Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study.
| Title: | Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study. |
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| Authors: | Coulman KD; Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; Margelyte R; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.; Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom.; Jones T; Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.; Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom.; Blazeby JM; National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; Macleod J; National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.; Owen-Smith A; Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom.; Parretti H; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.; Welbourn R; Department of Upper GI and Bariatric Surgery, Somerset NHS Foundation Trust, Taunton, United Kingdom.; Redaniel MT; The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.; Judge A; Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom. |
| Source: | PLoS medicine [PLoS Med] 2023 Sep 28; Vol. 20 (9), pp. e1004282. Date of Electronic Publication: 2023 Sep 28 (Print Publication: 2023). |
| Publication Type: | Observational Study; Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 101231360 Publication Model: eCollection Cited Medium: Internet ISSN: 1549-1676 (Electronic) Linking ISSN: 15491277 NLM ISO Abbreviation: PLoS Med Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: San Francisco, CA : Public Library of Science, [2004]- |
| MeSH Terms: | Overweight*/epidemiology ; Overweight*/therapy ; Overweight*/complications ; Bariatric Surgery*; Obesity/epidemiology ; Obesity/therapy ; Obesity/complications ; Adult ; Humans ; Female ; Male ; Secondary Health Care ; Cohort Studies |
| Abstract: | Background: Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both.; Methods and Findings: An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population.; Conclusions: Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.; (Copyright: © 2023 Coulman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) |
| Competing Interests: | HP has received speaker honoraria from Johnson & Johnson and Novo Nordisk for educational events. Honoraria received for participating in the development and presentation of an algorithm for the management of obesity in primary care supported by arm’s length sponsorship from Novo Nordisk. She is a co-author on a publication of UK data from a study funded by Novo Nordisk (no honorarium). |
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| Grant Information: | BRC-1215-20011 United Kingdom DH_ Department of Health; NIHR200181 United Kingdom DH_ Department of Health |
| Entry Date(s): | Date Created: 20230928 Date Completed: 20231002 Latest Revision: 20260127 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10538857 |
| DOI: | 10.1371/journal.pmed.1004282 |
| PMID: | 37769031 |
| Database: | MEDLINE |
Observational Study; Journal Article; Research Support, Non-U.S. Gov't