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GPs should routinely record waist circumference, say obesity experts

GPs should measure waist circumference rather than just BMI to help them identify patients who most at risk, recommends a new report into how to tackle the obesity crisis in the UK.

The report recommends that the measure is used as an indicator of ‘visceral adiposity’, as this predicts worse outcomes for patients.

It also recommends that QOF points should be linked to ‘action taken’ on behalf of overweight patients, rather than simply requiring GPs to record numbers of patients who are overweight.

The ‘State of the Nation’s Waistline’ report, published today by the National Obesity Forum, says that GPs have a ‘key role’ to play in tackling the looming obesity crisis which a new report warns is ‘one of the biggest threats to the UK’ in both damage to personal health and financial and societal cost.

It recommends the DH should encourage training and accredited schemes in obesity and weight management, to help GPs make ‘every appointment count’.

The report says: ‘GPs should be encouraged and indeed required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances.’

It adds that ‘increasing awareness’ is needed amongst GPs of the importance of ‘waist measurement during medical appointments in order to identify indicators of visceral adiposity or ectopic fat deposits, which can adversely affect health outcomes’.

The report also questioned whether existing national programs, such as the PHE’s flagship ‘Change4life’ campaign, were fit for purpose.

The report states: ‘Schemes such as Change4Life are well intentioned and extremely important. However, they cannot be expected to alter the public situation on their own, despite their merits. Harder hitting campaigns, similar to those for anti-smoking, are required.’

A spokesperson from Public Health England said: ‘PHE is also working with health professionals and local authorities to support the commissioning of weight management services. PHE have partnered with the RCGP to support the training of GPs in how to work with their local community to tackle obesity.’

Key recommendations

The QOF Framework needs to be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients.

GPs should be provided with appropriate support and training to help them have the necessary conversations with patients.

Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients.

GPs should measure waist circumference rather than just BMI to help them identify patients who most at risk and identify the indicators of poor health outcomes.

Initiatives such as Change4Life are important in demonstrating how individuals can improve their choices in terms of healthy eating. These healthy eating messages need to be supported by goodhydration and physical activity habit.

The importance of hydration, and the range of benefits which it provides, needs to be considered when developing strategies to promote healthy living.

Source: State of the Nation’s Waistline, Jan 2014