Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND16Topics suggested by general practitioners and practice nursesfor inclusion in guidance on the management of overweightand obesity in primary careTopics for inclusion in guidancena definition of which patients to target for advice and treatment3.60 There are already examples of good practice here. Forexample, Stockport Acute Services NHS Trust has set upa patient screening programme for pre-operativepatients, whereby obese patients are identified andreferred to their general practitioner if it is felt they wouldbenefit from advice and treatment (Case Study 3).nnnnnguidance on how to assess current physical activity and theadvice to be given to people on a weight maintenanceprogrammea protocol for deciding the most appropriate treatment pathwayfor each patientinformation on effective interventions in primary care for weightmaintenance and increased physical activitya protocol for deciding the most appropriate referral option foreach patientguidance on the development of care plans to meet the needsof individuals on a weight maintenance programmeSpecialist centres for the treatment of obesitymay be a cost effective way to address therising prevalence and associated ill health3.61 An unpublished survey carried out by the NHS ClinicalObesity Group in May 1998 identified 12 obesity clinicsin England, eight of which were run by physicians andfour by surgeons. Additionally, there were fourphysicians and 28 surgeons in England seeing patientsfor their obesity outside obesity clinics.nnnnndietary recommendations for those patients to be placed on aweight management programmeguidance on the appropriate intervals between consultations formonitoring of treatment and follow-upprotocols for follow-up weight maintenanceguidance on setting up registers for overweight and obesepatientscase examples of good practiceSource: National Audit Office interviews (Appendix 1)d) Interventions elsewhere in theNational Health Service3.58 Hospitals and specialist clinics provide other settings toidentify persons at risk of becoming overweight or obeseand for obese persons to seek help. There is, however,very little obesity-related activity within the NHS at thesecondary and tertiary care level.Hospital admissions provide an opportunityto undertake screening for obesity3.59 The link between obesity and associated diseases suchas coronary heart disease and Type 2 diabetes meansthat hospital admissions provide an opportunity,additional to screening undertaken in general practices,to identify patients who would benefit from treatmentfor obesity. Whilst it is common practice for hospitals toassess risk factors that might be contributing to thecondition for which the patient has been admitted, suchas obesity, arrangements need to be made to follow thisup through referral for appropriate treatment afterdischarge from hospital.3.62 Surgery to promote weight loss normally involvesplacing physical constrictions on the opening of thestomach, or reducing the size of the stomach. It is usedrarely, and there are probably no more than 200operations performed in England each year on the mostsevere cases of obesity 28 , many of them fundedprivately. Surgery is normally an effective way ofproducing weight loss, but places major limitations onwhat the patient may eat. This can be hard for patientsto tolerate and in some cases results in further surgery toreverse the procedure. There is also some risk thatsurgery will lead to clinical complications, includingnutritional deficiencies 10 .Case Study 3:Screening at Stockport Acute NHS TrustUnder the screening programme all patients,when admitted for a pre-operative assessment,are requested to complete a health educationquestionnaire with the assistance of a nurse. Thequestionnaire covers basic statistical data andlifestyle related issues including height, weight,body mass index, and eating and physicalactivity habits. One purpose of the questionnaireis to help patients stay healthy after theiroperation. The questionnaire is analysed andappropriate referral suggestions are made. Forexample, if there is an indication ofinappropriate eating habits or a sedentarylifestyle, combined with a high body mass index,the patient will be referred to their generalpractitioner for advice and treatment.Source: National Audit Office site visitpart three29