Evaluating the management of obesity in UK primary care

The context of the research: With the majority of the UK population living with obesity and its complications, weight management is a momentous task for public health and primary care. Unlike other lifestyle related chronic conditions whose monitoring and management have been incentivised through the Quality of Outcomes Framework indicators since 2004, the management of obesity has not been promptly prioritised in a similar fashion. Despite reluctance from the British Medical Association in 2020, the National Health Service (NHS) has now introduced a policy in 2021 to monetise referrals to weight management programmes in primary care.

Its aims and objectives: The aim of this project is to understand the impact of the National Enhanced Service Incentive (NESI) on weight management in UK general surgeries. Using a mixed methods approach, impact will be gauged by observing changes in the number of referrals, weight management advice given, weight, blood sugar, blood pressure, incidence of mental health, and changes in the perceptions, attitudes, and thoughts on weight management by primary care staff on the heels of the implementation of NESI.

Its potential applications and benefits: A proximal benefit of this project is the collaboration with key stakeholders for simultaneous evaluation and implementation. Through this work, we will provide direct feedback to the NHS as we evaluate the policy in close collaboration with their implementation team, to potentially refine the scheme as it is rolled out. More distally, this work will provide insight into the utility of national programmes aiming to incentivise weight management, which may influence future policy. Additionally, this project ties in four of the MRC-UKRI's seven strategic priorities; 1) prevention and early detection, 2), multimorbidities, 3) precision medicine and 4) mental health, which collectively support excellent discovery science to improve human health. To begin with the first two themes, weight management falls within the remit of prevention, by targeting an upstream cause of ill-health, which can pre-empt the risk factors of obesity such as diabetes, cardiovascular disease and certain cancers, and we will evaluate the impact on comorbidities using big data. Thirdly, the NESI scheme recognises the individuality of the patient, allowing for choice in selecting the weight management programme to meet their unique needs, and we hope to understand the importance of this feature from the patient perspective. Finally, we assume a biopsychosocial approach in our evaluation, and recognise the correlation between mental health and obesity. We will be curious to see the influence of increased engagement with weight management, and how this may influence mental health, namely anxiety and depression.