Access to weight reduction interventions for overweight and obese patients in UK primary care: Population-based cohort study

Abstract

Objectives: To investigate access to weight management interventions for overweight and obese patients in primary care. Setting: UK primary care electronic health records. Participants: A cohort of 91 413 overweight and obese patients aged 30-100 years was sampled from the Clinical Practice Research Datalink (CPRD). Patients with body mass index (BMI) values ≥25 kg/m2 recorded between 2005 and 2012 were included. BMI values were categorised using WHO criteria. Interventions: Interventions for body weight management, including advice, referrals and prescription of antiobesity drugs, were evaluated. Primary and secondary outcome measures: The rate of body weight management interventions and time to intervention were the main outcomes. Results: Data were analysed for 91 413 patients, mean age 56 years, including 55 094 (60%) overweight and 36 319 (40%) obese, including 4099 (5%) with morbid obesity. During the study period, 90% of overweight patients had no weight management intervention recorded. Intervention was more frequent among obese patients, but 59% of patients with morbid obesity had no intervention recorded. Rates of intervention increased with BMI category. In morbid obesity, rates of intervention per 1000 patient years were: advice, 60.2 (95% CI 51.8 to 70.4); referral, 75.7 (95% CI 69.5 to 82.6) and antiobesity drugs 89.9 (95% CI 85.0 to 95.2). Weight management interventions were more often accessed by women, older patients, those with comorbidity and those in deprivation. Follow-up of body weight subsequent to interventions was infrequent. Conclusions: Limited evidence of weight management interventions in primary care electronic health records may result from poor recording of advice given, but may indicate a lack of patient access to appropriate body weight management interventions in primary care.