Re: Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial
The Lighten Up trial, (1) plus the recent paper by Jebb and colleagues (2) showing that community weight loss services are more successful than traditional GP care raises important issues for primary care weight management. Unless these issues are promptly addressed, there is a risk that some will interpret these findings as a get-out clause for reluctant GPs to avoid weight management altogether, whilst confusing those GPs who offer an in-house weight management clinic (WMC) over whether to continue. Both papers clarify what GPs should not be doing – running weight management clinics as a first line approach.
But the Foresight (3) report called loudly for development of comprehensive team management – responsibility for all – and contrary to the suggestion in the linked editorial, (4) GPs do not need to compete with commercial WMCs but work with them to help more patients access appropriate support and be in the right frame of mind for that support to be beneficial. The role of the GP is different and complementary to community weight services and should reflect the unique skills and specific patient knowledge that GPs have. Lighten up achieved 11.5% uptake leaving 88.5% of those targeted presumably with unmet needs. GPs could fruitfully develop a role in sensitively raising awareness of the relevance of weight to health, assessing motivation and emotional fragility in order to ensure that chosen goals are feasible and will not erode self esteem further, (how often have we colluded with unrealistic targets and set our patients up to fail?) and to increase the numbers of patients that are signposted to local community services as a first line.
Further debate and research is needed on how best to manage those patients that are unsuccessful or for whom community services are unsuitable, and interested GPs could develop a role here. Development of clearer and funded bariatric pathways will complement this first line approach. Obesity training and educational resource developments are a high priority and the Royal Colleges are now actively engaged in both.
RCGP Clinical Champion for Nutrition for Health
Winyates Health Centre
Redditch, Worcestershire B98 0NR
1. Jolly K, Lewis A, Beach J, et al. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. BMJ 2011;343:d6500 doi: 10.1136/bmj.d6500
2. Jebb SA, Ahern AL, Olson AD, Aston LM, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. Lancet 2011 Oct 22: 3378 (9801): 1485-92. Epub 2011 Sep 7
3. Government Office for Science. Foresight: Tackling Obesities: Future Choices – Modeling Future Trends in Obesity and the Impact on Health, 2nd Edition. 2007 www.foresight.gov.uk/Obesity/14.pdf
4. Truby H, Bonham M. What makes a weight loss programme successful? BMJ 2011;343:d6629
Competing interests: No competing interests