Annex
THE COUNTERWEIGHT PROJECT: EXECUTIVE SUMMARY
BACKGROUND
The Counterweight Project was launched in 2000
as the result of a group of consultant physicians recognising
the need to tackle obesity management in primary care. The Counterweight
Board was established for project guidance and management. Counterweight
is a multi-centre practice nurse led obesity management project
being conducted in 80 general practices in seven regions of the
UK: Aberdeen, Bath, Birmingham, Glasgow, Leeds, London and Luton.
There is a Weight Management Adviser (WMA), a dietitian with specialist
training in obesity management in each region to facilitate the
process.
AIM
The overall aim is to improve the management
of obesity in primary care, thus reducing the disease burden of
obesity in the population.
OBJECTIVES
— To collect national anonymised weight
management data from primary care registers.
— To develop a treatment model for
obesity management.
— To facilitate the implementation
of this treatment model into primary care.
— To evaluate the impact of this model
of care, and lead future practice.
STRATEGY
Seven WMAs and a national co-ordinator facilitate
the implementation of the project. The WMAs conduct a review of
baseline medical practice, train staff participating in the project,
and then provide on-going support for the practice nurses for
a minimum of six months.
AUDIT AND
NEEDS ASSESSMENT
The WMAs conduct audit in each practice. An
audit of patient screening, practice equipment and patient education
literature is followed by a detailed patient audit. A randomly
selected sample of 100 obese patients is audited in five practices
in each region. In a second five practices, 50 obese patients
are randomly selected, and then age and sex matched with the same
number of both normal weight and overweight patients for within
practice comparisons. Data is gathered to achieve a comprehensive
clinical picture on each patient including demographic characteristics,
and screening for and recording of co-morbid conditions. NHS resource
use including primary and secondary care contacts, hospital admissions
and prescribing rates are also examined.
INTERVENTION PROGRAMME
Following the development of a structured pathway
for management of obesity in primary care, GPs and PNs are offered
one hour training on screening and recruitment of appropriate
patients. WMAs then conduct a six-hour training programme for
practice nurses. Guidance is provided on evidence-based treatment,
and the Counterweight weight management programme. Clinical support
is provided in the practice to assist the nurses in care of patients
in weight management clinics, groups or opportunistically. An
integrated package of patient education materials has been developed
to support the Counterweight programme. The WMAs work with the
nurses to guide them on the implementation of the programme until
the desired level of competency has been reached. The nurses are
advised to see individual patients for six appointments of 10-30
minutes duration or in six group sessions lasting one hour, over
a three month period. Patients are then followed up at least quarterly
until 12 months and reviewed annually thereafter
EVALUATION
Weight loss will be the primary way of evaluating
the success of the pathway, and the Counterweight weight management
programme. The number of patients reaching weight loss targets
deemed clinically beneficial (ie 5% and 10% of initial body weight)
will be examined. Secondary endpoints such as changes in blood
pressure, lipids and diabetes control will also be considered.
BENEFITS TO
PRIMARY CARE
The intervention programme offers the following:
— Guidance for practices developing
or considering the provision of a weight management service.
— Support for practices already providing
a weight management service.
— A consistent evidence based model
of care for patients requiring weight management intervention.
— Structures to support clinical decision
making, data collection and prospective audit of clinical outcomes.
— Resources for patients and clinicians.
PROJECT SPONSORS
This is a non-promotional five year project
funded by a non incumbent educational grant-in-aid from Roche
Products Ltd. It is managed by a clinician-led project board.
There are no contractual obligations between the Counterweight
Board and the sponsor.
PROJECT GOVERNANCE
The Counterweight Board includes membership
of seven leading experts in the field of weight management from
both academic and NHS clinical backgrounds. Other members of the
board are the director of the West of Scotland Cancer Surveillance
Unit (data and statistical analyst), the National Coordinator,
representatives from the British Dietetic Association and the
NOF, two of the seven WMAs, two representatives from the project
sponsors. Other attendees at board meetings have been/will include
a health economist, representation from the Department of Health,
and a qualitative research group.
All components of the project are formally agreed
by the project board. The project chair and national co-ordinator
manage the Counterweight budget. The lead clinicians/academics
receive no remuneration for any of their work in the programme
and their affiliated hospitals/universities provide bases for
the WMAs.
QUALIFICATIONS AND
INSTITUTIONAL AFFILIATION
OF BOARD
MEMBERS
Aberdeen: Professor John Broom, MBChB, MRCP(Glas),
FRCPath, Research Professor and Consultant in Clinical Biochemistry
and Metabolic Medicine, The Robert Gordon University, School of
Life Sciences, Aberdeen.
Bath: Dr John Reckless, DSc MD FRCP, Consultant
Endocrinologist and Hon Reader in Medicine & Biochemistry,
University of Bath, Royal United Hospital, Bath.
Birmingham: Professor Sudhesh Kumar, MD FRCP,
Professor of Medicine, Diabetes and Metabolism, Warwick Medical
School, University of Warwick.
Glasgow: Professor Mike Lean, MA, MD, FRCP,
FRCPS, Glasgow University Department of Human Nutrition, Glasgow
Royal Infirmary.
Leeds: Dr Julian Barth, MD FRCP FRCPath, Consultant
in Clinical Biochemistry and Immunology, Dept of Clinical Biochemistry
and Immunology, Leeds General Infirmary NHS Trust.
London: Dr Gary Frost, PhD SRD, Head of Therapy
Services, Honorary Reader in Nutrition, Imperial College London,
& Hammersmith Hospitals NHS Trust.
Luton: Dr Nick Finer, MBBS, R Nutr, FRCP, Consultant
Endocrinologist, Centre for Obesity Research, Luton and Dunstable
Hospital NHS Trust.
West of Scotland Cancer Surveillance Unit: Professor
David Hole, MSc FFPHM, Public Health and Health Policy, Division
of Community Based Sciences, University of Glasgow.
British Dietetic Association: Lyndel Costain,
BSc SRD, Chairman, Public Relations Committee, BDA, Charles Street
Birmingham.
National Obesity Forum: Dr David W Haslam, MBBS
DGM, GP and Chair National Obesity Forum, PO Box 6625, Nottingham.
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