Memorandum by Counterweight (WP 103)
The Counterweight programme was established
in 2000 by a group of consultant physicians with a special interest
in obesity. The remit was to develop a treatment model for obesity
management, facilitate the implementation into primary care and
evaluate the impact of this model of care. Preliminary results
were published in June 2004 showing that primary care can be effective
in weight management. The Counterweight Project team welcomes
the Government's White Paper entitled "Choosing Health: Making
Health Choices Easier".
1. Will the proposals enable the Government
to achieve its public health goals?
No 65. "We have put action in hand
to strengthen the evidence base on effective interventions. The
Department of Health has also commissioned NICE to produce definitive
guidance on prevention, identification, management and treatment
of obesity and this is due to be available in 2007".
Counterweight welcomes the long term vision
to develop NICE guidance on obesity prevention, identification
and management. While this long term goal is very welcome, the
Counterweight project team recognise the important of ensuring
that approaches which are adopted between 2005 and 2007 are evidence
based where possible. The white paper highlights areas of priority
but whether the Government can meet public health goals is dependant
on support which is available from the government now that the
Public Health White Paper is in the public domain.
No 61. "Recent studies have found clinical
services for obesity wanting with significant variations across
England. Although there are examples of good practice preventative
action is only taken when obesity co-exists with other chronic
diseases, rather as a clinical problem in its own right".
Counterweight recognises the need for obesity
to be addressed in the GMS contract before it is likely to be
addressed in its own right. The counterweight programme is undertaking
a health economic analysis of the burden of obesity on primary
care and the cost benefit of intervention. (York Health Economic
Consortium) This data will be available in April/May.
No 61. "Research has found that there
is a reticence among health professionals about raising the issue
of obesity wit patients, a lack of necessary skills to deal with
obese patients, and a lack of clear referral mechanisms and services.
Around 10% of areas did not have written information about services
available. There is a need for much improved information for health
professionals and the public on how to prevent weight gain".
The Counterweight Programme offers an evidence
bases model to enable healthcare professionals to address weight
management and prevention of weight gain.
No 67. "More specifically the prevention
and treatment of obesity will ensure that":
— That there are clear referral mechanisms
to specialist obesity services which will be staffed by multidisciplinary
teams with specialist knowledge and training in obesity management.
Specialist services at secondary and tertiary
have historically suffered from lack of resource. This impacts
on implementation of obesity pathways which depend heavily on
referral to secondary and tertiary care level. The Counterweight
Programme offers expertise in this area. Lead clinicians from
the Counterweight programme would welcome the opportunity to discuss
how best specialist obesity services at secondary and tertiary
level can support primary care.
No 68. "We will also commission production
of a weight loss guide to set out what is known about regimes
for losing weight and help people select approaches that are healthy
and the most likely to help them lose weight and then maintain
a healthier weight".
Counterweight have been invited to feature in
a directory of obesity training programmes for PCTs which is being
collated as a resource in response the release of funding for
obesity training. This programme is the only national weight management
programme in primary care which has been established and has evidence
from pilot phase.
2. Are the proposals are appropriate, will
they be effective and do they represent value for money?
No 64. We shall build on good foundations already
in place to implement the NSF for Coronary Heart Disease and Diabetes.
Guidance for PCTs on priorities and planning includes the need
to give advice on diet and activity. The next priority will be
to act on obesity in its own right using levers such as the new
primary medical care contracting arrangements, through enhanced
services and through negotiated changes which may be possible
in the quality and outcomes framework.
Counterweight has audited the burden of obesity
on primary care resources which provides a strong case for obesity
being addressed in its own right. Initial recommendations in the
White Paper have been supported with release of funding for training
for clinical staff. New funding to support obesity training is
very welcome, however no additional time will be provided to extend
clinical time to address obesity.
No 66. We will develop a comprehensive "care
pathway" for obesity, providing a model for prevention and
treatment.
The counterweight programme has evaluated an
obesity pathway over the past four years. The Counterweight Project
team welcome any request to discuss learnings from the development
and implementation of the pathway. A qualitative research programme
is also underway at present to identify factors which have influenced
practices which have successfully implemented the programme and
those who have dropped out of the programme. This research offers
vital learnings about factors which have influenced the ability
of primary care to adopt a more structured approach to intervention.
3. Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
No 63. The basic messages about how to maintain
a healthy weight by balancing energy in and out through diet and
activity are clear. But there is currently less evidence about
effective ways to help people who are obese or overweight. Although
we need better evidence the urgency of the problem means developing,
rapidly evaluating and implementing new approaches to managing
obesity alongside research on what works.
The counterweight programme which has been evaluated
2000-2005 provides an effective model for implementation of an
obesity pathway in primary care. Preliminary results were published
in June 2004 and final outcomes will be submitted for publication
mid summer 2005.
No 69. We will commission further studies to
support development of new approaches where there are gaps in
the evidence base within the new framework for research discussed
in Annex B.
The Counterweight Project team have a vision
to extend the Counterweight model in a roll-out across England.
The programme has an existing infrastructure of a statistical,
health economic and qualitative research team to assess effectiveness
of a roll-out. The project team plan to purse funding to measure
effectiveness of the roll-out.
| 
