Healthy Skepticism Library item: 7051
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Mayor S.
NICE requires primary care trusts to tackle prevention and management of obesity.
BMJ 2006 Dec 16; 333:(7581):1239
http://www.bmj.com/cgi/content/full/333/7581/1239-a
Abstract:
All primary care trusts must ensure that systems are in place to allow health professionals to implement interventions to prevent and treat obesity, the first national guidance from the National Institute for Health and Clinical Excellence (NICE) on obesity in adults and children in England and Wales says.
The guidance was developed by the National Collaborating Centre for Primary Care, a group of healthcare professions based at the Royal College of General Practitioners, and NICE’s Centre for Public Health Excellence. It aims to stem the rising prevalence of obesity and associated diseases, to increase the effectiveness of interventions to prevent overweight and obesity, and to improve the care provided to adults and children with obesity, particularly in primary care.
James McEwan, emeritus professor of public health at the University of Glasgow and chairman of the guidance development group, said: “In the past, there has been a lot of public health focus on problems such as smoking but obesity has largely been seen as an individual problem. It has not been high enough on the NHS agenda.
“This guidance recognises the scale of the problem and the need for coordinated efforts to reduce its impact. Its scope is ambitious but this is going to be a major public health problem if nothing is done.”
At a public health level, the guidance requires managers and health professionals in all primary care settings to ensure that preventing and managing obesity is a priority, at strategic and delivery levels.
As for all NICE guidance, primary care trusts and health authorities will be required to implement the recommendations with audit criteria, which are currently being developed.
Separate guidance has been developed for local authorities, providers of care to young children, schools, and workplaces about how they should help people stay a healthy weight.
In the NHS, health professionals are advised to discuss weight, diet, and activity opportunistically, but particularly at times when weight gain is more likely, including with women during and after pregnancy and at the menopause and with anyone trying to stop smoking.
They should use clinical judgment to decide when to measure a patient’s weight and height. Body mass index (BMI) should be used to classify the degree of obesity, taking into account that it may be less accurate in highly muscular people, Asian people, and elderly people. Waist circumference should also be used to assess health risks but is unreliable in people with BMIs greater than 35 kg/m2.
The guidance recommends that weight management programmes should include behavioural change strategies to increase physical activity or decrease inactivity, improve eating behaviour and diet quality, and reduce energy intake.
They should provide ongoing support-by telephone, post, or internet-and set realistic targets for weight loss, usually a maximum weekly loss of 0.5-1 kg and an overall aim of losing 5-10% of original weight. Self help and commercial weight management programmes should be recommended only if they follow these best practice standards.
Drug treatment for obesity should be considered only after dietary, exercise, and behavioural approaches have been started and evaluated. The guidance says it might be considered in patients who have failed to reach their target weight loss or who have reached a plateau with dietary, activity, and behavioural changes alone.
When drug treatment is prescribed, arrangements should be made for appropriate health professionals to offer information, support, and counselling on additional diet, physical activity, and behavioural strategies.
Bariatric surgery is recommended as a treatment option for adults with obesity only if they have a BMI of 40 or more, or a BMI of 35-40 with other important disease (type 2 diabetes or high blood pressure) that could be improved with weight loss. All appropriate non-surgical measures must have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least six months.
The patients must receive intensive management in a specialist obesity service, be generally fit for anaesthesia and surgery, and be committed to the need for long term follow-up. Centres should carry out prospective audits for short and long term monitoring of outcomes and complications of different procedures, and their impact on quality of life, nutritional status, and comorbidities.
