Study: Only 3% of Adults with Overweight or Obesity in England are Referred to Weight Management Programs by Primary Care Clinician

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New research presented at the European Congress on Obesity (ECO) 2022, held May 4-7, showed that just 3% of adults with overweight or obesity in England are referred to weight management (WM) programs by their primary care provider.

National obesity guidance was introduced in England in 2006, with a 2014 update stating that adults with a body mass index (BMI) of ≥25 kg/m² (≥23 kg/m² in minority ethnic groups) are eligible for referral to a lifestyle WM program. Additional publicly-funded adult WM programs in England include specialist medical WM services, and bariatric surgery for severe and complex obesity, according to the study abstract.

“Primary care plays a key role in identifying overweight and obesity and facilitating access to WM interventions,” wrote authors led by Karen Coulman, PhD, research fellow, Population Health Sciences, University of Bristol, United Kingdom. “WM programmes, however, are not consistently available across the country, and there is no national registry of non-surgical WM interventions, thus little is known about who accesses them.”

Coulman and colleagues used anonymized primary care electronic health records in England to quantify primary care referrals to WM programs. In addition, multivariable logistic regression was used to determine the association between patient and general practitioner (GP) practice characteristics and WM referral, reported using odds ratios (ORs) and 95% confidence intervals (CIs).

More than 1.8 million (31.1% of the corresponding adult population) adults had a recording of overweight or obesity in primary care between January 2007 and June 2020 and were included in the cross-sectional study. Of the 31.1% of adults with overweight or obesity, 56 783 (3.1%) received a WM referral.

Investigators found that the odds of receiving a referral were greater in:

• Women (OR=0.69, 95% CI, 0.67-0.70 for men vs women)
• Middle-age groups (OR=0.45, 95% CI, 0.43- 0.48 for those aged 18-24 years vs those aged 45-54 years)’
• Black individuals (OR=1.24, 95% CI, 1.17-1.33 vs White individuals)
• Adults living in most deprived areas (OR=1.19, 95% CI, 1.14-1.23 for deprivation level 5 vs level 1)
• Adults diagnosed with overweight or obesity in more recent years (OR=2.7, 95% CI, 2.52-2.90 for 2019-2020 vs 2007)
• Adults with a higher BMI (OR=6.50, 95% CI, 6.27-6.73 for ≥40.0 kg/m² vs 25-29.9 kg/m²)

Participants with type 2 diabetes mellitus (T2D) had a lower odds of WM referral than those without T2D (OR=0.89, 95% CI, 0.87-0.92).

The team found no differences between rural and urban GP practices; however, differences were observed across regions. The odds of referral were highest in the West Midlands, where persons were more than twice as likely to be referred than those in the Northwest.

The authors note that the prevalence of adult overweight and obesity (31.1%) revealed by their study is half that reported by the latest (2019) Health Survey for England (64%), indicating that overweight and obesity are being underreported in primary care.

“This is likely to be due to multiple factors, for example the requirement to have a register of patients with BMI ≥30 was only added to the Quality and Outcomes Framework (QOF) in 2017; pressures within primary care; and the need for more training in obesity for primary care professionals,” said Coulman in a University of Bristol press release.

Coulman et al are currently conducting research interviews with health professionals and patients to understand factors influencing referral to WM programs from primary care and to help explain observed differences across patient characteristics and region.

Reference: Coulman KD, Redaniel T, Margelyte R, et al. Patterns of adult weight management referrals in primary care in England (P04.28). Obes Facts. 2022;15:1-240.