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Empowering primary care to tackle the obesity epidemic: the Counterweight Programme

European Journal of Clinical Nutrition volume 59, pages S93–S101 (2005)Cite this article

Abstract

Objective:

To improve the management of obese adults (18–75 y) in primary care.

Design:

Cohort study.

Settings:

UK primary care.

Subjects:

Obese patients (body mass index ≥30 kg/m2) or BMI≥28 kg/m2 with obesity-related comorbidities in 80 general practices.

Intervention:

The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation.

Main outcome measures:

Proportion of practices trained and recruiting patients, and weight change at 12 months.

Results:

By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as ‘completers’ in that they attended the requisite number of appointments in 3, 6 and 12 months. ‘Completers’ achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months.

Conclusion:

The Counterweight programme provides a promising model to improve the management of obesity in primary care.

Sponsorship:

Educational grant-in-aid from Roche Products Ltd.

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Acknowledgements

We are grateful to the participating practices for their enthusiasm and cooperation. The Counterweight Project was funded by an Educational grant-in-aid to the Project Board from Roche Products Ltd. We thank Dr J Wilding and Professor A Barnett who participated in the initial discussions that led to the Counterweight Programme and Mr A Basar for participation during the early stages of the programme.

Author information

Authors and Affiliations

    Consortia

    The Counterweight Project Team

    Additional information

    Guarantor: RA Laws.

    Contributors: The principal investigators, WMAs and National Coordinator form the Counterweight Project team. The principle investigators were responsible for study design and directed the programme. The WMAs contributed to study design, conducted practice audit and facilitated implementation of counterweight programme, coordinated by the National Coordinator. RL wrote the first draft of this paper. All authors reviewed and contributed to the final manuscript.

    M McQuigg1, J Brown1, J Broom1, RA Laws2,12*, JPD Reckless3, PA Noble4, S Kumar5, EL McCombie6, MEJ Lean6, GF Lyons7, GS Frost7, MF Quinn8, JH Barth8, SM Haynes9, N Finer9, HM Ross10 and DJ Hole111Clinical Research Unit, Grampian University Hospitals Trust, Aberdeen, UK;2Nutrition and Dietetic Service, Royal United Hospital, Bath, UK;3University of Bath, Royal United Hospital, Bath, UK;4University Hospitals Coventry, Warwick NHS Trust, Birmingham, UK;5Warwick Medical School, University of Warwick, Birmingham, UK;6Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow, UK;7Nutrition & Dietetic Research Group, Hammersmith Hospitals NHS Trust, Hammersmith, UK;8Leeds General Infirmary, Leeds NHS Trust, Leeds, UK;9Centre for Obesity Research, Luton and Dunstable Hospital NHS Trust, Luton, UK;10Roche Products Ltd, Welwyn Garden City, UK; and11Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK12Has written the paper with contribution from other authors. All authors belong to the Counterweight Project Team. The names are in alphabetical order according to centre.

    Funding:

    Educational grant-in-aid from Roche Products Ltd.

    Intellectual property rights reside with the Counterweight Project Team.

    Competing Interest:

    MSAM3, JB2,3, RAL3, JPDR1,3, PN3, SK12,3, ELMcC3, MEJL1,2,3,4, GFL3, GSF5, MSQ3, JHB1,2,3,4, SMG3, NF1,2,3,4, HMR3, 6 declare potential competing interests:

    Here 1,2,3,4,5,6 represent:

    1Acted as consultants.

    2Have received lecture honoraria.

    3Have attended national/international meetings as guests of Roche Products Ltd.

    4Involvement as above with other pharmaceutical companies with an interest in obesity.

    5Research grant.

    6HMR is employed by Roche Products Ltd, but reports to the Counterweight Project Board.

    Discussion after Laws

    Brug: This was impressive. You showed in a structured way what behaviour change strategies you used in different parts of your programme. Would you also have had other differences between the dropouts and the people who stayed in the programme? Because you could of course argue that staying in the programme resulted in higher weight loss, but you could also say that higher weight loss resulted in staying in the programme.

    Laws: The only variables relating to completion of the programme were age, practice social deprivation and baseline BMI. We found a greater proportion of older individuals completed the programme along with those who attended a GP practice in a more affluent area and those with a higher baseline BMI. In terms of weight loss we have found that non diabetics and those with impaired glucose tolerance lose more weight than those with diabetes. Also the number of appointments the patient attends is correlated with weight loss. So again it comes back to social support.

    Kok: How is the current motivation of the persons who were in this trial? Are they in a continuous change mood or mode? The patients; they lost 5 kg or something like that; are they motivated to continue trying to lose weight?

    Laws: That is probably something I will be able to address in the qualitative study that we are adding on to the intervention. In this study, we want to find out with the patients what their experience with the programme was. We have the idea that the successful patients were motivated to have more appointments, and also the nurses wanted to see them more, because the success also was reinforcing for the nurses. But it is not yet clear whether people come back more often because they are successful or whether they have success because they come back more often.

    Kok: Your scientific objective is clear. What is the policy objective in the long run? Is this something that may be applied on a national scale?

    Laws: We are looking at the final results this year; we are going to do a health economic analysis, look at cost-effectiveness. Also bear in mind that the practices that became part of this programme actually volunteered to cooperate, so we probably are dealing with a more motivated group of practices. We need to look at this to find out whether it is applicable on a larger scale. This is one of the reasons we are doing the qualitative studies as well. But certainly we have had discussions with the UK Department of Health.

    Rosser: Have you done any analysis of the practices that dropped out? Do you have any preliminary information about that?

    Laws: We have only got feedback information from a few practices. We heard from a practice that a nurse left and the next nurse who came on board was not willing to take on the project.

    Truswell: You said that one out of six were a success so far, with 5% weight loss. But the others, they were partly a success, weren’t they?

    Laws: Absolutely. We found that three-quarters of patients were losing some weight at 12 months; and bearing in mind that the average BMI for this group was 37, it certainly was difficult for the patients.

    Truswell: And you may have stopped an even larger percentage from continuing to put on more weight.

    Laws: Yes, but unfortunately with this type of design, we did not have a comparable control group.

    Mathus-Vliegen: Do you know how much patients went through the second phase when more active treatment was provided.

    Laws: About 22% had more active treatment. And there were some patients going to dieticians and exercise groups.

    Mathus-Vliegen: So no one went for surgery?

    Laws: No. Interestingly, none of these patients were referred to special obesity centres, which is surprising. Maybe this is because a lack of these centres and long waiting times.

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    The Counterweight Project Team. Empowering primary care to tackle the obesity epidemic: the Counterweight Programme. Eur J Clin Nutr 59 (Suppl 1), S93–S101 (2005). https://doi.org/10.1038/sj.ejcn.1602180

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