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RCP report

NHS must change to deal with rising obesity cases

The RCP's report, "Action On Obesity".
Report recommends multidisciplinary team care of ‘severe and complex obesity’
Proposes the creation of subspecialty of obesity medicine for physicians
Aims to establish a specialist group of bariatric nurses in collaboration with the Royal College of Nursing

The NHS must adapt in order to manage the increasing numbers of patients presenting with severe complex obesity, according to a new report from the UK’s Royal College of Physicians (RCP).

The warning comes as the cost of dealing with the adverse consequences of obesity is estimated to be £5 billion per year with obesity rates in the UK among the highest in the world. It is estimated that the majority of Britain’s population will be obese by 2050.

The report, Action on Obesity: Comprehensive care for all, found that the delivery of healthcare to patients with an established obesity problem is ‘extremely patchy’.

Despite obesity leading to other complications such as coronary heart disease, diabetes, arthritis, sleep disorders and gynaecological disorders, the report found that there are few ‘joined up’ services for people who are overweight.

There are large variations in the way obesity is treated across the UK, with the rate of hospital bariatric procedures ranging from 0.4 per 100,000 of the adult population in some Primary Care Trusts, to 41.3 per 100,000 in others. The figures constitute a 93-fold variation.

“Britain is getting bigger and whilst we try to prevent the increase in obesity,  we must also prepare the NHS for the influx of patients presenting with severe complex obesity,” said Professor John Wass, chair of the working party and academic vice-president of the RCP. “A patient may arrive at my hospital with coronary heart disease, but if the root cause of their condition is obesity, we must be equipped to deal with that root cause.”

Recommendations

The report makes several key recommendations, including the creation of a new government role to coordinate the work of departments that could have an impact on obesity.

It also recommends the appointment of a lead physician for obesity at every hospital trust. The appointed doctor would interact with commissioning groups, be a source of patient information and act as a link between the hospital and the community.

The reports states that the commissioning of specialist obesity services should be for multidisciplinary team care of ‘severe and complex obesity’ and not just bariatric surgical treatment, as the management of these patients requires multidisciplinary team input and medical supervision pre-, peri- and post-operatively. Multidisciplinary team made up of physicians, surgeons, nurses and other health professionals must be available to cover severe and complex obesity throughout the UK.

The reports also encourages the appointment in government of one person to drive a coordinated obesity strategy between and across central government departments which include Health, the Treasury, Sport, Education, Agriculture, the Department of Work and Pensions, and local government responsible for the local environment. This person should have a strong but politically independent status (eg a member of the House of Lords) with the skills and authority to address issues which need multiple government departmental involvement.

The report states that an on-going group is set up based at the RCP which, like Action on Smoking and Health (ASH), can meet regularly and oversee the development and implementation of these recommendations.

“We need to see improved leadership on obesity at every level; from the appointment of a lead physician in every trust, to the creation of a cross- governmental role,” said Professor Nick Finer, co-author of the report and obesity specialist at the UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery.

The RCP says that it should oversee the development of multidisciplinary bariatric services and promote these multidisciplinary groups by developing and providing courses that advise, encourage and train doctors (and other healthcare professionals) on their formation.

All members of these multidisciplinary teams should be trained and experienced in motivational interviewing and incorporate these techniques into their clinical practice.

The multidisciplinary team should include specialist consultant physicians, consultant surgeons, dieticians, nurses, psychologists and psychiatrists and exercise/physical activity professionals. The specialist multidisciplinary team would require expertise in multiple obesity-related disorders.

Specialisation

The report also proposes the creation of subspecialty of obesity medicine for physicians: the terms bariatric medicine and bariatric physician are suggested. The subspecialty should be within the umbrella of diabetes and endocrinology, although this would not preclude physicians with other primary specialties from developing subspecialty recognition in bariatric medicine.

Physicians specialised in bariatric medicine would provide local leadership in the planning, provision and delivery of obesity treatments, within secondary care and in collaboration and partnership with primary care.

In addition, a specialist group of bariatric nurses who are trained in the specialist aspects of bariatric medicine and surgery should be established, in collaboration with the Royal College of Nursing.

Since type 2 diabetes is common among the overweight and obese population, and management of obesity may directly affect diabetes prevention and management, the report recommends the integration with diabetes services.

The report also suggests adopting of the Edmonton Obesity Staging System to allow better 'phenotyping' of the individual patient and facilitate audit and outcomes review and research.

The role of the GP and general practice team is also addressed within the report and it states that GPs should deal with weight issues as part of their agenda to address risk factors.

Role of the RCP

The report claims that the RCP should develop an independent multidisciplinary intercollegiate group (called the Royal College of Physicians’ Advisory Group on Weight and Health) to lead on obesity advocacy. The Royal College of Surgeons and the Royal College of General Practitioners have agreed to this, but the group should also develop to include other royal colleges, such as the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health, the Royal College of Anaesthetists, as well as the Royal College of Nursing and public health representatives. This group should meet two to three times a year with a programme of activity addressing the needs of the public and patients with obesity.

This group should monitor progress of the development of obesity services in the UK, develop a patient charter for obesity services and have a role in accrediting hospitals’ health and nutrition policy. Obesity services should be formally reviewed within two years.

Education and training

All healthcare professionals should know and understand the essential facts about obesity, as well as receive training in nutrition, physical activity, exercise and the public health aspects of obesity.

Every discipline in medicine should include training in the role of nutrition, physical activity and obesity in their core curricula, which should be examined because complications of obesity cross all specialty and professional boundaries.

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