Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND12 Within general practice, there is a wide range of different methods whichgeneral practitioners and practice nurses use for managing overweight andobese patients, and many remain uncertain about which interventions are themost effective. Whilst drug therapy, for example, was used by about 40 per centof general practitioners in our survey, most of those we interviewed hadreservations about its effectiveness, despite recognising that it could be a usefulaid to accelerating weight loss for some patients. The National Institute forClinical Excellence is currently undertaking an examination of anti-obesitydrugs to enable it to advise on their clinical and cost effectiveness.13 We also found some confusion over roles and responsibilities, and evidence ofa lack of 'buy in' by general practitioners for helping overweight and obesepatients to control their weight. There are wide divergences between practicesover aspects of management, including their use of health promotion on weightcontrol, diet and physical activity, and the extent to which they try to assesswhich patients are at risk from excessive weight gain. Only a small minority ofpractices were using a protocol for the management of obese patients, but themajority said that they would find a national protocol or guidelines useful.14 In general, there is little NHS activity related to the management of obesityoutside general practice. Some hospitals provide a valuable service byscreening pre-operative patients for obesity, and referring those who mightbenefit from weight management to their general practitioner for advice andtreatment. There are also a number of specialist centres for the treatment ofobesity, normally offering drug therapy, and about 200 surgical interventionsfor cases of extreme obesity each year. Resource constraints prevent specialistcentres from treating more than a small minority of those obese patients whoseek help from the NHS. There may be scope for more patients to benefit fromsuch specialist treatments, although to date there is only limited evidence oftheir long term effectiveness.15 We conclude that the NHS has a key role in assessing the risks from obesity atthe national and local levels, and devising appropriate strategies to reduce itsimpact. But work is needed at the local level to develop and implement effectivepolicies to prevent overweight and obesity, and to tackle the wider healthimpacts of obesity through effective treatment programmes. In particular, theNHS needs to focus on identifying and helping those who are at high risk ofobesity. This would include targeting interventions at the large proportion of thepopulation already in the "overweight" category, and at those groups where theprevalence of obesity is highest, such as Black Caribbean and Pakistani women.16 General practitioners and their teams can play a key role in assessing the riskto patients, providing health promotion, and providing individual advice andonward referral to relevant specialists. However, these activities need to beundertaken on a more consistent basis across general practice than is currentlythe case. There are opportunities for identifying and spreading good practicemore widely.17 We recommend in particular that:nnin devising local strategies to reduce overweight and obesity, healthauthorities must have regard to the Health Development Agency's guidanceon which interventions have proved most effective;health authorities should ensure that they set realistic milestones and targetsfor improving nutrition and diet, for promoting physical activity and forarresting the rising trends in the prevalence of overweight and obesity. Theyshould also develop indicators of progress in reducing health inequalitiesthrough initiatives that target the population groups at highest risk;executive summary3