I read with interest Dr Matthew Lockyer's comments on the National Obesity Forum (NOF) guidelines for the management of obesity in primary care, in the April issue of Guidelines in Practice.
He is, however, wrong in asserting that obesity management is not worthwhile in general practice. In the UK the prevalence of obesity has trebled over the past 20 years, and one in five of our adult patients is now clinically obese (BMI >30).1
One in three adults in the UK will die from an obesity-related disease. An average GP's list will have 350 such patients who are, because of their weight, at significantly increased risk of developing life-threatening co-morbidities including a threefold increased risk of myocardial infarction and a 12-fold risk of developing type 2 diabetes.1
Rather than being 'at risk of medicalising a multifactorial problem', as Dr Lockyer states, the NOF, in line with the World Health Organization,2 positively states that obesity is a major medical condition.
We are responding to overwhelming international recognition that obesity and the resulting metabolic syndrome of increased insulin resistance, hypertension and hyperlipidaemia is a major underlying cause of ischaemic heart disease and type 2 diabetes in our society.
The causes of obesity are complex and clearly the problem has to be tackled at a national, government level. However, when, as GPs, we encounter obese patients, we cannot and must not ignore them.
The evidence I have studied has shown that a comprehensive weight management programme, delivered with realistic expectations (aiming for a 10% weight loss), can produce appreciable and significant health benefits.3 There clearly is a need for sensible, evidence-based guidance on best practice in weight management.
The National Association of Primary Care, in a survey of its members,4 showed that 90% of practices thought that the availability of guidelines on obesity management would help them provide better patient care.
The NOF has filled that need by creating clear and workable guidelines, applicable to primary care and designed for use in a modern clinical environment.
We recognise that not every practitioner has access to specialist obesity services, but an inability to refer for secondary care would not normally inhibit us from attending to individual patient needs. Less than 1% of our obese patients normally require secondary care obesity management.
Dr Lockyer asks for more research into obesity management in primary care, and in this we are in agreement. The NOF is already involved in numerous projects to help improve the long-term outcome of weight management programmes throughout the NHS and beyond.
Obesity is a rapidly developing modern epidemic. We ignore it at our peril.
Dr Ian W Campbell, Chair, NOF, and GP, Nottingham
- National Audit Office. Tackling Obesity in England. London: The Stationery Office, 2001.
- World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997.
- Jung RT. Obesity as a disease. Br Med Bull 1997; 53(2): 307-21.
- National Association of Primary Care Survey on Obesity Management Services in Primary Care, first published October 2000.