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Beating diabetes: Talking point
Diabetes costs the NHS £10bn a year. In a bid to tackle the rising number of sufferers, the health service is turning to the health and fitness industry for help. Is this the move we’ve been waiting for? Kath Hudson reports
Ambitious plans were unveiled in March to try and combat the growing issue of type 2 diabetes across the UK – a condition that currently affects 2.6 million people in England, with around 200,000 new diagnoses every year.
The new Diabetes Prevention Programme – a collaboration between NHS England, Public Health England and Diabetes UK – will identify those with high blood sugar levels, deemed at high risk of developing diabetes, and refer them into a nine-month programme of health and fitness coaching funded by the NHS.
Known as Healthier You, the programme will incorporate personal training, exercise classes and nutritional advice. Over nine months, patients will be offered at least 13 education and exercise sessions – a total of at least 16 hours face-to-face.It will be offered to a total of to 100,000 people over the next four years, and from 2020 at a rate of 100,000 people each year (see HCM May 16, p5).
And why? Because Britain is now officially the second fattest nation in Europe, with 25 per cent of adults classed as obese. On current trends, one in three people will be obese by 2034, while one in 10 will develop type 2 diabetes.
The NHS can’t afford this: diabetes already accounts for a reported 10 per cent of its budget; Diabetes UK estimates that it costs £25,000 a minute to treat diabetes and its complications.
While type 1 diabetes can’t be prevented and isn’t linked to lifestyle, type 2 diabetes is strongly linked to lifestyle and being overweight. On the upside, with the right diet and exercise, it’s a reversible disease, even for those who have suffered the condition for up to a decade.
And that’s where Healthier You aims to step in: a pilot scheme that offered two exercise classes a week – including HIIT and interval training – as well as classroom sessions on diet and lifestyle found all participants lost weight, with more than half also reducing their diabetes risk.
Now would seem to be the perfect moment for the fitness sector to prove itself; while there are already examples of best practice at health clubs around the country, the health and fitness industry has been waiting for the medical community to get fully behind its services.
But how can it make the most of this golden opportunity – not just to get a slice of the action, but to make sure the results are achieved and the burden on the NHS is reduced? And can the industry use this initiative to spearhead more preventative healthcare measures? We ask the experts…
Oliver Patrick,
Co-founder,
Viavi Academy
This scheme reflects a growing understanding of the role of fitness and wellbeing professionals in relieving the pressure on an overloaded NHS. We need to get the cost of diabetes down fast; lifestyle management, in the form of movement and dietary control, will be a vital component of this.
In our experience, to sustain engagement with health intervention programmes, it’s important for participants to be shown tangible markers of improvement, ideally blood sugar levels and certainly body composition. Measurements taken at the beginning of a programme give a sense of strategy and importance, but also give a clear sense of reference and achievement when compared to end results. Proving the effort was worthwhile is key to driving compliance with healthy behaviours beyond the end of the programme and as part of a lifelong plan.
With programme delivery, we’ve found it’s helpful to create as few extra loops in the process as possible. Our models aim to have one highly competent fitness professional do the clinical testing, run the exercise class and coach the nutrition element. Fitness professionals can be easily skilled up to do all three roles and an individual practitioner, as opposed to a team of people, can have an advantage in building strong relationships with the participants.
"Create as few extra loops as possible. We have one highly competent fitness professional do the clinical testing, exercise class and nutrition element" - Oliver Patrick
Jenny Patrickson,
MD,
Active IQ
We’ve been talking about this for some time, and now it’s a case of working out the mechanics to establish how the NHS can roll the programme out in conjunction with the physical activity sector. At the moment, I don’t think the medical community and our sector fully understand what we can do for each other.
This demographic needs specialist knowledge, so instructors may need to upskill to a Level 4 qualification in order to deliver the programme. However, qualifications also have to be updated to make sure they’re in line with current needs. We’re in the process of refreshing the Level 3 qualifications now that ownership has transferred from SkillsActive to awarding organisations (following the recent changes to the qualification framework) and there will be an emphasis on client counselling, lifestyle management and motivational change strategies for dealing with people who have health issues like diabetes and obesity.
This initiative represents great progress from the medical community, but a more proactive approach is needed as well, to prevent these problems in the first place. Could it be taken a step further, having physical activity professionals based in GP surgeries to give exercise and lifestyle advice as a further preventative measure?
Similarly, the health and fitness industry is still predominantly focused on formal sessions in the gym and studio, rather than the broader-based community physical activity spectrum, and we need to move beyond that approach.
Dr John Morgan,
GP,
Pennygate Medical Centre
Type 2 diabetes is a reversible and curable disease, so this is a very welcome development. Sometimes only a small amount of exercise is needed to bring a massive benefit to physical and mental health, as well as quality of life.
Education will be key to making this programme a success, and any support the health and fitness industry can give to promote the message that poor lifestyle, and poor diet, poses a significant risk to health would be very helpful.
Exercise is the mainstay in the fight against diabetes, but this doesn’t only have to happen in gyms and health clubs, or even as deliberate ‘exercise’. I think, if we’re going to reverse the pandemic, we need to create living and working environments that encourage people to move more. This could include measures such as introducing standing desks to offices, encouraging active commuting and moving more during the day. Ultimately, we need to build more muscle and reduce the amount of glucose in our system.
I’d like to see more fitness professionals coming out of clubs and engaging with people in medical and community settings, such as churches and day centres, effectively taking the gym into the community setting to reach the unconverted.
Nikki Joule,
Policy manager,
Diabetes UK
A joint initiative between Diabetes UK, NHS England and Public Health England, Healthier You: NHS Diabetes Prevention Programme has been designed based on the evidence of successful trials and programmes. It will offer personalised support to help those at high risk of type 2 diabetes to reduce their risk by making changes to their diet and levels of physical activity.
Behaviour change is a key component of the programme, so as well as lifestyle advice, those referred will get support to set and achieve goals and make lasting changes.
However, while the NHS Diabetes Prevention Programme is a major step in the right direction, the programme will not be enough on its own to halt the rising tide of obesity and type 2 diabetes. We want to see action taken across a range of areas to encourage people to lead healthier lives. This must include placing restrictions on marketing junk foods to children and having the government set targets for the food and drinks industry to reduce the salt, fat and sugar content in their foods. All of these measures should be included in the government’s Childhood Obesity Strategy.
Meanwhile, the health and fitness industry needs to make sure it’s sufficiently aware of what type 2 diabetes is, and how diet and physical activity can help reduce risk of the condition. Fitness professionals also need to be confident to refer their clients to their GP if they think they’re at risk.
Neil King,
MD,
1 Life
Our healthcare system won’t be sustainable without a plan to tackle the growth of lifestyle diseases, so it’s important that the dialogue which has been opened between the medical community and the active leisure sector remains intact and grows stronger. We need a partnership approach, with consideration given to the reach and impact that physical activity providers can bring.
Operators need to ensure they have a team of properly trained staff, as well as a clear vision of what outcomes they’re trying to achieve – and these should be specific to the local authorities’ health and wellbeing objectives.
As a bare minimum, we need to engage with the agenda and decide how best we can help, without trying to be a total solution. As with many things, collaboration will be the key.
We also need to have a plan in place to promote physical activity to the next generation in a way that’s fun, engaging and creates habits for life. That will be the best possible safeguard against the continued rise of diabetes.
"We need to have a plan in place to promote activity to the next generation in a way that’s fun, engaging and creates habits for life" – Neil King
