News Focus  

Obesity is a hot topic at the moment. Judy Sands looks at how the government wants primary care to battle the bulge

Obesity has been regularly hitting the headlines in the past month.

A government report announced that nearly one third of all men will be obese in 2010, along with one million children, if no action is taken to stem the problem.

The government then appointed a ‘fitness’ minister, Caroline Flint, to co-ordinate cross-government policy to make everyone more active, while NICE was asked to produce guidance on promoting physical activity in children.

In addition, the results of a primary care-based weight management pilot called Counterweight were also published at the International Congress on Obesity in Sydney, Australia.

This privately funded programme was trialled in 65 practices across the UK with nearly 2,000 patients taking part. Nurses were trained by specialist dietitians in implementing a structured weight management pathway including advice on diet, exercise and calorie control.

Effective weight loss programme

Over two years, patients were found to have an average weight loss of 2.4 kilograms, rising to 3.3 kilograms in high attenders. The programme also reduced blood pressure and cholesterol and was found to be cost-effective.

The government has said it is investigating the results and the Scottish Executive and 10 English PCTs reportedly want to expand their involvement.

Dr David Haslam, the clinical director of the National Obesity Forum and a GP in Hertfordshire, says these results provide the ‘missing link’ in obesity research and prove that interventions in primary care can make a difference.

‘We will certainly be presenting this research to the QOF committee in order to ask for more points to be devoted to obesity in the next round of changes,’ he says.

But is there really a role for primary care in the fight against the obesity epidemic?

Dr Laurence Buckman, deputy chairman of the BMA’s GP Committee says GPs will remain unconvinced by the results of just one study ‘no matter how successful it’s been’.

‘GPs will firmly resist interfering in other people’s lives, other than what we already do, which is identify people who are obese and highlight to them the health problems it can lead to,’ he says.

‘These people need help but not medical help. They need lifestyle help so they can make better choices about the food they eat.’

The government has attempted to insert obesity management into the QOF before. However, the GP Committee opposed anything except the inclusion of a register of people with a BMI over 30.

Dr Buckman is adamant that GPs will go no further.

‘I will need a huge amount of convincing that these people are my responsibility when I don’t shop for them and I don’t cook for them. This kind of an intervention is hopelessly inappropriate,’ he says.

Lynn Young, primary care adviser at the RCN, points out that obesity is often a social problem, not a medical problem. ‘The area where there are the most obese people is in Easington in the north-west of England. This is a desperately poor area with lots of social problems like unemployment,’ she says.

‘Until we unpick the reasons that these people eat too much unhealthy food and don’t take enough exercise we will not win this fight.’

Ms Young believes it is a PCT issue and should involve the newly reorganised PCTs working with local government and other agencies to implement public health policies.

Public health cuts worrying

However, she is worried about the loss of the public health function in the new PCTs and the continuing job cuts and funding cuts for public health nurses, such as health visitors and school nurses.

Ros Godson, professional officer for school nurses with CPHVA/

Amicus, believes only trained professionals such as school nurses and health visitors should be dealing with childhood obesity.

‘There are certain skills involved and while practice nurses are very good they don’t always know the best way to approach a child. The real relationship should be between the practice nurse and the school nurse.

‘When the practice nurse sees a child, she needs to be able to say ‘I saw your school nurse and I know what she says’ and vice versa. That way everyone is singing from the same songsheet and the child knows that people are watching and caring.’

Support for parents

Ms Godson also points out that often parents have many children, only one of whom is obese, and so are confused about what to do.

‘That’s when they need to know that we are all there to support them, offer advice and help them deal with it. I sometimes think if we banged on a bit less about responsibility and focus more on the practical side of solving the problem we’d be better off,’ she says.

However, Jane DeVille-Almond, nurse adviser with the National Obesity Forum and an independent nurse consultant, points out that obesity will never be solved through tackling it from only one angle.

‘One size doesn’t fit all. Some people will respond best to a doctor giving them advice, children may respond better to getting information at schools. At the end of the day an obese child goes home to a family and no strategy will succeed unless the parents are signed up and aware as well,’ she says.

Ms DeVille-Almond points out that practice nurses and GPs may only see the patient if they also have co-morbidities and it makes sense to manage obesity as part of the management of the co-morbidities.

‘The reason we need more QOF points on obesity is because things get miraculously done when they earn QOF points and we need more of a focus on obesity from health professionals and PCTs.’