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Gold, incentives and meh

GPs should not worried about 'offending patients' in helping them lose weight

GPs opportunistically offering patients the chance to attend a weight loss programme in a routine consultation is effective and only takes 30 seconds of GP time, a study in the Lancet has found.

The randomised trial by researchers from the University of Oxford included almost 2,000 patients attending a consultation unrelated to weight loss and found that those offered a 12 week weight management referral lost on average 1.43kg more than those who weren't.

The authors concluded that GPs should not be concerned about discussing a patient's weight with them.

The study involved 137 GPs and 1,882 patients in the south of England with participants having a BMI of at least 30 (or 25 if of Asian ethnicity) and a raised body fat percentage.

At the end of the consultation, half of the participants were offered a 12 week weight management referral while the other half were advised that losing weight would benefit their health. Both these interventions lasted 30 seconds.

For who accepted the referral to the weight management programme (which was free on the NHS), the GP ensured the first appointment was made and offered follow up.

Both groups of patients lost weight 12 months later, but those in the referral group lost on average 1.43kg more than those in the control group (2.43kg compared to 1.04kg).

Around 77% of those offered the weight management treatment agreed to take part, and 40% of those offered it attended.

In total, 81% of people in both groups found the intervention appropriate and helpful. Over the course of the study, a similar proportion of both groups had taken some action to lose weight, but five times more people in the referral group (54%) took effective action than in the control group (11%).

The authors said that this intervention was cost effective, saying the 30 seconds of GP time costs around £1.45, and the 12 week weight loss programme costs around £50.

Booking the place on the programme could be done by GP admin staff for £0.76 - the cost of the two minutes to take a convenient time and transfer voucher details. Overall, the cost per kg loss over the 12 months was about £16.

In the study the authors said that this is the first study approaching people opportunistically when people were not consulting about their weight. They said: ‘Guidelines recommend that physicians offer brief opportunistic interventions to patients who are obese, and, to our knowledge, this trial is the first to directly support these recommendations.’

Professor Paul Aveyard a GP and lead author of the paper based at the University of Oxford said: ‘Doctors can be concerned about offending their patients by discussing their weight, but evidence from this trial shows that they should be much less worried. Our study found that a brief, 30 second conversation, followed by help booking the first appointment onto a community weight loss programme, leads to weight loss and is welcomed by patients.’

He added: ‘On average, people consult their doctor five times a year meaning there is huge opportunity to deliver this low cost intervention on a large scale.’

Dr Imran Rafi, RCGP chair of clinical innovation and research, said: 'Obesity related conditions – which are continuing to rise across the UK - cost the NHS billions every year, and if this scheme is low cost and effective, which this research claims it is, it makes sense to consider it on a wider scale. However, the costs and benefits should be constantly evaluated in terms of patient care and the wider NHS.

'We must understand that while some patients in this study did benefit from a referral to a weight loss programme, it won’t work for everyone and shouldn’t be considered as a blanket solution to curb growing levels of obesity.'



Readers' comments (15)

  • except our local council has stopped funding the local weight loss program, combining this with punters that do not want to pay for anything....

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  • I see they were willing to help a BMI of just 30. Our local weight management service now excludes anyone with a BMI less than 45 unless they have co-morbidities. So now when I ask them if they want help to lose weight and they do, I tell them it's a terrible shame, they have to go away and get a lot fatter before Greater Glasgow and Clyde deems them worthy of helping.

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  • What a lot of poor "research" produced by academics who do not see any patients?
    Have to go now sorry......carry on offending patients for not finding jobs...and vote for Brexit.

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  • Wait till they complain to NHSE, GMC and the ombudsman and you spend years of your life defending yourself and trying to prove you are not racist, sexist or weightiest. The country will get the GPs they deserve unless GP get some rights and protections.

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  • To be fair although we get the usual nonsense from a Professor about a "huge opportunity" this is balanced by the more sensible real world comment from Dr Rafi-"However, the costs and benefits should be constantly evaluated in terms of patient care and the wider NHS"

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  • Societal problem being pushed our way again. I didn't train for over 10 years to tell someone they need to lose weight. Everyone knows this. They don't need to see a GP to work out they're too fat.

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  • But we cant call them fat - especially fat Norwegians;

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  • 30 secs?? I assume that doesn't include filling in referral forms as that'll take at least 30 secs in it's own right.

    Even if it "only" took 30secs, that's 5% of our consultation time. I would quite happily kill anyone who tries to tell me I have 5% more to contribute in my daily work

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  • I have appraised two GPs who have totally given up opportunistically advising patients to lose weight after receiving complaints. "It's not what I came for, it's none of your business and anyway I hardly eat a thing."

    Good luck.

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  • I always love that scenario when you have managed to diplomatically raise the subject of excessive weight and it's consequences and the patient says "So how do I go about losing weight then Doc?". You know then that it will never happen

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