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Updated guidance

Experts publish updated guidance for overweight and obese services

Focus on needs of children and young people
A blueprint for better care across the NHS
Guidance is a ‘roadmap’ for GPs to help patients

Guidance on commissioning weight assessment services and management clinics in the UK, first published in 2014, has been updated and now includes guidelines on children and young people. The guidance is sponsored by and represents the views of 22 professional organisations including nine medical Royal Colleges directly concerned with patient care.

The guidance entitled, “Commissioning Guidance: Weight Assessment and management clinics (Tier 3)”, states about two-thirds of adults in the UK are overweight, one in four are clinically obese, and one in three children aged 10-11 are overweight or obese. Both conditions predispose to diseases such as type 2 diabetes, high blood pressure, strokes, heart attacks, cancer and general ill-health.

As the treatment is often complex, a wide range of professionals, including medical and surgical doctors, nurses, psychologists and anaesthetists may need to be involved.

However, the guidance notes that most hospitals do not have services for these patients and, even if clinics do exist, patients and many GPs may not be aware of them, so patients who need and could benefit from expert assessment and management are not referred in a timely manner including children and young people.

Professor Helen Stokes-Lampard

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "Obesity is a serious health issue for patients regardless of their age, but that one in four children are now thought to be overweight or obese in the UK is a serious cause for concern given that it condemns our next generation for a lifetime of other potentially serious and debilitating health conditions, such as diabetes, cardiovascular disease and cancer. The College is proud to endorse this updated guidance, which should give CCGs the advice and support they need to commission the most appropriate services to allow GPs - and other healthcare professionals across the NHS - to deliver the care our young patients who are struggling to maintain a healthy weight need."

The Guidance - released on World Obesity Day - calls for the NHS to prioritise and develop services to allow patients with severe diseases caused by obesity to have access to treatment and describes the infrastructure needed to set up or commission Weight Assessment and Management Clinics (Tier 3 Clinics) in the NHS in England.

The document describes in detail which patients may most benefit from being referred for assessment for surgery (bariatric surgery) and includes a section on specialist Children’s and Adolescent Weight Assessment and Management Clinics.

Mr Richard Welbourn

“There is an urgent need for services to help people of all ages who have severe weight problems which address their needs and find ways to lead more fulfilling and productive lives,” said lead author, Mr Richard Welbourn, a consultant bariatric surgeon and a past-President of the British Obesity & Metabolic Surgery Society (BOMSS). “The new Guidance offers a blueprint for the NHS to provide better care, starting in primary care with suggested pathways for General Practitioners depending on the patient’s history and current health. It offers suggestions for the care of children and adolescents with the most severe obesity and gives several options for people with diabetes.

It recommends that a multi-disciplinary team for children and young people should contain at least a paediatrician with a special interest in obesity, a children’s/adolescent dietitian, a specialist children’s or adolescent nurse, a clinical psychologist with expertise in paediatrics and with access to a social worker, a physical therapist and a liaison child and adolescent psychiatrist.

“Looking at secondary care, the challenge of managing the epidemic of patients with severe and complex obesity disease is largely unmet despite repeated guidelines from NICE,” said Mr Welbourn. “The updated Guidance describes in detail how services can be provided by multi-disciplinary teams in weight assessment and management clinics. This includes advice on setting up services for children and young people who unfortunately suffer the same problems as adults and are just as much in need of treatment for weight loss and management. These services have been developed in several parts of the UK but there are many areas where there is nothing available - an unfair postcode lottery of care. The models for setting up weight assessment and management clinics should be urgently adopted across the NHS to provide the services so many people need.”

A minimum of six months of comprehensive assessment and management is recommended as appropriate for children and young people and says they should only be referred for surgery when all other options have been tried.

Professor Russell Viner, Officer for Health Promotion at the Royal College of Paediatrics and Child Health, said: “Obesity is affecting more children at a younger age - and it’s only going to be tackled through robust policies that focus on prevention.  Medical intervention and particularly surgery should always be a last resort. But it’s crucial that children and young people who are currently severely overweight get the right help through weight advice and management clinics which are designed to cater specifically for their needs. This guidance is much needed and I urge all CCGs to adopt it.”

Other additions to the updated guide include recommendations on anaesthetic assessment and ongoing shared care with general practitioners.

The Royal College of Physicians’ obesity spokesperson, Professor John Wass, said: “There are currently significant differences in coverage when it comes to Tier 3 services and, as such, many do not have ready access to help. This guidance is helpful, because it puts in clear advice and support for the future and provides a framework for better care for people who have an obesity or weight problem.”

The 2017 Commissioning Guide: Weight assessment and management clinics (Tier 3) can be viewed here

Obesity Review will carry an article on the Guidance which is available online here

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British Obesity and Metabolic Surgery Society

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