Archive

Obesity has existed ever since civilisation has been recorded. The Venus of Hohle Fels, a crude statuette of a naked obese woman, is estimated to be 35000 years old - 10000 years older than her more famous cousin, the Venus of Willendorf. The recorded history of the treatment of obesity goes back thousands of years: in 500 bc, the ancient Indian surgeon Sushruta described "obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushion" (Bhishagratna, 2006).

Weight management in primary care remains an area of controversy owing to inadequate mechanisms to define roles and responsibilities and to fund work done in this area, as well as an uncertain evidence base for the effectiveness of management by primary care clinicians. However, there are clear areas in which weight management is closely related to primary care, including risk assessment and signposting to self-help and tiered weight management services, plus an evolving role in long-term follow-up after bariatric surgery. This article summarises some of the methods whereby GPs can support weight management in primary care and explores limitations and barriers to carrying out those responsibilities, as well as emerging solutions. It also outlines the work of the Royal College of GPs Nutrition Group in developing new resources to support training in obesity management for primary care clinicians.

Obesity stigma is reported across population groups, impacting the wellbeing of obese people. Perhaps counterintuitively, healthcare professionals have stigmatising attitudes and, in some cases, fail to provide advice and treatment to obese patients. The reports summarised in this review suggest that intervention is required to improve treatment and to reduce adverse patient behaviours such as avoiding appointments and not reporting concerns to healthcare providers.

The NHS Commissioning Board has recommended the introduction of medical, multidisciplinary, multicomponent weight management services (Tier 3 services) for obese patients requiring specialised management, including assessment for bariatric surgery. Unfortunately, these have not yet been commissioned in many areas. Barriers identified include obesity being a low commissioning priority, therapeutic nihilism, medical workload constraints, a lack of trained staff, financial barriers to developing new services, and challenges of evaluation. A particular challenge is the lack of long-term funding and the complex tendering processes used in some areas. However, patients value these services, and the sparse academic literature shows encouraging results. Nonetheless, more robust evaluation of these services, including additional outcome measures and longer follow-up after discharge, is required to demonstrate cost-effectiveness to the NHS.