Dr David Unwin, of Norwood Surgery in Southport, is the RCGP National Champion for Collaborative Care and Support Planning in Obesity and Diabetes and a RCGP Clinical Expert in Diabetes. In 2016, he won the NHS Innovator of the Year Award. His wife, Dr Jen Unwin, is a consultant clinical health psychologist, who has worked in the NHS for over 30 years, helping people with chronic illnesses to improve their lives. She is also former chair of the UK Association for Solution Focused Practice. David and Jen are both founding members of the Public Health Collaboration. Together, the Unwins have pioneered the use of low carbohydrate diets in the treatment of obesity and diabetes through a patient-centric model of ‘hope’. This talk was given at the PHC conference 2017 in Manchester.
David begins by presenting data from his practice, collated over the four years since beginning his low carbohydrate initiative. These include profound improvements in patients’ HbA1c, lipid profiles, weight, blood pressure and liver function of patients, as well as a huge reduction in diabetes medication spending of the practice. In fact, Norwood surgery now spends less on diabetes medication than any other practice in its CCG. These data, in addition to anecdotal evidence from patients, attest to the overwhelming success of the initiative.
Having interviewed many of the patients following their success on a low carbohydrate lifestyle, Jen outlines multiple aspects of the program that they felt contributed to its success. The improvements to health parameters, as evidenced by the data, provide measurable progress for the patients to take pride in. The program offers patients new knowledge and understanding, for example the sugar equivalence charts, so that they are well informed throughout the process. Sincere feedback and support from the GP provides motivation throughout. Many patients commented that low carb is “a way of life” instead of merely a prescription, meaning it is easy to personalise depending on individual needs. All of these factors contribute to the success of, and long-term adherence to, the low carb initiative.
One key point is that every piece of bad news, for example a type 2 diabetes diagnosis, can be turned on its head to become a golden opportunity for change. Some healthcare professionals may feel that medication is a quick and easy solution, however, the Unwins note that the vast majority of patients would rather give low carb a try than take more tablets.
Since the success of the low carb initiative is largely reliant on hopen, the most important part is to address the patient’s personal goals. The Unwins demonstrate how this can be done with some doctor-patient roleplay. The two contrasting scenarios that the Unwins portray highlight important differences between monologue and dialogue in the GP’s office. A two-way discussion is informative, motivating and fulfilling for both doctor and patient.
Through hard work, perseverance and most of all, taking the time to understand each patient’s individual needs and goals, David and Jen have proven that low carb lifestyles work, that they last and that they can be made accessible to all.