Whitewater Health PPGManaging a Healthy Weight Project

1. BackgroundWhitewater Health is a GP practice based on 2 sites in Hook and Hartley Wintney and has approximately 17,000 patients. Every general practice in the country is required to have a Patient Participation Group [PPG] as part of their contract with the NHS. The PPG are all patients and volunteers of the practice, and meet as a group on a monthly basis. One of the roles of the PPG is to work with the practice to try and improve the patient’s experience and the service provided.In early 2017 the PPG asked the GP’s what health promotion topic they would like to focus on to specifically target the practice population. The GP’s suggested obesity and self management of a healthy weight.With help from the health policy manager at Hart District Council, a project group was set up with Annette Rushmere and Andrea Thomas from the PPG, Liz Glenn Health Policy Manager from Hart DC, Sarah Preece, Senior Public Health Specialist from Hampshire County Council, Joanna Lockhart Public Health Principal at Hampshire County Council and Paul Davey Head of Communications for North Hampshire Clinical Commissioning Group [NHCCG]. The project group worked closely with the practice manager, Beccie van Oostrum, and two lead GPs from Hook and Hartley Wintney surgeries, Dr Fernando and Dr Hutchings.

2. The projectThe first meeting was held in April 2017and as the project fitted into the NH CCG’s local framework the CCG was happy to support the project.The group was provided with local health profile data [2016] from Public Health England for Hook and Hartley Wintney. Children are routinely weighed and measured at reception and year 6 as part of the National Child Measurement Programme in schools.

2.1 Local DataPublic Health England Data 2016

Obese children %Hartley Wintney Hook Hart England5.6 7 6.5 9.311.6 7.4 12.7 19

Excess weight-children %Hartley Wintney Hook Hart England17.8 18.9 18.2 22.225.9 18 24.1 33.4 Adults %20.7 18.7 21 24.1

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This data was discussed and differences between Hook and Hartley Wintney noted.There was a lot of discussion about campaigns, literature and current research around obesity interventions and different ways of approaching the project.In order for the project to be successful it was agreed that interventions that were recommended needed to be proven to be effective.

2.2 Next steps were: An action plan with timescales was developed Local information was collected with named links The baseline was discussed with the practice Project publicity and communication methods were discussed A launch date with information promoted in local magazines was agreed PPG volunteers would then identify and visit local groups to publicise the project as

widely as possible.

2.3 Baseline in practiceIt was estimated that 8-10% of the practice population are obeseThe following are currently in place:

NHS 20 minute checks for patients aged 40-75 years Opportunistic weighing and BMI checks by GPs and Health Care Assistants Referral to 12 week tier 2-weightwatchers if over 18 and have a BMI of 30+ or 28+

with other medical conditions [ objective is 5% weight loss] Referral to tiers 3 and 4 and onto surgery Obesity register that all GP’s have

The whole practice were committed to the project and very supportive and it was agreed that they would be briefed at each stage. GP’s were asked if they would take a patient’s weight before referring to an initiative and then encourage the patient to come back for progress and to record that data.

2.4 SurveyIt was agreed at the next project meeting that a survey needed to be developed to ask patients how the practice could help them maintain a healthy weight. This was developed with the project group. The survey had 8 questions and asked people :

if they were happy discussing their weight with their GP or nurse would they like more information from a list of choices were people concerned about their/their family’s weight challenges and barriers to maintain a healthy weight from a list if people were happy to be measured that day comments /suggestions age / gender

[Appendix 1 Survey]The project and survey were advertised in the local magazines, placed on the practice website in word format and as an electronic survey and in paper form in the practices, and text messages were sent to all patients. The survey commenced on the 1st October 2017.

2.5 Below is the information placed in the local press:‘Whitewater Health GP practices and the Patient Participation Group in Hook and Hartley Wintney are committed to the importance of promoting healthy weight for all their patients to help improve and maintain their health and well being.

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We want to know how we can support our patients to maintain a healthy weight and have put a survey together which we would be grateful if you would complete. The survey is available in the practice, and on the practice website.’

The practice and the PPG promoted the survey throughout October 2017 and the PPG attended the ‘flu clinics’ to give out questionnaires, which gave a better survey response rate.

2.6 Results of the surveyMost of the responses were from people in the over 55 age group, of which 61% were female and 37% were male. There were 127 responses to the questionnaire.Below is a précis of the results:

95% [or 121 people] were comfortable talking to Dr or Nurse about their weight and 90% felt they could ask their Dr /nurse for support. Other comments were ‘if the nurse was not overweight, difficult to get an appointment with a dietitian, Doctor should raise the issue if it will / is causing a medical problem, evidence based not opinion, and somebody sympathetic not judgemental/privacy/kindness/tone of doctor and to understand- I’m struggling with my weight’.

More information was required on [90 people answered this question]:Healthy food choices x 31% [28 people]Preparing healthy food x 26% [24 people]What is a healthy weight ? x 52% [47 people]Opportunities to get active x 30% [27 people]Local weight management support x 29% [26 people]How to fit exercise around life x 27% [24 people]Other responses were they were well informed and already took exercise

84% [48 people] were concerned about their weight and 25% [14] their family’s weight

70% [ 81] were happy to be weighed at their next appointment, but 30% [34] did not want to be weighed that day.

When asked about barriers, 34% [39] stated their barrier was starting but not able to keep it up and 46% [52] didn’t find it a challenge.People also stated that other barriers were motivation, enjoy eating, lead a busy life, social life, snacking, and that the Doctor should tell people, and healthy lifestyles should be promoted.

[ Appendix 2 Survey results]

2.7 Display and leafletsAs a result of the survey a display was developed, and 2 customised leaflets for adults and children created with the help from the CCG. There were 5000 printed .The displays were put up in both surgeries with associated literature, and 200 customised leaflets were made available in all clinical and waiting rooms in both surgeries.

[ Appendix 3 Display and leaflets]

Weighing scales and height measures were also placed in all the consulting rooms so that the GP’s and practice staff could calculate BMI’s. All practice staff were informed at all stages of the project and were very supportive.

A text message was sent out from the surgery by the practice manager on 25th May 2018 to all patients with known mobile telephone numbers informing them of the project and encouraging them to maintain a healthy weight.

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2.8 Health visitors and school nursesThe health visitors and school nurses were also informed of the project and sample leaflets were sent to the Clinical team lead.She reported that the school nurses were actively involved with the national child measurement programme, following up proactively with parents after results, and raising awareness with children in schools. She also reported that school meals were healthier. Some schools were also taking part in the golden mile initiative promoting exercise in schools.

3. Project Visits by PPG members

A list of schools, nurseries and local groups in Hook and Hartley Wintney were compiled by the PPG members and most PPG members took a group to visit. Groups were divided into age bands. A sample script and key facts sheet together with a pack of leaflets was provided to PPG members to assist them with their visits.

3.1 Visits took place from 12th April -21 June 2018Details are below:0-4 years Hartley Wintney Hook

1. Bumps & Babies 1. Oakley House2. HW Under 5s, 2. Hook Village Nursery3. Monkey Puzzle Day Nursery 3. St John’s Pre-school4. Caterpillars Montessori Pre-School 4. St John’s Toddlers5. James Farm Day Nursery 5. Anchors6. Grey House School Nursery 6. Heather Rabbit7. Pumpkin Patch Mattingley 7. Busy Bees8. Oakwood pre-school play group 8. Scout Hall.

5-16 Years Hook and Hartley Wintney1. Oakwood School2. Greenfields School3. Hook infant and Junior Schools4. The Grey House School5. Whitewater 6. The Base.

55-65 yrs Hartley Wintney

1. U3A2. Over 50s Forum3. Rosefield Luncheon Club4. Hartley Wintney Parish Council

Hook1. Townswomen’s Guild2. U3A

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3. Hook Health Walks– Mondays /coffee at St John’s Church after the walk)

4. MHA Coffee mornings5. Village agents6. St John’s Church Coffee Mornings 7. Local History Group8. National Women’s Register9. Life church coffee mornings10.Hook Parish council

Mattingley Nursery and Mattingley Parish Council

3.2 Script and data collection for each visit 11th April 2018‘Hello I’m from Whitewater Health patients group or PPG. We are a group of voluntary patients from the HW and Hook surgeries that meet up on a regular basis and work with the practice to try and improve the patients experience and the services provided.We are working on a project with the practice to try and help patients maintain a healthy weight. We all know that a healthy weight is vital for a person’s health and well being. There are many resources available locally to help people and on display in the surgeries.Please can you help us make Whitewater health patients healthier ?’Key facts to help youPublic health data for Hartley Wintney and Hook 2016Obese children %

Hartley Wintney

Hook Hart England

Reception 5.6 7 6.5 9.3Year 6 11.6 7.4 12.7 19Obese adults 20.7 18.7 21 24.1

Excess weight %Hartley Wintney

Hook Hart England

Reception 17.8 18.9 18.2 22.2Year 6 25.9 18 24.1 33.4

Waist size‘Measuring your waist is a good way to check you're not carrying too much fat around your stomach, which can raise your risk of heart disease, type 2 diabetes and stroke. Regardless of your height or BMI, you should try to lose weight if your waist is: 94cm (37ins) or more (men) 80cm (31.5ins) or more (women) You are at very high risk and you should contact your GP if your waist is: 102cm (40ins) or more (men) 88cm (34ins) or more (women)’

Data collection / Questions to ask-adapt per group1. How many families attend this nursery / playgroup etc ?-give out leaflets 1 per

family2. Have you seen the display / information in the surgeries / website ?

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3. What could you/ your group do to help us promote this project?4. Does your group do anything to help people eat well or be more active?

3.3 Comments from PPG following visits

0-4 yearsAltogether all 16 nurseries and playgroups in Hook and Hartley Wintney were visited and given leaflets, posters and information about the project. All the nurseries reported that they had distributed the leaflets, but not much feedback was received from parents. Oakleigh House [Hook] reported that the parents of the toddler class found the leaflets useful. St John’s Church playgroup [Hook] had independently invited a GP and a dentist to visit the playgroup and they were very pleased with the information the children received regarding their health.

5-11 yearsFive out of 6 schools were visited, and the sixth school [Oakwood] was informed about the project informally. All the schools were very supportive of the project and agreed to place PDF’s of our leaflets on their electronic newsletters to parents. They all agreed to place the posters in the school. Children have fruit snacks and healthy lunches that are now calorie controlled and physical activity is promoted. Greenfields school head thought that this would be a good project for their school council to take on later. Hook Infants school asked for someone to talk to the children about healthy eating-but so far this has not been achieved.

Whitewater and Hook Junior schools take part in the ‘Golden mile’, Greenfields school has its own variation called RAG-‘Run Around Greenfields’, and information was given to Hook infants school. The Grey House promoted physical activity and was very supportive of the project, but unfortunately the school has now closed.

55-65 yrs+

HookAt the life Church Coffee morning [Hook] on 23 May, 7 people attended and listened to the project description with interest, and 2 people had seen the display in the surgery. Ten leaflets were left about the project and 6 PPG leaflets.The Hook local history group were contacted but had completed its meetings, and the National Womens’ Register group were not able to accommodate the PPG until the autumn. The MHA group and the St Johns walking group were also informed of the project and leaflets were left.

MattingleyThe local nursery was visited and Mattingley parish council was informed of the project. The council suggested that information was placed in the local magazines.

Hartley WintneyAt the Over 55s Forum 29 people were provided with leaflets and informed about the project.

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At the Methodist coffee morning 9 people were informed and provide with literature.At Hartford court coffee morning 13 people were informed and provided with a leaflet.At Rosefield court 12 people were informed and provided with a leaflet.At Hartley Wintney U3A, the PPG were not allowed to talk to the group, but as people arrived for the monthly meeting 99 people were given leaflets.Comments received were:‘That the real obesity epidemic is not amongst the old, and that there is some evidence that a surprising number suffer from malnutrition. The real issue is amongst children. People were pleased to hear that the PPG were planning to engage with schools and parents’.

3.4 Presentations by chairAs well as project visits, the chair made several presentations /provided a stand about the project to various groups listed below:

1. CCG PPG meeting held on 16th February 2018, a presentation to the CCG and to the other PPG representatives from other GP practices in the CCG area.

2. Hartley Wintney and District over 55s forum on 20th February 2018, a presentation to the various voluntary groups.

3. Hook Parish Council Annual village meeting on 23rd May 2018, a presentation and stand with PPG members, where approximately 80 people attended.

4. CCG TARGET event held on 4th July, a stand only and approximately 80 people attended this event.

5. Information Day at Hartley Wintney on 3rd August 2018, a stand and a short presentation.

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4. Evaluation Evaluation of the project has included data from the questionnaires, results from the yes / no boxes, data from the practice staff, as well as data from weight watchers, healthy walks, GP exercise referral to leisure centre and new membership to Hook runners in the last 6 months.

4.1 QuestionnaireA simple questionnaire was developed with help from the health policy manager to evaluate the project.The practice manager alerted staff and GP’s, put the survey into survey monkey and placed the information on the practice website as well as providing paper copies in the surgeries.During the week of 13 August 2018, PPG members had one hour slots in both surgeries to manually give out questionnaires. Altogether approximately 20 hours were covered over the whole week.

4.2 ResultsResults were manually inputted into survey monkey:180 responses were received, with 122 from Hartley Wintney and 58 from Hook.

Question1 ‘Have you been into the practice in the last 6 months’?[179 answered] 84% [151] have attended and 15% [28] had not

Question 2 ‘If you answered yes did you notice the healthy weight display?’[156 answered]Yes 19%[ 31] and no 80% [125]

Question 3 ‘Did you hear about the managing a healthy weight in any of the following ways?’[31 answered]Text message from surgery 32% or 10 peopleLeaflet from a school or group 19% or 6 peopleWhitewater health website 19% or 6 peopleFriend or family member who had been to the surgery 29% or 9 peopleOther comments were:

Saw in the surgery x 9, and via doctor Through friend, forum meeting, and focus article

Question 4 ‘Did you use any of the following information from the campaign?’[31 people answered]One you website 3% or 1 personHealthy eating apps 32% or 10 peopleHow to measure BMI etc 29% or 9Weight watchers 22.6% or 7Hook runners 16% or 5Power 3% or 1Health walks 25.8% or 8Exercise apps or websites 22.6% or 7Email or text people more

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Question 5 ‘Is there anything else the practice could do to help patients maintain a healthy weight?’[67 answered]Responses

On a visit give individual view / assessment of their weight, provide help and track x 5 people . ‘Don’t be scared to tell us!’

Warn re type 2 diabetes Facilitate access to dietitian x2 Teach children and young mums to cook Think practice has done a great deal-keep it up! Social media / facebook Put something in with prescription Several people unaware of project

[Appendix 4 Evaluation survey]4.3 Display yes /no boxesBoxes were also provided in both surgeries asking people to place raffle tickets in the boxes indicating if they found the display helpful.ResultsHartley Wintney HookYes x 17 and No x10 Yes x 30 and No x 6

Out of a total of 63 responses, 47 found the display helpful and 16 did not, so the majority of people found the display useful.

4.4 Data from the practice staffA short questionnaire was developed for practice staff to complete. The practice manager circulated this to all [40 people]. Four responses were received. The following are the responses :

1. The display Was excellent but I didn’t have any patients specifically mentioning it. Patients do seem to be more keen and happy to discuss their weight. Until I received this email, I wasn't aware there was a PPG Healthy Weight

Project. I didn't pay any attention to the display, and no patients referred to the project.

For some reason I have had a flurry of people wanting to lose weight, but this might be random variation. I suppose it might be subconscious recognition from the poster.

Did not see-no sorry Display was very helpful and referred patients. I noticed an increase in

patients wanting to discuss their weight. Feedback from patients seeing display made them more aware and got them thinking about weight loss, and wanted to know why it had been taken down.

2. The leaflets Are brilliant and I have used it a lot. The information within it is excellent and

the code to refer to weight watchers saves a lot of time I didn't use the leaflet when I discussed weight loss with them. Occasionally used. Seems good, succinct, good advice and links provided Used leaflet but not as much as I could

3. Referrals 9

I have referred a lot of people to weight watchers and some to Hook runners. I've made a few referrals to weightwatchers this year. Referred to weightwatchers and weighed a few. I have referred to weightwatchers and Hook runners and weighed more

patients.

4. Project overall I think the project was really helpful and definitely made it easier to discuss

weight especially as the leaflet has so much helpful information. To be able to suggest something constructive is so much better than just saying 'eat less and exercise more'.

So overall, the project didn't have any specific impact of my management of people with obesity. Sorry that this doesn't appear to be enthusiastic, and I'm sorry that hard work might have gone unnoticed. I genuinely didn't pay attention to the project. Obesity is such a significant problem, I'm grateful that the PPG are attempting to give us some tools to help patients who want help with this.

The project encouraged me to discuss patients weight Project was quite helpful, and try to remember to use leaflet more ! Overall the project was very helpful in raising awareness and encouraged me

to discuss patients weight. Thank you so much for the time and investment in this excellent project.

4.5 Data from weight watchersWeightwatchers provide a 10-12 week course free to people with a BMI of 30+. People can self refer or be referred by a health professional. Completers are defined as those who have attended at least 10 out of 12 sessions. Lapsers are defined as those who have attended any number of sessions from1-9. The national average completion rate is 55%, and the contract target agreed by public health Hampshire with weightwatchers is 52%.

The completion rate is the number of completers/number of completers+ lapsed members. [Active members are not included as they have yet to complete.]

On 5th July 2018 the data for the previous 6 month period was:28 new referrals9 completers and all 9 lost more that 5% weight loss12 are currently active and 7 have lapsed out. Weightwatchers calculate the completion rate as 56%However 9/28 is 32%

4.6 Data from Healthy walks Hart health walks reported that in the RG27 area which covers the Hook and Hartley Wintney walks, in December 2017 there were 9 new walkers, and 11 new ones in January 2018, [and 35 as a total for Hart.]Walkers in the Hartley Wintney area are now increasing while those in Hook are remaining as a stable number.In Hart district as a whole, from April 2017-March 2018 there are 61 new walkers.

4.7 Data from GP exercise referral to leisure centreEveryone Active confirmed that they have had 4 referrals from Hook and Hartley Wintney surgeries since January 2018.

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4.8 Data from Hook RunnersHook running club currently have 208 paid members for 2018-19, of these 139 are female and 69 are male. The age breakdown is as follows

18-20 - 021-25 - 126-30- 1231-35 - 2336-40 - 3741-45 - 4246-50 - 4651-55 - 2856-60 - 1461-65 - 466-70 - 1

58 of the members for 2018-19 are new members to the club - joining since 1st April 2018.

5.Findings /ResultsThe project has taken from April 2017-September 2018 to complete, and has involved a multidisciplinary team with a collaborative approach. All have been very supportive and helpful throughout providing expertise and guidance.

It has been very helpful to engage with the Hart health policy manager, the communications team from the CCG, and public health specialists.

Although many of the practice staff did not complete the evaluation survey, those that did were on the whole positive about the project and there were also several informal positive responses. GP’s stated that they found the display helpful, it helped to raise awareness, to discuss a patient’s weight and they found the leaflets very helpful.

The project has also raised the profile of the PPG with the patients, the practice and with the CCG, and has involved PPG members actively in a defined project. The PPG is now better known locally, although it is better known in Hook than HW.

Altogether 6 schools, 15 nurseries and playgroups and 15 other local groups including all three parish councils were visited and or informed of the project. There were also 4 presentations and 5 display stands .

Results from the first survey were surprising as although the public have been deluged nationally with healthy lifestyle information over the past 20-30years, people felt that they didn’t know about healthy food choices, preparing healthy food and 52 % didn’t know what a healthy weight was. People wanted to know what opportunities locally were available for exercise and how to fit exercise into a busy life.84% people were concerned about their weight, and 25% of their family’s weight, and although most ie 70% were happy to be weighed, 30% were not.Some people still think they should see a dietitian to help them lose weight.

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In the evaluation survey, it was interesting but perhaps not surprising that when asked, when people visited the surgery, 80% did not notice the display. However, when asked in the yes / no box if the display had been helpful 47 people found it helpful.When people visit the surgery they are focussed on signing in, sitting down, and then being called. Most people do not get up, walk around or look at the displays / notice boards. One comment was the ‘boards were too busy and it becomes like wallpaper’.A few people acknowledged that they heard of the project via text, leaflet, website or a friend.Most people used the healthy eating apps, some used the BMI measurement, weight watchers and exercise apps.

The practice referred 28 new people to weight watchers, 9 completed the course and 12 are currently active.

There are 20 new people ‘healthy walking’ in Hook and Hartley Wintney, and Hartley Wintney numbers are increasing, while Hook numbers are constant.

There were 4 new GP exercise referrals to the Hart leisure centre.

Hook runners have increased their membership by 58 since April 2018.

It is clear that people think that GP’s should play a major role in identifying overweight and obese patients, and should explain the risks to them, and not ‘be scared’ to confront them.It was suggested that information be put in with prescriptions and that the practice should text people more.

This was a very worthwhile project, helping to raise awareness of obesity and managing a healthy weight in the practice population. It provided the GPs and practice staff with a practical tool in the form of customised leaflets to give out to patients. The project will be revisited in the future as the challenge of obesity as a major healthcare problem still remains in the population.

Annette RushmereChair Whitewater Health PPG 14th January 2019

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APPENDIXAppendix 1 Initial Survey

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Whitewater Health GP practices and the Patient Participation Group in Hook and Hartley Wintney are committed to the importance of promoting healthy weight for all their patients to help improve and maintain their health and well being.

We want to know how we can support our patients to maintain a healthy weight

Please would you complete the short survey below to help us help you.[The survey will take around five minutes to complete.]

Any information you provide will only be used in accordance with the Data Protection Act 1998 and will be held securely. We will not share your information with anyone. The information we collect about you during the survey will be combined with all the information we collect on everyone involved so that you cannot be identified.

Any information you provide will be kept until the end of the project and it will then be securely destroyed.

Information provided for this survey will not be used for any other purpose than those specified.

1. To what extent do you agree or disagree with the following statements? [please tick relevant box]

I would feel comfortable…

Strongly Agree

Agree Neither Agree or Disagree

Disagree Strongly Disagree

Talking to my doctor / nurse about my weight if they raised the subject with me

Asking my doctor / nurse for support in managing my weight

2. What would help you feel more comfortable to discuss your weight with your doctor / nurse?

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3. Would you like more information and support for any of the following? [please tick all that apply]

□ Healthy food choices

□ Preparing healthy food

□ What is a healthy weight

□ Opportunities to get active in my local area

□ How to fit physical activity around my life

□ Local weight management support

□ Other, please give details

…………………………………………………………………………………………

4. Are you concerned about either of the following? [please tick all that apply]

Your weight Your family’s weight

5. Maintaining a healthy weight can be challenging for many people. If you feel this applies to you, what would you say your main challenges/ barriers are in trying to reach or maintain a healthy weight? [please tick all that apply]

I don’t have time

It’s more important I look after others

I don’t know what to do

I don’t have the money

I start but can’t keep it up

I’m ill or disabled

Other I would rather not say

Or I don’t find it challenging

6. Would you be happy to have your height / weight measured today?

Yes No

If yes, please let your doctor / nurse know when they see you

7. Do you have any other comments or suggestions about how we can help you/ your family to maintain a healthy weight ?

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8. What is your gender? [Please tick one box]

□ Male

□ Female

□ I would rather not answer

9. In which age category are you ? [Please tick one box]

□ Under 18

□ 18-24

□ 25-34

□ 35-44

□ 45-54

□ 55-64

□ 65-74

□ 75+

□ I would rather not answer

Please put survey in box at reception

Thank you

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Appendix 2 Survey results

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Question 3

What would help you feel more comfortable to discuss your weight with your doctor / nurse?

Answered: 72 Skipped: 55

Nurse x 5Doctor x 2I would have to see my own registered Doctor. Nurse and doctor x 1Either x 17Happy with either Whoever I don’t mind

Nothing I would feel comfortable I would feel comfortable anyway Nothing I have no problem discussing that subject This has never been a problem but I would happily discuss any health matter with

our doctor I have no problem with talking about it now I would never feel uncomfortable I’m happy to discuss weight with both I would feel completely comfortable anyway I have no issues anyway - happy to discuss. Problem is lack of advice from

dieticians If the nurse was not overweight!

I have raised the subject myself. I found it difficult to make an appt with a dietitian. Unsure. I think the Dr should raise it if they believe it will cause /is causing a

medical problem Health Concerns Happy to discuss weight at any time without caveats or predictions If the appropriate amount of time was available to discuss it properly availability of

options after discussion within the local area . Knowing they would give me a tailored ‘diet’ for each meal over a 2 week period. A

list of “good” things means nothing to my wife. Evidence based information and not opinion. And me approaching it - not them Have already spoken to nurse regarding weight very helpful I do keep my weight at a good level An appointment Being monitored to help lose weight eg weekly weigh

N/a x 4 Nothing I have no issue about it None No problem Never had a problem

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Honesty

Diet advice on line Visible charts to show weights and worries

Somebody sympathetic Not being judged A non-judgemental response. Privacy and kindness. No judgement. Nothing really, in the light if my earlier answer. What would put me off is the tone

that any doctor might use to discuss my weight For them to understand if I’m struggling with weight problems it is not easy Knowing there is help for me. Not just eat better but things I could do for myself. I would be happy to talk to either. Really need help with my weight and any advice

help would be greatly appreciated It's something I need to face up to and resolve so likely.

Simply don’t understand this survey if weight is a health issue( which it is) why feel constrained talking about? How do you cope with issues around STDs and mental health?

Everything is very good

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Question 4

Would you like more information and support on any of the following? Other

Answered: 90 Skipped: 37

I don’t need any info /support and already well informed and able to react as appropriate/ or required

No x 8 I know these. Sticking to them is the problem. No concerns Not at the moment, thank you. Dietician in surgery Discussion with trained dietician My BMI is very good so I don’t need any info or support I am conscious of and sensitive to my weight I’m a keen runner and am informed about healthy lifestyle At the moment not necessary Refer people to Fleet Health I’m not fat I’m underweight so none of this is relevent to me Swimming Opportunities to get active in my local area - very much

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Question 6 Maintaining a healthy weight can be challenging for many people.  If you feel this applies to you what would you say the main challenges / barriers are in trying to reach or maintain a healthy weight (please tick all that apply )OtherAnswered: 112 Skipped: 15

Motivation once the target weight is reached. No TY. Perfectly capable of appropriate DIY action if required Promote healthy lifestyles to the community further My wife cannot stick to a plan . Make it easy Do not think NHS will cover excess skin surgery Not really None x3 Only me to be concerned about No comment Doctors should tell people cannot stick whatever Know what I should do but don’t do it ! Survey about internal weight around organs emphasise more publicly how bad fizzy drinks are etc and hidden sugars in

prepared meals When issued with a prescription for gym I went I was left waiting by the trainer I was

seeing for 25 mins he then said his next client was here so we would have to rearrange, even though it was a booked slot, I did moan and he told his manager her had forgot he had my appointment and hadn’t seen me, I had spoken to him he said he would be 5 minutes he wasn’t, I could see him the entire time he was flirting with a female staff member. Took a lot for me to go and it made me feel extremely low. I’ve tried weight watchers through the surgery but no answer or call back received from the organiser, I firmly beleive that swimming would be the best form of exercise for me as I’m obease, I do go but financially I can’t go regullarly.

Comments on 7 maybe notices on the board re opportunities to get active in my local area

I just really enjoy eating and having alcohol 3 or 4 days a week. Menopausal My previous doctor in Northamptonshire told me to lose weight as i was at risk of

cancer and diabetes. Great incentive - I lost 2 stone! lead a very busy life and eat what I can when I can social eating I love food Snacking at certain times of the day eg. when watching TV; reminding oneself of

the number of calories in alcoholic drinks which are basically unnecessary calories.

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APPENDIX 3 Display and leaflets

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APPENDIX 4 Evaluation questionnaire

Whitewater Health and the Patient Participation Group‘Managing a Healthy Weight ‘project.

Over the past 6 months we have been promoting a project to help patients achieve and maintain a healthy weight. Please would you complete the short survey below to help us evaluate this project.

Any information you provide will only be used in accordance with the GDPR and the Data Protection Act 2018 and will be held securely. We will not share your information with anyone. The information we collect about you during the survey will be combined with all the information we collect on everyone involved so that you cannot be identified. Any information you provide will be kept until the end of the project and it will then be securely destroyed.Information provided for this survey will not be used for any other purpose than those specified.-------------------------------------------------------------------------------------------------------

1. Have you been into the practice in the last six months ?

Yes No

2. If you answered ‘yes’ to question 1 did you notice the healthy weight display?

Yes No

3. Did you hear about the ‘managing a healthy weight’ project in any of the following ways?

Text message from the practice

Leaflet from a school or group you belong to

Whitewater health website

Friend or family member who had been into the surgery

Other-please give details

4. Did you use any of the following information from the campaign?

One Youwebsite

Healthy Eating Apps

How to measure BMI / waist measurement

Weight Watchers

Hook Runners

POWeR Health Walks

ExerciseApps orwebsites

5. Is there anything else the practice could do to help patients maintain a healthy weight ?

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Thank you 16 July 2018

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