부산대학교 도서관

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. Using routinely collected primary and secondary care data, Karen D Coulman and colleagues investigate how access to weight management services varies across England. Author summary: Why was this study done?: Nearly two-thirds of adults in England live with overweight or obesity, which can affect physical, mental, and social health and well-being. According to national guidance, these individuals should be able to access publicly funded weight management (WM) programmes, including bariatric surgery for those where weight is having a serious impact on their health (severe and complex obesity). However, researchers have previously uncovered concerns that a very low percentage of people were accessing these services, and it is unknown whether this has improved in line with the growing number of people who might benefit from them. What did the researchers do and find?: The researchers used routinely collected health data to identify 1,811,587 adults who had overweight or obesity documented in their primary care record during 2007 to 2020. Only 3% of these adults had a WM referral recorded during the study period. Only 1% of the 436,501 adults with severe and complex obesity underwent bariatric surgery. Higher body mass index and region of GP practice were the factors that were most strongly associated with receiving a WM referral and undergoing bariatric surgery. What do these findings mean?: This study suggests that access to WM interventions in England has not improved over the last 10 years, despite obesity rates continuing to rise. The regional differences in access to WM programmes including bariatric surgery are important and require national attention. Not everyone with overweight and obesity have their weight recorded in their primary care record, and so, the true percentage receiving a WM referral may be even lower. We did not, however, identify individuals who may receive WM advice through other disease programmes. [ABSTRACT FROM AUTHOR]