes Child
Health, Health Promotion and Education. They provide a universal service to all families with children 4 and a half to 16
years of age.
School Nursing is based on the child centered public health principles with a strong focus on the early identification of health
problems and a preventative emphasis. The School Nursing Teams provide a range of health improvement activities.
With specific reference to addressing healthy weight, the School Nursing Service can:
•Provide targeted 1:1 intervention – offering advice and support to enable the child and family to adopt healthier eating/
lifestyle approaches
• Deliver group health promotion sessions about healthy eating/healthy lifestyle
• Refer to Specialist Services if deemed appropriate by the School Health Advisor/Nurse
School Health Nurses/Advisors use a partnership framework in their work, operating in collaboration with other colleagues
and agencies in order to address the wider threats to health eg: housing, transport, crime reduction, social exclusion etc...
School Health Nurses/Advisors also provide advice and help on a one to one basis with children and young people on areas
such as personal relationships, managing stress and risk taking behaviours. They compliment Primary Care Services by
providing a safety net for children and young people particularly the most disadvantaged.
Referral criteria
Referrals can be made by any agency or by self referral by client or parent/carer.
Contact Details
North District
Charlestown Road Health Centre
Tel: 0161 741 2000
Cheetham Primary Care Centre
Tel: 0161 202 8775
Clayton Health Centre
Tel: 0161 231 1151
Harpurhey Health Centre
Tel: 0161 861 2400/ 861 2433/4
Central
Tel: 0161 861 2300
Alexandra Park Health Centre
Tel: 0161 226 0101
The Vallance
Tel: 0161 274 1550
South
Northenden Health Centre
Tel: 0161 945 3624
Wythenshawe Offices
1 Stancliffe Road
Tel: 0161 946 0065
Newton Heath Health Centre
Tel: 0161 684 9696
Plant Hill Clinic
Tel: 0161 740 8004
29
Sure Start
Sure Start is a national government programme which aims to achieve better outcomes for children under 5 years old,
parents and communities by:
• increasing the availability of childcare for all children
• improving health and emotional development of young children
• supporting parents through parenting programmes and in their aspirations towards employment.
There are 40 Children’s Centers in the City of Manchester.
For more information contact the local Children’s Centre or go online at:
www.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/1
Referral criteria
Groups have differing referral criteria dependent on the focus of the activity. Referral criteria is always included in publicity.
Contact details
Websites:www.surestart.gov.uk
www.manchester.gov.uk/info/200016/childcare/3109/childrens_centres/1
30
Services which Support a Healthy Weight
Support for People Drinking at Higher Risk or Dependent Levels
Manchester Community Alcohol Team provides specialist alcohol assessments and structured treatment for anyone over the
age of 16 drinking at higher risk or dependent levels.
Appointments are held with an Alcohol Linkworker and take place on a one-to-one basis in doctor’s surgeries or nearby
health centres. Following initial assessment, the Alcohol Linkworker agrees a care plan with the patient aiming to enhance
motivation, support reduction, stabilisation or abstinence from alcohol. If there is a level of alcohol-dependence requiring
“planned withdrawal” with detoxification, the Alcohol Linkworker will advise the safest location to do this (e.g. at home or
in a residential environment) and ensure a recovery plan is in place prior to treatment.
Referral criteria
This service is aimed at patients who have been identified as possibly alcohol dependent (AUDIT scores 20-40) or higher
risk drinkers who have not responded to a brief intervention (AUDIT scores 16-19). Referrals can be made by telephoning
the number below or by completing the referral form and faxing to the CAT on the details below. Please see appendix 7.
Contact details
Manchester Community Alcohol Team
Longsight District Office
523 Stockport Road
Manchester
M12 4LL
Tel: 0161 225 9293
Fax: 0161 882 1344
Website: www.manchestercat.org
31
Expert Patients Programme
The Expert Patients Programme is a course for anyone with long-term health conditions. It aims to support people who
would like to find ways of managing the impact of living with health problems, in order to improve their quality of life. The
programme builds on the principal that people who live with long-term health problems or have difficulties in managing the
impact of being over or under weight can affect their over all health and well being, It has been nationally recognised that
people who live with health problems know best how their condition affects the way they feel on a day to day basis, how it
affects their lifestyle and their ability to accomplish activities important to them. The course also looks at ways to positively
manage symptoms, how to improve on daily activities and manage the changing emotions that can be brought about by
living with long term health conditions.
There is a wealth of evidence to back claims that the Expert Patients Programme has significant benefits for the individuals
who participate.
The course is free and consists of 6 weekly sessions – each lasting 2 ½ hours. It is delivered by two nationally trained
volunteer tutors who themselves have long-term health problems and have previously attended an Expert Patient Course
prior to becoming a tutor. This means they understand the challenges people face in having health problems and coming
on the course.
Weekly sessions provide information on specific topics such as managing symptoms and medicine, relaxation techniques,
healthy eating and physical activity; how and why this can help reduce symptoms and learn how to communicate effectively
with health care practitioners and GPs. On each course there are between 8 and 10 participants. The venues are checked
to ensure they are fully accessible.
Referral criteria
This programme is open to anyone with long term health problems. Any one can refer into the programme and the patient
may also self refer if they wish to. To refer into the programme please complete the patient registration form – please see
appendix 8.
Contact details
Expert Patients Programme Referral Team,
University Hospital of South Manchester NHS Foundation Trust,
Newton House, Newton Silk Mill,
Holyoak Street,
Newton Heath,
Manchester,
M40 1HA.
Tel: 0161 219 9424
Fax: 0161 219 9477
32
Family Nurse Partnership
Family Nurse Partnership (FNP) is an intensive, preventative home visiting programme for young women who are having their
first baby. A specially trained nurse will visit the mum (and partner) regularly throughout pregnancy until the baby reaches
2 years of age.
•The family nurse will share lots of information about pregnancy, giving birth and looking after babies and toddlers:•The nurse and young parents get to know each other really well.
•The nurse will help parents to build strong networks of support in the community.
•Make the home a safe place for baby to live and play.
•The focus is on mums bonding and attachment interactions with her baby.
•Supports with childcare, job training, housing and other support services available in the community.
•Find ways to help mums to continue with their education and develop job skills.
•Set goals for the family’s future and find ways to help reach them.
•The nurse provides support/ information about stopping smoking better nutrition, feeding, weaning and ways to maintain
a healthy weight.
•It improves children’s emotional and behavioural development and readiness for school
•It improves ante natal health, child health and parents’ economic self sufficiency, self efficacy and change behaviour.
•It is a licensed programme developed and researched over 30 years in the U.S.
Referral criteria
Any young woman who is:Under the age of 20 years
Pregnant with her first child
Can join as early as 12 weeks gestation
Must join before 28 weeks gestation
Client can self refer
There may be a short waiting list
please see appendix 9.
Contact details
Family Nurse Partnership,
Manchester’s Science Park Ltd,
1st Floor,
Unit 21 Enterprise House,
Lloyds St North,
Manchester,
M15 6SE.
Tel: 0161 227 0600
Fax: 0161 227 0605
33
Paediatric Physiotherapy for Children with Weight Management
Issues and Associated Musculoskeletal Conditions
If a child aged between 0 and 16 has weight issues and also a musculoskeletal condition ie. back pain then the physiotherapy
team could see the child and incorporate healthy exercise into their management plan.
What to expect from the service
The physiotherapy team would see the child until their pain had resolved or other services needed to be involved eg
orthopaedics.
Referral criteria
When to refer
• Children/young people who are 16 and under
• Identification of weight issues using IOTF BMI centile cut offs
•Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take part in physical activity or
increase their activity levels
When not to refer
• When a child and their family are not in agreement with the referral
Please see appendix 10 and 11.
Contact details
Paediatric Physiotherapy & Occupational Therapy Department
Children’s Community Services
Central Manchester University Hospitals NHS Foundation Trust
Cornerstones Centre
2 Graham Street
Beswick
Manchester
M11 3AA
Tel: 0161 220 7110
Fax: 0161 220 3991
34
Partnership for Older People Project (POPP)
POPP is an 8 week programme of health promotion and supported exercise for people who have survived a stroke and/or a
Transient Ischaemic Attack (TIA)- “mini-stroke”- and their carers. This is an ongoing project, which aims to give people affected
by stroke an opportunity to improve strength, mobility and confidence, by trying physical exercise in a safe environment.
The project will run in the form of an 8 week session based at a venue in Gorton and, if needed, transport can be provided.
Participants will have an increased awareness of the health benefits of taking regular exercise and be able to make other
healthier lifestyle choices. They will be able to access other facilities and services in their community where they can take part
in physical exercise after the programme has finished.
Carer’s will either have the opportunity for respite or to relax with other carers during the sessions. It is hoped that this
will improve carer’s confidence and emotional well being by helping them to feel less isolated. They will also be able to
participate in the healthy living education programme, which will help carer’s to make healthier lifestyle choices.
Referral criteria
The following must apply to the referred person:
• Have had a stroke or TIA at any time in the past
• Any age can attend
• Be a resident in the Central, South or North Manchester area
To refer a participant please use the referral form in appendix 12. The referral form can be faxed or sent to the service once
gaining permission of the referred person. This form may be copied if needed and completed with as much information as
possible.
Contact details
For more information or to make a referral please contact
Helen Gilbertson
The Stroke Association
1st Floor
Stamford House
Northenden Road
Sale
M33 2DH
Tel: 0161 972 0559
Fax: 0161 962 3323
35
Stop Smoking Service
Manchester Stop Smoking Service is a free NHS service, dedicated to providing non-judgmental advice and support to help
people give up smoking.
Trained specialist advisors offer one-to-one support on a drop-in or appointment basis. Anyone going to a drop-in or
appointment can get help to plan their quit attempt as well as receive free or discounted nicotine replacement therapy
(NRT). Advisors provide support from a number of venues around the city, including pharmacies, hospitals, health centres,
GP practices, community centre’s, Childrens Centres, workplaces and local markets.
Referral criteria
Manchester Stop Smoking Service is open to people who live, work or are registered with a GP in Manchester. People can
contact the service directly or be referred by a health professional.
Contact details
For more information about this service or to quit smoking please contact
Tel: 0161 205 5998.
If an interpreter is required Text ‘LANG’ plus the language the client would like to be called back in to 81025.
Website: www.stopsmokingmanchester.co.uk
36
Supporting Health Programme
The Manchester Supporting Health Programme is in two parts, one part is focussed on improving physical health of people
with severe mental illness and the other part is focussed on improving physical health of people with dementia and their
carers.
The programme team to develop the work includes Supporting Health Nurses and Public Health Development Advisors,
based within Manchester Mental Health and Social Care Trust.
To view reports, please look in the reports section of the mental health pages of the Public Health Development website at
www.mphds.org.
The Supporting Health Nurses have built experience in providing detailed physical health checks to the client groups. This
experience is now going to be utilised to support and guide others who have roles to offer health checks, both within
primary and secondary care. They also work closely with specialist mental health services so that supporting improved
physical health can become a part of care planning for the service user.
Some of the key areas being developed are:
•Appropriate support for people who want to improve their health
•Improving access to information about health improvement
•Improving pathways to healthcare and health promotion services in the community
•Increasing the public health skills of mental health specialists
•Offering mental health awareness and dementia awareness training for staff/volunteers of services engaged in health and
community work
Contact details
Supporting Health Nurses - Severe Mental Illness
Sue Blakeley
Mobile: 07949765541
Margaret Muldown Mobile: 07553365349
Supporting Health Nurse – Dementia
Pam Kehoe
Mobile: 07553377135
To discuss access to health improvement opportunities for people with severe mental illness, resources and training
Shamin Malik
Tel: 0161 861 2539
To discuss access to health improvement opportunities for people with dementia and associated resources and training
Alpa Raja
Tel: 0161 861 2545
37
Support for people with Mental Health Problems Services for Adults:
NHS services are divided into those that offer support and treatment for common mental health problems and those that
offer support and treatment for serious mental illnesses.
Primary care services
Manchester Primary Care Mental Health Services offer short term support to residents, aged 16 and older, who are registered
with a GP and have common mental health problems and/or associated social problems such as anxiety and panic, phobias,
depression, bereavement difficulties, obsessions, compulsions and stress related problems.
The service provides brief psychological interventions based on Cognitive Behavioural Therapy, and includes problem solving,
guided self help, help with physical health, advice and information and signposting to other services. North and South teams
provide counselling services and the Central team can sign post to counselling.
There are three Primary Care Mental Health Teams in Manchester, who can accept referrals from GPs, professionals and self referrals.
These services can be contacted by frontline staff if you need advice and guidance about someone experiencing mental distress.
Primary Care Mental Health Team (North Districts) 0161 231 0017
Primary Care Mental Health Team (Central District) 0161 861 2236
Primary Care Mental Health Team (South Districts) 0161 946 8260
Manchester Psychological Wellbeing Service
The Psychological Wellbeing Service provides one-to-one assessment and treatment for common mental health problems.
Psychological Wellbeing Service - 0161 226 3871
Manchester computerised Cognitive Behavioural Therapy (cCBT) service - 0161 232 7854
Secondary care services
Secondary Care services help people who are diagnosed with a severe or enduring mental illness under a care plan, including
people with dementia. Conditions such as psychosis, schizophrenia, bipolar disorder and severe depression are considered to
be the more serious mental health problems.
In Manchester, most of the secondary care services provided for adults and older people are by the Manchester Mental
Health & Social Care Trust (MMHSCT). This can be contacted on 0161 882 1000 or visit www.mhsc.nhs.uk for a service
directory which holds details on the Trust’s services, including descriptions, contact details and referral methods.
Services on offer include hospital and specialist services that support people during a mental health crisis and offer continuing
treatment when the crisis has stabilised and a wide range of services to support the recovery and social inclusion of individuals
in the community.
It is very important for individuals to seek help early; identifying that there is a problem and getting treatment early leads to
better recovery and longer term outcome.
How to get support for clients or make a referral
If you are concerned that someone is suffering from a severe mental health problem:
•They should see their GP. They will consider whether to make a referral to a specialist mental health service where an
assessment can be made by a psychiatrist, a psychologist or other specialist; this is usually through the Single Point of
Access (SPA).
• You or they can telephone the Manchester Contact Service for Social Care (see below).
• Alternatively as a professional you can make a referral into the SPA or get advice from them (see below).
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Manchester Contact Service for Social Care
If there is a concern that someone may have a mental health problem, referral to NHS secondary care mental health
services would in most cases be through the Manchester Contact Service for Social Care on 0161 255 8250 in the first
instance. Anybody can contact this number including self, friends, family and neighbours. This number can be used if you are
concerned about someone’s mental health, about the mistreatment of a child or vulnerable adult or to report a hate crime.
Single Point of Access
Referral to individual services provided by the MMHSCT Trust for people who have mental health problems, can be made
through the Single Point of Access (SPA): contact 0161 276 6155. Any professional can make a referral; most referrals come
from GPs and the Manchester Contact Service for Social Care.
Crisis Resolution and Home Treatment Team
They support clients who are in crisis (risk to self or others). Referrals are only accepted from medical staff and mental health
professionals who must have seen the individual within 12 hours. Referrals need to be made by phone. They will do their
best to see someone within 48 hours.
• CRISIS Central: Tel: 0161 901 7380/0161-276-5368 Fax: 0161-276-4730
• CRISIS North: Tel: 0161-720-2045 Fax: 0161-720-4200
• CRISIS South: Tel: 0161-882-1029 Fax: 0161-882-1035
Early Intervention Service
Many people will experience their first ‘psychotic episode’ between the ages of 14 and 35. If you notice that someone is
experiencing persistent changes in mood and behaviour, is becoming isolated and not getting on with people, has strange
thoughts, ideas or odd behaviour, or is using drugs or alcohol more, then these could be just some of the signs that they are
experiencing difficulties. It is vital to act early. The Manchester Early Intervention Service offers assessment and treatment to
young people in Manchester aged between 14 and 35. They can be contacted on 0161 277 6830.
Voluntary and community sector organisations
In Manchester there are a large number of voluntary and community sector organisations (e.g., charities) that provide a wide
range of services. Some of these are mental health specialists providing services like counselling and self-help groups. Others
offer a wider range of services that can support good mental health, e.g., housing advice or social support and volunteering.
There are a few organisations that provide services specifically for black and minority ethnic communities.
Please see Manchester Psyscological Wellbeing Service information on page 36.
39
Support for People with Mental Health Problems Services for Children and Young People
Child and Adolescent Mental Health Services (CAMHS)
Child and adolescent mental health services in Manchester offer a range of services including psychiatry and psychology for
0-16 year olds. Contacts are: Central Manchester - The Winnicott Centre, 0161 248 9494), North Manchester - The Bridge,
0161 203 3250/3251) and South Manchester - The Carol Kendrick Centre, 0161 902 3400).
CAMHS services accept referrals from GPs, Community Paediatricians, School Doctors, Educational Psychology, Health
Visitors, School Nurses, Social Services and Youth Offending Teams. Most CAMHS services do not accept self referrals.
Emerge 16/17 Community Mental Health Team is part of CAMHS. Emerge offers confidential support for 16 and 17
year olds around mental health issues; this is one to one and group support. The service will accept referrals from young
people, family members, carers and professionals; contact 0161 226 7457.
Voluntary sector services for young people
There is a range including:
•42nd Street offers individual support for anyone aged 13 to 25 and under stress. Services include counselling, groups and
individual support.
Contact: 0161 832 0170
Swan Buildings, 20 Swan Street, Manchester, M4 5JW
•Young Adult Advice and Support Project (YASP) is a community based Young Mental Health Project providing practical
advice and support for 15-25 year olds around issues such as housing, benefits, money, health, education, relationships
and sexual health
Contact: 0161 221 3054
832 Stockport Road, Levenshulme, Manchester, M19 3AW
Emergency and crisis for young people
Options to deal with emergencies are:
•
•
•
•
Contact GP
Go to the nearest Accident & Emergency hospital department
Call 999 and ask for an ambulance
Police
Current users of Manchester Mental Health & Social Care Trust services who are in crisis should contact the 24 hour crisis
line on 0161 901 1477.
Website for further information and directory of services
For more information about the range of services for adults and young people, visit www.mhim.org.uk. A directory of
mental health services across Manchester and a list of counselling services can be downloaded from the site.
40
The Common Assessment Framework
The Common Assessment Framework (CAF) is a key component in the Every Child Matters: Change for Children programme.
The aim is to identify, at the earliest opportunity, a child or young person’s additional needs and provide timely and coordinated
support to meet those needs. This can include children who are overweight and obese.
What is the CAF?
It has three elements:
• A simple pre-assessment checklist to help practitioners identify children or young people who would benefit from a
common assessment;
• A process for undertaking a common assessment to help practitioners gather and understand information about the needs
and strengths of the child – based on discussions with the child, their family and other practitioners as appropriate;
• A standard form to help practitioners record and, where appropriate, share with others the findings from the assessment
in terms that are helpful in working with the family to find a response to unmet needs; agreeing with the child and family
what support is needed.
CAF benefits
The CAF provides an assessment that is common across services. It will help embed a shared language, support better
understanding amongst practitioners, reduce the number of different assessments, facilitate early intervention and speed
up service delivery.
The lead professional is the one practitioner who takes a ‘lead role’ to ensure that front-line services are coordinated,
coherent and achieving intended outcomes. This way all children and young people who require integrated support from
more than one practitioner should experience a seamless and effective service.
What is the role of a lead professional?
The lead professional is not a new role. Instead s/he delivers three core functions as part of their work:
• Act as a single point of contact for the child or family;
• Coordinate the delivery of the actions agreed;
• Reduce overlap and inconsistency in the services received.
A lead professional is accountable to their home agency for their delivery of the lead professional functions. They are not
responsible or accountable for the actions of others.
Implementation
CAF and the lead professional role are being implemented in Manchester.
Practitioners, children and families are already seeing the benefits.
Contact details
41
Health Exercise Nutrition for the Really Young
Introduction to this training
HENRY is a health promotion, prevention and early intervention scheme that aims to tackle child obesity by enhancing the
skills of practitioners working with parents of babies, toddlers and preschoolers.
Henry aims
•to make professional training widely available for all those working on the promotion of a healthy lifestyle with young
families (health visitors, community nursery nurses, Children’s Centre staff, nutritionists, etc.)
• to work with Children’s Centres to optimise their efforts in developing community resilience to an obesogenic environment
•to offer parent groups with a particular focus on intervening to arrest the development of obesity in babies and young
children (0–5 years) within a framework of emotionally healthy parenting
• to provide informative, entertaining resources for professionals and parents
HENRY training courses include
• 2-day Core Training for community practitioners and Children’s Centre teams
• e-learning course
•2-day Group Facilitation Course, which enables the trainee to deliver the ‘8 week Lets Get Healthy with HENRY’ parents/
carers course
•1-day HENRY in Childcare course for Private Nursery Providers and Childminders
Lets get healthy with HENRY
Lets get healthy with HENRY is a course for groups of parents/carers. This course offers 8 weekly 2½-hour sessions aimed at
developing the parent/carers knowledge about and skills in adopting a healthier lifestyle for themselves and their families,
and helps them find the motivation and confidence to give their children a healthy start in life.
Contact details
For more information about this training please contact
Jane Brophy
Greater Manchester Sub-Regional Programme Manager - HENRY Programme
Tel: 07929 465251
For local information and to identify trained staff please contact
Amy Ashton, Public Health Manager - Healthy Weight (NHS Manchester)
42
Physical Activity, Healthy Eating
Management Training Courses
and
Weight
Introduction to these courses
Manchester Public Health Development Service provides a number of training courses, relating to healthy weight. The
courses delivered include:
•
•
•
•
•
•
•
•
•
•
•
Getting Manchester Moving
Turning people on to Active Transport
Cook and Taste Groups: a practical guide
Healthy Weight Manchester – Be Aware
Healthy Weight Manchester
Food Safety RSPH level 2 (Royal society of Public Health)
Healthy Eating for All Level 1, 2 and 3 (RIPH accredited)
Active travel - walk, cycle or take the bus
Food and Mood
Supporting Healthy Weight - A Practical Approach
Motivating Behaviour Change
Referral criteria to these courses
All courses are free of charge. Applicants can book onto a course by self-referral.
Contact details
For further information about the courses or to enquire about the date/s of each course please contact
Ruhana Miah
1st Floor
Fallowfield Library
Platt Lane
Fallowfield
M14 7FB
Tel: 0161 248 1766
43
X-PERT – Structured Diabetes Education Programme
The aim of the X-pert programme is to empower people with diabetes to develop the knowledge, skills and confidence to
make informed decisions regarding their lifestyle and diabetes self –management.
The programme is aimed at adults with diabetes and is free to attend. The courses run across Manchester at a variety of venues.
The programme is run over six weeks and participants are encouraged to attend all 2 ½ hour sessions. The sessions include:
Week 1. What is Diabetes
Week 2. Weight Management
Week 3. Carbohydrate Awareness
Week 4. Supermarket Tour
Week 5. Possible Complications
Week 6. Questions and Evaluation
Clients are welcome to take along a family member or friend, however the session are not suitable for children.
Referral Criteria
Any adult with diabetes can self refer to the programme using the referral form. Health care professionals can also refer
patients to this programme. The referral form can be faxed or posted to the detail below. Please see appendix 13.
Contact details
Amy Griffiths
Community Dietitian – Long Term Conditions,
Wythenshawe Offices,
Stancliffe Road
Sharston,
Manchester,
M22 4PJ.
Tel: 0161 946 8210
Fax: 0161 946 8209
44
Mental Health Training Courses
Manchester’s Public Health Development (MPHD) – Public Mental Health team aim to support all organisations in the city
to be able to promote better mental health for the people they work with and to be able to respond helpfully to people
experiencing emotional distress and mental health problems.
As part of this work, a range of training opportunities are available for people working in Manchester, including:
Interventions for Mental Health in Everyday Practice (IMHEP)
This is a two day course for frontline staff working with people who are vulnerable to poor mental health (for example,
because of poverty, unemployment, poor physical health, insecure housing, discrimination). Participants will learn how best
to help their clients manage their mental health. The course develops practical skills in identifying and responding to distress
effectively, using a structured model of support.
Understanding Mental Health
This is a half-day introduction to mental health and the Manchester context and also an optional basis for further training. It
is for staff working with people who are vulnerable to poor mental health (for example, because of poverty, unemployment,
poor physical health, insecure housing, discrimination).
Emotional Aspects of Your Consultations
This training is for clinical staff working in Primary Care (GP practices) and Community Health Services (in the Acute
Hospital Trusts) in Manchester who work with patients and suspect that their emotional health is a barrier to managing
their physical health conditions and achieving better health. These brief workshops will provide simple tools to help move
patients forward who have been experiencing difficulty in coming to terms with and managing their condition. This will not
add to your current workload, but will provide you with some simple skills that you can use everyday.
The training comprises two x 2 hour sessions - attendance at both parts of the workshop is required. For further information
contact: Teresa Czajka, Wythenshawe Offices, 1 Stancliffe Rd, M22 4PJ. Tel: 0161 946 9446, Email: [email protected]
Specialised Mental Health Topics and / or Specific training for your organisation
From time to time we organise courses on specialised mental health topics. These are normally advertised through our
website. We are happy to discuss the provision of our training courses adapted for your organisation’s needs, if you have a
group of staff you want to train together.
If you have specialised topics on which you would like us to consider offering training or would like us to run a course
specifically for your organisation please contact Caroline Bedale.
Referral criteria to these courses
All courses are free of charge. Applicants can book onto a course by self-referral.
Contact details
For more information about the courses, contact:
Douglas Inchbold, Tel: 0161 861 2543, Email: [email protected]
For further information, dates of open courses, and evaluations of previous courses, see the MPHDS website:
www.mphds.org/mphds/mental-health/mental-health-training.html
For further information about Child and Adolescent Mental Health Training Programme (for those who work
with children and young people up to 18 years old) contact:
Kevin Buchanan, Tel: 07890 076 183, Email: [email protected]
For applications for mental health courses, contact:
Madge Strong, Tel: 0161 861 2547, Email: [email protected]
45
The Common Assessment Framework (CAF) Training Programme
The CAF training programme has been devised following feedback from practitioners, local and national evaluations and has
been developed in collaboration with The Workforce Development Group.
CAF is a vital tool in ensuring that children’s needs are identified and met at the earliest opportunity, and relies on us all
working together to help children reach the five Every Child Matters outcomes. The aim of the CAF training is to equip
practitioners with the skills and knowledge to initiate a common assessment, complete a common assessment and act as
the lead professional. In addition we aim to develop and foster the following:
• A shared understanding of principles, processes, tasks, roles and responsibilities as outlined in national and local guidance
• Improved communication between professionals, including a common language to describe children’s needs, and based
on best practice in information sharing
• Effective working relationships built on mutual trust and respect
• More effective and integrated services
• A commitment to helping all children achieve the best and fulfil their potential
Wherever possible we aim to deliver the training in the districts in order to promote networking and knowledge of local resources.
Which Common Assessment Framework (CAF) Training is for you?
Level 1: Awareness
Anyone who works with children and young people will need an awareness of what the Common Assessment Framework is.
This short briefing gives an overview of what the Common Assessment Framework is and how it fits in with integrated working
in Manchester. It also gives an overview of the lead professional role and information sharing - key elements of the CAF.
This course is a pre-requisite for the Level 2 training.
Level 2: Practitioner – for practitioners working closely with children and young people
This is a practical one day training session which enables practitioners to:
• Identify when a CAF should be initiated
• Complete a CAF assessment
• Undertake the lead professional role
• Know when and how to share information with other services
Level 2: Practitioner for Managers/Supervisors – for those who supervise other practitioners.
This is a one day training session which provides an overview of the Common Assessment Framework from a management
perspective. Managers/supervisors will look at:
• How to complete a common assessment
• How CAF fits with their existing assessments
• What skills their teams will need to complete a CAF assessment
• What skills their teams will need to take on the lead professional role
• What implications CAF has for their organisation and how it can be implemented.
Refresher training is also available
Contact details
46
Alcohol Identification and Brief Advice Training
Providing more help to encourage people to drink less
Public Health Development Service provides training for frontline staff working in targeted settings where alcohol should be
discussed routinely as part of a larger role within adult services (such as services that support people to maintain a healthy
weight) .
Various training options are available which aim to:
•Raise confidence in identifying those at risk of harm from the amount of alcohol they drink as an integral part of practice
•Equip staff to provide brief interventions that encourage people to drink less
•Standardise knowledge and skills in using AUDIT-C/AUDIT as a validated identification tool and providing brief interventions
•Contribute to the achievement of multi-agency targets to reduce alcohol related harm
•Enable organisations and services to implement NICE guidelines
We are also available to support you with setting up internal systems or protocols as well as on-going development through
skills practice and staff updates.
Contact details
Alcohol Team, Manchester Public Health Development Service
Tel: 0161 248 1750
Website: www.mphds.org
47
Health Information and Resources Library
The Health Information and Resources Library (HIRL) supports your evidence based practice by providing access to information
and has the resources to support your health promotion work.
Where We Are
The service is located at:
Fallowfield Library
1st Floor,
Platt Lane,
Fallowfield, Manchester M14 7FB
Who can Use the Health Information and Resources Library?
NHS Staff, students and contractors and also health promoters working in Manchester. For full details of our services and
terms & conditions of membership, please ask a member of staff.
Library Services
•
•
•
•
•
•
•
•
•
Multidisciplinary collection of books, reports, journals and multimedia resources such as DVDs and CD ROMs
Health promotion models and teaching resources
Enquiry service
Literature searching service
Training on searching for information on the Healthcare Databases
Current awareness: email bulletins of new information
Wide range of electronic resources, available through NHS Athens
Access to documents through our inter-library loan service
Free leaflets and posters to order on a range of health promotion topics
How can you find us?
1st Floor, Fallowfield Library,
Platt Lane,
Fallowfield, Manchester M14 7FB
Tel: 0161 248 1769
Fax: 0161 248 1751
Website: www.mhsc.nhs.uk/services/library-services
Open: Monday to Friday 9.00am to 4.30pm
Emily Hopkins – Library Manager
Carnell Bell-Smith – Resource & Information Advisor
Sarah Race – Resource & Information Advisor
48
Mental Health Information and Self Help Guides
There are a number of mental health resources available in the City, including:
Self help guides to help mental health problems
We distribute a range of self help guides on different aspects of Mental Health. For up to dates lists of whats available please
visit: www.mphds.org/mphds/mental-health/mental-health-resources.html
All these guides can be downloaded from www.mhim.org.uk
Physical activity and mood
Taking part in physical activity on a regular basis can have a positive impact on mental health and the symptoms that are
associated with poor mental health. This guide will help people to think about the type and amount of physical activity they
can do to improve their health. It gives practical guidance about how to include more physical activity in their life, how to do
it safely and how to overcome the issues that may make it difficult to start or stick to a more active lifestyle.
This guide can be downloaded from
http://www.mhim.org.uk/document_uploads/stayingwell/Physical_Activity_&_Mood.pdf
Food and mood
What we eat and drink can affect our mental health and experiencing emotional distress and mental health problems can
affect how a person feels about eating. Eating regularly and eating more of certain foods can have a positive impact on our
mental health and the symptoms associated with poor mental health. This guide provides information on:
• The benefits of certain foods and water to our mental health
• Ideas and tips to make changes, including a food and mood diary
This guide can be downloaded from
http://www.mhim.org.uk/document_uploads/stayingwell/Food_and_Mood_Booklet.pdf
All the above guides can be used as a one to one tool to assist someone to help themselves or be given to clients to work
through on their own.
Hard copies can be obtained from the Health Information and Resource Library (see library information).
Further information and contacts about work to improve mental health in Manchester can be found on
www.mphds.org/mphds/mental-health/mental-health.html
49
Getting Manchester Moving Website
Getting Manchester Moving is a website designed to encourage and support Manchester people to get more physically
active, eat more healthily and in some cases to lose weight.
www.gettingmanchestermoving.org provides a one stop shop of information regarding physical activity, healthy eating
and weight management provisions across Manchester.
Contact Details
To submit or amend information on the website please contact
Sarah Race
Resource and Information Advisor
Public Health Development Service
1st Floor
Fallowfield Library
Platt Lane
Fallowfield
M14 7FB
Tel: 0161 248 1753
Website: www.gettingmanchestermoving.org
50
Alcohol Resources Available
Introduction
Public Health Development Service has a number of resources available to support alcohol identification and brief advice as
well as general alcohol awareness campaigns:
•
•
•
•
•
•
•
Unit calculators / kcal estimates for popular alcoholic products
Measuring tumblers to support smaller home measures
Copies of AUDIT questionnaires (Alcohol Self-Test)
Brief advice and extended brief intervention tools
Drink Smart self-help guides
Posters for display in reception areas, clinics and interview rooms
Standardised text and information for websites
Contact details
Contact Us - Alcohol Team, Public Health Development Service
Tel: 0161 248 1750
Website: www.mphds.org
51
Manchester’s care Pathway for Child and Family
Healthy Weight
52
Manchester’s Care Pathway for Overweight and
Obese Adults
53
Guidelines for the use of Pharmacotherapy in the
Management of Adult Obesity
These guidelines are intended for use in conjunction with NHS Manchester’s care pathway for overweight
and obese adults. Anti-obesity drugs are to be used to support healthy lifestyle and behaviour changes
and not in isolation.
Scope of the guideline
These guidelines relate to the use of orlistat in adults over 18 years, in line with NICE (2006) guidance. It is anticipated
that for most patients, the General Practitioner (GP) is the most appropriate prescriber; however anti-obesity drugs
may be commenced by hospital specialists, as long as appropriate support is arranged.
When should pharmacological management for obesity be considered?
•D
rug therapy for obesity should only be considered after dietary, exercise and behavioural approaches have been
started and evaluated
• Drug therapy may be considered for patients who have not reached their target weight loss or have reached a
plateau on dietary, exercise and behavioural changes alone
• Orlistat drug therapy should be prescribed only as part of an overall plan for managing obesity in adults who meet
one of the following criteria:
• a BMI of 28.0kg/m2 or more with associated risk factors
• a BMI of 30.0kg/m2 or greater (NICE, 2006)
Which drug?
Orlistat may be used as first line therapy after discussing with the patient the mode of action, adverse effects
and monitoring requirements. In a meta-analysis of randomised trials, orlistat reduced weight by 2.9kg more than
placebo (Rucker, Padwal & Li et al, 2007).
Anti-obesity drug sibutramine has had its license suspended and GPs are not to issue any new prescriptions for the
drug. The suspension follows a review of the drug’s safety by the European Medicines Agency (EMEA) on the basis
of data from the Sibutramine Cardiovascular Outcomes Trial (SCOUT). This review concluded there was an increased
risk of non-fatal cardiovascular events, such as heart attacks or strokes, with sibutramine, compared with placebo
(http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf).
Prescribers are being advised not to issue any new prescriptions for sibutramine and to review the treatment of
patients taking the drug. Pharmacists are asked to cease dispensing the medicine
(http://www.ema.europa.eu/pdfs/human/referral/sibutramine/3940810en.pdf).
Points to consider:
•M
any drug treatments cause weight gain. These include antipsychotics, antidepressants, corticosteroids, COC,
beta blockers, oral hypoglycaemics and anticonvulsants
•B
MI may be less accurate in highly muscular people. These people may have an artificially high BMI because
muscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with caution and
used alongside other measures such as waist circumference
•P
atients following a very low fat diet may respond less well to orlistat due to its affect on fat absorption.
Similarly, if a person has a very high fat diet and has difficulty knowing which foods/meals in their diet contain
too much fat, the side effects of orlistat can help them develop a better understanding of their diet. This should
prompt swift changes in the diet to reduce the fat content (with the aid of healthy eating advice from a health
professional)
54
•D
rugs should not be substituted or alternated with healthy eating and activity habits to provide ‘breaks’
or a ‘way out’ of making the necessary changes. The individual should be motivated to continue diet and exercise
changes once they start on anti-obesity drugs
•R
ealistic targets for weight loss are a maximum weekly weight loss of 0.5-1kg and an overall aim to lose 5-10%
of original weight. These should be modified in the light of other factors (see following points)
•W
eight loss may be slower for some people than others i.e. less than 1-2lb/week or less than 5% of their
weight over 3 months. This may be due to medical conditions (e.g. diabetes, hypothyroidism), medication (e.g.
beta blockers), physical disabilities, very little mean muscle mass or changes to metabolism due to a long history of
dieting. Anti-obesity drugs may be complementary treatment to increase their average weight loss
•R
egular review is recommended to monitor the effect of drug treatment and to reinforce lifestyle advice and
adherence
•C
onsider less strict goals for patients with type 2 diabetes, because they may lose weight more slowly. Agree
goals with the patient and review regularly
•B
e aware of the potential for hypoglycaemia in diabetic patients who have managed to reduce calorie intake
without appropriate adjustment of oral antidiabetic drugs (and possibly insulin)
•A
nti-obesity drugs are not appropriate for patients with any evidence of an eating disorder, such as
compulsive over-eating or binge eating. These patients should be referred to an eating disorders or local psychology
service
•A
nti-obesity drugs should not be available on repeat prescriptions without consultation with an appropriate
health professional. Reinforce lifestyle advice throughout treatment
• Combination therapy involving more than one antiobesity drug should not be used
•D
rug treatment may be used to help patients maintain weight loss, as well as to continue to lose weight.
This should be limited to certain patients, e.g. diabetics
•C
onsider micronutrient intake whilst on a low calorie diet. A supplement providing vitamins and trace
elements (e.g. Forceval capsules) can be prescribed, particularly for vulnerable groups who may be at risk of
malnutrition
• Orilstst improves total cholesterol and LDL cholesterol profiles
• If withdrawing drug treatment, offer support to help maintain weight loss because the patient’s self-confidence
and belief in their ability to make changes may be low
•U
se the British National Formulary (http://bnf.org/bnf/) or Summary of Product Characteristics (SPC)
(www.medicines.org.uk) for full prescribing information
55
Drug Interactions
The following table should be used in conjunction with the overview of drug therapy table and the appropriate
flowchart (See following pages)
Acarbose: Avoid concomitant use.
Amiodarone: Clinical and ECG monitoring is recommended as orlistat may decrease
amiodarone plasma levels.
Orlistat
Ciclosporin: Orlistat may decrease ciclosporin levels. If concomitant use is unavoidable,
ciclosporin levels should be monitored more frequently, particularly after both addition and
discontinuation of orlistat until stabilised.
Fat-soluble vitamins: If a supplement is prescribed, it should be taken at least 2 hours after
orlistat or at bedtime.
Oral contraceptives: Additional precautions are recommended if severe diarrhoea occurs.
Warfarin: Monitor INR.
56
Prescribing Orlistat
57
Orlistat
MCH Medicines Management (2009)
58
8 Tips for Healthy Eating
The two keys to a healthy diet are:
• eating the right amount of food for how active you are and
• eating a range of foods to make sure you’re getting a balanced diet.
A healthy balanced diet contains a variety of types of food, including lots of fruit, vegetables and starchy foods such as wholemeal
bread and wholegrain cereals; some protein-rich foods such as meat, fish, eggs and lentils; and some milk and dairy foods.
8 tips for eating well:
1. Base your meals on starchy foods
Starchy foods such as bread, cereals, rice, pasta and potatoes are a really important part of a healthy diet. Try to choose
wholegrain varieties of starchy foods whenever you can.
Starchy foods should make up about a third of the food we eat. They are a good source of energy and the main source of a
range of nutrients in our diet. As well as starch, these foods contain fibre, calcium, iron and B vitamins.
Most of us should eat more starchy foods - try to include at least one starchy food with each of your main meals. So you
could start the day with a wholegrain breakfast cereal, have a sandwich for lunch, and potatoes, pasta or rice with your
evening meal.
Some people think starchy foods are fattening, but gram for gram they contain less than half the calories of fat. You just
need to watch the fats you add when cooking and serving these foods, because this is what increases the calorie content.
Wholegrain foods contain more fibre and other nutrients than white or refined starchy foods.
2. Eat lots of fruit and vegetables
Most people know we should be eating more fruit and vegetables. But most of us still aren’t eating enough.
Try to eat at least 5 portions of a variety of fruit and vegetables every day. It might be easier than you think.
You can choose from fresh, frozen, tinned, dried or juiced, but remember potatoes count as a starchy food, not as portions
of fruit and veg.
3. Eat more fish
Most of us should be eating more fish - Aim for at least two portions of fish a week, including a portion of oily fish. You can
choose from fresh, frozen or canned - but remember that canned and smoked fish can be high in salt.
Fish is an excellent source of protein and contains many vitamins and minerals.
Some fish are called oily fish because they are rich in certain types of fats, called omega 3 fatty acids, which can help keep
our hearts healthy. For children, women who are pregnant, breastfeeding or trying for a baby, see the NHS Choices – 8 tips
for healthy eating website www.nhs.uk/livewell/goodfood/pages/eight-tips-healthy-eating.aspx.
Don’t have more than one portion a week of shark, swordfish and marlin because these fish contain high levels of mercury.
4. Cut down on saturated fat and sugar
Fats
To stay healthy we need some fat in our diets. What is important is the kind of fat we are eating. There are two main types of fat:
•saturated fat - having too much can increase the amount of cholesterol in the blood, which increases the chance of
developing heart disease
•unsaturated fat - having unsaturated fat instead of saturated fat lowers blood cholesterol
59
Try to cut down on food that are high in saturated fat e.g. meat pies, sausages, hard cheese, butter, cakes, cream and have
foods that are rich in unsaturated fat instead, such as vegetable oils (including sunflower, rapeseed and olive oil), oily fish,
avocados, nuts and seeds.
For a healthy choice, use just a small amount of vegetable oil or a reduced-fat spread instead of butter, lard or ghee. And
when you are having meat, try to choose lean cuts and cut off any visible fat.
Look at the label to see how much fat a food contains. Generally the label will say how many grams (g) of fat there are in
100g of the food.
High is more than 20g fat per 100g
Low is 3g fat or less per 100g
Saturated fat - what’s high and what’s low?
High is more than 5g saturates per 100g
Low is 1.5g saturates or less per 100g
Sugar
Most people in the UK are eating too much sugar. We should all be trying to eat fewer foods containing added sugar, such
as sweets, cakes and biscuits, and drinking fewer sugary soft and fizzy drinks.
Having sugary foods and drinks too often can cause tooth decay, especially if you have them between meals. Many foods
that contain added sugar can also be high in calories so cutting down could help you control your weight.
How do I know if a food is high in added sugar?
Take a look at the label. The ingredients list always starts with the biggest ingredient first. But watch out for other words
used to describe added sugars, such as sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrup
and honey. If you see one of these near the top of the list, you know the food is likely to be high in added sugars.
Another way to get an idea of how much sugar is in a food is to have a look for the ‘Carbohydrates (of which sugars)’ figure
on the label. But this figure can’t tell you how much is from added sugars, which is the type we should try to cut down on.
High is more than 15g sugars per 100g
Low is 5g sugars or less per 100g
5. Try to eat less salt - no more than 6g a day
Lots of people think they don’t eat much salt, especially if they don’t add it to their food. However every day in the UK, 85%
men and 69% women eat too much salt. Adults - and children over 11 - should have no more than 6g salt a day. Younger
children should have even less.
Three-quarters (75%) of the salt we eat is already in the food we buy, such as breakfast cereals, soups, sauces and ready
meals. So you could easily be eating too much salt without realising it.
Eating too much salt can raise your blood pressure. And people with high blood pressure are three times more likely to
develop heart disease or have a stroke than people with normal blood pressure.
How do I know if a food is high in salt?
Check the label to find out the figure for salt per 100g.
High is more than 1.5g salt per 100g (or 0.6g sodium)
Low is 0.3g salt or less per 100g (or 0.1g sodium)
6. Get active and try to be a healthy weight
Physical activity is a good way of using up extra calories, and helps control our weight. But this doesn’t mean you need to
join a gym.
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Just try to get active every day and build up the amount you do. For example, you could try to fit in as much walking as you
can into your daily routine. Try to walk at a good pace.
Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activity
each day. At least twice a week this should include activities to improve bone health, muscle strength and flexibility
F or general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate intensity physical
activity on five or more days of the week.
Whenever we eat more than our body needs, we put on weight. This is because we store any energy we don’t use up usually as fat. Even small amounts of extra energy each day can lead to weight gain.
7. Drink plenty of water
We should be drinking about 6 to 8 glasses (1.2 litres) of water, or other fluids, every day to stop us getting dehydrated.
When the weather is warm or when we get active, our bodies need more than this. But avoid drinking soft and fizzy drinks
that are high in added sugar.
Alcohol
There is nothing wrong with the occasional drink. But drinking too much can cause problems. Alcohol is also high in calories,
so cutting down could help you control your weight.
Women can drink up to 2 to 3 units of alcohol a day and men up to 3 to 4 units a day, without significant risk to their health.
For good health, it’s a good idea to spread your drinking throughout the week and avoid binge drinking. Drinking heavily
over a long period of time can damage the liver.
8. Don’t skip breakfast
Breakfast can help give us the energy we need to face the day, as well as some of the vitamins and minerals we need for
good health.
Some people skip breakfast because they think it will help them lose weight. There is some evidence to suggest that eating
breakfast can help people control their weight.
Please see the following websites for information for use with patients/clients:
NHS Choices - Healthy Eating
www.nhs.uk/livewell/healthy-eating/pages/healthyeating.aspx
NHS Choices - 8 tips for healthy eating
www.nhs.uk/livewell/goodfood/pages/eight-tips-healthy-eating.aspx
DH Eatwell Plate - 2011
www.dh.gov.uk/en/publichealth/nutrition/dh_126493
DH Eatwell Plate Flyer - 2011
www.dh.gov.uk/prod_consum_dh/groups/dh/digitalassests/documents/digitalassest/dh_126489.pdf
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The Eatwell Plate
If you want to get the balance of your diet right, use the eatwell plate. The eatwell plate makes healthy eating easier to
understand by showing the types and proportions of foods we need to have a healthy and well balanced diet. Look at the
eatwell plate to see how much of your food should come from each food group. You don’t need to get the balance right
at every meal. But try to get it right over time such as a whole day or week.
Try to choose options that are lower in fat, salt and sugar when you can.
(To see a larger version of the eatwell plate, see the following page).
The eatwell plate shows how much of what you eat should come from each food group. This includes everything you eat
during the day, including snacks.
So, try to eat:
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plenty of fruit and vegetables
plenty of bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you can
some milk and dairy foods
some meat, fish, eggs, beans and other non-dairy sources of protein
just a small amount of foods and drinks high in fat and/or sugar
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Physical Activity Recommendations
The chief medical officer’s report Start Active, Stay Active: A report on physical activity from the four home
countries (2011) updates existing physical activity guidelines for children, young people and adults and
includes new guidelines for early years and older people for the first time in the UK.
Early years (under 5s):
• Physical activity should be encouraged from birth, particularly through floor based play and water based activities in safe
environments.
• Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes
(3 hours), spread throughout the day.
• All under 5’s should minimise the amount of time spend being sedentary (being restrained or sitting) for extended
periods (except time spent sleeping).
Children and young people (5-18 years):
• All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes
and up to several hours every day.
• Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.
• All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods of time.
Adults (19-64 years):
• Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) of
moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5
days a week.
• Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the
week or a combination of moderate and vigorous intensity activity.
• Adults should also undertake physical activity to improve muscle strength on at least two days a week.
• All adults should minimise the amount of time spent being sedentary (sitting) for extended periods.
Older adults (65+ years):
• Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of
good physical and cognitive function. Some physical activity is better than none, and more physical activity provides
greater health benefits.
• Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) of
moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5
days a week.
• For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75
minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.
• Older adults should also undertake physical activity to improve muscle strength on at least two days a week.
• Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week.
• All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.
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The Definition of Overweight and Obesity
Overweight and obesity are terms which refer to an excess accumulation of body fat, to the extent that health may be
impaired. Overweight and obesity in adults is most commonly measured using Body Mass index (BMI), which is defined as the
body mass in kilograms divided by the height in meters squared (World Health Organization (WHO) 2004). The calculation
produces a figure that can be compared to various thresholds that define the weight status of an individual (see table 1).
Table 1. WHO (2004) classification of ‘healthy’ and ‘unhealthy’ weight in adults:
Classification
BMI (kg/m2)
Underweight
Less than 18.5
Healthy weight
18.5-24.99
Overweight
25.0-29.99
Obese I
30.0-34.99
Obese II
35.0-39.99
Obese III (Morbidly obese)
40.0 or more
BMI is a widely accepted method used to define overweight and obesity, however it is not a direct measure of adiposity (fat
tissue) and it fails to distinguish between mass due to body fat and mass due to muscle (North West regional public health
group, 2008). Therefore people who are muscular may not appear to be overweight or obese but may have an artificially
high BMI because muscle is three times denser than fat (HSE, 2007). BMI results should therefore be interpreted with caution
and used alongside other measures such as waist circumference (National Institute of Clinical Excellence (NICE), 2006). NICE
(2006) recommends the use of BMI in conjunction with waist circumference to measure weight status and determine health
risks for those with a BMI less than 35kg/m2 (see table 2) (NICE, 2006). For adults with a BMI of 35kg/m2 or over, health
risks are assumed to be very high with any waist circumference (NICE, 2006).
Table 2. NICE (2006) waist circumference thresholds and risk categories for adults:
BMI
classification
Waist circumference
Low
<94cm
Male
<80cm
Female
High
Very High
94-102cm
>102cm
80-88cm
>88cm
Healthy weight
18.5-24.99
No increased Risk
No increased Risk
No increased
Overweight
25.0-29.99
No increased Risk
Increased Rrisk
High risk
Increased Rrisk
High risk
Very high risk
Obese I
30.0-34.99
Source: NICE (2006)
Measuring overweight and obesity in children and young people is more complex than adults. This is because the relationship
between BMI and being overweight and obese in childhood is subject to variation by age, height and gender (NICE, 2006).
To overcome these problems BMI reference charts are used. NICE (2006) recommends the use of the UK 1990 BMI growth
reference standards to give age and gender specific information (NICE, 2006). A child above the 91st centile is considered
overweight and above the 98th centile obese (Cole, Freeman & Preece, 1995. Cole et al, 2000. NICE, 2006).
Among children aged from birth to 4 years of age new UK-WHO Growth Charts developed for the Department of Health by
the Royal College of Paediatrics and Child Health were launched in May 2009. These growth charts replace UK 1990 charts
for this age group, which were based on predominately formula fed babies. The new charts are based on the World Health
Organization (WHO) children growth standards which describe the optimal growth of healthy breast fed children. The new
UK-WHO growth charts will provide more accurate measurements for infant growth of breastfed babies and will also help
healthcare professionals and parents to identify early signs of overweight or obesity and provide support (DoH. 2009).
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NHS Manchester’s Checklist before using Commercial
Weight Management Organisations (CWMO)
At present [June 2010] NHS Manchester has not entered into any agreements with CWMO, it is not possible therefore to
recommend or endorse any schemes specifically. However the following principles should be checked before considering
using any CWMO;
NICE compliant; this means that they include;
• Information and encouragement on activity sessions tailored to the requirements /needs of individuals.
•Use behaviour management techniques to support new healthier lifestyle habits and long term maintenance of weight
loss.
• Recommend evidence based dietary changes i.e. food choices based on the Eat Well plate and portion control advice.
• That expected weight loss is no more than 0.5-1kg per week.
Extract from NICE guideline 43: Management of weight Commercial, self-help and community organisations
• Discuss the range of weight management options and help people decide what is best for them in the long term.
• If recommending commercial, community and/or self-help weight management programmes, continue to monitor patients
and provide support and care.
• Check that any you recommend to patients meet best-practice standards by:
• helping people decide on a realistic healthy target weight (usually to lose 5–10% of their weight)
• aiming for a maximum weekly weight loss of 0.5–1 kg
• focusing on long-term lifestyle changes
• addressing both diet and activity, and offering a variety of approaches
• using a balanced, healthy-eating approach
• offering practical, safe advice about being more active
• including some behaviour-change techniques, such as keeping a diary and advice on how to cope with ‘lapses’ and ‘highrisk’ situations recommending and/or providing ongoing support.
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NHS Manchester - Referral Criteria for Bariatric Surgery
Since 1st April 2009 a Greater Manchester contract has been in place for bariatric surgery, this sets out the NICE criteria for
bariatric surgery but also identifies priority categories, agreed by all Greater Manchester PCT’s, which NHS Manchester has
decided to adopt. Therefore referrals for bariatric surgery from GPs contracted to NHS Manchester must meet the
following criteria;
• BMI above 50 with no co-morbidities
•BMI 45 and above with significant co-morbidities [i.e. Diabetes , CVD … And people needing obesity surgery to enable
other surgery to be successfully performed e.g. knee replacement,]
The bariatric review panel of NHS Manchester require full information, including dates and weights and the non surgical
treatment completed by people seeking obesity surgery, in these priority categories.
NICE guideline 43: Management of weight:
States that bariatric surgery should be considered for people with severe obesity if:
•they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example,
type 2 diabetes, high blood pressure) that could be improved if they lost weight
• all appropriate non-surgical measures have failed to achieve or maintain adequate clinically
• beneficial weight loss for at least 6 months
• they are receiving or will receive intensive specialist management
• they are generally fit for anaesthesia and surgery
• they commit to the need for long-term follow-up
NICE guideline 43: Management of weight:
States that bariatric surgery should be considered as a first-line option for adults with a BMI of more than 50 kg/m2
in whom
•surgical intervention is considered appropriate; consider orlistat before surgery if waiting time is long.
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Evidence Based Advice to Protect Dental Health
•Breast feeding should be promoted as it provides the best nutrition for babies. There is no clear evidence that breastfeeding
can cause dental decay
•From six months infants should be drinking from a cup and from the age of one the use of bottles should be discouraged,
especially at night
•Sugar should never be added to drinks or weaning foods
•Sugary foods and drinks should not be consumed more than 4 times daily and never close to bedtime
•If a child requires medication it should be sugar free whenever possible and especially when it is required regularly
•Teeth should be brushed as soon as they erupt with a smear (for under 3s) or a pea size amount (for over 3s) of a
family fluoride toothpaste (contains 1350 -1450 parts per million fluoride) for maximum protection and parents should
supervise the brushing of teeth
Smear for under 3s
Pea-sized blob for 3-6 s
•Children’s toothpastes containing less than 1000 parts per million of fluoride do not give adequate protection
against decay and should not be used
•Everyone should brush their teeth with fluoride toothpaste at least twice daily – last thing at night and on one other
occasion
• Everyone should be encouraged to spit out after brushing and not rinse with cups of water
• Adults and children should attend dental services regularly for examination and preventive interventions
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National Institute for
Health and Clinical Excellence
Promoting Physical Activity –
Brief Intervention in Primary Care Recommendations
NICE public health guidance (2006) - Four Commonly Used Methods to Promote Physical Activity: endorses the delivery of
brief interventions for physical activity in primary care as both clinically and cost effective in the long term
Brief interventions involve opportunistic advice, discussion, negotiation or encouragement. They are commonly used
in many areas of health promotion, and are delivered by a range of primary and community care professionals. The
interventions vary from basic advice to more extended, individually focused attempts to identify and change factors that
influence activity levels.
Recommendation 1
Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them to
aim for 30 minutes of moderate activity on 5 days of the week (or more). They should use their judgement to determine
when this would be inappropriate (for example, because of medical conditions or personal circumstances). They should use
a validated tool, such as the Department of Health’s general practitioner physical activity questionnaire (GPPAQ), to identify
inactive individuals.
Recommendation 2
When providing physical activity advice, primary care practitioners should take into account the individual’s needs,
preferences and circumstances. They should agree goals with them. They should also provide written information about
the benefits of activity and the local opportunities to be active. (See Physical Activity section of this resource pack) They
should follow them up at appropriate intervals over a 3 to 6 month period.
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Raising the Issue of Weight in Children and Young People
1 WHEN TO INITIATE A DISCUSSION ABOUT WEIGHT
• If the family expresses concern about the child’s weight.
• If the child has weight-related co-morbidities.
• If the child is visibly overweight.
2 RAISE THE ISSUE OF OVERWEIGHT
Discuss the child’s weight in a sensitive manner because parents may be unaware that their child is overweight. Use the
term ‘overweight’ rather than ‘obese’. Let the maturity of the child and the child’s and parents’ wishes determine the level
of child involvement.
If a parent is concerned about the child’s weight:
‘We have [child’s] measurements so we can see if he/she is overweight for his/her age.
If the child is visibly overweight:
‘I see more children nowadays who are a little overweight. Could we check [child’s] weight?’
If the child presents with co-morbidities:
‘Sometimes [co-morbidity] is related to weight. I think that we should check [child’s] weight.’
3 ASSESS THE CHILD’S WEIGHT STATUS
Refer to UK Child Growth Charts and plot BMI centile. Explain BMI to parent: eg ‘We use a measure called BMI to look at
children’s weight. Looking at [child’s] measurements, his/her BMI does seem to be somewhat higher than we would like it to be.’
If the child’s weight status is in dispute, consider plotting their BMI on the centile chart in front of them. In some cases this
approach may be inappropriate and upsetting for the family.
Overweight
Severely overweight
BMI centile
BMI centile
>91st centile
>98th centile
4 ASSESS SERIOUSNESS OF OVERWEIGHT PROBLEM AND DISCUSS WITH PARENT
If child is severely overweight with co-morbidities, consider raising the possibility that their weight may affect their health
now or in the future. This could be left for follow-up discussions or raised without the child present as some parents may
feel it is distressing for their child to hear.
‘If their overweight continues into adult life, it could affect their health. Have either you [or child] been concerned about his/
her weight?’
Consider discussing these points with the parent at follow-up:
• Age and pubertal stage: the older the child and the further advanced into puberty, the more likely overweight will persist
into adulthood.
•P
arental weight status: if parents are obese, child’s overweight is more likely to persist into adulthood.
• Co-morbidities: (see overleaf) increase the seriousness of the weight problem
5 REASSURE THE PARENT/CHILD
If this is the first time that weight has been raised with the family, it is important to make the interaction as supportive as possible:
70
Together, if you would like to, we can do something about your child’s weight. By taking action now, we have the chance
to improve [child’s] health in the future.’
6 AGREE NEXT STEPS
Provide patient information literature, discuss as appropriate and:
• If overweight and no immediate action necessary: arrange follow-up appointment to monitor weight in three to six
months: ‘It might be useful for us to keep an eye on [child’s] weight for the next year and refer to available services as
listed in the resource pack’
• If overweight and family want to take action: offer appointment for discussion with GP, nurse or other health professional;
arrange three-to six-month follow-up to monitor weight and refer to available services as listed in the resource pack.
• If overweight and family do not wish to take action now: monitor child’s weight and raise again in six months to a year.
• If overweight with co-morbidities: consider referral to appropraite services in this resource pack or to secondary care:
‘It might be useful for you and [child] to talk to someone about it.’
BACKGROUND INFORMATION
Identifying the problem
Ascertaining a child’s weight status is an important first step in childhood weight management. Parents who do not recognise
the weight status of their overweight children may be less likely to provide them with support to achieve a healthy weight. In
a British survey of parental perception of their child’s weight, the overwhelming majority (94%) of parents with overweight
or obese children misclassified their child’s weight status.1 Given this low level of parental awareness, health professionals
should take care to establish a child’s weight status in a sensitive manner.
Assessing weight status in children
The child growth charts for the UK allow easy calculation of BMI based on a child’s known weight and height.2 Measures
of body fat in children can also be a useful way of assessing a child’s weight status. Details of body fat reference curves for
children are now available,3 although, in practice, body fat cannot be assessed without the necessary equipment.
Assessing the severity of the problem
A number of factors are known to increase the risk of childhood obesity and the likelihood that a weight problem will persist
into adult life. Considering these factors will help you to make an informed decision about the most appropriate mode of
action.
• The older the child, the more likely it is that their weight problem will continue into later life and the less time they have
to ‘grow into’ their excess weight.
• A child is 20–40% more likely to become obese if one parent is obese. The figure rises to around 80% if both parents are
obese.
• While weight problems can lead to psychosocial issues such as depression and low self-esteem, weight loss may not
necessarily resolve these problems, so don’t rule out referral to CAMHS.
Health risks of excess weight in childhood 4,5
Being obese in childhood or adolescence increases the risk of obesity in adult life. Childhood obesity will also increase the
chances of developing chronic diseases typically associated with adult obesity:
• insulin resistance and type 2 diabetes;
• breathing problems such as sleep apnoea and asthma;
• psychosocial morbidity;
• impaired fertility;
• cardiovascular disease;
• dyslipidaemia;
• hypertension;
• some cancers;
• orthopaedic complications.
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Importance of weight control
For many overweight children, prevention of further weight gain is the main goal because as long as they gain no more
weight, they can ‘grow into’ their weight over time. This goal can be achieved through lifestyle changes:
• improving the diet, eg by increasing fruit and vegetable consumption, reducing fat intake and portion sizes, considering
intake of sugary drinks, and planning meals;
• increasing activity, eg playing football, walking the dog;
• reducing sedentary behaviours such as time spent watching TV or playing computer games. If the child is more severely
overweight, or has already reached adolescence, ‘growing into’ weight is more difficult and weight loss has to be considered.
Need to offer solutions
Unless the child is severely overweight with comorbidities, be led by the parents’ and/or child’s wishes. Encourage action if
appropriate. Health professionals should be ready to offer referral support so that they are seen as taking the issue seriously.
If the child is very overweight and has co-morbidities, the child (and family) may require on-going support despite referrals,
eg through continued weight monitoring, additional specialist referrals, or help with family-based lifestyle modification.
Carnell S et al (2005) Parental perceptions of overweight in 3–5 year olds. Int J Obes 29: 353–5.
Cole T et al (2002) A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr 56: 1194–9.
3
Jebb S et al (2004) New body fat reference curves for children. Obes Rev (NAASO Suppl) A156.
4
McCallum Z and Gerner B (2005) Weighty matters: An approach to childhood overweight in general practice. Aus Fam
Phys 34(9): 745–8.
5
British Medical Association Board of Science (2005) Preventing Childhood Obesity. BMA.
1
2
© Crown Copyright 2006 274544 1p 60k Apr06 (BEL)
Produced by COI for the Department of Health. First published April 2006
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Raising the Issue of Weight in Adults
1. RAISE THE ISSUE OF WEIGHT
If BMI is >25 and there are no contraindications to raising the issue of weight, initiate a dialogue:
‘We have your weight and height measurements here. We can look at whether you are overweight. Can we have a chat
about this?’
2 IS THE PATIENT OVERWEIGHT/OBESE?
BMI (kg/m2)
Weight classification
<18.5
Underweight
18.5–24.9
Healthy weight
>25–29.9
Overweight
>30
Obese
Using the patient’s current weight and height measurements, plot their BMI with them and use this to tell them what
category of weight status they are.
‘We use a measure called BMI to assess whether people are the right weight for their height. Using your measurements,
we can see that your BMI is in the [overweight or obese] category [show the patient where they lie on a BMI chart]. When
weight goes into the [overweight or obese] category, this can seriously affect your health.’
WAIST CIRCUMFERENCE
Increased disease risk
Men
Women
>40 inches (>102cm)
>35 inches (>88cm)
Asian men
Asian women
>90 cm
>80 cm
Waist circumference can be used in cases where BMI, in isolation, may be inappropriate and to give feedback on central
adiposity. In Asians, it is estimated that there is increased disease risk at >90cm for males and >80cm for females.
Measure midway between the lowest rib and the top of the right iliac crest. The tape measure should sit snugly around the
waist but not compress the skin.
3 EXPLAIN WHY EXCESS WEIGHT COULD BE A PROBLEM
If patient has a BMI >25 and obesity-related condition(s):
‘Your weight is likely to be affecting your [co-morbidity/condition]. The extra weight is also putting you at greater risk of
diabetes, heart disease and cancer.’
If patient has BMI >30 and no co-morbidities:
‘Your weight is likely to affect your health in the future. You will be at greater risk of developing diabetes, heart disease and
cancer.’
If patient has BMI >25 and no co-morbidities:
‘Any increase in weight is likely to affect your health in the future.’
4 EXPLAIN THAT FURTHER WEIGHT GAIN IS UNDESIRABLE
‘It will be good for your health if you do not put on any more weight. Gaining more weight will put your health at greater risk.’
73
5 MAKE PATIENT AWARE OF THE BENEFITS OF MODEST WEIGHT/WAIST LOSS
‘Losing 5–10% of weight [calculate this for the patient in kilos or pounds] at a rate of around 1–2lb (0.5–1kg) per week
should improve your health. This could be your initial goal.’
If patient has co-morbidities:
‘Losing weight will also improve your [co-morbidity].’
Note that reductions in waist circumference can lower disease risk. This may be a more sensitive measure of lifestyle change
than BMI.
6 AGREE NEXT STEPS
Provide patient literature and:
• If overweight without co-morbidities: agree to monitor weight and refer to services available.
• If obese or overweight with co-morbidities: arrange follow-up consultation and refer to services available.
• If severely obese with co-morbidities: consider referral to appropraite services in this resource pack and to secondary care.
• If patient is not ready to lose weight: agree to raise the issue again (eg in six months).
BACKGROUND INFORMATION
Raising the issue of weight
Many people are unaware of the extent of their weight problem. Around 30% of men and 10% of women who are
overweight believe themselves to be a healthy weight.1 There is evidence that people become more motivated to lose weight
if advised to do so 2 by a health professional.2
Health consequences of excess weight
The table below summarises the health risks of being overweight or obese.3 In addition, obesity is estimated to reduce life
expectancy by between 3 and 14 years. Many patients will be unaware of the impact of weight on health.
Greatly increased risk
• type 2 diabetes
• gall bladder disease
• dyslipidaemia
• insulin resistance
• breathlessness
• sleep apnoea
Moderately increased risk
• cardiovascular disease
• hypertension
• osteoarthritis (knees)
• hyperuricaemia and gout
Slightly increased risk
• some cancers (colon, prostate, postmenopausal
breast and endometrial)
• reproductive hormone abnormalities
• polycystic ovary syndrome
• impaired fertility
• low back pain
• anaesthetic complications
Benefits of modest weight loss 4
Patients may be unaware that a small amount of weight loss can improve their health.
Condition
Mortality
Health benefits of modest (10%) weight loss
Diabetes
• up to a 50% fall in fasting blood glucose
• over 50% reduction in risk of developing diabetes
• 20–25% fall in overall mortality
• 30–40% fall in diabetes-related deaths
• 40–50% fall in obesityrelated cancer deaths
• 10% fall in total cholesterol, 15% in LDL, and 30% in TG, 8% increase in HDL
Lipids
Blood pressure • 10 mmHg fall in diastolic and systolic pressures
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Realistic goals for modest weight/waist loss (adapted from Australian guidelines) 5
Duration
Short term
Medium term
Long term
Weight change
Waist circumference change
2–4kg a month
1–2cm a month
5–10% of initial weight
5% after six weeks
10–20% of initial weight
aim to be <88cm (females)
aim to be <102cm (males)
Patients may have unrealistic weight loss goals.
The need to offer support for behaviour change
The success of smoking cessation interventions shows that, in addition to raising a health issue, health professionals need
to offer practical advice and support. Rollnick et al suggest some ways to do this within the primary care setting. Providing
a list of available options in the local area may also be helpful as included in this resource pack. 6
Importance of continued monitoring of weight
Weight monitoring can be a helpful way of maintaining motivation to lose weight. Patients should be encouraged to
monitor their weight regularly. 7 Interventions for smoking cessation have found that behaviour change is more successful
when follow-ups are included in the programme. 8
Wardle J and Johnson F (2002) Weight and dieting: examining levels of weight concern in British adults. Int J Obes 26:
1144–9.
2
Galuska DA et al (1999) Are health care professionals advising obese patients to lose weight? JAMA 282: 1576–8.
3
Jebb S and Steer T (2003) Tackling the Weight of the Nation. Medical Research Council.
4
Department of Health (2002) Prodigy Guidance on Obesity. Crown Copyright.
5
NHMRC (2003) Clinical practice guidelines for the management of overweight and obesity in adults. Commonwealth of
Australia.
6
Rollnick S et al (2005) Consultations about changing behaviour. BMJ 331: 961–3.
7
O’Neil PM and Brown JD (2005) Weighing the evidence: Benefits of regular weight monitoring for weight control. J Nutr
Educ Behav 37: 319–22.
8
Lancaster T and Stead LF (2004) Physician advice for smoking cessation. Cochrane Database of Systematic Reviews, 4.
1
© Crown Copyright 2006 274543 1p 60k Apr06 (BEL)
Produced by COI for the Department of Health. First published April 2006
75
Useful Websites
www.apho.org.uk - Association of Public Health Observatories
www.babyfriendly.org.uk - There is lots of information on this site that can help services go Baby Friendly, as well as a
comprehensive research archive and a section for parents
www.bbc.co.uk/health - BBC Health Topics and Health News
www.bhf.org.uk/keeping_your_heart_healthy/staying_active.aspx - Ways to get more active and information on the
benefits of activity
www.bmj.com - The BMJ is an international peer reviewed medical journal and a fully “online first” publication. NHS staff
and students have full online access to the British Medical Journal using their NHS Athens details
www.britishcycling.org.uk - Go to Skyride for information on led rides and mass participation events. Have a look at the
Travel and Recreation sections for online cycling support, cycling routes and events
www.cks.nhs.uk/obesity - The NHS Clinical Knowledge Summaries (formerly PRODIGY) are a reliable source of evidencebased information and practical ‘know how’ about the common conditions managed in primary
care e.g. overweight and obesity. They are aimed at healthcare professionals working in primary
and first-contact care
www.counterweight.org - Weight management in primary care
www.cwt.org.uk – Caroline Walker Trust, nutritional and practical guidelines for both young and old
www.dancechampions.org.uk - Developed to support and encourage more people to be more active
www.dh.gov.uk – Contains Your Weight Your Health (2006) which is a comprehensive package that comprises materials
for health professionals as well as information to be given to patients
www.dietaryadvicedirect.co.uk/ - Dietary advice direct is an online guide that helps people through the process of setting
realistic and achievable goals to lose weight for life
www.eatwell.gov.uk – Information from the Food Standards Agency
www.evidence.nhs.uk - NHS Evidence
www.food.gov.uk – Information from the Food Standards Agency, which has information about food safety only, not
nutrition and advice
www.foodfutures.info - Food Futures is a partnership that embraces a wide range of individuals and organisations with an
interest in improving food in the city
www.fph.org.uk - Faculty of Public health
www.gettingmanchestermoving.org - Getting Manchester Moving is a project designed to encourage and support
Manchester people to get more physically active, eat more healthily and in some
cases to lose weight
www.gmphnetwork.org.uk - Greater Manchester Public Health Network
www.greatersport.co.uk – This website lists many physical activity opportunities for children and young people
www.hpa.org.uk - Health Protection Agency
www.ic.nhs.uk - The Information Centre
76
www.library.nhs.uk - NHS evidence
www.manchester.gov.uk/health/jhu - The Joint Health Unit is a key part of the public health system in Manchester. It
is a team that focuses on strategic planning and partnership working for health
improvement and tackling health inequalities
www.manchester.gov.uk/jsna - Manchester Joint Strategic Needs Assessment 2008 – 2013
www.manchester.nhs.uk – NHS Manchester Public Health
http://manchester.plings.net/index.php - P laces to go, things to do. This website includes a list of sporting/physical activity
opportunities for children in Manchester
www.map-project.org.uk - Manchester’s Multi Agency Partnership for Disabled Children and Young People (includes a list
of physical activities/clubs in Manchester)
www.mendprogramme.org – Mind exercise nutrition do it - Fitter, healthier, happier families. MEND is an organisation
dedicated to reducing global overweight and obesity levels among children and young people
www.mhim.org.uk - Information about mental health
www.mhsc.nhs.uk/services/library-services - Health Information and Resources Library in Manchester
www.mphds.org/ - Manchester Public Health Development Service
www.mymanchester.net - M
y Manchester is a community portal, from Manchester Community Information Network
which provides links to Manchester related information
www.myschoollunch.co.uk/manchester - Making school lunch times the ninth lesson
www.ncmp.ic.nhs.uk –National Child Measurement Programme results
www.netmums.com - Netmums is a unique local network for Mums (or Dads), offering a wealth of information on both a
national and local level e.g. local physical activity opportunities for parents and children.
www.nhs.uk/livewell/healthy-eating/pages/healthyeating.aspx - NHS Choices - Healthy Eating advice
www.nhsdirect.nhs.uk – NHS Direct
www.nhs.uk/lifecheck - NHS Choices - NHS LifeCheck is an online health service for babies, teens and middle-aged adults
www.nhs.uk/5aday - NHS Choices - Top tips for eating more fruit and vegetables
www.nhs.uk/Change4Life - NHS Choices - Change for Life: Tops for healthy kids and families
www.nhs.uk/livewell/alcohol - N
HS Choices - How drinking can affect health, with alcohol units and recommended
limits explained
www.nhs.uk/LiveWell/Loseweight - NHS Choices - Articles to help with all aspects of attaining a healthy weight
www.nhs.uk/ServiceDirectories/Pages/ServiceSearchAdditional.aspx?ServiceType=SportAndFitness&WT.mc_
id=090905 – NHS Choices - Find local physical activity/sporting opportunities close to home/work
www.nhs.uk/livewell/fitness - NHS Choices - Information on becoming more active
www.nhs.uk/News/Pages/NewsIndex.aspx - NHS Choices - NHS Choices (Behind the Headlines)
www.nhs.uk/planners/nhshealthcheck/Pages/NHSHealthCheck.aspx
- N
HS Choices - The new NHS Health Check is for adults in England between the ages of 40 and 74. In this
site you can learn more about what the check is, what it involves, and when and how you can get it
77
www.nice.org.uk – National Institute for Healthcare and Clinical Excellence
www.nwpho.org.uk - North West Public Health Observatory
www.promotingactivitytoolkit.com - The Promoting Activity toolkit helps bring the Change4Life campaign to life in
local areas. It has photos, an online design tool to help create Change4Life posters,
calendars of campaigns to help plan when to do marketing and an activity search
tool to help make it easier for the public to find their local activity
www.ramblers.org.uk - Details of many locally organised walking groups, catering for all levels of fitness
www.smokefree.nhs.uk - Quit smoking information and advice
www.sustrans.com - Information on starting off cycling and national cycle network maps
www.walkengland.org.uk/walknowgettingstarted.aspx - A comprehensive website, with information on how to get
active through walking, linking to lots of different local
opportunities
www.walkit.com - Walkit.com is an urban walking map and route planner that helps you get around town on foot
www.whatisseries.co.uk - The “What is…?” series on Healthcare
www.whi.org.uk - ‘Walking the way to health’ aims to encourage people, particularly those who take little exercise, to do
regular short walks in their local community
www.who.int - World Health Organisation
http://www.yougo4it.co.uk/manchester - Advice about food and exercise for young people in Manchester
If you would like also to receive a daily media digest of health news called presswatch, just send your email address to:
[email protected]
Access to websites is available at every public library
78
Appendix 1
79
Appendix 2
FAMILY CLUB
Family Weight Management – Active Lifestyles
Referral to the programme
Preliminary child suitability assessment (please circle where appropriate)
Is the child age between 5 – 16 years
Yes/ No
Is the child, together with a parent/ carer, able to commit to weekly sessions?
Yes/ No
If YES is answered to both of these questions please proceed with the referral
Child’s Details
First Name:
Parent/ Carer’s Name:
Surname:
Sex: (Please circle)
Relationship to child:
Male/ Female
Address:
Date of Birth:
Postcode:
NHS Number:
Telephone Number:
Height & Weight (Please enter)
Height (cm)
Weight (kg)
Date Taken:
Medical History
Relevant medical history:
Current Medications:
Additional social information, learning and/ or behavioural difficulties if relevant:
Medically is the child able to participate in physical activity sessions? Please circle
If NO please state the reasons for this:
Referrers Details
Referred by (print name):
Address:
Job Title/ Profession:
Signature:
Postcode
Date:
Telephone Number:
Email:
Referral Return Address – please send this completed form to:
Active Lifestyles
Tel 0161 232 3114/ 3117/ 3100
Denmark Road, Hulme, Manchester, M15 6FG
Fax 0161 276 7483
Office Use Only
80
Yes/ No
Appendix 3
81
Appendix 4
‘Your Choice’ -
Weight Management Programme
Thank you for requesting information from us to try to help you to control your weight. Losing weight is
not easy and we do not claim to be able to prescribe any miracle potions. We certainly cannot do it for
you – the hard work and effort must come from you.
One thing we will promise to do is to work with to provide the advice and support you require in order to
achieve long term successful weight loss. You need to be a Manchester resident or have a Manchester
GP (This does not include Trafford, Stockport, Tameside or Salford).
What we do to help you;
�
Education Morning – A group session to discuss food, eating and energy intake we
also look at activity and motivation to make these lifestyle changes to lose weight.
�
Activity - with help from P.A.R.S.* and qualified instructors if you wish you can work
on increasing your activity. Activities to suit all levels of ability are available.
�
Health checks – You will be offered health checks to monitor your weight, body fat,
blood pressure and heart rate to check if you are losing weight and getting fitter. We
will help you set goals to achieve this.
�
Drop-in - You can come along anytime during the half hour to have a chat and get
weighed if you wish.
Mondays – 12:00 to 12:30 upstairs at the Forum Health Centre
�
1 to 1 – An appointment with a Registered Dietitian
�
Initial Appointment with a Health Trainer if your Body Mass Index is less than 30
*Physical Activity Referral Scheme
What do you need to do?
If you are ready to make a start and want to lose weight, you need to fill in the referral form and return to
us at the address at the foot of this letter. We will then get in touch and invite you to an education
morning (usually 10am – 12.30pm)
Yours sincerely,
Ray Green, Suzanne Paul and Jen Bramley – Dietitian and Nutrition Assistants
‘Your Choice’ (Community Nutrition Service)
Wythenshawe Offices, 1, Stancliffe Road, Sharston, Manchester, M22 4PJ
Tel: 0161 946 8210 Fax 0161 946 8209,
82
YC/Ed Day/ YC Letters/ YC-1 Pat Interest
Appendix 4
Referred by:
Date:
Self Referral
Health Care Professional (Name and Designation)
‘Your Choice’
*
Your patient will only be seen if they agree to the referral
Weight Management Programme
Application Form
Please tick if your patient has agreed
Please complete all sections of this form. We may otherwise need to return it to you for completion.
If you need any help, contact our team or ask the person who handed you this form.
First Name:
Surname:
Date of Birth:
Telephone number:
Address:
Postcode:
Doctors Name:
Doctors Address:
Current Weight:
Height:
Do you have any medical conditions (please state)?
Do you take any medicine or tablets (please list)?
Weight history over the past 2 years?
Do you do require an interpreter?
Referral Reason:
Please return to:
“Your Choice” Community Nutrition Service
Wythenshawe Offices, 1, Stancliffe Road, Sharston, M22 4PJ
YC/Ed Day/ YC Letters/ YC-1 Pat Interest
Tel: 0161 946 8210 Fax 0161 946 8209
83
84
CounterWeight [ ]
Your Choice [ ]
Is the client currently on the Counterweight or the Your Choice programme?
(please tick which programme if yes)
Weight management history
Postcode………………………………………………………………
Tel/ Mobile……………………………………………………………
Date of Birth…………………………………….……………………
Name………………………………………………………………….
Address……………………………………………………………….
Client Details
(Name)……………………………………………………………….
(Date)…………………………………………………………………
(Position)……………………………………………………………..
(Tel/ Email)…………………..……………………………………….
…………………………………………………………………………
Referred by:
 Daytime and evening sessions on various days of the week; there will
always be two sessions per week at the same venue.
 Nutrition/ Support advice workshops run for the first half-hour of
sessions (these can be excluded if the resident is already receiving
nutritional advice from another weight management programme).
 Additional Personal Development workshops will run as part of the
programme.
 Sessions are at venues across the city.
 Health checks/ measurements recorded.
 Sessions are only suitable for residents with no co-morbidities and
that have a BMI over 25.00
Programmes:
Please complete this referral form if you know of a resident who would benefit
from the Weight No More programme. Here’s a quick guide to show what is
offered on the programme.
[email protected] OR
[email protected]
Please address for the attention of Angela Matthews OR Ross
McGuigan.
For any enquiries please contact us on Tel: 0161 232 3114 / 3117.
Email:
Please send this form either by post:Active Lifestyles, Denmark Road, Hulme, Manchester, M15 6FG or
Fax: 0161 276 7483
Thank you for completing this referral form. Once you
have sent this to us we will contact the resident.
…………………………………… ……………………………………
…………………………………… ……………………………………
…………………………………… ……………………………………
Medical History
Please list any relevant medical conditions and / or any medication that may
affect participation:
How mobile or active is the resident? (Please describe if possible)
Current Weight (if known)………………………………………………….
Height (if known)…………………………………………………………….
BMI (if known)………………………………..…Date taken…..................
Blood Pressure (if known)…….......................Date taken……………….
Is the client currently on any other weight management programme?
(Please list/ describe)
Weight No More - Referral Form
Appendix 5
Appendix 6
Tel: 0161 861 2548
Fax: 0161 203 5817
HEALTH TRAINER REFERRAL FORM
Client number:
(Health Trainer use only)
HT initials
Year
Client no
Name of client referred:
Client’s address:
Telephone no:
Client’s full postcode:
Referrer’s name and position:
Address:
Referrer’s contact details:
Tel:
/
Date:
D
D
/
M
M
Y
Y
Y
Y
Thank you for your interest in the Manchester Community Health Trainers service. Manchester
Community Health Trainers aim to support people to adopt health promoting behaviour. Health
Trainers do this by helping people to identify their own goals and stick to them. They will also
give some practical support, particularly around losing weight, eating more healthily and doing
more physical activity. Health Trainers can also provide information on other services that can
help individuals to achieve their goals.
What do you want to focus on?
(tick all that apply)





food (healthy eating)
physical activity (exercise)
smoking
drinking
other  what? …………………………………………….
You can send the completed form or make further enquiries to this freepost address:
Manchester Community Health Trainers, Business Reply Licence No RRBL-ASHX-YYCB, Manchester
Public Health Development Service, Victoria Mill, Lower Vickers Street, Miles Platting, Manchester M40
7LJ Tel: 0161-861-2548; Fax: 0161-203-5817
Official use only
Outcome:




couldn’t make contact
didn’t want service at this time
booked in for first visit
didn’t meet service criteria
85
Appendix 7
Alcohol Linkworker Referral Form
Details of person wanting advice / support
Date of referral:
DOB:
Name:
Address:
Post code:
Tel No:
GP details (if known):
Name:
Practice Address:
Tel No:
Details of person making referral if different from above
Name:
Address:
Tel No:
Brief reason for referral:
CAT Referral Form 2011-07-01
86
Organisation / relationship to person
requesting help:
Appendix 7
How to send your referral to Manchester Community Alcohol Team
BY SECURE FAX:
0161 882 1344
BY POST:
Longsight District Office
523 Stockport Road
Manchester
M12 4LL
When we receive referrals by post or by fax, we will telephone the person wanting
advice / support so they have a chance to ask any questions about our service.
87
CAT Referral Form 2011-07-01
Appendix 8
88
Appendix 8
89
Appendix 9
Manchester Science Park
1st Floor, Unit 21
Enterprise House
Lloyd Street North
M15 6SE
Tel: 0161 227 0600
Fax: 0161 227 0605
Family Nurse Partnership
Referral form for Family Nurse Partnership Project Wave 1 & Wave 2
Supervisors Vanda Wellock & Lesley Lamb
Young women under 20yrs who are pregnant for the 1st time?
Date:
Name:
NHS Number:
DoB:
EDD:
Address:
Postcode:
Home Number:
Mobile Number:
Weeks Gestation:
GPs name:
Telephone number:
Referrers name:
Contact Details:
Is it O.K for Family Nurse to contact client: Yes/No
90
Appendix 10
Paediatric Referral Form for Children with Weight Management
Issues and Associated Musculoskeletal Conditions
Please fax completed form to 0161 220 5809 then send original in post
Criteria For Referral (when to refer)
•
•
•
17 and under
Identification of weight issues using IOTF BMI centile cut offs
Associated joint pain e.g. In knees or back which is impacting on the child’s ability to take part
in physical activity or increase their activity levels
(When not to refer)
•
When child and their family are not in agreement with the referral
Name:
Date of Referral ____/____/____
DOB:
NHS No.
Name of Referrer:
Address:
Address:
Tel No:
Postcode:
Home Tel:
GP Name:
Address:
Mob Tel:
Postcode:
Tel No:
Name of Carer
Relationship
Reason for Referral:
Relevant Medical Details:
Current Weight
Current BMI
BP
Summary of previous weight management interventions
Associated joint pain
Other services involved
MSK Team – Cornerstone Centre, 2 Graham Street, Beswick, Manchester, M11 3AA. Tel No. 0161 220 7110 Fax: 0161 220 3991
91
Appendix 11
Children and Young People’s Services Referral Form
Please select the service you are referring to by marking “X” in one of the appropriate boxes below:
Audiology
Children’s Community
Nursing Team
Physiotherapy
Paediatrics
Disabled Children’s
Team Nursing Service
Podiatry
Occupational
Therapy
Speech and
Language Therapy
School Health / School Nursing Service
Health Visiting Service
Orthoptics
Other – please state
* Starred fields are mandatory. If any of these fields are not completed the form will be returned to the referrer.
Surname: *
Forename: *
Previous Surname:
Address: *
Date of Birth: *
NHS Number: *
Gender: *
Male / Female
Home Telephone: *
Mobile Telephone:
Postcode: *
Is copy appointment letter required: Yes / No
E-mail Address:
Please give details:
Reminder required for appointments (if available):
Text: Yes / No
E-mail: Yes / No
Appointment Preference (mark with x):
Monday
am
pm
Tuesday
am
pm
Wednesday
am
pm
Thursday
am
pm
Friday
am
pm
Common Assessment Framework (CAF) Completed: *
Yes / No
Multi Agency Case Planning:
Language Spoken: *
Interpreter Required: * Yes / No
Ethnicity: *
Religion: *
Disability: * Y / N Access Needs:
GP Name: *
Practice Name: *
Practice Address: *
Yes / No
Lead Professional / Key Worker:
Name:
Address:
Nursery / School Attended:
Manchester Health Record Holder & Base:
Telephone:
Other Professionals Involved:
Diagnosis / Reason for referral / treatment required: *
Additional information (including test results or
provide clinic letter as appropriate):
Referrer Name: (PLEASE PRINT) *
Date of referral: *
Designation: *
Address: *
Telephone: *
Have parents agreed to referral? *
Yes / No
Has this child been referred to
this service previously:
Yes / No
Office Use Only
Date referral received …………………….....…............... Demographic details checked on child health system? Yes / No
Name……………………………………………….……….. Date……………………………………
Date of appointment………………………………………
92
CYPS1v6
November 2010
Appendix 12
Stroke Association – Healthy Living Referral Form to 8 week programme
Name:
Name of NoK:
Male/Female:
Relationship:
Address:
Address:
Ethnicity:
Telephone:
Telephone:
GP Name:
Discharge Address if different:
GP Address:
Discharge Telephone if different:
Date of Stroke:
DoB:
Ward/Consultant:
Age:
Marital Status:
Married Single Widowed Div/Sep
Lives Alone: Yes/No
Transferred to:
Stroke/TIA:
Date of Discharge:
Home Stroke/Neuro Outreach:
(if applicable)
Referrers Name:
Discharged to:
Details of carer if different from NoK
Does the carer wish to attend the
session?
Date of Transfer:
Referrers Job Title:
Name:
Relationship:
Transport required or not:
Address:
Telephone:
1
93
Appendix 12
Brief Medical History:
Comments with regard to current medication and medical status:
Communication:
Dysarthria �
Dysphasia �
Receptive:
Dyspraxia �
No Problem |____|____|____|____|____|____|____|____|____| Severe
Expressive: No Problem |____|____|____|____|____|____|____|____|____| Severe
Comments:
Exercise experience prior to stroke:
Present Mobility:
Additional support needed:
Flexibility:
Other health problems:
Comments with regards to suitability to programme:
94
Appendix 13
A STRUCTURED PATIENT EDUCATION PROGRAMME FOR
PEOPLE WITH DIABETES
Do you want to increase your skills, knowledge and
confidence in managing your diabetes?
The local X-PERT programme is a six-week group diabetes education programme. You will learn
all about the up-to-date treatments and management of diabetes and will have the opportunity
to explore and address problems/issues that you may have with your diabetes.
The programme has been shown to improve
diabetes control, increase self-management skills,
improve lifestyle and quality of life.
Comments from patients:
You are invited to attend the X-PERT
programme. It is important to attend all the
weeks to get the most out of the course. You
are welcome to bring along a family member
or friend, however the session are not
suitable for children to attend.
‘Very glad to be offered the course, much appreciated
(Thank you NHS!). Feel much encouraged in dealing with
myself and more understanding with latest knowledge’
Week
Week
Week
Week
Week
Week
1.
2.
3.
4.
5.
6.
What is Diabetes
Weight Management
Carbohydrate awareness
Supermarket Tour
Possible Complications
Questions and Evaluation
The sessions will last for 3 hours except on
Week 4 that’s 2 hours and at your nearest
Supermarket.
‘This is the first time in 10 years of being a diabetic that
anybody has told me these things’
‘I am more at ease with diabetes from what I have learnt
and able to control it better’
‘I was very impressed – the sessions have been delivered
in a manner that had obviously gone beyond that
required to make them understandable’
‘Don’t feel as frightened as I did.....feel more confident in
myself…things explained so that anybody & everybody
can understand’
‘This course was really helpful in helping me understand
diabetes as all demonstrations were in laymen’s language
- programme should have been implemented years ago’
95
Appendix 13
If you would like to attend, please complete the reply slip below.
If
Reply Slip
(Please Complete as much as possible)
I would like to attend the X-PERT Programme. (Please circle)
Yes
No
Your Name:
Home Address:
PostCode:
Telephone Number:
Date of Birth:
GP Practice:
Date of Diagnosis of Diabetes:
Treatment for Diabetes (please circle)
Diet
Tablets
Insulin
Would like to bring a friend/carer/ family member? (please circle) Yes
No
Please return the reply slip to one of the diabetes team or post to:
‘X-PERT Diabetes’, Community Nutrition Service, Wythenshawe Offices, Stancliffe Road,
Sharston, Manchester, M22 4PJ.
If you would like any further information please contact:
Amy Griffiths - Dietitian: 0161 946 8210
Helen Tyrer – Podiatrist: 07970 650787
Jackie Price – Diabetes Specialist Nurse: 0161 945 8203.
96
Appendix 14
Appendix 14
General Referral to Community Nutrition Service
NHS No:
First Name: ………………………………
GP Name:…………………………………………..
Surname:…………………………………
Address:…………………………………………….
Address:………………………………….
………………………………………………………
…………………………………………….
Current Weight: ……………………………………
Postcode:………………………………..
BMI: …………………………………………………
Date of birth: ……………………………
Ethnic Origin:………………………………………
Phone No: ……………………………….
Medical History/Reason for referral:
Medication:
Relevant Social/Personal
Information/disability:
Please tick box if Home Visit is Required
(We have a limited capacity to visit at home and will only do so if absolutely necessary)
Referred By:
Name (please print)
Address
Phone No::
Date:
Send to:
Community Nutrition Service
Dunstable Street
Manchester
M19 3BX
Tel : 0161 861 2333
Fax: 0161 248 0389
Use from April 2011.
97
Appendix 15
Referral Form
VERSION 1.0
Please complete the form as clearly and fully as possible to ensure no delay to the referral
Level 3 Adult Specialist Weight Management Service for NHS Manchester, Oldham and Salford
Manchester
Salford
Oldham
Name of referring GP
(Please PRINT name)
Address of referring GP practice
(Or use practice stamp)
Client Personal Information
NHS Number
Mr/Mrs/Miss/Ms/Other
First name
Gender (Please circle)
Ethnicity
Male/Female
Date of birth (DD/MM/YYYY)
Address
Preferred contact telephone
98
Client email
Surname
Appendix 15
Client Health Data
Eligibility Criteria
• Client has a BMI >35
• Client has a BMI >30 and pregnant
• Client requests and is eligible for Bariatric Surgery
Physical Health Data
Please provide the following
Height (m)
Resting Heart Rate (bpm)
Current weight (kg)
BMI (kg/m2)
BP (mmHG)
Current Medication
Please provide a list of medication the client is currently taking or attach a list of medication to the referral form
Client’s Past Medical History
(please tick and fill in relevant boxes)
Type 1 diabetes
Type 2 diabetes
Myocardial infarction
Ischaemic heart disease
Hypertension
Heart failure
Cardiomyopathy
CVA/TIA
Hyperlipidaemia
Peripheral vascular disease
Polycystic ovarian syndrome
Joint problems
Obstructive sleep apnoea
Severe dismobility
Obesity hypoventilation
Subfertility
Back pain
Hypothyroidism
99
Appendix 15
Specify other medical problems that the service may need to be aware of
Biochemical Readings (these must be dated within 3 months)
Cholesterol
HDL
LDL
Triglycerides
HBA1C
Date:
Date:
Date:
Date:
Date:
Does the patient have any communication difficulties, e.g literacy, vision or require an interpreter? Y / N
If yes – please state the nature of support required
Are there any safety/security issues around seeing this patient? Y / N
If yes – please state the nature of issue
Is the patient housebound? Y / N
All patients will be assessed medically by our team and physical activity will be tailored according to their ability. From
your personal knowledge of this patient, please outline any concerns you may have regarding their ability to partake in
any form of physical activity?
Signature
Date of referral
Please return the completed referral form to:
Email: [email protected] Safe Haven Fax: 01204 570 965
Post: ABL Health Ltd, Royal Bolton Hospital, Farnworth, Bolton BL4 0JL
If you wish to speak to a member of the team please telephone:
01204 570 999 between 8am and 6pm
100

Manchester’s Healthy Weight Resource Pack 2012: overweight and obese patients

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New drugs clinic at the Lesbian and Gay Foundatio

Coventry Local School District to Waterloo High School

noche mexicana - SEIU Local 1984