Obesity module 1: management in primary care

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2. Assess lifestyle, comorbidities and willingness to change

See table 3.

3. Management

Interventions to encourage lifestyle change through increased physical activity, improved eating behaviour and healthy eating should be offered. Drug treatment should be considered where appropriate. The initial level of intervention to discuss can be guided by table 4.3 (More recent NICE guidance has given best practice guidance that these interventions should meet to motivate and support people making lifestyle changes).20

Table 4. A guide to deciding the initial level of intervention to discuss
Table 4. A guide to deciding the initial level of intervention to discuss

4. Consider recommendation of community services or referral

  • For assessment of the underlying causes of overweight or obesity
  • If a person has complex disease states
  • If conventional treatment has failed
  • If considering drug therapy for a person with a BMI > 50 kg/m2
  • If specialist interventions may be needed
  • If surgery is being considered

• How to accurately measure obesity – best practice tips

The GP plays a pivotal role in weight management
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Other guidance

The Scottish Intercollegiate Guidelines Network has produced guidance on the management of obesity (available in full here). The National Obesity Forum has also published guidelines on the management of adult obesity and overweight in primary care – available here. Guidance is also in development by the Royal College of General Practitioners.

Management

Assessment

Screening for obesity-related comorbidities in primary care should be accompanied by assessment, examination, investigations and a full medical history (see table 5). The multifactorial nature of the condition including physical and mental health issues, ethnicity and deprivation should always be considered.21 Identify those with more complex needs who should be referred to more appropriate services (mental health, psychological etc).

Table 5.  What to include in a typical consultation(21)
Table 5. What to include in a typical consultation(21)