Quality statement 5: Weight loss

Quality statement

Adults with osteoarthritis who are overweight or obese are offered support to lose weight.

Rationale

Weight loss is a core treatment for osteoarthritis that will improve joint pain and function. Adults with osteoarthritis who are overweight or obese should be offered support to help them to lose weight, which may include weight‑loss programmes tailored to their individual needs. It is important that support and encouragement to lose weight are ongoing and reinforced at every opportunity. Ongoing weight management support may be needed to ensure that a lower weight is maintained.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with osteoarthritis who are overweight or obese are offered support to lose weight.

Data source: Local data collection.

Process

Proportion of adults with osteoarthritis who are overweight or obese who are offered support to lose weight.

Numerator – the number in the denominator who are offered support to lose weight.

Denominator – the number of adults with osteoarthritis who are overweight or obese.

Data source: Local data collection. Data on BMI values and dietary advice are included in the 'care.data' extract for the Health and Social Care Information Centre (not specific to people with osteoarthritis). Data on BMI values and weight advice are included in the Keele Primary Care Consortium Osteoarthritis (OA) e-template for primary care consultations (endorsed by NICE).

Outcome

a) Weight loss in adults with osteoarthritis who are overweight or obese.

Data source: Local data collection. Data on BMI values are included in the 'care.data' extract for the Health and Social Care Information Centre (not specific to people with osteoarthritis). Data on BMI values are also included in the Keele Primary Care Consortium Osteoarthritis (OA) e-template for primary care consultations (endorsed by NICE).

b) Patient satisfaction with support to lose weight.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (GPs, community healthcare providers and hospitals) ensure that processes and referral pathways are in place so that adults with osteoarthritis who are overweight or obese are offered support to lose weight.

Healthcare professionals ensure that they offer support to adults with osteoarthritis who are overweight or obese to lose weight, such as referral to a weight‑loss service.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with osteoarthritis who are overweight or obese are offered support to lose weight. Commissioners also ensure that there is sufficient capacity in weight‑loss services to meet demand for adults with osteoarthritis.

What the quality statement means for patients, service users and carers

Adults with osteoarthritis who are overweight or obese are offered help to lose weight, because being overweight can make joint pain worse and losing weight should improve symptoms.

Source guidance

  • Osteoarthritis (2014) NICE guideline CG177, recommendations 1.2.5 (key priority for implementation) and 1.4.3

Definitions of terms used in this quality statement

Overweight or obese

An adult with a BMI of 25–29.9 kg/m2 is classified as overweight and an adult with a BMI of 30 kg/m2 or more is classified as obese. Waist circumference may be used in addition to BMI to identify health risk in people with a BMI below 35 kg/m2. BMI may be a less accurate measure of body fat in adults who are very muscular, so BMI should be interpreted with caution in this group. Some other population groups, such as people of Asian family origin and older people, have comorbidity risk factors that are of concern at different BMIs (lower for adults of an Asian family origin and higher for older people).

[Adapted from Obesity: identification, assessment and management of overweight and obesity in children, young people and adults (NICE guideline CG189) recommendations 1.2.7 and 1.2.8]

Support to lose weight

Support to help someone with osteoarthritis to lose weight should focus on diet and physical activity, and may also include pharmacological and surgical interventions. The level of support should be determined by the person's needs, and be responsive to changes over time. Weight management programmes should be delivered by a trained professional. They should include behaviour change strategies to increase physical activity and encourage healthy eating. Pharmacological and surgical treatment options should be considered only after dietary, exercise and behavioural approaches have been tried and evaluated.

[Adapted from Obesity: identification, assessment and management of overweight and obesity in children, young people and adults (NICE guideline CG189) recommendations 1.2.11, 1.4.1, 1.4.4 and 1.10.1]

Equality and diversity considerations

Healthcare professionals should take into account cultural and communication needs (including any learning disabilities) when providing information and support for adults with osteoarthritis. This should include providing printed information for people who cannot access information online and providing information in accessible large print and easy read formats where needed.

When referring adults with osteoarthritis to a weight loss service, any potential difficulties in accessing services, which may include distance, disability and financial obstacles, should be taken into account.