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Weight management in primary care: how can it be made more effective?

Published online by Cambridge University Press:  07 March 2007

Alan Maryon-Davis
Alan Maryon-Davis
Affiliation:
Southwark Primary Care Trust, Mabel Goldwin House, 49 Grange Walk, London SE1 3DY, UK and Guy‘s, King's and St Thomas’ School of Medicine, King's College London, Capital House, 42 Weston Street, London SE1 3QD, UK
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Abstract

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Obesity is often difficult to tackle in primary care. Pressure of time in the consultation, a lack of appropriately-trained primary care staff, a shortage of community dietitians or nutritionists, the potentially enormous caseload, language or cultural barriers and the sheer intractability of patients' eating habits, exercise behaviour and their clinical condition, all conspire to make general practitioners, other team members and often the patients themselves lose heart and stop even trying. However, there are ways of overcoming these difficulties. Examples of changes that evidence suggests are able to support and enhance basic one-to-one interventions in general practice include: improved clinical guidelines; better training of primary care staff; at-risk patient registers; smarter database search tools; new quality incentives; closer working with dietitians, counsellors and pharmacists; more hospital outreach clinics; designated general practitioner specialists and practice clustering; expanded exercise referral schemes and links with leisure providers; subsidised referral to commercial slimming groups; better use of patient groups and voluntary and community workers. The present paper describes a proposed ‘triple-tier’ pathway for weight management incorporating most of the elements mentioned earlier. With a more joined-up and creative approach to the development and organisation of primary care, more comprehensive training and workforce planning, and better integration with social care, voluntary groups and the commercial sector, weight management in general practice has the potential to be much more effective.

Keywords

ObesityWeight managementPrimary care
Type
Symposium on ‘Biology of obesity’
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 1 , February 2005 , pp. 97 - 103
Copyright
Copyright © The Nutrition Society 2005

References

Activity Counseling, Trial Research Group (2001) Effects of physical activity counseling in primary care. Journal of the American Medical Association 286, 677–687 CrossRefGoogle Scholar
Banegas, JR, Lopez-Garcia, E, Gutierrez-Fisac, JL, Guallar-Castillon, P, Rodriguez-Artalejo, F (2003) A simple estimate of mortality attributable to excess weight in the European Union. European Journal of Clinical Nutrition 57, 201–208 CrossRefGoogle ScholarPubMed
Centre for Reviews and Dissemination (1997) The Prevention and Treatment of Obesity. Effective Health Care Bulletin, Vol. 3 York: University of YorkGoogle Scholar
Chief Medical Officer (2003) Health Check on the State of the Public Health: Annual Report of the Chief Medical Officer London Department of HealthGoogle Scholar
Chief Medical Officer (2004) At Least Five a Week – Evidence on the Impact of Physical Activity and its Relationship to Health London Department of HealthGoogle Scholar
Department of HealthDepartment of Health (2000) National Service Framework for Coronary Heart Disease: Modern Standards and Service Models London Department of HealthGoogle Scholar
Department of HealthDepartment of Health (2003a) Delivery Strategy for the Diabetes National Service Framework London Department of HealthGoogle Scholar
Department of HealthDepartment of Health (2003b) Delivering Investment in General Practice: Delivering the New GMS Contract. Guidance London Department of HealthGoogle Scholar
Department of HealthDepartment of Health (2004a) National Standards. Local Action. Health and Social Care Standards and Planning Framework 2005/06–2007/08 London Department of HealthGoogle Scholar
Department of HealthDepartment of Health (2004b) Choosing Health – Making Healthier Choices Easier London Department of Health.Google Scholar
Diabetes Prevention, Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 346, 393–403 CrossRefGoogle Scholar
Douketis, JD, Feightner, JW, Attia, J & Feldman, WF (1999) Periodic health examination, 1999 update. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care. Canadian Medical Association Journal 160, 513–525 Google ScholarPubMed
Foster, Dr (2003) Obesity Management in the UK – A Weighty Issue for Primary Care Organisations London Dr Foster LtdGoogle Scholar
Elley, CR, Kerse, N, Arroll, B & Robinson, E (2003) Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. British Medical Journal 326, 793 CrossRefGoogle ScholarPubMed
Halbert, JA, Silagy, CA, Finucane, PM, Withers, RT & Hamdorf, PA (2000) Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice. Medical Journal of Australia 173, 84–87 CrossRefGoogle ScholarPubMed
Harvey, EL, Glenny, A-M, Kirk, SF & Summerbell, CD (1999) A systematic review of interventions to improve health professionals' management of obesity. International Journal of Obesity and Related Metabolic Disorders 23, 1213–1222 CrossRefGoogle ScholarPubMed
Harvey, EL, Glenny, A-M, Kirk, SF & & Summerbell, CD (2004) Improving health professionals' management and the organisation of care for overweight and obese people (Cochrane Review). The Cochrane Library, Issue 2. Chichester, West Sussex: John Wiley & Sons Ltd.Google Scholar
Hillsdon, M, Foster, C, Naidoo, B & Crombie, H (2004) The Effectiveness of Public Health Interventions for Increasing Physical Activity Among Adults: A Review of Reviews. Evidence Briefing London Health Development AgencyGoogle Scholar
House of, Commons Health Committee (2004) Obesity: Third Report of Session 2003–04 London: The Stationery Office.Google Scholar
Joint, Health & Surveys, Unit (2003) Health Survey for England 2002. National Centre for Social Research London The Stationery OfficeGoogle Scholar
Laws, R, the Counterweight & Project Team (2004) A new evidence-based model for weight management in primary care: the Counterweight Programme. Journal of Human Nutrition and Dietetics 17, 191–208 Google ScholarPubMed
Maryon-Davis, A (2003) Oral evidence given to the House of Commons Select Committee on Health. Minutes of Evidence. 6 November 2003, HC 23II, Q519. London: The Stationery Office.Google Scholar
Maryon-Davis, A (2004) Obesity Action Plan. Working Paper for the CHD NSF Implementation Group London Southwark Primary Care TrustGoogle Scholar
Moore, H, Greenwood, D, Gill, T, Waine, C, Soutter, J & Adamson, AJ (2003) A cluster randomised trial to evaluate a nutrition training programme. British Journal of General Practice 53, 271–277 Google ScholarPubMed
Mulvihill, C & Quigley, R (2003) The Management of Obesity and Overweight: An Analysis of Reviews of Diet, Physical Activity and Behavioural Approaches. Evidence Briefing London Health Development AgencyGoogle Scholar
National Audit Office (2001) Tackling Obesity in England: Report by the Comptroller and Auditor General London The Stationery OfficeGoogle Scholar
National Heart, Lung, and Blood Institute (1998) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults Bethesda, MD National Institute of HealthGoogle Scholar
National Institute, of Clinical Excellance (2001a) Guidance on the Use of Orlistat for the Treatment of Obesity in Adults. NICE Technology Appraisal Guidance no. 22 London NICEGoogle Scholar
National Institute, of Clinical Excellance (2001b) Guidance on the Use of Sibutramine for the Treatment of Obesity in Adults. NICE Technology Appraisal Guidance no. 31 London NICEGoogle Scholar
NHS, National, Programme, for & Information, Technology (2004) GMS IT – QMAS Bulletin. http://www.dh.gov.uk/assetRoot/04/08/42/61/04084261.pdf Google Scholar
Padwal, R, Li, SK & Lau, DC (2003) Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. International Journal of Obesity 27, 1437–1446 CrossRefGoogle ScholarPubMed
Rollnick, S, Mason, P & Butler, C (1999) Health Behavior Change: A Guide for Practitioners Edinburgh Churchill LivingstoneGoogle Scholar
Scottish Intercollegiate & Guidelines Network (1996) Obesity in Scotland: Integrating Prevention with Weight Management. SIGN Guideline no. 8 Edinburgh SIGNGoogle Scholar
Stevens, W, Hillsdon, M, Thorogood, M & McArdle, D (1998) Cost-effectiveness of a primary care based physical activity intervention in 45–74 year old men and women: a randomised controlled trial. British Journal of Sports Medicine 32, 236–241 CrossRefGoogle ScholarPubMed
Sturm, R & Wells, KB (2001) Does obesity contribute as much to morbidity as poverty or smoking. Public Health 115, 229–235 CrossRefGoogle ScholarPubMed
Summerbell, CD (1998) Dietary treatment of obesity Clinical Obesity 377 – 408 Kopelman P Stock MJ Oxford Blackwell Scientific PressGoogle Scholar
Swinburn, B, Egger, G & Raza, F (1999) Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine 29, 563–570 CrossRefGoogle ScholarPubMed
Wanless, D (2004) Securing Good Health for the Whole Population London: H. M. TreasuryGoogle Scholar
Wardle, J (2005) Understanding the aetiology of childhood obesity: implications for treatment. Proceedings of the Nutrition Society 64, 73–79 CrossRefGoogle ScholarPubMed