Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND3.63 Specialist obesity clinics use a combination ofinterventions to achieve weight loss, normally includinga very low calorie diet and drug therapy, in some caseswith input from a psychologist. The majority of clinicsare highly constrained by resources and thus thenumber of patients they can treat. For example, a typicalphysician-led clinic in London operated on one half dayper week, seeing between six and eight new patientseach time, while another in Bedfordshire opened forone half day per fortnight, admitting three new patientseach time. The physicians leading these clinics told usthat the waiting list for admitting patients was long, oftenin excess of six months. They were therefore only ableto admit the minority of patients who could demonstratea very strong motivation to make changes to theirlifestyle in order to lose weight. Case Study 4 providesan example of the type of treatment offered within aspecialist obesity clinic.3.64 Specialist centres can play a potentially important rolein the management of obesity for those patients whohave sufficient motivation to benefit. However, there isonly limited evidence of their effectiveness. Selfevaluationsundertaken by physicians operating obesityclinics suggest that they are effective in helping mostpatients to achieve medically significant weight loss, butthat this is rarely sustained in the long term 30 .Case Study 4:Inside an obesity clinicThe clinic is offered as part of acute medical services through the general medical clinics of diabetes and endocrinology andis staffed by a consultant physician, a clinical psychologist and a senior dietitian. It is held fortnightly.Patients are referred by their general practitioner. Potential patients are sent a detailed questionnaire and returned questionnairesare analysed. If the analysis suggests that the patient suffers from a significant lack of motivation or readiness for lifestyle changeor a significant eating disorder, the patient is directed back to their referring general practitioner and no appointment is offered.The consultant physician assesses those patients selected for treatment on their first visit. They will then see the psychologistand dietitian. A joint decision is made as to an appropriate treatment plan. The treatment options are:nnnnnnna group behaviour modification and low calorie liquid diet programme, the programme about half the clinic patientsfollow;dietetic-led management, used with most patients with uncomplicated obesity, which involves three or moreappointments with the dietitian followed by an appointment with the doctor;medically-led management, which involves a series of three appointments with the doctor and one appointment withthe dietitian, and is offered to approximately 20% of the patients, in particular those with obesity-related medicalcomplications;clinical psychology assessment, where patients attend two or three appointments to explore their suitability for othertreatment options at the clinic. Less than five per cent of patients require long term psychological intervention and arereferred to the psychology services offered by the local Community Health team;pharmacological intervention, where patients are prescribed a course of anti-obesity drugs;referral to other units for surgical intervention, an option offered to less than one per cent of patients when appropriate;recruitment into clinical research programmes where appropriate.An evaluation of the low calorie liquid diet programme undertaken by the clinic in 1998 found that on average patients lost12 per cent of their body weight during the course of the programme. It was difficult to draw conclusions about long termeffectiveness, however, as of the 91 patients who completed the programme, only nine returned for follow-up 18 monthslater.Source: National Audit Office site visit and self-evaluation report by the clinic 29part three30