Endocrine Abstracts

Introduction: Weight gain and obesity promote metabolic syndrome, diabetes and other cardiovascular risk factors. Weight loss achieved by lifestyle change can limit progression of cardiovascular risk factors. What is the current approach to obesity in general practice and can a nurse- led programme result in clinically beneficial weight change?

Methods: The Counterweight Programme has developed a model of best practice for obesity management in UK primary care. 80 primary care practices from 7 areas of the UK have been recruited. The project provides retrospective audit, practice training and support, protocols and prospective evaluation for an evidence based intervention programme for weight loss and maintenance.

Results: retrospective audit: Women were more likely than men to have a record of their weight (69.2%: 57.0%; P<0.0001) or BMI (70.7%: 58.1%; P<0.0001). In those with a BMI record, 13.6% males and 16.5% females were obese. Previous interventions for obese individuals included practice based diet counselling (20%), dietetic referral (4%), anti-obesity medication (2%) and referral to an obesity centre (1%).

Results: intervention programme: By March 2004 1549 patients had been recruited into the programme. Ratio of males to females was 1:3. Mean BMI was 37 kg/m² and mean age 49 years. 74% had at least one obesity-related co-morbidity. 51% of patients having reached 12 months (n=893) were classified as ‘completers’ in that they had attended the minimum required number of programme appointments (4 in 3 m, 5 in 6 m or 6 in 12 m). Of all those with 12 month data (n=445) 34% lost at least 5%. For ‘completers’ this increased to 40%. Mean weight loss at 12 months was 3.2 kg for the whole group and 4.5 kg for ‘completers’. Including those lost to follow up ITT analysis shows 6 people need to enter the programme to have 1 patient with at least 5% weight loss at 12 months.

Conclusion: Improved screening for obesity is a priority for referral into weight management services. This study has shown that clinically effective weight reduction can be achieved in the Primary Care setting.