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

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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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