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GPs' different school to consultants

By Nerys Hairon

General practice schemes to tackle obesity can help patients to lose weight without sending GP workload soaring, a new pilot study concludes.

The Lifestyle Improvements for Everyone scheme increased patients' physical activity and fruit and vegetable consumption, cut blood pressure and helped around three-quarters of participants lose weight.

The pilot is highlighted as an example of best practice in a new report circulated to PCTs by the NHS Modernisation Agency and NHS Alliance to help

them commission anti-obesity services.

Obesity experts applauded the scheme, run by a dietitian and a practice manager at a practice in St Ives, Cambridge-shire, but other GPs were sceptical about its value at a cost of £2,771.

The pilot included 111 patients with a BMI of more than 25 and used group meetings, diet and activity advice, health assessments and weigh-ins (see box). Some 77 per cent of patients lost weight over a nine-month period, with an average loss of 3.2kg, and 21 per cent lost 5 per cent of their bodyweight or more.

Systolic blood pressure also fell by an average of 9mmHg and diastolic by an average of 2mmHg.

Dr George Smerdon, a GP at the St Ives surgery, said other practices might find the programme attractive as it did not need GP involvement. 'It means patients can go into the programme without the need for GPs or nurses to supervise their progress and this liberates GPs to work with the more complex patients.'

Dr David Haslam, clinical director of the National Obesity Forum and a GP in Watton-at-Stone in Hertfordshire, said: 'I think the results are rather impressive. As far as the cost is concerned you have got to look at the cost of not treating obesity, and if you can prevent one case of diabetes, heart disease or stroke, then you save a fortune in both human terms and cost terms.'

But Dr Peter Brindle, a Wellcome fellow in health services research and a GP in Bristol, was sceptical about the cost of the project.

'Is it any better than saying to the patients they should go to Slimming World, which doesn't cost the practice anything? Before I invested £3,000 I would want to know it was better than giving a diet sheet or referring my patients,' he said.

nhairon@cmpinformation.com

Obesity scheme

· Patients completed a health assessment, paid £5 and filled in a lifestyle questionnaire

· Teams of 8 to 12 people set up

· Patients received individualised health information at induction meetings

· Each patient given a fortnightly or monthly lifestyle monitoring form

· Information on healthy meals, snacks, puddings, recipes and physical activity

· All patients had at least two health assessments and were weighed at each group meeting

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