Journal of Human Nutrition and Dietetics (1998), 11, 207–208

ABSTRACT

An evolution for obesity—SIGN guideline

R. JungNinewells Hospital and Medical School, Dundee, UK

The Scottish Intercollegiate Guideline advice, with an increase in their educationalrole, especially towards community nurses,Network (SIGN) published a definitive report

on obesity in 1996 which is a blueprint for and consider themselves the team leaders of allthose delegated to deliver weight management.the development of a coherent plan for the

prevention and management of obesity in Weight management involves an initial 3-month structured weight reduction plan whichScotland, and hopefully in the UK. The obesity

report was developed using the methodology advises group support, a moderate reductionin energy input of about 2.5 MJ (600 kcal),adopted by SIGN and accepted as the Scottish

national guideline from which local protocols behavioural modification and promotion ofsensible exercise. This is then followed by ashould be derived. The report emphasizes the

prevalence and future predictions for the 3-month programme emphasizing weightmaintenance, although continued weight lossweight of the Scottish nation and the risk that

this poses to the nation’s health. At present is an option. After this 6-month period, furtherweight loss targets can be negotiated.approximately 58% of men and 49% of women

are overweight. The 20% of Scottish children The role of the secondary NHS sector shouldbe one of tertiary referral, with the provisionwith a weight problem suggests that obesity in

Scotland is set to rise into the next millennium. of bariatric obesity surgery for certain patientcategories, based on experience from recentThe report discusses the morbidity and

mortality risks of excess weight and provides trials in Sweden and the USA. Also there is arole for very low calorie diets, but the advice onevidence that a 10% weight loss markedly

improves co-morbid risk factors. Such a appetite suppressants has had to be suspended.Since publication of the guidelinemodest weight loss reduces overall mortality

by 20%, reduces systolic blood pressure by fenfluramine and dexfenfluramine have beenwithdrawn, necessitating a review of the10 mmHg and diastolic pressure by 20 mmHg,

is associated with a 15% fall in HbAlc, a guidance on appetite suppressants, which hasresulted in SIGN withdrawing itsreduction in angina symptoms by as much as

90% and a 10% fall in total cholesterol. It is recommendations on this subsection. SIGNformally reviews each guideline every 2 yearsadvised that all patients are assessed not only

for weight and waist measurement, but also but does react at any other time when asignificant amendment become necessary, asfor co-morbid risk factors and psychological

parameters. witnessed by the above. This rapid responsemakes the SIGN guideline a valued real-timeA modular approach to management is

advised, bringing together in one cohesive plan instrument for an effective delivery ofrecommendations on health practice.a new approach to tackling the weight problem

of a nation. The task is such that the guideline The implication of the SIGN guidelinerecommendations is that the nation’s target forconsiders that it is essential for the service

to be delivered mainly from the community weight will not be reached unless there is somesubstantive financial expenditure, althoughsector, and dietitians should be considered as

having a ‘practitioner’ role in this respect. this should be counterbalanced by the ultimatefinancial gain from having a thinner nation.Dietitians should provide a wider remit of

1998 Blackwell Science Ltd 207

208 R. Jung

Reference no. 8. Available from the SIGN Secretariat,Royal College of Physicians, 9 Queen Street,SIGN (1996) Obesity in Scotland; Integrating

Prevention with Weight Management. Report Edinburgh EH12 1JQ, UK.

1998 Blackwell Science Ltd, J Hum Nutr Dietet 11, 207–208