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The waiting game

My frustration over tsunami relief bid

Dr David Haslam, the GP who leads the National Obesity Forum, tells Nerys Hairon why GPs must embrace the obesity challenge

Dr David Haslam, chair of the National Obesity Forum, is prepared for a fight.

He is well aware of the difficulties of promoting weight loss. His own BMI was just under 30 a year ago, until he lost 21 pounds in a three-month low-carbohydrate diet.

But Dr Haslam, a Hertforshire GP, is now braced for a less personal but potentially far more difficult battle, as he presses for greater management of obesity in primary care.

Dr Haslam is no crank. He has the ear of senior members of the Government, who want to see management of obesity join the next draft of the quality and outcomes framework. A fortnight ago, Dr Haslam provoked outrage among some GPs after suggesting that obesity could carry as many as 100 points.

Speaking this week in his sur-gery in the village of Watton-at-Stone, he is understandably more cautious.

While he reiterates that 70 to 100 points would be his 'ideal scenario', he seems well aware of the mammoth task he faces in persuading sceptical GPs.

'A hundred points would be too big a step in one go,' he concedes. 'Ideally for treatment of the condition it would be the full 70 to 100 but that's not the only criterion ­ it must be fair and practical for GPs.'

Dr Haslam is planning for a 'semi-engaged scenario' in which obesity management is introduced into the framework gradually. He thinks 30 or 40 points for drawing up an obesity register, giving lifestyle advice and measuring fasting blood sugar, blood pressure and cholesterol would be realistic for the next draft.

But while he insists he is no 'table-thumper', he remains adamant that outcome targets will eventually need to be included.

'To have all the other aspects of the metabolic syndrome in the framework and not have the root cause is illogical. Treating obesity and reducing BMI and waist circumference are so important that any possible measures should be taken to make that happen in primary care.'

Dr Haslam knows some GPs will remain fiercely opposed to his proposals.

'It's thorny because your quality points rely on someone else much more than with blood pressure. GPs will argue that salary should not depend on compliance. I sympathise, but obesity management is so important that like it or not we need some sort of measurable outcome,' he says.

'It's not easy but things don't get into the contract because they are easy ­ they get in because they are important.'

He is similarly bullish when pressed on the evidence base for obesity management, in the wake of new research questioning the evidence for exercise advice.

Dr Haslam insists a 'holistic package' of interventions is required and points to the success of the Counterweight Project, a Roche-funded scheme in which up to 40 per cent of patients achieved weight loss after a year.

The National Obesity Forum is pushing the Department of Health to roll Counterweight out nationally. Dr Haslam admits it would be a 'very big ask although he says the department is 'supportive'.

He says: 'More realistic is that it gets rolled out in

areas where PCTs are more enthusiastic.'

GPs may be alarmed at the prospect of even a limited roll-out, given estimates of practice workload as high as 400 hours a month.

But Dr Haslam is dismissive of such claims. 'It's not going to create a lot of extra work for GPs. A lot of these patients are being seen anyway.'

He can certainly not be accused of failing to practise what he preaches. In his own practice he runs a weight management programme that includes advice on diet and physical activity and measurements of waist circumference and BMI.

And it seems his own personal battle to lose weight has come in useful. 'I've always carried extra weight which I find an advantage in day-to-day practice,' he admits. 'There is nothing worse than being told to lose weight by someone who has never carried an extra milligram.'

How contracts could look if

the NOF gets its way

Semi-engaged scenario

·Obesity to carry 30 to 40 points in total

·Organisation markers: points for drawing up registers of obese patients and measuring fasting blood sugar, cholesterol, and blood pressure

·Interventional markers: points for giving obesity advice

Ideal scenario

·Obesity recognised as a chronic disease, carrying

70 to 100 points

·Outcome markers:

Points paid for achieving weight loss in 20 to 30 per cent of patients (as measured by BMI, waist circumference or 5 per cent weight loss)

Points for percentage of patients attending exercise referral schemes

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