Medacs Healthcare

JAN 07/2013

Obesity prevention and treatment a 'core responsibility' for general practice teams

Obesity is widely viewed as the most significant public health problem faced by the UK, with the country recording the second highest prevalence in the world. Prevention is vital, as obesity is associated with a whole host of health problems, including heart disease, type-2 diabetes and infertility. Those working in GP jobs have an important role to play in this respect, but there is also a need to support those patients who are already obese and who may require a range of different services.

A new report from the Royal College of Physicians (RCP) highlights the patchy provision of care for obese people and underlines the need for the medical profession to take the lead in tackling the problem. Our latest guide looks at ways in which GPs and practice teams can help to combat obesity, by supporting patients to lose weight, diagnosing and monitoring co-morbidities and leading by example.

GPs' role in weight management
GPs and other professionals working within the general practice team have a "core responsibility" for preventing obesity, as well as for assessing the risk of illness in people who are already obese and facilitating patients' access to weight management support, according to the RCP. Its report calls for those in permanent and locum doctor jobs to deal with weight issues "as part of their agenda to address risk factors", noting that every single GP consultation provides "a potential opportunity" for doing so.

In order for family doctors to fulfil this role, the RCP underlines the importance of training in various practical behavioural techniques, such as motivational interviewing. It argues that the application of these skills to weight management and obesity should be part of GPs' initial training as well as their ongoing continuing professional development.

The RCP also recommends including evidence-based targets for successful obesity management in the Quality and Outcomes Framework (QOF), the annual reward and incentive programme for GP surgeries in England. And it highlights the need for special attention to be paid to certain disadvantaged groups who may find it difficult to access community weight management groups, such as people with learning disabilities, physical disabilities or mental health issues, those living in rural locations or socially excluded groups, and those with severe morbid obesity.

Primary care pathways
Once a patient has been identified as obese, either through assessment by a primary care healthcare professional or through self-reporting by the patient, they should be clinically assessed to determine the root causes of their weight problem. GPs should also determine whether the patient has any obesity-related complications, such as type-2 diabetes, obstructive sleep apnoea or liver disease. A psycho-social history should be recorded, along with any previous attempts to lose weight in order to determine the most appropriate way forward. This may be a practice-based service, referral to a community dietetic service, pharmacological intervention or referral for possible bariatric surgery.

GPs with a special interest
The RCP believes there is a need for GPs with a special interest in weight management to be developed. Training would be differentiated from the core training needs that apply to all GPs, enabling them to deliver more specialist activities. While all GPs should be in a position to adopt certain core approaches, including the ability to raise awareness of weight issues with sensitivity and the ability to abandon judgemental attitudes, GPs with a special interest in weight management would have other clearly defined roles, such as offering in-house weight management support, targeting disadvantaged groups with particular weight issues, and providing ongoing support for patients who have undergone bariatric surgery.

Leading by example
In its latest report, the RCP says it aims to engage the medical profession with weight management issues and ensure that GPs and other healthcare workers have an increased awareness of the subject, "resulting in a healthier workforce leading by example". At present, some 700,000 NHS employees are thought to be obese, with just 15 per cent of these being assessed - something that could set a bad example to patients. In light of this, the RCP has called on NHS trusts to place workplace health and wellbeing high on their agendas, through the encouragement of healthy eating and physical activity among staff, and by diagnosing and addressing obesity in new and existing employees.

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