Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND12 Most commonly used interventions for treating overweight and obese patients in primary care10080Percentage6040200Oral advice on diet and/orphysical activityRegular check-ups andweight monitoringWritten advice on diet and/orphysical activityGeneral PractitionersPractice NursesSource: National Audit Office based on responses to postal survey (Appendix 1)part three243.36 The exercise model used varies from scheme to scheme.Case Study 1 shows how a well-designed scheme,incorporating rigorous pre-programme assessment,progress monitoring and follow-up, can help patients tolose weight and improve fitness.3.37 The largest evaluation of exercise on prescriptionschemes in England was undertaken by the HealthEducation Authority in 1998 26 . This review estimatedthat there were over 200 referral-based exerciseschemes in operation in England. The evaluationincluded a systematic review of empirical data relatingto the effectiveness of schemes and three case studies ofexisting schemes.3.38 The Health Education Authority found some evidence ofimprovements to physical activity patterns. They alsonoted, from case studies, wider impacts from theschemes, including social and psychological benefits forparticipants. However, there was a wide variety in thetype and quality of exercise programmes provided. Noneof the programmes employed an accepted model forhelping people to achieve lifestyle change, and manywere not the most appropriate for helping people withweight problems. The Health Education Authorityconcluded that such schemes should include morerigorous evaluation, which would involve systematicgathering of quality data using carefully chosen outcomemeasures to provide better evidence on effectiveness.3.39 In June 2000, the Department of Health announcedplans to publish new guidelines to help generalpractitioners to start such schemes for their patients. Todo this, they have commissioned experts in physicalactivity and health to produce a National QualityAssurance Framework for Exercise Referral Systems. Theframework will provide guidelines for best practicewithin the whole referral process, from selection ofpatients to exercise programming, evaluation and longterm follow-up. The aim is to improve the quality ofphysical training provided, thus maximising the benefitsto patients, and to establish indicators to demonstratehow closely the guidelines are being followed.General practice offers a range of innovative butuntested help3.40 Some practices provided other forms of help, includingslimming groups and exercise programmes at thepractice, and in a very few cases offered alternativetherapies such as yoga, meditation or hypnosis. Twoexamples of innovative practice are illustrated below inCase Study 2. Although these examples have not beenindependently audited for either clinical or economiccost effectiveness, evidence from self-evaluationssuggests that they may be promising developments.There is uncertainty about what comprises effectiveintervention for obesity3.41 Our survey found widespread uncertainty amongstgeneral practitioners about the effectiveness of thedifferent interventions at their disposal. Their viewsreflected general uncertainty about which interventionsare effective in preventing and treating obesity. Seventythreeper cent of general practitioners believed therewas a lack of proven, effective interventions available toassist them in determining the most appropriatetreatment pathway for their patients. And 64 per centbelieved the range of treatments available to them wasof little or no effectiveness. Practices told us, both in ourvisits and in responses to our postal questionnaire, thatthey would like more information on what were themost effective ways to help obese patients lose weight.