Under the new NICE guideline, GPs have been told when to offer lifestyle advice, prescribe anti-obesity drugs and refer for bariatric surgery in adults and children who are overweight or obese.
The guidelines put primary care at the fore to deliver interventions to help patients eat healthier and increase physical activity levels.
But with 20 per cent of the UK population overweight or obese, surgeries will struggle to deliver without extra training, said Southampton GP Professor Paul Little, who was on the guideline development group.
‘It is clear we can’t do this at the moment,’ he said.
‘If this is going to be reality, then the resources need to be put in to develop this.’
Adults who are overweight or obese should be put on a tailored weight-loss programme in primary care. Patients who fail to meet their target weight or reach a plateau can be considered for drug therapy.
Referral for surgery should only be considered in those with a BMI greater than 40kg/m2 or a BMI greater than 35kg/m2 with co-morbidities. Bariatric surgery can be considered first line for patients with a BMI greater than 50kg/m2.
In overweight or obese children, targeted multicomponent strategies to improve eating habits and physical activity should be used. If this fails, drug treatment is an option but only in children over 12 who have physical or severe psychological comorbidities.
Bariatric surgery is generally not considered appropriate for children. But it can be used if all alternatives have failed and the child has almost achieved physiological maturity and meets BMI criteria. NICE estimated that no more than 10 children a year would undergo bariatric surgery.
Alberic Fiennes, a bariatric surgeon at St George’s Hospital in south west London, said that GPs need to work with patients undergoing bariatric surgery to ensure they understand the long-term impact of surgery.
