‘Only 3%’ of eligible patients referred to weight management services

GP practices are referring only 3% of overweight and obese adult patients to publicly-funded weight management services, a study has found.

In England, referral routes include community lifestyle weight management services, specialist medical weight management services and bariatric surgery for severe and complex obesity, explained researchers presenting at this month’s European Society of Obesity Congress in Maastricht.

According to national guidance, adults with a BMI ≥25 (≥23.0 in minority ethnic groups) are eligible for referral to a lifestyle weight management programmes, but the schemes are not consistently available across the country and there is no national registry of non-surgical weight management interventions, so little was known about access to them.

The cross-sectional study used anonymised primary care electronic health records in England from the Clinical Practice Research Datalink and included 1,811,587 adults with a recording of overweight and obesity between January 2007, which coincided with the introduction of national obesity guidance, and June 2020.

This number equated to 31% of the corresponding adult population, researchers noted, yet the Health Survey of England found overweight or obesity in 64% of adults, indicating underreporting/underdiagnosis of overweight and obesity in primary care.

Findings included:

• Of the adults with a recording of overweight or obesity, records showed 56,783 (3.1%) received a weight management referral, with researchers findings gender, ethnicity, age and BMI all affected the likelihood of referral.

• Men had 31% lower odds of receiving a referral than women, while people with Black ethnicity had 24% greater odds of being referred than those with white ethnicity.

• Adults with a BMI of 40 or more were six and a half times more likely to be referred than those with a BMI of 25-29.9.

• Age was also a factor, with patients aged 18-24 years having 55% lower odds of being referred than patients aged 45-54 years.

• Referral rates seemed to have improved across the period studied, with the odds of being referred 2.7 times higher for those diagnosed in 2019-20 compared with those diagnosed in 2007.

• People living in areas of highest deprivation had a 19% higher chance of being referred to a programme compared with people living in areas of the lowest deprivation.

• There were no differences in referral rates between rural and urban GP practices but there were regional differences.

Researchers also found people type 2 diabetes had 11% lower odds of being referred to a programme compared with people without the condition. This might be referred to condition-specific lifestyle programmes instead, but further research was needed to confirm this.

Study co-author Dr Karen Coulman, of Population Health Sciences, Bristol Medical School, University of Bristol, said weight management programmes were known to be effective and national guidance stated that anyone with overweight or obesity was eligible for referral.

‘Our research shows that not only is overweight and obesity being under-reported in primary care but just 3% of those who were given a recorded diagnosis of overweight or obesity between 2007 and 2020 received a referral for weight management,’ she said.

‘We are undertaking research interviews with health professionals and patients to understand the reasons for this.’

She added that the underreporting of overweight and obesity found in the study could be due to several factors including that the requirement to have a register of patients with BMI 30 or over was only added to the Quality and Outcomes Framework in 2017.

Pressures within primary care and the need for more training in obesity for primary care professionals could also be at play.

‘Further research is needed to investigate this finding, however the current Enhanced Service Specification for weight management should help improve recording of weight in primary care,’ she said.

NHS England announced £20m towards the new weight management DES last summer, although this was only for obesity not overweight. Some 97% of practices are signed up to the DES.

Meanwhile, the NHS diabetes prevention programme has helped some 18,000 patients avoid type 2 diabetes, according to a recent study.

And NHS England has expanded its ‘soups and shakes’ weight loss programme, which targets type 2 diabetes by helping obese patients lose weight.

Meanwhile, NICE said last month that people should take their own waist measurement to identify if they are at risk of potential health problems.

A version of this story was first published by Pulse’s sister title Nursing in Practice