Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement

Abstract

Background: Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings.

Aim: To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving >or=5% loss at 12 and 24 months.

Design of study: Prospective evaluation of a new continuous improvement model for weight management in primary care.

Setting: Primary care, UK.

Method: Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI)>or=30 kg/m2 or>or=28 kg/m2 with obesity-related comorbidities.

Results: Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI>or=40 kg/m2 and 74% had >or=1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for >or=12 months, and 825 for >or=24 months. Mean weight change in those who attended and had data at 12 months (n=642) was -3.0 kg (95% CI=-3.5 to -2.4 kg) and at 24 months (n=357) was -2.3 kg (95% CI=-3.2 to -1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of >or=5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months.

Conclusion: This intervention achieves and maintains clinically valuable weight loss within routine primary care.

Figure 1

Counterweight Programme intervention. Patient education booklets are shown in blue (two other patient booklets are available: Advice for Patients taking Orlistat, and Advice for Patients taking Sibutramine).