Tackling Obesity in England - National Audit Office

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.