Memorandum by Leeds North West Primary
Care Trust Weight Management Project (OB 72)
A baseline survey undertaken by the PCT towards
the implementation of the CHD NSF found a significant proportion
of the Leeds population, 77,011 people to be obese (Leeds Lifestyle
Survey 2002).
Within primary care there is work to promote
healthy lifestyles and manage weight, but this, as in many parts
of the country is often uncoordinated and not evidenced based.
The PCT secured funding for a 15-month project
to develop a service for weight management within four GP practices
in the Leeds North West area. The project aims to modernise obesity
management in these GP practices by introducing a systematic evidence
based approach. This involves changing the way the staff work
and shifting the way current resources are used to be more effective
ie moving from a medical model to community support for lifestyle
change approach.
The project is working in partnership with leisure
services and community groups to ensure a broader approach to
obesity management and gives practitioners a number of different
providers to refer to outside of the NHS.
The project has involved several strands:
— The development of guidelines for
weight management. This is a stepped approach to weight management
interventions which links to community activities, commercial
weight loss clubs and acute surgical services as well as having
guidance for anti-obesity medication and monitoring.
— The provision of high quality training
for health professionals to develop skills for motivating clients
to change health behaviours.
— The development of educational resources
around evidence based weight reduction advice and behaviour change.
— The setting up and running of 10%
clubs. The 10% club is a 12 week structured programme in a group
setting with post intervention follow-up sessions for continued
support. The programme incorporates components of food, activity
and cognitive behavioural therapy. A practice nurse or health
care assistant observes a Dietitian and is part of the session
until competent to facilitate the session alone. This ensures
the introduction of a sustainable service.
— The establishing of a network of
local physical activity opportunities, and information in the
practices on how clients can access this. The project is also
funding training for existing exercise instructors to be more
sensitive to the exercise needs of obese clients and provide appropriate
and safe sessions.
The project is being evaluated by the University
of Leeds, which includes data gathering views of service users
as well as those who did not attend and of health professionals.
EARLY INDICATIONS
— At this early stage it is anticipated
that the 10% club is one part of a "menu" based approach
offering a number of weight management options to clients, which
is provided by both primary care and partnership agencies.
— There appears to be scepticism of
the evidence base which has an impact on attitude and competence
of those providing weight management in primary care, this needs
addressing in training programmes both pre and post qualifying.
— Obesity is seen as a risk factor
for other conditions rather than needing addressing in its own
right. Recruiting practices to the project was difficult. Practice
nurse time was required, and obesity is not an explicit NSF target.
Giving obesity management greater priority within the nGMS contract
may address this.
— Funding projects for short periods
of time make forwards planning difficult, as further development
is dependent on successful bidding for continued funding. Obesity
management is a key part work to reduce health inequalities and
needs mainstream funding to support and implement guidance and
change practice.
LEEDS NORTH
WEST OBESITY
PROJECT—PROGRESS
REPORT
BACKGROUND
Obesity in England has become a significant
public health problem. The number of obese people in England has
trebled over the last 20 years. In 2001, one in five adults were
obese with nearly two-thirds of men and over half of women in
the population being overweight or obese. (1) The local picture
is similar, the Leeds Lifestyle Survey estimated 199,423 people
aged 15-74 to be overweight, and 77,011 to be obese. It also showed
that over half of men and more than one third of women are over
weight or obese in Leeds. (2)
The health costs of obesity through it impact
on CHD, Diabetes, hypertension, osteo-arthritis and cancers is
well recognised. The human cost of obesity has been estimated
at causing 30,000 deaths per year and on average shortens life
by nine years. The economic burden of an obese population is substantial,
causing 18 million sick days a year, £½ billion in treatment
costs to the NHS and an excess of £2 billion to the wider
economy. On present trends, the costs of obesity could increase
by a further £1 billion by 2010. (1)
On a more positive note, the benefits of weight
loss are well researched, reductions in 10% of body weight can
lead to significant lowing in risk of mortality, especially cardiovascular
risk factors and diabetes. (3)
Obesity is one of the key risk factors for Coronary
heart disease (CHD) and is highlighted in the NSF standards for
CHD (4) and Diabetes (5). Addressing CHD is one of the delivery
areas for the Neighbourhood Renewal Fund targets. Preventing and
addressing obesity is a high priority public health issue, requiring
population level activity across a number of sectors (eg transport,
education, leisure) to evidenced based care interventions.
At present most of the NHS (including Leeds
North West PCT) has no systematic approach for the management
of obesity at any level of BMI. The secondary care service for
morbid obesity has a closed waiting list.
The GP surgery is often the first port of call
for client wishing to lose weight. Anecdotal evidence would suggest
a significant amount of health professional time is spent discussing
changing lifestyles. At present, primary care professionals are
offering short-term support to people who are obese within current
resources which may include diet, activity and behavioural strategies,
Unfortunately this is often on an ad-hoc basis with little structure
to these key interactions. Costs of prescribing drugs for obesity
are rising. A key issue for PCTs (as a healthcare provider) is
investment into evidence based obesity management strategies ie
multidisciplinary interventions and longer-term support in the
community.
THE LEEDS
NORTH WEST
OBESITY PROJECT
The NW Leeds Obesity project is a pilot project
funded for 15 months by Neighbourhood Renewal Fund. The scope
of the project is to test the feasibility of the introduction
of a structured approach to obesity management within primary
care. As such this project is of regional and possibly national
significance.
Project aims
— Support health care services towards
time being spent on obesity management to be more evidence based
and therefore effective.
— To show how an effective approach
to obesity management can be mainstreamed across primary care.
Project objectives
— To develop an integrated care pathway/guideline,
in association with a multidisciplinary working group. The pathway
will link to opportunities in wider community, which support sustainable
changes to lifestyle. This will also give guidance to use of anti-obesity
drugs.
— To run intensive diet, physical activity
and behavioural change interventions with motivated obese clients
(10% clubs).
— To produce, pilot and evaluate a
programme for training the professionals who will run the 10%
clubs.
— To provide training to enable leisure
service staff to run appropriate and safe sessions for obese and
overweight clients.
— To develop, pilot and evaluate weight
loss resources for use by both clients and health professionals.
— To identify and build links with
community resources local to the pilot practices.
Outcomes April 03.
Project manager recruited January 2003.
Five practices recruited to participate in pilot.
Developed an integrated care pathway for obesity
management, using a model in place elsewhere. To be pre-tested
in collaboration with pilot sites.
Questionnaire developed, gathered baseline data
on current obesity management practice in pilot practices.
Currently mapping community resources local
to pilot practices, which would support obesity management.
Commissioned training in changing health care
behaviour for 20 healthcare professionals to attend—Running
12 April 2003.
Training to develop group work and facilitation
skills required to run the 10% clubs to be provided for 10 practice
nurses—6 June 2003.
Training for five physical activity specialists
employed by leisure services, to enable the running of safe and
appropriate physical activity sessions for obese clients within
the pilot—Presently recruiting. Date to be arranged.
Health professional cue cards for brief interventions
with patients developed Piloted in project practices.
Laminated cycle of change for losing weight
resource for use by health professionals with clients developed
to be piloted in project practices.
Recruited evaluation team for Leeds University,
to beginning work May 2003. Looking at health professionals and
users views on the 10% model and will give guidance on feasibility
of roll out across the city. Project team considered that given
the significance of this pilot project, it was desirable to consider
a detailed evaluation to ensure that all of the learning was captured
and the components of the project were mainstreamed.
FINANCIAL BREAKDOWN
Staff Cost-salary
| £6,635 |
| Staff Cost-Travel and expenses | £365
|
| Evaluation | £16,000 |
Training courses: Motivational interviewing, working with groups,
time management
| £6,638.63 |
| Other resources eg leaflets/publishing |
£1,205.55 |
| Total | £30,844.18 |
| |
PROJECTED OUTPUTS
FOR 2003-04
Provide in-house training on diet and nutrition in obesity
management and on physical activity and obesity in five practices.
To develop and provide training and resources to implement
use of guidelines/care pathway.
Development of training programme, written guide and supporting
resources to enable the sustainable running of a 10% club.
Recruitment of clients to 10% club approx. 150 clients.
Development of a resource directory of community activities
promoting healthier lifestyles. This is to be used by health professionals
with all clients requiring information within the five pilot practices.
Completion of evaluation and recommendations for mainstreaming.
ANTICIPATED IMPACT
— Sustained wt loss/maintenance and therefore reduced
risk of CHD or diabetes.
— The provision of an improved service for obese
patients within primary care.
— A co-ordinated, whole practice approach to obesity
management via the use of care pathway
— A sustainable, evidence based obesity management
programme being run in each pilot practice
— More confident, effective health care professionals
treating obesity.
— Reduction in drugs prescribing for anti-obesity
medication and prescribing for other co-morbidity's ie blood pressure,
diabetes medication.
— Recommendations from evaluation to shift care
of obese clients to a model that is effective and evidence based.
REFERENCES
1. National Audit Office 2001. Tackling Obesity in England.
Report by the comptroller and auditor general. The Stationary
Office. London.
2. Gent M, Fear J. 2002. Leeds Lifestyle Survey.
3. Scottish Intercollegiate Guidelines Network (1996).
Obesity in Scotland: integrating prevention with weight management.
Scottish Intercollegiate Guidelines network.
3. Department of Health (2000) National Service Framework
for coronary heart disease: Modern Standards and Service Models.
4. Department of Health (2003) National Service Framework
for Diabetes: Modern Standards and Service Models.
5. Barth J. (2003) Tackling Obesity in Leeds. An Executive
Summary.
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