GPs pressed to screen all adults for obesity
By Nerys Hairon
GPs will be expected to screen the entire adult population for those who are overweight or obese under far-reaching Government recommendations.
New guidance insists GPs opportunistically measure BMI in all adults, signalling ministers' determination to make managing obesity part of the key business of general practice.
The guidance also hands GPs a central role for the first time in identifying and managing childhood obesity. It follows recommendations made in the Government's Choosing Health White Paper and reported by Pulse last March that GPs should screen opportunistically for obesity.
But the guidance prompted an angry reaction from GPs, with even the National Obesity Forum dismissing it as worthless in the absence of any new resources.
GPs will be expected to assess obesity using both BMI and waist circumference and to consider interventions in patients with a BMI of 30 or over, or 28 or over with co-morbidities.
The new document Care Pathway for the Management of Overweight and Obesity stresses the importance of a 'sensitive, empathic, non-judgmental approach' to obesity-related interventions. Its section on adults says: 'All patients should have their BMI recorded, because there is strong evidence for a link between the increasing prevalence of co-morbidities and increasing BMI.'
GPs are not being asked to record BMI in all children, but should raise the issue of weight in those under 20 if a family expresses concern about it, if a child has weight-related co-morbidities or if the child is visibly overweight.
But Dr David Haslam, clinical director of the National
Obesity Forum and a GP in Watton-at-Stone in Hertfordshire, branded the guidance 'a waste of time' and demanded more
He said: 'There are two categories of GPs; those who are motivated, and it will make no difference to them, and those who are not motivated and a bunch of guidelines telling them how to do it will be neither use nor ornament.'
Dr Gill Jenkins, a GP with an interest in obesity in Bristol, said following the guidance would take 'far more' than the usual seven minutes per patient. 'As for telling us how to break unpleasant news to patients without upsetting them what does the [Government] think GPs do all day?'
Screening for obesity
Record BMI in all patients
Assess obesity using combination of BMI, waist circumference and body shape
Consider intervening if BMI is 30 or more, or 28 or more with
co-morbidities, with lower
cut-offs for most Asian patients
Assessment should include medical and family history and record of alcohol consumption, smoking, medication,
diet and physical activity
Test patients first-line for blood pressure, fasting blood glucose, lipid profile and thyroid function
Assess the patient's readiness to change and if they are not ready, give them the Why Weight Matters card
As first-line management, give patients advice on healthy eating, increasing physical activity and behaviour change