Can GP intervention tackle obesity?

Shocking increases in the nation's level of obesity have prompted calls for government action, reports Joe Lepper.

Health Profile 2007, the government's annual public health check, released last week, was the latest evidence to show the rise in obesity and diabetes.

According to the report, which covers England, over the decade ending 2005 the proportion of obese men rose by around 40 per cent, the number of obese women by 35 per cent and obese children by a massive 50 per cent.

In addition, rates of diabetes have also increased from 5.8 to 8.4 per cent of the population between 1998 and 2004.

Government action
The government has claimed action is being taken, ploughing £141 million into public health initiatives through the Choosing Health agenda. But with rates continuing to rise it is clear more needs to be done.

According to the Association of Directors in Public Health, a key problem is that money promised for public health is instead being ploughed into reducing PCT debt.

Its latest figures show that, of the £141 million made available through Choosing Health, just £46 million has been committed to public health initiatives.

In the North East of England, which has some of the highest obesity rates in the country, only £4.7 million out of the £12.7 million allocated is being used.

Tim Crayford, the association's president, said a key reason why trusts placed such a low priority on public health was that 'balancing the books and addressing very public targets such as waiting times have taken priority'.

'No one complains if a trust hasn't set up a public health initiative so it is a low priority,' he said, adding that he would like to see targets for trusts on public health or ring fencing of money.

Dr Martin Hadley-Brown, chairman of the Primary Care Diabetes Society, said that another funding issue was that even when money was used to address diabetes, most funding went to treatment and management rather than prevention.

'Diabetes management is getting better and there are improvements in looking at areas such as heart disease among diabetes patients,' he said. 'But that is treating it after it has happened, more needs to be spent on preventing obesity in the first place.'

Dr David Haslam, clinical director of the National Obesity Forum and a GP in Hertfordshire, said as well as a stronger commitment to public health funding and prevention, there also needs to be recognition within government that wholesale social, political and commercial change needed to take place to properly address obesity and the growth of type-2 diabetes.

He said: 'There's so much more they could do such as bans on food advertising, better labelling and commitment to cycle paths, as well as public health and education initiatives. It needs to be across all policy to make a real impact.'

Public health minister Dawn Primarolo has pledged to prioritise the battle against obesity across departments through a 'cross government drive for action on obesity'.

Backed up by funding in the latest comprehensive review, this will focus largely on childhood obesity and has the aim of reducing the proportion of overweight and obese children to 2000 levels by 2020.

Areas of inspiration
Dr Neil Munro, a Surrey GP and chairman of Primary Care Diabetes Europe, said that a good place for ministers to start looking for inspiration was Finland, where, he said real progress has been made to reduce obesity.

'The government there has incorporated the aim of addressing obesity across all policy areas, so there you have restrictions on fast food and minimum standards on exercise among children for example,' he said.

One programme that Dr Haslam is involved with that he is particularly keen to see trusts use public health cash for is the Counterweight Programme.

This nurse-led scheme involves regular meetings with a diet expert who develops a tailor-made eating and exercise plan with a view to reducing body weight by between 5 and 10 per cent. In Lanarkshire, one of the areas where it is being used, a recent evaluation found that out of 400 patients, 40 per cent lost 5 per cent of their body weight in a year.

Dr Hadley-Brown, said that despite such evidence there was still a lack of consensus across government as well as the medical professions regarding the effectiveness of clinical intervention in tackling obesity.

'There is a consensus that smoking cessation services help people to give up smoking but that isn't the case when it comes to obesity,' he said.

Quality framework
For GPs, the quality framework has become a battleground for this argument, with GPs such as Dr Haslam arguing that GP intervention does effectively counter obesity and that more points should be made available.

In contrast, Dr Dean Marshall, GPC Scotland chairman, acknowledged the successes of the Counterweight programme but wanted to see more evidence that clinical intervention could effectively reduce obesity.

He believed that the problem had been too medicalised, when it is more of a social issue.

Dr Munro said that whatever solutions were adopted the task of addressing obesity should not be underestimated, 'as what you are doing is countering the basic primitive instinct of greed'.

'That is a tough job that will take society as a whole to address rather than the medical profession in isolation,' he added.

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