Mercer's discussion paper1 on the usefulness of clinical guidelines for the management of obesity in general practice is commendable and yet raises serious concerns.
It is misleading that the NICE obesity guidelines focus so much attention on drugs and bariatric surgery, neglecting the only true treatment (and prevention) options of lifestyle modification through increased physical activity and improved diet. In the summary NICE clinical guideline 43, these get a single feeble line and this is a grossly misleading representation. One might also wonder how well equipped GPs currently are to, ‘offering multi-component interventions to increase physical activity, increase healthy eating, and improve eating behaviour’ during the average 9-minute consultation and when many GPs are not aware of the importance of physical activity.2
This persistent focus away from physical activity and diet as the main primary and secondary prevention options are a worry and reflect educational needs and faults within modern medicine, where the true causes of chronic disease are neglected and forgotten, to an extent, to have been largely self-inflicted. Perhaps this is commercially driven by the pharmaceutical industry and the relative simplicity of researching drugs by RCTs with dichotomous outcomes (it works or it doesn't) against more complex long-term studies assessing physical activity and diet with numerous multi-end point outcomes. There are not much promising long-term data for obesity treatment with drugs, plenty of side effects, and none of the collateral benefits of regular physical activity, including the potential to treat and prevent over a dozen chronic conditions.3
NICE guideline 43 is also unjustified in promoting negative attitudes towards lifestyle improvements in primary care when these have not been researched. Evidence shows that even brief consultations (3–10 minutes) or simple pedometer-based programmes delivered through health professionals can lead to substantial increases in patients' activity levels (by approximately 30%).4
There is a lot of convincing evidence from exercise medicine alone to suggest that physical inactivity is the causal factor for most western chronic diseases (including obesity) rather than obesity per se.5 So, is it time to focus our resources on finding the best ways to achieve and sustain increased levels of physical activity and improvements in diet within primary care, rather than focusing on the unproductive symptom of obesity and increasing its societal stigma?
- © British Journal of General Practice, 2009.