Eligible young White men are the least likely to be referred for weight-management programmes, researchers have found

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Researchers from the University of Bristol have found that only one in 33 patients who are overweight or obese are referred by their GP to a weight-management programme, and that overweight and obesity are under-reported in primary care.

In the new research, which was presented at the European Congress on Obesity (ECO) in Maastricht, the Netherlands (4–7 May 2022), researchers found that just 3.1% of adults with a recording of overweight or obesity in England were referred to weight-management programmes by their GP.

The lifestyle programmes, which focus on making behaviour changes to eating and physical activity habits, are available for adults with a body mass index (BMI) of 25 kg/m2 or more (23 kg/mor more in minority ethnic groups).

Dr Karen Coulman, Population Health Sciences, Bristol Medical School, University of Bristol, said: ‘Weight-management programmes are known to be effective, and national guidance states that anyone with overweight or obesity is eligible to be referred to one.’

Overweight and obesity under-reported in primary care

However, the availability of weight-management programmes varies across the country, and with ‘no national registry of nonsurgical weight-management interventions’, the researchers said, ‘it isn’t clear how many people are getting the opportunity to access them’.

In fact, although there were no differences in referral rates between rural and urban GP practices, the researchers said that there were regional differences; the likelihood of being referred was highest in the West Midlands, where people were more than twice as likely to be referred as those in the North West.  

In the most recent Health Survey for England, it was estimated that 64% of adults are overweight or obese. However, the researchers of the new study found that only 31.1% of the adults whose records were studied had a primary care recording of overweight or obesity—effectively half of those actually affected. This indicates, the researchers said, that overweight and obesity are being ‘under-reported in primary care’.

Dr Coulman suggested that this discrepancy was likely to be due to multiple factors. These include pressures within primary care, and the need for primary care healthcare professionals to receive more training in treating obesity. In addition, she highlighted that the requirement to have a register of patients with a BMI of 30 kg/mor over was only added to the Quality and Outcomes Framework in 2017, which may explain why the researchers found that adults diagnosed with overweight or obesity in more recent years were more likely to be referred. Specifically, they found that those diagnosed with overweight or obesity in 2019–20 were 2.7 times more likely to have been referred compared with those diagnosed in 2007.

Young White men least likely to be referred for weight management

In their cross-sectional study, the researchers used the anonymised primary-care electronic health records of almost 2 million (1,811,587) patients between January 2007 and June 2020. In addition to establishing how many adults with overweight and obesity receive referrals to weight-management programmes, including both lifestyle and specialist interventions (for example, bariatric surgery), they also investigated the characteristics of the patients who had received referrals, and of the GP practices making the referrals.

They identified that:

  • men were almost one-third (31%) less likely to be referred than women
  • younger people (aged 18–24 years) were half as likely (54%) to be referred as middle-aged people (aged 45–54 years)
  • people with Black ethnicity were 23% more likely to be referred than those with White ethnicity
  • a higher BMI made referral more likely, with those with a BMI of 40 kg/mor more being over six times more likely to be referred than those with a BMI of 25.0–29.9 kg/m2
  • those living in the most deprived areas were 20% more likely to be referred than those living in the least deprived areas.

Of interest, people with type 2 diabetes, heart disease, or hypertension had 11%, 20%, and 27% lower odds, respectively, of being referred than those without these conditions. This may be because these groups are being referred to lifestyle programmes tailored to their condition, said the researchers, who added that more research is needed to confirm this.

Lack of funding ‘deeply disappointing’

In July 2021, the Government announced new weight-management services as part of £100 million of additional funding to support people in achieving a healthier weight, through access to digital apps, weight-management groups, and individual coaches. At the time, Professor Jonathan Valabhji, NHS England’s National Clinical Director for Diabetes and Obesity, said: ‘The NHS long-term plan committed the NHS to a stronger focus in preventing illness and reducing the serious health concerns that people living with obesity can experience.’

However, last month, the DHSC announced that this investment was to be cut, saying that the advent of the COVID-19 pandemic had meant that they needed to ‘ensure there are plans in place to maintain resilience against significant resurgences or future variants.’ In turn, this had ‘forced’ them to make challenging decisions on additional funding, resulting in planned resources for healthy weight activities being ‘reduced’.

This announcement prompted great concern and disappointment from experts, with Professor Jim McManus, President of the Association of Directors of Public Health, describing the Government’s decision not to extend the funding as ‘deeply disappointing’.

In light of the new study findings that overweight and obesity are under-reported in primary care, and that only 3% of those who were given a recorded diagnosis of overweight or obesity received a referral for weight management, Dr Coulman said: ‘We are undertaking research interviews with health professionals and patients to understand the reasons for this.’

This article was originally published on Medscape, part of the Medscape Professional Network.

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