GP practices 'need obesity specialists'

Britons are increasingly affected by obesity-related problems, yet GPs and their colleagues in primary care struggle to offer effective solutions, says obesity expert Professor Tony Leeds.

In this week's Scrubbing Up, he calls for an army of "obesity GPs, nurses and dietitians" - a team in every surgery - whose job it would be to tackle the epidemic.

The impact of Britain's obesity epidemic continues to increase, and so does the cost, both human and financial.

Obesity now costs the NHS around £4.2bn annually, and the wider economy a frightening £16bn.

Britain must face the facts - while prevention is vital, we don't have the luxury of anticipating some future dilemma.

It is here, and now; the immediate challenge is to help those whose health is already directly threatened.

'It's not their fault'

I see the full spectrum of this tragedy in my work in obesity clinics in the Central Middlesex and Whittington hospitals.

I have patients who are several stones overweight and blighted by diabetes, and those who are up to 60 stone (381kg), awaiting surgery.

Yet if real help was more available in primary care, fewer would reach me and my colleagues in specialist hospital centres in the first place.

Britain's front-line obesity management could be done in primary care if adequate resources were provided, yet with a few exceptions health care professionals recognise they are not skilled in managing obesity.

It's not their fault - most practice nurses and GPs have simply never been equipped with the specialist skills and knowledge for today's needs.

A recent report from the Royal College of Physicians spelled out the skills and knowledge needed by health care professionals for obesity management, and we must now convert theory into practice.

This training about obesity management is largely missing from most GP training schemes.

In short, GPs are well equipped to treat the consequences of obesity with drugs but not the core problem - the weight gain itself.

Where is the will?

So if a patient asks for help with their weight problem, most GPs have little to offer beyond conventional diet for the person who needs to shed 10-15lbs (4.5-6.8kg), or referral for surgery if there is a need to shed, say, more than five stone (31kg).

For the 13m Britons in the middle - who need to lose between 15lbs and five stones - most GPs are hard pressed to help them.

I would like to see all doctors, nurses and pharmacists trained in obesity management as part of their basic education.

We also need each general practice to have a fully funded "obesity team" where a designated GP becomes the "lead" in day-to-day weight management.

There should also be a fully integrated national scheme providing surgery for those who need it - but adequate support for those who are not eligible.

And patients should be pointed towards appropriate diet plans, even if they're from the commercial sector.

The will from the professions is there. Dr Clare Gerada, Chair of the Royal College of General Practitioners has said GPs would welcome a structured approach to this huge burden, but it would have to be adequately funded and resourced.

And the Royal College of Nursing is willing to develop and implement training programmes.

What we need is the political will, starting with a full health economics analysis of the costs and benefits of effective weight management in diabetes and other conditions where obesity is a significant factor.

I believe this alone would produce conclusive - and possibly breathtaking - results.

We must also have clinical trials to produce a range of evidence-based primary care solutions which are proven to be cost-effective.

Obesity is a global problem and few countries have found really effective solutions.

Who, now, will take the lead on this for Britain?