Adult Weight Reduction Referral Guidelines in Derbyshire County

BMI ≥ 25 BMI ≥ 30 BMI ≥ 40 BMI ≥ 45 with related co- Early Intervention Or BMI ≥ 28 with co- or BMI ≥ 35 with related and morbidities morbidities significant co-morbidities BMI ≥ 50 Tier 1 Tier 2 Services Tier 3 Services

ASSESS MOTIVATION (See 5 step tool on reverse )

*IF NOT MOTIVATED — ALL BMI’s: Provide information on risks of further weight gain. Opportunistically reassess motivation level in the future

Motivated Motivated Motivated Motivated

Attended Tier 2 and failed to lose weight Refer directly to Live Life Better BMI≥ 40 must have attended x 1 (Tier 3 service) BMI≥ 35 +co-morbidities must have attended x 3 Advise, signpost and Refer to WaistWise or review in 6 months Health Referral using NO – Tier 2 YES – Tier 3 Derbyshire Health Referral

Information on lifestyle: brief and WaistWise Referral form Refer to Live Life better (formerly Tier 3 weight Reduction consultation and provision of or Service) using LLB referral form or standard letter relevant information. Set up Self Management Patients must fit the service referral criteria outlined in the clinical care

pathway to access this service. Patients must have completed a Tier 2 Signpost to relevant services - WaistWise: 6 or 12 week programme in order to be eligible for referral to this service, unless they have walking groups, leisure centre course. Physical Activity a BMI ≥ 45 with co-morbidities or BMI >50. based activities, local community component. Groups may be based groups. gender specific or mixed. The service provides intensive weight management programmes, tailored to

meet individual needs and delivered by a multidisciplinary team with the Some services available in Health Referral Scheme: following specialist inputs: Psychological, Dietetics and Nutrition, Physical Derbyshire promoting a healthy Currently delivered as a Activity, Occupational Therapy, Key link workers lifestyle: supporting physical activity 5 A Day promotion programme across the pathway. Cooking groups Must have attended LLB Jog Derbyshire Self Management Option: Tier 4 Bariatric surgery: For patients assessed as appropriate the Tier 3 Walking groups - Supported through websites Weight Reduction Service will implement a pre-surgery lifestyle programme, Leisure/Health centre based outlined in the pathway guidance activities which the patient must comply with in order to be referred for surgical or relevant health education intervention. Active Derbyshire booklets provided to the patient. www.activederbyshire.co.uk Live Life Better will offer lifestyle intervention and support following surgery. - Document BMI and weight Bariatric surgery teams will return any referrals that do not meet the criteria or - Review regularly www.nhs.uk/Livewell/loseweight/Pag pre-requisites to the Central Administration Team (CAT). es/Loseweighthome.aspx

For Tier 2 referral forms please e-mail [email protected]

For LLB (Tier 3) referral form please e-mail [email protected]

FIVE STEPS TO ASSESSING READINESS TO LOSE WEIGHT

STEP 1: How to begin STEP 2: Use a rating scale to measure readiness Say something like: “I’m interested in finding out how you E.g. “How ready do you feel to make changes regarding your weight at the moment?” On a scale feel about trying to lose weight. Can you help me by of 0 to 10, where 0 is not ready at all, and 10 is totally ready, what score would you give yourself?” answering a few simple questions? 0-1-2-3-4-5-6-7-8-9-10 Not ready Totally ready Ask targeted open questions: Some suggestions are: Follow up as necessary, with questions such as: “How do you feel at the moment about losing weight? a “What puts you at a _ (chosen number) and not a _ (higher number)?” “How would life be different if you were to lose weight? b “What would it take to move you from a _ (chosen number) to a _ (higher number)?” What changes, if any, are you thinking of making A score of 0-3 indicates that the patient may not be ready to make changes at the moment. It may regarding your weight?” not be the right time to discuss treatment options and may be best to summarise your discussion and make the patient aware of future support. If the patient scores 4 -10 GO TO STEP 3.

STEP 3: Use a rating scale to measure importance and confidence For example: “On a scale of 0 to 10, with 0 being not at all important and 10 being extremely important, how important is it for you to lose weight at the moment?” 0-1-2-3-4-5-6-7-8-9-10 Not at all important Very important “Also on a scale of 0 to 10, with 0 being not at all confident, and 10 being extremely confident, how confident do you feel about being able to lose weight at the moment?” 0-1-2-3-4-5-6-7-8-9-10 Not at all confident Very confident

Use appropriate follow-up questions. Low rating on importance - target questions on what could help to make losing weight a higher priority. Low rating on confidence - target questions on what could help them feel more confident about losing weight. Plan with the patient how to increase importance and/or confidence. Then, when appropriate, ask the patient to rate again. Scores of 0-3 on both scales indicate that the patient may not be ready to make changes at the moment. It may be best to summarise your discussion and make the patient aware of future support. If ratings are 4-6 explore further by using a pro’s and cons list STEP 4. If ratings are 7-10 GO TO STEP 5.

STEP 4: Using a pros and cons list STEP 5: Check barriers to change Ask the patient to list pros and cons or advantages and Before discussing a referral, check whether there are any significant barriers which may disadvantages of losing weight. This can help explore prevent the patient from making good use of the weight management options at the ambivalence (mixed feelings) about change. moment. Check: current stressors/time available/lack of knowledge/support, psychological issues. Plan with patient how to manage or overcome barriers.

Tier 2 Referrals: Health Referral Central Administration Team (CAT), NHS Derbyshire County, Babington Hospital, Derby Road, Belper, Derbyshire. DE56 1WH Or electronically [email protected] Live Life Better Referrals: Live Life Better, The Lodge, Walton Hospital, Whitecotes Lane, Chesterfield, S40 3HW. OR [email protected]