Background
Obesity
Targets for improvement
Recommendation | ||
---|---|---|
1 | Determining degree of overweight and overweight | • Use clinical judgement to decide when to measure weight and height |
• Use body mass index to classify the degree of overweight or obesity | ||
• Use waist circumference in people with a body mass index less than 35 kg/m2 to assess health risks | ||
• To tell the patient their classification, and how this affects their risk of long-term health problems | ||
2 | Assessment of lifestyle and willingness to change | • Presenting symptoms and underlying causes of overweight or obesity |
• Risk factors and comorbidities | ||
• Eating behaviour, diet and physical activity | ||
• Willingness and motivation to change | ||
3 | Management of overweight and obesity | • Increased physical activity |
• Improved eating behaviour | ||
• Healthy eating | ||
• If appropriate, drug treatment | ||
4 | Referral | • For assessment of the underlying cause of overweight or obesity |
• If conventional treatment has failed | ||
• If specialist interventions may be needed |
Health system context
Usual care
The Tailored Implementation for Chronic Diseases project
Objectives
Research questions
Methods/Design
Trial design
Participants and setting
Clinical Commissioning Group (CCG) | Average index of multiple deprivation IMD 2010 score | Population density (persons per hectare) | Population from black ethnic groups | Population from Asian ethnic groups | Disease prevalence (number and percentages); that is, patients on general practice quality and outcomes framework registers with these conditions | ||
---|---|---|---|---|---|---|---|
Obesity | Coronary heart disease | Diabetes mellitus | |||||
Corby CCG | 26.49 | 7.6 | 1.6% | 1.3% | 4,869 (11.9%) | 1,732 (3.4%) | 2,119 (5.2%) |
East Leicester and Rutland CCG | 9.96 | 2.0 | 0.7% | 7.2% | 24,258 (9.4%) | 10,786 (3.4%) | 13,555 (5.3%) |
Leicester City CCG | 33.68 | 45.0 | 6.2% | 37.1% | 28,405 (9.8%) | 10,018 (2.7%) | 19,959 (7.0%) |
Lincolnshire West CCG | 19.29 | 1.9 | 0.5% | 1.3% | 22,375 (12.2%) | 9,163 (4.1%) | 10,219 (5.7%) |
Lincolnshire East CCG | 24.14 | 0.9 | 0.3% | 0.8% | 12,675 (5.3%) | 24,711 (12.2%) | 14,784 (7.4%) |
Mansfield and Ashfield CCG | 29.32 | 11.3 | 0.4% | 1.1% | 21,473 (14.3%) | 7,887 (4.3%) | 8,714 (5.9%) |
Nene CCG | 16.92 | 3.1 | 2.6% | 4.0% | 50,416 (10.1%) | 18,977 (3.1%) | 26,742 (5.4%) |
Newark & Sherwood CCG | 19.05 | 1.8 | 0.3% | 0.9% | 13,354 (12.7%) | 5,168 (4.1%) | 5,563 (5.4%) |
North Derbyshire CCG | 17.84 | 2.4 | 0.4% | 1.0% | 26,401 (11.0%) | 12,345 (4.3%) | 14,307 (6.0%) |
North East Lincolnshire CCG | 29.77 | 8.3 | 0.3% | 1.3% | 17,943 (13.2%) | 7,101 (4.3%) | 8,227 (6.2%) |
North Lincolnshire CCG | 22.21 | 2.0 | 0.3% | 2.7% | 18,424 (13.4%) | 7,681 (4.6%) | 8,582 (6.3%) |
Nottingham City CCG | 35.48 | 41.0 | 7.3% | 13.1% | 27,070 (9.7%) | 9,675 (2.8%) | 13,328 (4.9%) |
Nottingham North & East CCG | 17.46 | 9.3 | 1.3% | 2.5% | 6,741 (5.8%) | 5,635 (3.9%) | 13,039 (11.0%) |
Nottingham West CCG | 14.41 | 13.7 | 0.9% | 4.1% | 8,271 (10.7%) | 3,826 (4.1%) | 4,178 (5.5%) |
Rushcliffe CCG | 7.62 | 2.7 | 0.6% | 4.2% | 8,489 (8.5%) | 4,375 (3.6%) | 4,373 (4.4%) |
Southern Derbyshire CCG | 19.96 | 4.7 | 1.6% | 6.8% | 47,205 (11.1%) | 18,745 (3.6%) | 26,086 (6.2%) |
West Leicestershire | 13.09 | 4.2 | 0.5% | 4.9% | 29,878 (9.9%) | 11,790 (3.2%) | 16,329 (5.5%) |
Patients
Implementation programme
Development of the implementation programme
Recommendation | Determinants | Interventions | |
---|---|---|---|
1 | Determining degree of overweight and overweight | Acceptable ways to raise and discuss the issue with patients | Training and model scripts on discussing weight with patients |
How to effectively measure waist circumference | Training in waist measurement | ||
2 | Assessment of lifestyle and willingness to change | Ways to assess willingness to change | Training |
Resources to motivate and inform | Booklet for patients | ||
3 | Management of overweight and obesity | Lack of prescriptive information | Training and booklet |
Lack of knowledge | Discussion with practices on delegation and the role for practice nurses | ||
4 | Referral | Lack of information on referral pathways | Provision of information on local referral pathways |
Logic model
The recommendations
Recommendation 1: Determining the degree of overweight and obesity
-
Acceptable ways to raise and discuss the issue of weight with patients
-
How to effectively measure waist circumference
Recommendation 2: Assessment of lifestyle and willingness to change
-
Ways to assess willingness to change
-
Resources to motivate and inform patients
Recommendation 3: Management of overweight and obesity
-
Lack of prescriptive information
-
Lack of knowledge
Recommendation 4: Referral
-
Lack of information on referral pathways
Determinants not addressed by the implementation intervention
-
Use of health care assistants/receptionists to weigh patients
-
Patients are only weighed as part of their routine care. Therefore, some patients are not weighed on a regular basis.
-
A trained specialist individual within primary care who can conduct everything (weighing, advice, assess motivation, offer referral).
-
Local referral policies may restrict the range of patients who can be referred to specialist care.
-
Dietitian run clinic in GP surgery.
-
Running a group service at the GP surgery which provides weekly advice/support.
Outcomes
Primary outcome
Secondary outcomes
-
The proportion of patients with a BMI or waist circumference measurement recorded within the study period (recommendation 1);
-
the proportion of patients with a record of lifestyle assessment (recommendation 2);
-
referral to external weight loss services (recommendation 4);
-
the proportion of overweight/obese patients who changed weight (lost or gained 1 kg) during the study period;
-
the mean weight change over the same period.
Measurement procedures
Process evaluation
Recruitment
Randomisation
Blinding
Statistical methods
Sample size
Average cluster size (M) | > 1,130 | 163-212 | 213-309 | 310-568 | 569-3,464 | > 3,464 | > 287 |
Power (1-β) | 0.80 | 0.80 | 0.81 | 0.82 | 0.83 | 0.84 | 0.85 |
Number of clusters (N) | 12 | 13 | 14 |