Tackling Obesity in England - National Audit Office

More documents

Recommendations

Info

TACKLING OBESITY IN ENGLANDAppendix 1 Auditmethodology1 The techniques used to examine the issues identified forthe study can be classified into five areas:nnLiterature review and consultation with experts;Cost-of-illness study;nnProfessor Peter Kopelman, Professor of ClinicalMedicine, St Bartholomew's & the Royal LondonSchool of Medicine & DentistryProfessor Ian Macdonald, Head of the School ofBiomedical Sciences, University of NottinghamnnnSurveys of health authorities, general practitionersand practice nurses;Review of policy objectives and initiatives acrossGovernment;Site visits to examine local initiatives.Literature review and consultation withexperts2 We carried out literature searches and a review ofpublished literature from the United Kingdom andabroad on all aspects of the study. A list of the papersreferenced in this report is at the Bibliography(page 65).3 We attended a number of conferences and seminars,including the 8th International Congress on Obesity,held in Paris in August 1998, and the 9th EuropeanCongress on Obesity, held in Milan in June 1999. Wealso attended a series of conferences and seminarshosted by the Association for the Study of Obesity,including a joint conference with the British Associationof Sport and Exercise Sciences held in Leeds inSeptember 1999.4 We convened a panel of experts to advise and assist usat strategic points throughout the study. The panelcomprised:nnnnnnDr Elizabeth Evans, Scientific Director, SlimmingMagazine ClubsDr Gene Feder, General Practitioner and Professor ofPrimary Care Research and Development,St Bartholomew's and the Royal London School ofMedicine and DentistryProfessor Ken Fox, Head of Exercise and HealthSciences, University of BristolProfessor John Garrow, Editor, European Journal ofClinical NutritionDr Andrew Hill, Senior Lecturer in BehaviouralSciences, Leeds University School of Medicine, andChairman, Association for the Study of ObesityProfessor Philip James, Chairman, InternationalObesity Task ForcennnMr Rae Magowan, Assistant Director of PublicHealth, Trent Regional Office, National HealthService ExecutiveDr Sue Martin, Team Leader of Police Training,Home Office (formerly Unit Head, Public HealthGroup, Department of Health)Dr Carolyn Summerbell, Reader in HumanNutrition, University of Teessiden· Professor Martin Wiseman, Head of Nutrition andRegulatory Affairs, Burson-Marsteller (formerly Headof the Nutrition Unit at the Department of Health).5 We also consulted more widely with importantstakeholders in issues related to the management andprevention of obesity, diet and nutrition, and physicalactivity. We consulted academics, clinicians,professional bodies in the health sector, voluntarybodies (including those established to represent obesepeople), and the private sector. This process includedthe following organisations:Adrian Davis AssociatesAssociation for the Study of ObesityBritish Dietetic AssociationBritish Heart FoundationBritish Medical AssociationBritish Obesity Surgery SocietyCentre for Obesity Research (Luton and DunstableHospital)Child Growth FoundationEurobesitasFood and Drink FederationInfant and Dietetic Foods AssociationInternational Association for the Study of ObesityKnoll PharmaceuticalsNational Heart ForumNational Primary Care Facilitation ProgrammeRoche PharmaceuticalsRoyal College of General PractitionersRoyal College of NursingRoyal College of PhysiciansRoyal College of SurgeonsSustainTesco Stores LtdThe Obesity Awareness and Solutions Trustappendix one47
TACKLING OBESITY IN ENGLANDappendix one48Cost-of-illness study6 We employed Medtap International Inc to advise on thefeasibility and to propose a methodology for a study toestimate the cost of obesity in England, both to theNational Health Service and to the wider economy. Wethen appointed City University to undertake the studyand to prepare a report to present their findings. Thedetailed methodology, results and conclusions drawnfrom this work are provided at Appendix 6.The surveysHealth authorities7 During the Summer of 1999 we carried out a postalsurvey of Directors of Public Health at all healthauthorities in England. The purpose of the survey was togather information about the extent to which healthauthorities had addressed the issue of obesity throughlocal strategies and action plans, and through supportfor local services and initiatives. We also asked howeach health authority had addressed obesity through itsHealth Improvement Programme as at April 1999. Atotal of 94 of the 100 health authorities at the time of thesurvey replied.Postal survey of general practitioners and practice nurses8 During July 1999, we carried out a survey of generalpractitioners and practice nurses. The objectives of thesurvey were:nnnnto learn what general practices were doing to helpprevent obesity and to manage both overweight andobese patients;to explore their perceptions of the problem ofobesity and to seek their views on what role theyshould play in helping to address it;to identify any factors that constrained the efforts ofgeneral practitioners and practice nurses to helpoverweight and obese patients, and to explore whatwould most help them to manage such patientsmore effectively;to identify potential examples of good practice.9 We sent two self-completion postal questionnaires to1200 practices across England. One questionnaire wasaddressed to a named general practitioner at thepractice, the other to the practice nurse. The sample wasstratified to provide a range of general practitioners byregion of practice, gender of practitioner, and size of thepractitioner's patient list.10 We calculated the sample size to provide us withsufficient data, working on the assumption that no morethan a third of general practitioners would return acompleted questionnaire. Many general practitionersurveys receive a considerably lower response rate, anda pilot survey indicated that we could expect about30 per cent to respond. This in part reflects the heavyday to day workload of general practitioners. Given thatgeneral practitioners are independent, self-employedprofessionals, they are under no obligation to respond.In the event, we received a satisfactory response rate of36 per cent (428 respondents) to the survey of generalpractitioners, and 52 per cent (627 respondents) to thesurvey of practice nurses.11 Figure 26 summarises the information requested in thequestionnaires.26Information requested in postal questionnairesBackground information about the general practitioner/practice nurseand the practiceQualitative interviews with generalpractitioners and practice nurses12 Following receipt of the self-completion postalquestionnaires, we selected a sample of generalpractitioners and practice nurses at 20 practices for faceto-face,structured interview. The purpose of theinterviews was to explore further the answers given tothe postal questionnaire and to:n examine in more depth the interviewees'perceptions of the issue of obesity;nnUse of, and attitudes to, protocolsRoles in weight managementAssessment and recording of body weight/shapeHealth promotion and preventionManagement of overweight and obese patients, including advice andtreatment provided by the practice and referral outside the practiceEffectiveness of prevention and treatment programmesunderstand how general practices determine theirapproach to the treatment of overweight and obesepatients;follow up examples of good practice.13 We selected the practices to ensure a geographicalspread in England, and to cover a wide spectrum fromthose general practitioners whose questionnaireresponse indicated that they spent relatively little timeadvising and treating overweight and obese patients, tothose who were very active in this area. The interviews,with 20 general practitioners and 16 practice nurses,were carried out late in 1999.
Page 1 and 2: Tackling Obesity in EnglandREPORT B
Page 3 and 4: Tackling Obesity in EnglandREPORT B
Page 5 and 6: TACKLING OBESITY IN ENGLANDPart 3:
Page 7 and 8: TACKLING OBESITY IN ENGLAND5 The Go
Page 9 and 10: TACKLING OBESITY IN ENGLANDnnnthe D
Page 11 and 12: TACKLING OBESITY IN ENGLANDnnnna jo
Page 13 and 14: TACKLING OBESITY IN ENGLAND2The way
Page 15 and 16: TACKLING OBESITY IN ENGLANDStudy me
Page 17 and 18: TACKLING OBESITY IN ENGLANDThe prev
Page 19 and 20: TACKLING OBESITY IN ENGLANDnnnless
Page 21 and 22: TACKLING OBESITY IN ENGLAND2.21 As
Page 23 and 24: TACKLING OBESITY IN ENGLANDPart 3Ma
Page 25 and 26: TACKLING OBESITY IN ENGLAND10Exampl
Page 27 and 28: TACKLING OBESITY IN ENGLAND3.28 Vie
Page 29 and 30: TACKLING OBESITY IN ENGLANDCase Stu
Page 31 and 32: TACKLING OBESITY IN ENGLAND13 Refer
Page 33 and 34: TACKLING OBESITY IN ENGLAND16Topics
Page 35 and 36: TACKLING OBESITY IN ENGLANDPart 4In
Page 37 and 38: TACKLING OBESITY IN ENGLANDInitiati
Page 39 and 40: TACKLING OBESITY IN ENGLANDCase Stu
Page 41 and 42: TACKLING OBESITY IN ENGLANDaccounta
Page 45 and 46: TACKLING OBESITY IN ENGLANDoffer fi
Page 47 and 48: TACKLING OBESITY IN ENGLAND4.51 To
Page 49: TACKLING OBESITY IN ENGLAND25Inters
Page 53 and 54: TACKLING OBESITY IN ENGLANDAppendix
Page 55 and 56: TACKLING OBESITY IN ENGLANDAppendix
Page 57 and 58: TACKLING OBESITY IN ENGLAND31 Preva
Page 59 and 60: TACKLING OBESITY IN ENGLANDImpact o
Page 61 and 62: TACKLING OBESITY IN ENGLANDthe data
Page 63 and 64: TACKLING OBESITY IN ENGLAND25 Third
Page 65 and 66: TACKLING OBESITY IN ENGLANDStudies

Tackling Obesity in England - National Audit Office

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?