Abstracts / Posters
A Primary Care Obesity Programme
Invited oral presentation at Association of obesity conference (ASO) 2003
The Counterweight Project Team
Aim: To provide an overview of the Counterweight Programme
Methods: The Counterweight Programme aims to evaluate the management of obesity in primary care. 80 practices from 7 areas of the UK were recruited into the programme. Specialist obesity dietitians undertook audit and provided training, clinical support and evidence based structured protocols for GPs and nurses.
- Audit: Recording of weight/BMI was assessed by retrospective review of computerised medical records over an 18 month period (n= 117,785) in 40 practices. 50 obese and 50 normal weight patients (age and sex matched) were randomly selected from 23 practices. (n=1150 obese, 1150 normal weight) Data is reported on prevalence of obesity-related co-morbidities and differences in prescribing between the obese and normal weight.
- Intervention: Patients attended 6 individual appointments (10-20 minutes) or 6 group sessions (1 hour) with a practice nurse over 3 months and thereafter were reviewed quarterly. Data are reported from the first 30 practices.
Results:
Audit: Women were more likely than men to have a weight (69.2%: 57.0%; P<0.0001) or BMI (70.6%: 57.7%; P<0.0001) ever recorded. Obese patients were more likely than normal weight patients to have a recorded diagnosis of type 2 diabetes (12%:3%), hypertension (24%:12%), dyslipidaemia (8%:4%), cardiovascular disease (10%:6%), back pain (16%:10%), arthritis (7%:4%) and gallstones (2%:0.2%);all p<0.001. A higher percentage of obese, compared to normal weight patients, were prescribed at least one drug in the following BNF disease categories: gastrointestinal (25:17), cardiovascular (38:21), anti-hypertensives (29:14), lipid regulators (12:5), endocrine (28:18) diabetes drugs (11:4), musculoskeletal & joint disease (31:22), central nervous system (44:33) and infections (43:35); all p<0.001, anti-depressants (16:13; p<0.05), respiratory (22:18; p<0.05) & skin (24:19; p<0.01).
Intervention: 682 patients (mean BMI=37.0kg/m2) were recruited at point of analysis. Mean age at baseline was 50.8 years (SD =14.1) and 75% of patients were female. 316 patients have now completed 3 months and 199 have completed 6 months. At baseline 75% had at least one obesity related co-morbidity (32% hypertension, 15% diabetes, 15% hyperlipidaemia, 10% cardiac co-morbidities). Mean weight loss at 3 months (n=316) was 3.3kg (SE=0.19), range -22.0kg to +6.4kg, while at 6 months (n=199) it was 4.3 kg (SE=0.36), range -20.5kg to +6.0kg . At 6 months 13% of patients had lost >= 10% (n=25) and 43% lost >= 5% (n=85).
Conclusion: Obesity can be effectively treated in primary care with modest resources. The Counterweight Programme will provide data on treatment efficacy and outcome that may lead to evidence-based recommendations.