Cut the Waist

Cut the Waist

Illustrative photo for 'Cut the Waist'
Motivating behaviour change and weight management in primary care


In dealing with my own at-risk patient in clinical practice, I have developed a two stage expert patient intervention called Barometer.

Barometer is a motivational tool which helps participants to bring about the lifestyle and behavioural changes necessary to achieve long term weight management success.

Barometer: "Motivation through explanation"

Barometer - Health improvement, risk reductionBarometer is an expert patient weight management programme specifically tailored towards people who have medical problems associated with obesity such as high blood pressure, pre diabetes or established Type 2 diabetes, dyslipidaemia or fatty liver disease.

Barometer serves to motivate and empower through education and ongoing support. The Barometer programme encourages self monitoring to enable individuals to take control over their own lifestyle changes and monitor their success. Step-o-meters, food diaries, serial abdominal circumference measurement, weight and body composition analysis are examples of the various self monitoring tools used as part of the Barometer programme.

The ethos behind the whole Barometer concept is that reductions in weight and waist circumference serve as a useful Barometer to demonstrate that participants have successfully adopted appropriate behaviour changes following the programme. The various monitoring tools therefore serve a useful barometer of behaviour change and health improvement, and provide positive feedback and motivation for ongoing lifestyle change.

Barometer provides high quality patient education to explain the impact of weight on health and encourage confidence in behaviour change by setting appropriate and realistic weight loss targets.

As an intervention, the focus of Barometer is diabetes and cardiovascular disease prevention through successful weight and waist reduction in high-risk individuals.

Barometer as a motivational tool

Barometer content can be used as brief intervention material as part of a practice nurse or GP consultation.

As a motivational tool, Barometer also lends itself to be usefully incorporated into the vascular screening programme for the further management of "screen positive" individuals.

Barometer can also be integrated into a multidisciplinary weight management programme within primary care.

Barometer-motivated patients may be referred to other local weight management interventions such as exercise on referral schemes, commercial slimming organisations and dietetic services, or may be used as an appropriate lifestyle and behavioural change adjunct to anti-obesity pharmacotherapy to enhance efficacy of this therapeutic approach to weight management.

In this way Barometer offers the flexibility to be integrated into a tailored advice and support approach to weight management, depending upon the preference of participants, commissioners and primary health care teams.

Barometer as a specialist multidisciplinary obesity service in primary care

Following a successful pilot, Barometer is now being delivered by NHS Berkshire West PCT in association with Cut the Waist as a tier 2/3 multidisciplinary obesity service in primary care.

The Barometer team comprises two general practitioners with specialist interest in obesity medicine, two practice nurses, a dietitian, a physical activity specialist and a psychologist.

This intervention is highly valued by participants and has been developed as a Practice Based Commissioning Initiative, joint funded by NHS Berkshire West PCT and Eli Lilly via an unrestricted educational grant, donated to NHS Berkshire West PCT by Eli Lilly to promote development and delivery of innovative services to patients.

Ten local practices in Reading are presently able to refer patients to the Barometer expert patient weight management programme. The programme comprises five group education sessions with capacity for ten patients each month. Each Barometer cohort has a twelve month period of ongoing multidisciplinary support as part of the programme.

A "Barometer of Barometer" is tracking the ongoing weight loss success of participants referred to this intervention. If the Barometer MDT pilot proves itself as a successful intervention it is hoped that the capacity of this programme will increase and Barometer will be rolled out to other centres within NHS Berkshire West Primary Care Trust.

For updates on the progress of the Barometer project, follow Cut the Waist Barometer on Twitter.