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Obesity Treatment Study - UK
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Obesity Treatment Study - UK

Obesity Treatment Study Background
The National Audit Office (2001) reported that - within the NHS - the majority of activity intended to treat obesity takes place in primary care. They also reported a lack of 'buy in' on behalf of GPs and recommended that weight management activities needed to be undertaken more consistently. In addition, primary care teams themselves identified the need for more information about effective interventions and resources to use with patients (National Audit Office, 2001). A recent systematic review identified the need to investigate educational methods that encourage health care workers to improve delivery of weight management to their patients (Harvey et al., 1999).

Obesity Treatment Study Subjects
This cluster randomised controlled trial assessed the effectiveness of a training program (the intervention) intended to improve the management of obesity, delivered by dietitians to general practice teams (unit of randomisation). 44 practices in the North East of England were recruited to the trial. Practice staff asked consecutive adult patients (Body Mass Index [BMI] ³ 30; aged 16-64) to participate, as they consulted over a 6-month recruitment phase and prior to randomisation.

Obesity Treatment Study Method
The training program offered a model approach to obesity treatment, incorporating best evidence, and judged brief enough to be implemented in primary care. The model advocated prescription of a moderate energy deficit diet and exercise. Practitioners were encouraged to see patients regularly (about every 2 weeks) until they had lost 5 percent of their original body weight and then less regularly (about every 1 to 2 months) for weight maintenance.

The primary outcome measure was difference in weight between patients from intervention and control arms at one-year post intervention. Secondary outcome measures included: difference in weight at 3 and 18 months, change in practitioner knowledge of obesity management, and change in practitioner behaviour in obesity management consultations.

Obesity Treatment Results
44 (100 percent) practices completed the trial and 840 subjects were randomised, with 564 patients (67 percent) providing follow-up at 1 year post-intervention. Adequate balance of baseline characteristics was attained for both patient (weight, BMI, age, sex) and practice (size of practice, presence of a dietetic service, socioeconomic status of practice site) characteristics. No difference in weight was observed between intervention and control patients at 12, 3 or 18 months. Some evidence of change to practitioner knowledge and behaviour was observed.

Obesity Treatment Study Conclusion
General practices participating in this trial were likely to be a motivated subset of primary care and similarly, patients opting to join the trial might be expected to be more interested in weight loss. The training program was well accepted and attended, however, it had no effect on the target patient level outcome measure - patient weight. The level of implementation of the weight management model being promoted was low. This study raises questions about the ability and motivation of UK primary care teams to manage obesity in routine clinical practice, within current resources for service delivery.

Sources:
1. National Audit Office. (2001) Tackling Obesity in England. Report by the Comptroller and Auditor General. The Stationery Office, London. www.nao.gov.uk.
2. Harvey EL, Glenny AM, Kirk SFL, Summerbell CD. (1999) A systematic review of interventions to improve health professionals' management of obesity. International Journal of Obesity 23:1213-1222

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