Obesity guidance hampered by lack of school nurses

New NICE guidance to tackle obesity will be hampered by the lack of school nurses, according to Amicus/The Community Practitioners' and Health Visitors' Association (CPHVA).

Obesity guidance from NICE

Under the new NICE guideline, practices 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.

Amicus/CPHVA said that there would be no need for medication and surgery if there were a comprehensive obesity prevention programme.

It argued that school nurses play a vital role in tackling obesity but there are not enough of them in the UK’s 3,400 secondary schools.

Ros Godson, Amicus/CPHVA’s professional officer for school health and public health, said: ‘There are far fewer school nurses and health visitors employed by PCTs, resulting in a loss of services to schools and nurseries.’

Southampton GP Professor Paul Little, who was on the NICE guideline development group, said practices would struggle without extra training.

‘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.

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