Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLANDThe majority of practices promote healthy eating andphysical activity through general information3.21 Our survey indicated that over three quarters ofpractices made general information on healthy diet andphysical activity available to all patients who visited thesurgery, normally in the form of a waiting room displayor leaflets available in the waiting room. Approximatelyhalf provided general information in this way to educatepatients specifically about the issue of weightmanagement (Figure 11).3.22 A small minority of practices - around seven per cent ofthose that reponded - had not in the last year providedany general information in the surgery to promotehealthy eating, physical activity or weight management.Patients attending these surgeries, not necessarily forweight problems, would therefore only receiveimportant messages about healthy eating, exercise andweight control should they be raised in the course of aconsultation with the general practitioner or practicenurse.3.23 Whilst many general practices take the opportunity topromote healthy lifestyles through the provision of suchmaterial, little is known about the effectiveness of thisapproach. None of the general practitioners or practicenurses we interviewed had evaluated the extent towhich such material was used by patients or its impacton lifestyle. However, given the rate at which theprevalence of obesity is increasing in England, theremay be benefits for all general practices, rather thanaround half as at present, to make information availableto all patients on the risks of obesity and how to manageone's weight.11 Percentage of practices that made general information ondiet, physical activity and weight management available toall patientsPercentage of practices10080604020Many general practitioners seek to identify thosepatients at risk of obesity, but not the majority3.24 General practitioners are in a position to assess whichpatients might benefit from advice or treatment to helpthem manage their weight. These patients might beidentified based on an already elevated body massindex or waist measurement, lifestyle factors that mightput them at high risk of weight gain, or the risk ofassociated diseases such as coronary heart disease,diabetes or hypertension. In March 2000, the NationalService Framework for coronary heart disease waspublished 6 , which includes plans for generalpractitioners and primary care teams to identify allpeople at risk of cardiovascular disease, includingbecause of their weight, and to offer them appropriateadvice and treatment to reduce their risks.3.25 At the time of our survey (which pre-dated the NationalService Framework), we found that almost all practicesrecorded the height and weight of all patients. Inaddition, about 95 per cent recorded the body massindex of all patients. A small minority took a moreproactive approach to identifying those patients at riskby recording other indicators of body fat: aroundfour per cent recorded waist circumference, andthree per cent recorded waist:hip ratio.3.26 However, only 40 per cent of general practitioners toldus that they attempted to identify those patients athighest risk of excessive weight gain. They looked forrisk factors such as a high or rising body mass index,family history or associated health risks such as diabetesor heart problems.Most general practices accept a responsibility fortreating obesity or referring patients to appropriatespecialists3.27 General practitioners decide whether to treat patientswho would benefit from weight loss personally, orwhether to refer them on to appropriate specialists. Twothirds of general practitioners in our survey felt thattreating patients for excess weight or obesity was theresponsibility of the primary care team. A greaterproportion - three quarters - thought they had a role inreferring obese persons to appropriate specialists fortreatment. However, a small number of generalpractitioners (two per cent) neither treated obesepatients personally to help them achieve weight loss,nor referred them to specialists.part three0Healthy diet Physical activity Weight ManagementSource: National Audit Office based on responses to postal survey (Appendix 1)22