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We must go beyond the 'fat register' in the QOF

Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat one of the known and obvious causes, writes Dr Matt Capehorn.

Harm from obesity may already be worse that that from smoking, and prevention has certainly failed.  Treatment should now become the priority and GPs must provide more direct help to our patients, as we do when we refer smokers to structured cessation clinics.

The National Obesity Forum (NOF) is urging the Government to tackle this head on, and in particular to address the irony of the Quality Outcomes Framework (QOF), which rewards GPs for recording the numbers of obese patients – but not for doing anything about it. Although this information is useful, merely drawing up a register will not prevent a single overweight person from developing type-2 diabetes or a single obese person from having a heart attack.

NOF began a campaign in June 2012 to reform the way in which GPs are paid.  QOF needs reform in order to reward those GPs who steer their overweight and obese patients into structured weight management programmes that help them to lose weight in a safe way and with the necessary support and advice to help them maintain this weight loss.

What is needed are QOF indicators for the identification of obese patients (similar to the eight points that currently exist for having an obesity register). But we also need further indicators for the appropriate screening of these ‘at risk’ patients for the other common associated co-morbidities (such as diabetes, dyslipidaemia and obstructive sleep apnoea) plus additional indicators for ensuring that appropriate weight management advice has been given and that a referral has been offered.

In an ideal world we would have enough time to deal with all of the problems that our patients have on every occasion, but we rely on the QOF to help us identify priorities. 

The NOF agrees with the BMA and our medical colleagues that a GP’s pay should never be determined by the weight of their patients, or their success in a weight management clinic, but that GPs should be incentivised to refer obese patients into structured weight management programmes, similar to the successful smoking cessation programme. 

This can be achieved very easily with QOF points for appropriate screening and referral of such patients. It may also drive up the number and quality of weight management services. A Government White Paper already insists that each PCT must have an obesity strategy, but it lacks specifics – if we incentivised more referrals then over time we would end up with more programmes, and more effective ones. 

See what we’re doing

At present there is a huge geographical variation in the quality of weight management services.  The obesity strategy in some areas may just be to rely on GPs referring patients to practice- or secondary care-based dietitians. 

In other areas, such as Rotherham (where I work), there are services that include comprehensive specialist multi-disciplinary teams, and facilities for weight management.  Over time having more weight management programmes across the country will add to the existing evidence base and allow us to see what works best for patients.

It is reassuring that MPs are finally beginning to grasp the scale of Britain’s obesity epidemic, and its central role in the range of potentially fatal and highly expensive ailments.  However, some may still need to get out and spend some time in our surgeries to appreciate the problem. My invitation goes out to them to spend a day at the Rotherham Institute for Obesity. 

After all, it is urgent that we start to deal with obesity more effectively.  Currently one in four adults is clinically obese, and this is predicted to rise to one in two by 2050. 

Direct and indirect costs of obesity may reach a staggering £50bn a year, or more by then, which we are told will bankrupt the NHS.  The latest National Child Measurement Programme figures show that the numbers of overweight and obese children in Year 6 (aged 10-11) is still increasing, and this will be adding to the future burden on the NHS. 

The Government wants us to tackle diabetes and other long-term conditions, as well as reduce admission etc, and we need to appreciate that obesity causes or worsens nearly all of these long-term problems.  Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat one of the known and obvious causes: the weight of the nation.

The latest Health Survey for England data (2011) and shows obesity prevalence is 24% in men and 26% in women.

The percentages that are overweight or obese are 65% men and 59% women.

Source: HSE, 20 Dec 2012

Dr Matthew Capehorn is a GP in Rotherham and clinical director of the National Obesity Forum

Readers' comments (8)

  • Oh please, go away, majority of people know they are fat , and they also know what to do, ie eat less and exercise more, it's not rocket science and referral to weight management is not the answer, Qof is certainly not the solution, I would however like to see the government do far more public health wise like put out mass advertising campaigns promoting exercise and balanced diets, and banning food and alcohol, and fast food advertising all together. It's bad that McDonald's sell toys with their "happy" meals. What kind of MSG does that send out.
    When banning smoking in public places came out this did far more to improve people's health then any crappy Qof, gp intervention

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  • Good argument but we already have a full QoF workload and I am sure most GPs give ad hoc advice. We can't embrace every GP's special interest under the umbrella of QoF. It is not a panacea for the government to address all of society's ills for 1000 points. They are doing their best under the sleigh of hand euphemistically called 'incentivising' and 'retiring indicators'

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  • Mark Struthers

    People lob litter out of their car windows. Have you noticed the extraordinary epidemic of littering that is spoiling England's once green and pleasant land? There are discarded McDonald’s bags, fag packets, beer cans, plastic coke bottles, littering the verges, everywhere, including Rotherham. Littering is complex social issue, like the 'epidemic of obesity'. Gathering QOF points won't even begin to address it.

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  • "Over time having more weight management programmes across the country will add to the existing evidence base and allow us to see what works best for patients." This is the rub, We are being asked to tackle the "obesity epidemic" by dong more, but in all the articles that I see by enthusiasts, most is taken up by the problem, and little by what can primary care do effectively. Because there isn't evidence to support these interventions. As a profession, we need to avoid taking responsibility for solving the problem, while government pussyfoots around legislation to control food companies, fast food outlets, school meals etc

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  • Need to really be lobbying government to prevent food additives and pesticides and other ingredients the human body does not know how to process. Once this is tackled a decrease in obesity will be seen I'm sure of it! I also agree to some extent regarding fast food, advertising targeting minors is a bad thing. "Get the kids hooked on junk and they'll eat it for life".....must be the company motto for a lot of these fast food companies. Just like Bingo advertising currently reaching the target audience of those in their late 20's. there's not much difference really in the strategy!

    Not all obesity is caused by the individual being a layabout. Sometimes it can be a direct result of medication causing weight gain, or through particular illnesses. Come on people surely you haven't forgotten that have you???

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  • Fast food is cheap, healthy food is expensive. Try reversing them and people on lower wages may actually be able to afford healthier foods. Most exercise programmes/gym fees are expensive too. Motivation needs to be creative in order for Jo public to start their own healthy programme.

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  • As always political special interest groups like The National Obesity Forum (NOF) want to medicalise obesity. For smoking the major influence was through legislation like banning advertising or the smoking bans and these had more effects on smoking numbers even when Primary care was doing everything we could. For obesity the obvious changes should be to have to put calories on all food (like New York restaurants), ban certain adverts and promotions of unhealthy foods and while they are at it to ban trans-fats (like in Denmark).

    I have not been aware of any benefit of the QOF Obesity domain. I would have to admit to a poor result to weight loss advice despite a near evangelical determination to help the obese.

    There is no point in damaging overworked Primary care with more QOF domains when it is a Local Authority matter to provide diet and exercise opportunities for people. Adding it to the QOF is free I suppose and therefore will happen.

    I presume from the boasting of Dr Capehorn here with all the ‘comprehensive specialist multi-disciplinary teams, and facilities for weight management of the Rotherham Institute for Obesity’ that there is now no obesity in Rotherham and that the medical input has transformed the local population. From a GP

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  • There are weight management programmes throughout the country, though not provided by the NHS, they are peer support groups and have proven benefits and efficacy, perhaps we need to look at how they may be subsidised in some cases. The producers of fast food, ready meals etc do also need to be brought to task, try finding a low salt ready meal. Finally perhaps a return to traditional teaching in schools of cooking, meal planning etc would increase the ability to cook healthy nutritious food.

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