The draft NICE guidance on obesity, which is out for consultation until 11 May, recommends lifestyle interventions should be used first-line, but that drug therapy should be offered to those who have not lost weight following lifestyle change. This will mean that more patients need to be monitored.
The draft guidance recommends orlistat (Xenical) for the management of obesity in adults with a BMI of at least 28 with associated risk factors, or a BMI of 30, and no longer requires that they have lost 2.5kg prior to the start of drug therapy.
Continuing treatment beyond three months will need to be supported by evidence of loss of at least 5 per cent body weight, and vitamin supplementation should be considered for older or younger people.
The guidance also recommends sibutramine (Reductil) for those with a BMI of 27 or greater with other risk factors, type-2 diabetes or dyslipidaemia, and for those with a BMI of 30 or more, but adds that it should not be prescribed without arrangements for monitoring weight loss and adverse effects.
It does not recommend drug treatment for children aged under 12, but states that drug therapy initiated by a specialist may be continued in primary care.
Hertfordshire GP Dr David Haslam, clinical director of the National Obesity Forum, said that the recommendations would mean extra work for GPs.
'There is going to be a lot more patient-led demand for treatment for obesity,' he said. 'Patients on anti-obesity drugs will need a lot of follow-up, especially those on sibutramine who need it two-weekly at first.'
Dr Haslam said that the recent revisions to the quality framework had failed to provide points for this extra work.
But Dr Ian Campbell, a Nottingham GP with an interest in obesity, said that good incentives already existed.
'There are more than 100 quality points to be gained through a better management of weight,' he said. 'Lowering cholesterol and lowering BP are both rewarded within the diabetes domain and elsewhere.'
- Opinion, page 23