Shared learning database

Adams Insight Ltd (Adams Portion Pot)
Published date:
September 2009

Practical tool to help overweight and obese people to manage recommended calorie deficit

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim has been to develop a practical tool to help overweight and obese people self manage the NICE recommended calorie deficit with a measure of accuracy without needing to count calories. The tool had to be able to teach individuals to visually measure quantities of food and provide a specific guide to assist patients to stay within the calorie range as described by NICE. The anticipated impact of this was to increase clinician confidence in implementing the specific NICE recommendation and to raise self-confidence and self-efficacy in obese individuals to manage their weight and reduce their dependency on commercial or other external support. 1. To use the NICE guidance (CG43) and Food Standards Agency 'Eat well' guidance and produce a nutritionally balanced food, drink and exercise portion system that would enable obese individuals to keep within the recommended range of calories required for effective weight loss, whilst upholding a nutritional balance 2. To develop an affordable measuring pot that would teach individuals how to visually measure the right amounts of the right foods to stay within the calorie range required for weight loss 3. To promote and facilitate self management of weight and reduce the need for obese individuals - in particular those on a low income, to rely on external support for life long weight management.

Reasons for implementing your project

For five years I managed an NHS Obesity service where many of the patients were on a low income, had low expectations, often poor literacy and had battled with their weight for many years. Describing portion control was difficult for reasons of ambiguity in describing a portion size, commercial confusion in the supermarket and the promises of quick fix diets in the popular media. We were delighted when the NICE obesity guidance was published providing clear calorie guidance for weight loss. However, the difficulty of describing portions and measuring calories in visual terms remained a problem despite the advances in food labelling - patients often underestimating the amount of food they ate. In my NHS role I searched for tools to help and was disappointed at the lack of inexpensive practical tools available. I finally teamed up with my husband, a designer with a manufacturing background, to develop a portion pot weight management system. We introduced the first pots in 2007. The Pots provide vertical bar measures of a single portion of a variety of everyday foods from each nutrient group. Users are given a numerical guide of how many portions of each nutrient group to consume each day to achieve the calorie deficit. (See Pot samples provided) The Pot has been used in primary care for two years. The Pot system has been further developed and it is now a complete 'service in a box' with full interactive behaviour change, exercise and nutritional support available on a dedicated website. We have also developed an Alcohol Portion Pot. This provides measures of alcohol portions and units of alcohol based on the % volume of each alcoholic drink. We have been able to produce the Pot at a very low cost (from £4.90), which makes it an affordable option for public sector/workplaces to purchase for their target audiences and distribute widely. The Pots are also available to purchase by individuals online.

How did you implement the project

Objective 1 A recognised system distributing the recommended 1500-1600 kcals a day across the right nutrient groups for optimum physical health provided the foundation for the Pot development. The NICE guidance for physical activity was also integrated. The Daily Balance: 7-8 portions of starchy carbohydrates 7-8 portions of vegetables/fruit 2-3 portions dairy/dairy alternative 2-3 portions protein 0-2 portions fats/sugars/alcohol 30 minutes of brisk physical activity The Pot system also suggests the amount of energy expenditure required to use up any excessive calories consumed - further supporting the recommended calorie deficit guidance. For example; 25-30 minutes of brisk activity = 1 portion fats/sugar and alcohol Objective 2 We designed, developed and produced a plastic pot and took a selection of everyday foods from each of the nutrient groups, measured a single portion quantity and printed a vertical measuring bar on the pot for each selected food. We recognised that we could only provide printed measures for a small selection of foods, so also printed a mm/ml measure on the cup and provided updated printable downloads on a wide selection of foods on the website for no extra charge. The Pot has been in use in primary care for two years. Objective 3 - We designed a colour coded 'Tick Box' chart which enables users to tick off the number of portions they consume/ record the exercise taken. This was a designed to be used across literacy levels and the pot has received interest from services for Adults with Learning Difficulties - We promote visual measurement of quantity rather than exact measurement as a way of teaching people how to manage their own food consumption, without having to calorie count/read labels/follow a nutrionally imbalanced regime. Self-management extends the reach of the NICE guidance, by putting the guidance into the hands of the public/patient

Key findings

The Portion Pot evolution from concept to product has taken time and investment. We are now preparing to commission a RCT of the Pots in 2010 to evidence what we know anecdotally to be the outcomes of Pot use with obese and overweight patients. Consultation and clinician/ patient prompted feedback is the basis for the anecdotal evidence. We recently developed an online performance tool to capture outcomes more accurately. This tool was operational from Aug 2009 so currently the quantity of data available over a meaningful period is insufficient to evidence the long term results. We have supplied over 100,000 pots since 2005 which have been distributed across the UK and Ireland. The main purchaser the 'early' pots (a pharmaceutical company- NB we have no relationship with this company other than as a supplier of goods) has not maintained records of outcomes relating to pot usage. However clinicians have contacted us noting improved outcomes for those patients using the Pot compared with those who have not. They describe confidence in the system as it is built on the NICE guidance. Clinicians describe the Pot as a reference point for patients when at home and demonstrates how the NICE recommendation can be implemented with ease. Users report that the Pot - helped them recognise how they were overeating - taught them how to measure portions visually - promoted gradual weight loss between 2-5lb a week Barriers At the time of development there was no known NHS product investment available. The decision to develop the pot privately was the only expedient option. Implementing the Changes The Pot is purchased by public sector/workplaces/pharmaceutical companies and used as a support tool within weight management clinics and distributed widely across populations as a DIY tool. Outcome Monitoring Our web based performance tool reports - Uptake of use of pot (in % terms) - Weight changes over time for those using the pot and web tools

Key learning points

Clinicians comment that their weight management advice is constrained by - Their nutritional training/ knowledge - The mixed, subjective interpretation of portion messages by patients - The educational ability/literacy of patients - Time to fully inform patients of all they need to know to manage their weight Clinicians report that the Pot brings to life key nutrition messages for patients, which they otherwise fail to achieve through consultation or literature alone. Whilst we feel the Pot is a simple low cost solution our learning to be transferred is around confidence to innovate. The best ideas are often the simple ones, as the Pot has proved. We would encourage health service workers to consider innovative ways to implement guidance published through talking with colleagues and patients, being prepared to think "out of the box" when problem solving, and being willing to try new ideas out!

Contact details

Sarita Adams
Development Manager
Adams Insight Ltd (Adams Portion Pot)

Is the example industry-sponsored in any way?

private company