The Counterweight Programme: England and Wales Rollout

Strategy

The model is based on Weight Management Advisers (WMAs; dietitians specialising in obesity management), working across Primary Care Trusts and CHPs training and supporting healthcare staff to put the Counterweight weight management programme into practice.  Counterweight is tailored to suit local priorities, services and available personnel. Counterweight is designed to integrate into a wider obesity management strategy involving key stakeholders from primary and secondary care. Within primary care the whole team including GPs, nurses, assistants, dietitians, practice managers and receptionists should be engaged in decisions regarding implementation of the programme.

Counterweight Programme

Following the development of a structured pathway for management of obesity in primary care, practices are offered a workshop on screening and recruitment of appropriate patients. WMAs then conduct a 8 hour training programme for practice nurses. Guidance is provided on evidence-based treatment, and the Counterweight weight management programme. Lifestyle intervention is recommended as a first line approach to weight management, this is delivered individually or in groups; second line interventions may include the use of anti-obesity medications, referral to a dietitian, psychologist and/or a secondary care service.  Weight maintenance is encouraged either following weight loss or as the first option with particular groups of patients.

Clinical support is provided in the practice to assist the nurses in care of patients in clinics, groups or opportunistically. An integrated package of patient education materials has been developed to support the Counterweight programme. The WMAs work with the nurses to guide them on the implementation of the programme until the desired level of competency has been reached. It is anticipated that each trained practice could treat an average of 50 patients in a year. Each Counterweight patient is recommended to have nine appointments of 10-30 minutes duration in the first year.

Patients are followed up at least quarterly until twelve months and reviewed annually thereafter.

Outcomes

Implementation and weight loss are the primary ways of evaluating the success of the project. All results from the research phase (2000-2005) will be submitted for publication in peer reviewed journals.

Benefits to Primary Care

Counterweight offers the following:

• Guidance for practices developing or considering the provision of a weight management service
• Support for practices providing a weight management service
• A consistent evidence based model of care for patients requiring weight management intervention
• Structures to support clinical decision making, data collection and prospective audit of clinical outcomes
• Resources for patients and clinicians

Project Resource

The research phase was funded by a non incumbent educational grant-in-aid from Roche Products Ltd. Currently the Counterweight model in England is funded partly from government money made available to PCTs, with the remaining costs being met by an unencumbered educational grant.  In Scotland the programme is completely funded by the Scottish Executive as part of a roll out alongside the CVD anticipatory care initiative P2010/ Keep Well. It is managed by a clinician-led project board. There are no contractual obligations between the Counterweight Board and the sponsor

Project Governance

The Counterweight Board includes membership of seven leading experts in the field of weight management from both academic and NHS clinical backgrounds. Other members of the board are the director of the West of Scotland Cancer Surveillance Unit (data and statistical analyst), the National Coordinator, representatives from the British Dietetic Association and the NOF, two of the seven WMAs. All components of the project are formally agreed by the project board.