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• be multi-component, addressing both diet and activity, while offer- ing a variety of approaches;

• use a balanced healthy eating approach;

• recommend regular physical activity, ideally daily activities like walking and gardening, and offer advice about increasing activity safely;

• include behaviour change tech- niques, such as keeping food diaries, dealing with lapses and high risk situations;

• recommend or provide ongoing support.

Slimming World www.slimmingworld.com

The Slimming World approach is based on a Food Optimising eating plan and Individual Motivation and Group Experience (IMAGE) Therapy, where a number of motivational and behavioural change techniques and tools are used to help members make positive lifestyle changes. The Food Optimising plan revolves around unlimited ‘Free Foods’. These include starchy carbohydrates, lean proteins, low fat yoghurts and fruits and vegetables. Allocated portions of ‘Healthy Extras’ like wholegrain cereals, breads, milk, cheese and dried fruits and nuts are included, along with an additional daily al- lowance of ‘Syns’ - high energy foods such as confectionery, sa- voury snacks and alcohol. ‘Syns’ are optional extras, but are included in the plan to help members learn that no foods need to be banned in a healthy diet, and to encourage the idea of balanced eating without counting calories and grams of fat. The term ‘Syns’ was chosen to rep- resent the synergistic way that Food Optimising and IMAGE Therapy helps Slimming World members to achieve their goals.

Physical activity is encouraged and members are advised to start off gently and gradually build up their activity levels to enhance their weight loss.

The weekly group meeting is a critical part of the plan where IMAGE information, recipes and general mo- tivation and support from the group leader and other members are ex- changed. Personal action plans and strategies are developed. Weight loss targets are chosen by the member and lowest acceptable weights are used to prevent members aiming for

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unrealistic targets. Slimming World recommends the merits of attending group meetings on a regular basis. Weight loss of 0.5-1kg per week is the goal and, when a member reaches their 10 percent target, the health benefits of this weight loss are rewarded and celebrated in the group meeting. Maintenance of that loss for 10 weeks results in a free week. In addition to group meetings, further support is avail- able via a free interactive website, Slimming World magazine and a cata- logue of recipes books.

Patient experiences

Slimming World meets the NICE best practice standards. The ethos of their plan is supported by high quality, published research which demonstrates the plan’s efficacy and cost effectiveness. Attendance for the whole of the group meeting is encouraged, but not compulsory, so it is possible for members to simply attend, get weighed and leave. It seems that this is Slimming World’s biggest weakness and they do allude to the pitfalls of not attending the meetings in their case study stories on the website.

Some patients tell me that they have been confused at the inclusion of foods like potatoes in the ‘Free Foods’ section of the food plan and were worried that they were over consuming; of course these may have been members who didn’t attend meetings! Others struggled to resist their ‘Syns’ and would have preferred them not be included in the plan at all. I tend to find Slimming World most suitable for people with time to plan their meals and who like the accountability of recording their food intake throughout the day (food diaries are kept for the first four weeks of the programme) and also enjoy the social aspect of group meetings.

Jenny Craig www.jennycraig.co.uk

Jenny Craig launched in the UK earlier this year following success in the US, Canada, Australia and New Zealand and brings a new approach to commercial weight management. The holistic Food- Mind-Body approach is based on portion controlled, nutritionally balanced food delivered to your door, increased physical activity and long-term behaviour change. It has been developed by dietitians and is underpinned by clinical trials which

compared the approach to diet-only weight loss interventions.

The published trial showed Jenny Craig to be three times more ef- fective than dieting alone. Clients participating in the trial not only lost weight at an average rate of one to two pounds per week, but also achieved wider health benefits, including reduced total cholesterol levels, improved physical fitness and increased fruit and vegetable con- sumption.

Each Jenny Craig client has a personal Weight Management Coach, who, during private weekly telephone consultations, adjusts and customises the programme and menus to suit the member’s needs. The coach also provides encourage- ment, support strategies and advice and information to help the client overcome challenges like eating out and going on holiday. The coach’s chief role is to help the client take control of their weight in the long term.

Jenny Craig produces its own portion-controlled breakfasts, meals and snacks which are delivered to the member’s address each week. There is a wide choice of meals including vegetarian options. Menu plans are available from 1,200-2,300 calories per day, depending on the member’s needs and provide 50-60 percent carbohydrate, 20-30 percent protein and 30 percent fat per day. There is also a focus on a minimum of five portions of fruit and vegetables a day which clients must purchase to add to their daily selection of Jenny Craig meals and snacks. The coach designs a personalised, weekly activity plan for the member, includ- ing daily activities like walking and cycling, together with, if appropriate, planned exercise like running, yoga or dancing. Targets for weight loss are agreed between the client and the coach and the plan is designed to achieve a weight loss of 0.5-1kg per week. A weight maintenance programme is available when the target weight is achieved.

Patient experiences

Jenny Craig meets the NICE best practice standards and its conve- nience and personal attention from the coach are two key programme attributes which are popular with its followers. Building a real rapport with the coach for support and motivation is a unique feature of the plan. I have

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