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New GP role in obesity care

By Daniel Cressey

GPs are set for a far greater future role in managing obesity after results from a landmark trial showed primary care could promote long-term weight loss.

The nationwide Counterweight Project found intensive lifestyle intervention produced sustained reductions in weight, blood pressure and cholesterol over two years.

The Department of Health and NICE are now considering the results ­ with obesity management set to become a routine part of GP work.

The Scottish Executive has already decided to expand its involvement and 10 English PCTs have signed up. Experts believe obesity outcome targets will form part of future versions of the QOF.

Professor Iain Broom, chair of Counterweight, told Pulse: 'It's a major step forward ­ it's the only programme known to produce sustained weight loss that brings clinical benefit.'

Professor Broom, professor of clinical biochemistry and metabolic medicine at the Robert Gordon University in Aberdeen, added: 'We are in discussion with the DoH about taking this on board. We have a waiting list of PCTs.'

He said Counterweight seem-ed to be cost-effective and surprisingly was most effective in deprived areas.

The final outcome data, to be presented at the International Congress on Obesity in Sydney, Australia, show an average weight loss of 2.4kg at 24 months, rising to 3.3kg in high attenders to the scheme.

The department confirmed it was interested in a wider rollout of Counterweight, with a Government report this week due to warn that nearly 15 million people will be dangerously overweight by 2010.

Dr David Haslam, clinical director of the National Obesity Forum and a GP in Watton-at-Stone in Hertfordshire, said there could now be outcome targets for obesity in 'the next QOF or next QOF but one'. He added: 'The department is very pro obesity being in the QOF.'

But Dr Paul Singer, a GP in Luton who participated in the project, warned QOF outcome targets would have to be implemented with care.

'It is an additional pull on the time of clinical staff. We can provide it but it would require extra resources.'

GPs insisted they were too stretched to take on an intensive obesity programme such as Counterweight ­ which involves fortnightly sessions over a three-month period (see box, left).

Dr David Love, joint chair of GPC Scotland and a GP in Edinburgh, said: 'In terms of management of patients and actual treatment regimens, it is not something GPs have the capacity to take on.'

The Counterweight Project

· Pilots at 65 practices at seven sites across the UK

· GPs or practice nurses trained to deliver programme by specialist dietitians

· Nearly 2,000 patients received six 10-15 minute individual appointments or six hour-long group sessions over 12 weeks

· Patients received advice on exercise, diet and calorie control, with second-line drug treatment or referral to dietitian, psychologist or secondary care

· The Roche-funded programme reduced weight, blood pressure, cholesterol and overall costs at two years

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