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GPs should refer a quarter of all patients for weight management, suggests NICE

GPs could be incentivised to refer all obese patients for weight management within three months, under draft proposals for a new QOF indicator published by NICE.

However, GPs pointed out this would come with significant workload to practices and place a huge burden on already overstretched weight management services, as over a quarter of the population is estimated to be obese.

The new obesity indicator would see GP practice achievement measured on 'the percentage of patients with a BMI ≥27.5 kg/m2 (or ≥30 kg/m2 if ethnicity is recorded as White) in the preceding 24 months who have been referred to a weight management programme within 90 days of the BMI being recorded'.

In a consultation launched on the new GP indicator, NICE said it 'aims to increase the proportion of people referred to digital and non-digital weight management programmes by general practice when they have been identified as obese based on their BMI measurement'.

It said this comes as people from BAME backgrounds have 'higher risks for certain conditions, such as Type 2 diabetes, at lower BMIs'.

The consultation, which closes 15 July, also proposes a new indicator to measure the 'percentage of patients with hypertension or diabetes and a BMI ≥27.5 kg/m2 (or ≥30 kg/m2 if ethnicity is recorded as White) in the preceding 12 months who have been referred to a weight management programme within 90 days of the BMI being recorded'.

The consultation said: ‘Patients with hypertension or diabetes may experience additional benefits from attaining and maintaining a healthy weight and patients should be given a targeted offer of support.’

NICE added that in both cases ‘weight management advice’ can include discussion of the patient’s weight and risks, as well as a healthy diet and exercise.

Before any such indicators could be included in the QOF, they would be subject to negotiation between NHS England and the BMA's GP Committee.

However GPs said that while 'well meaning', the proposal would cause a 'not insignificant workload' for GPs and may not be well received by patients.

The Health Survey for England 2017 estimated that 28.7% of adults in England are obese and a further 35.6% are overweight.

But Kent GP Dr Stephanie de Giorgio warned that in some areas potentially 50-60% of patients may have obesity.

She said: 'There aren't the services to send them to, so that's not possible without massive investment when you think of the number of patients this is going to involve.

'At the moment, weight management services are incredibly patchy and for the most part of very little value.'

Obesity is 'not a temporary state of affairs' but a chronic disease, Dr de Giorgio added.

She said: 'We know that only 5% of people who have obesity will lose weight and maintain that weight loss ever. So unless significant input is put into effective weight management - which includes psychology, proper nutritional information, obesity medicine and bariatric surgery - then there is really very little point in doing any of this.'

RCGP senior educator Dr Mike Smith, a GP in St Albans, said: 'If it was just to measure the BMI as an indicator that would be sensible and doable. But a lot of these patients don’t want the intervention to weight management services - the vast majority of them decline it.

‘Making it a tick-box is not going to solve the problem.’

He added: ‘Does our weight management service have the capacity to cope with those referrals? Even if everyone did consent to it, the concern would be that an already overwhelmed service would be flooded.’

It comes as a senior primary care adviser to the Government has said that patients with diabetes, hypertension and cardiovascular disease should be added to the list of clinically extremely vulnerable patients who should shield during a second Covid-19 spike.

PHE's delayed report into the risk factors associated with coronavirus recommended the improved management of conditions such as hypertension and diabetes.

Meanwhile, the RCGP was forced to apologise for branding Covid-19 as a 'lifestyle' disease on the grounds that obesity, diabetes and other lifestyle diseases are associated with poorer outcomes from infection.

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Readers' comments (43)

  • Azeem Majeed

    Most adults are perfectly capable of measuring their own height and weight, calculating their BMI, and then contacting an NHS weight management service if they need support. They don’t need a health professional to do it for them.

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  • There should be an organisation that looks at lifestyle and social interventions for the ‘public’ to improve their ‘health’ that could do this.
    What should we call them?

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  • No capacity in the service.
    No desire from patients.
    It’s a public health issue.

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  • Absolute nonsense. Storing up this document to burn for winter fuel . People need to take complete responsibility for their weight. Everyone knows what to do but most struggle because of the high calorific food we can get hold of easily and a current lifestyle that means far less movement in general. Advice is one thing and I agree a chat now and again with a member of the health care team is very productive and motivational for a short period but otherwise please don’t medicalise a lifestyle choice and give more work for doctors.. Why can’t public health deal with public health issues.. more often.

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  • To whom? This is a social issue, not a medical one. The solutions to obesity lie in society and culture. Another attempt to medicalise life.

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  • Social collapse associated with catastrophic loss of grain production globally and environmental implosion in the next 10 years will sort this out.
    Let's hope that the dolphins make a better job of things.

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  • GPs are well placed to give advice and indeed refer patients with obesity - their guidance carries a lot of weight (pardon the pun!). However blanket recommendations for referral will crash the system, albeit online could offer significant capacity (if it works). This has to be a multidisciplinary/system approach involving everyone - including people themselves, Public Health, Government etc.

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  • We need to stop treating adults like idiots. Everyone knows what to do to loose weight and they don't need a GP to refer them.

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  • NICE should take Covid holiday!

    Do they not realise Hospitals arent even fully doing Cancer work at the moment, let all alone extra Weight Clinics for 15 million people?

    Twice that if you cound the likely DNAs!

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  • Will the referral forms for weight management be:
    1. A simple self referral that patients use;
    2. A 3 page form requiring GPs to demonstrate consent for the referral, record family history, ethnicity, complete a weight chart over time, measure abdominal circumference, ensure various 'baseline bloods' have been done recently, list all medications and that will results in one 2 ring call back to the patient's home phone only with instant discharge if they miss the call - GP to re refer with new form if patient still wants to be seen?

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