Examination of Witnesses (Questions 1104-1119)
18 DECEMBER 2003
MS PAULA
HUNT, DR
JACQUIE LAVIN,
MS JACKIE
COX AND
DR HELEN
TRUBY
Q1104 Chairman: I welcome our final group
of witnesses. Thank you for your submissions. We have had a fairly
brief session this morning, and we would be grateful if you could
give concise answers, and you can follow up with written information.
Would you briefly introduce yourselves?
Dr Lavin: I am Jacquie Lavin,
Partnerships Manager at Slimming World. We were involved in the
feasibility studies which Amanda Avery mentioned earlier.
Dr Truby: I am Helen Truby. I
am a dietician and nutritionist from the University of Surrey.
We run a large training institution for nutritionists and dieticians.
The reason we are here today is that I am the principal investigator
of the Diet Trial Study, which examines the effectiveness of commercial
weight-loss programmes in the UK.
Ms Cox: I am Jackie Cox, Joint
Chair of TOAST, The Obesity Awareness Solutions Trust, which is
a charity that originated in 1996 because there was nothing out
there for obese people.
Ms Hunt: I am Paula Hunt, a nutritionist
and dietician. I have 20 years' experience as a dietician and
I am here today representing Weight Watchers. Weight Watchers
is all about a balanced, healthy, moderate diet of normal food.
Q1105 Dr Naysmith: We will start with
a very brief question: why do most diets fail?
Dr Truby: I do not think it is
necessarily that the diets fail. Most diets will work if people
stick to them, but the trick is finding an eating plan.
Q1106 Dr Naysmith: To re-phrase my question,
why is it that most people who undertake a diet regime fail in
achieving their objective?
Dr Truby: Okay, that is a completely
different question.
Q1107 Dr Naysmith: That is the one we
really intend to put.
Dr Truby: In terms of people's
objectives for weight loss, they are often quite unrealistic.
If people start off thinking their objective is to lose four or
five stone, this can be very difficult to achieve. This is one
of the clear outcomes of Diet Trials: people who went in with
those kinds of aims were often disappointed at both the rate of
weight loss and their ability to sustain it. People then become
disillusioned and give up, whereas if people had a more realistic
idea of the sort of weight loss they could expect, perhaps one
or two pounds a week, with the aim of maintaining a body weight
10 per cent lower than they were, then that is more realistic
and achievable. It is probably people setting themselves with
high ideas of what they are going to be able to do, who have ups
and downs and look at themselves in terms of failing, whereas
there needs to be more awareness of the health benefits of some
loss, even though they might not ever get down to the size they
really want to be.
Q1108 Dr Naysmith: Ms Hunt, you set targets
for people and quite often they fail. Actually I am an example
of one of those. I have begun, but failed to complete a parliamentary
Weight Watchers weigh-in.
Ms Hunt: There is always another
chance, as there is a regular weigh-in weekly on Tuesday evenings.
Q1109 Dr Naysmith: At the next session
I might start again.
Ms Hunt: For me, the thing at
the heart of this is about motivation. Because of the time constraints
of the system within the NHS there is very little time for busy
GPs and practice nurses, and dare I say busy dieticians—because
I have been one and I know that developing people's motivation
and helping them sustain that throughout this change process—because
let us be realistic, it is a hard work, hard slog, and ongoing
and for life. If you have a difficulty with maintaining your weight,
without it sounding like a life sentence, you are always going
to have to work hard at that. I think this business about motivation
is something that is key, and the recent health development agency
review has highlighted the need for ongoing support. I have to
say that one of the things we believe is a big part of the success
of something like Weight Watchers is that it can offer lifelong
support. The evidence is showing very clearly that with support
people can succeed in losing weight. Helen has talked about the
10 per cent weight loss. However, the evidence has shown that
as soon as that support is withdrawn, people then start to re-gain.
Ms Cox: Many overweight and obese
people have lost loads of weight in the past, and I think one
of the fundamental errors is that the problem has been seen as
a weight problem; so therefore when you have lost some of the
weight, you have lost the problem; and you certainly have not.
Maintenance has been much neglected over the whole spectrum, both
in the NHS and the commercial organisations. There is a great
misunderstanding of the problem. As well as being seen as a weight
problem, it has been seen as just a food problem—so if you
teach somebody how to cook a low-fat chocolate cake, they will
be cured; whereas most people in this country are quite knowledgeable
about whether they should have an apple or a Mars bar, and that
they should walk about more and so on. My background is psychology,
and I have worked with people with a drink problem, and in fact
I chose to do that because I was interested in the links between
those with a food problem and some of those with a drink problem.
Some of you may recognise this in your own behaviour. When I worked
with groups of alcoholics, if I put a blindfold on, I might as
well be dealing with the same group of people; and the language
around the misuse an over-consumption of alcohol is very, very
similar when you talk to overweight/obese people. That has been
grossly misunderstood. You need to look also at the other areas
that have changed over the last 20 years—and I will just
chuck the word "stress" in. We have to look at other
changes in society as well as the ones you have spent a lot of
time looking at—changes in the food industry and so on.
Weight management programmes at all levels need to understand
what they are dealing with, and I think there is a lack of understanding
both in the industry and—
Q1110 Dr Naysmith: We are very clear
that there are all sorts of other things that contribute to gains
in weight, but at the moment we are particularly concentrating
on diet and what effect that has. Do you think people embark on
diets, as was suggested by Ms Hunt, expecting too much to be achieved,
does that fit in with what you believe?
Ms Cox: Certainly the great health
benefits of losing 10% is a valuable message to get across but
the health benefits increase the more you lose. It would be a
shame to simply focus on a 10% weight loss. If you think you can
you can and if you think you cannot you cannot. I think we also
have to look at it from that perspective, a greater weight loss
than 10% is certainly achievable.
Dr Lavin: I agree with what Helen
and Paula have both said in terms of if somebody maintains their
behaviour change then they can maintain their weight loss long-term.
As Paula mentioned the aspect of support is very crucial. Slimming
World's data shows we promote a 10% weight loss which we call
Club Ten and we know from our records that once members achieve
10% weight loss if they stay with us then over 90% of those will
maintain their 10% weight loss six months or one year down the
line. One benefit of the commercial sector is the groups are always
there so that people can dip in and out when they need to. They
may reach a certain personal target or their 10% weight loss and
if they go away and see their weight increasing they can always
come back, that is slightly different from primary care, where
perhaps there are limited places but in the commercial sector
people are very welcome to come back and re-use the services as
and when they need to.
Q1111 Dr Naysmith: I am going to ask
Dr Truby about her research where she compared four very different
types of diet which were very different in cost, you found that
there was really no difference or very little difference in the
outcome between the four, are there any lessons the National Health
Service can learn from that particular part of your research?
Dr Truby: The first part of the
study lasted six months, which is relatively short in terms of
weight management strategies, obviously we would have a much longer-term
approach, and we found at the end of six months there was not
a great deal of difference in fat loss and weight loss over the
diet groups, however I think there were important differences
in terms of the approaches and what people told us about them,
so we know these different diets are going to suit different people.
I believe this provides some evidence for the fact that people
need some assistance in trying to perhaps identify which dietary
approach may well suit their lifestyle and if it is going to suit
them they are going to be able to stick to it for a longer period
of time and that is therefore helpful information to try and give
them. We asked them to come back after 12 months, we found that
people in the supported programmes had generally done better than
the people who had decided to do their own type of diet, ie they
had carried on trying, they thought they would increase their
exercise and they thought they would have a more healthy diet
but they were better off if they had carried on with some kind
of diet in a supported way. There were also gender differences
with men and women behaving differently, I think this is a very
important factor, and men do not really appreciate going to groups
so much, they did better in the first six months in the unsupported
programmes. There needs to be quite a lot more evidence I think
collected about what dietary approaches suit people and how they
might be best advised as to how they might be managed to start
off with.
Dr Naysmith: Thank you. Does anyone want
to comment on that?
Q1112 Chairman: Can I comment on that,
I am interested in the gender differences, thinking about the
evidence that we heard about from one of the previous witnesses
doing group sessions, your evidence would incur that men would
be more reluctant than women to share in that kind of approach?
Dr Truby: Women appreciated a
more sharing approach, they quite liked that, women seemed to
cope better with that whereas men did feel that was not the way
to go, although it must be said the majority of the people going
to Weight Watchers and Rosemary Connolly are women, men are in
the minority.
Dr Truby: There has been some
research done about men-only groups and they can be quite successful
but they need to be much more targeted towards the needs of men
and perhaps include men in them.
Q1113 Chairman: This is a men-only group
as you have noticed, we do not often share our feelings!
Dr Truby: I had noticed you were
men-only.
Chairman: We do have a woman member and
we are going to have another one in due course.
Q1114 Dr Taylor: With the problems of
weight increasing across the country is the take-up of services
to Weight Watchers and Slimming World increasing as well?
Ms Hunt: I have heard people say
in Weight Watchers "this has been our best year ever".
I think Weight Watchers at any one time has about one million
members, some of those members will be wanting to get to a target
weight which is at a BMI of 25 or less, others are happy to get
into the next dress size down or the next belt hole down, people
go for very different reasons, with very different goals. Sometimes
people are happy to continue paying week in and week out because
of the support they get and occasionally you will get people who
just want to maintain not gaining weight, which we know will happen
but if people do absolutely nothing the trend will tend to be
they will gain weight over the years. We even have people who
will come along and be happy for their goal to be to maintained
at a weight that is steady, albeit still overweight or even obese,
but to keep it at a steady weight.
Q1115 Dr Taylor: Do you have any figures
about the long-term attendees and the re-attenders out of that
one million?
Ms Hunt: I do not have that off
the top of my head but I can get that sent to you. Somebody told
me anecdotally a story yesterday of a Weight Watchers member in
Scotland who said she reckoned it had been really good value for
money because she had been a member for 25 years and within six
months she reached her goal weight and has weighed in for free
every month since that time, quite good value for money. Not everybody
will reach their target weight, some will reach a 10% weight loss,
others will lose even less than that but we still feel that is
offering very helpful support, a sort of camaraderie where people
are in this together, they are getting a drip of behavioural support,
practical tips, ideas that will help them amidst this kind of
food supply we are in, where shopping is difficult with a never-ending
range of new foods to choose from, where eating out is a nightmare,
people are eating out more and more. People do welcome that kind
of on-going support they get where they are given a little card
with this week's top tips, something which is seasonal, this is
about autumn activities for walking and gardening in the autumn,
very practical ideas that on a weekly basis can drip feed people
to keep their motivation going and hopefully maintain that effort
and energy that is required to sustain the changes.
Q1116 Dr Taylor: I think you said that
90% maintain their weight loss if they stay with you.
Dr Lavin: We can only report back
on the people who are still attending our groups. A number of
people do go away and some will rejoin but that is seen as a very
positive thing and not viewed negatively as if offering a service
that fits with peoples lifestyle needs .
Q1117 Dr Taylor: It would be interesting
to have some figures.
Dr Lavin: We are certainly at
the moment in the stages of putting together a programme to develop
that sort of evidence base but it is important because of member
confidentiality and because we do not track individual people
that it needs to be set up more as a study so that we get that
approval to track people one year or two year's down the line
if they are no longer a member. You mentioned about increasing
membership, certainly in Slimming World ,we have about 250,000
members and at the moment our group sizes are increasing. Interestingly
what we have had an increase in is the number of men attending
our classes. This year we developed a strategy to develop more
men-only classes, getting more men running the groups as well.
It is interesting that the increase in the number of men attending
classes has occurred mainly through the mixed groups, although
we have more men-only groups now too.
Q1118 Chairman: That is a slightly different
message to what we have heard earlier on.
Dr Lavin: Some people prefer to
join a men-only group but some men may want to go along with their
wife or their partner or be the only man in the class as well
and they get a bit upset when another man joins.
Q1119 Jim Dowd: What is the proportion?
Dr Lavin: It is currently 5% of
our total membership. This year it has risen from 4% to 5% but
we have had a general increase in membership. It is a limited
number.
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