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NICE to extend statin use to risk of stroke

Obese patients found to be more prone than normal to infections, stomach problems and skin complaints

By Nerys Hairon

The rising tide of obesity is swamping GPs with even greater workload than ex-pected, two related studies conclude.

Obese patients saw their GP more often and were prescribed more drugs for a range of chronic and acute conditions than those of normal weight, researchers found.

The studies, from the national Counterweight Project, came as separate research warned that forcing GPs to manage obesity could throw doctors and patients into conflict.

Counterweight researchers reviewed prescribing data on more than 2,000 patients.

In eight of the 15 British National Formulary prescribing categories, more prescriptions were made for obese patients than those of normal weight.

The study, in this week's British Journal of General Practice, found increases with a number of conditions not normally linked to obesity, such as infections and gastrointestinal and skin complaints.

Some 42 per cent of obese patients had a prescription for an infection compared with 35 per cent of normal weight patients. Prescribing volumes were two- to four-fold higher in a wide range of drug classes including ulcer drugs, antibiotics, NSAIDs and fibrates.

A second study by the Counterweight team, published in Obesity Research, found obese patients made more visits to GPs, practice nurses and hospital outpatient units than normal weight patients.

Study researcher Louise McCombie, senior research fellow at Robert Gordon University in Aberdeen, said: ‘I think it begins to demonstrate the full extent of clinical conditions obesity is having an impact on. It's much broader than those conditions normally considered to be related.'

Dr David Haslam, primary care representative on the Counterweight Project board, said: ‘The ramifications are so widespread. It's really not just heart disease and diabetes – obesity also causes leg ulcers, respiratory problems, cancers, gout, fertility problems and mental health problems.'

But a qualitative study of 21 GPs, also published in the BJGP, found GPs believed obesity was the patient's responsibility, but felt patients wanted to hand responsibility to doctors (see box, below).

‘This contradiction creates a sense of conflict for the GPs, exacerbated by their lack of faith in existing treatment options and a desire to maintain a good doctor-patient relationship,' the researchers said.

Managing obesity – how GPs feel

• ‘He wanted me to magic him lighter.'

• ‘He was looking to what I was going to do about his weight rather than what he was going to do about it.'

• ‘Usually patients say: "It's in my genes – we all eat nothing and we're all overweight".'

• ‘It is a major problem and yet as primary care providers we are very ineffective and rather powerless.'

• ‘I'm not a dietitian and I don't feel able to monitor their diet properly.'

Source: British Journal of General Practice, October 2005

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