title: Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care.
abstract: A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m(-2) , or 30 kg·m(-2) with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m(-2) . A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jennings
authors.forename: C A
authors.initials: CA
authors.lastname: Hughes
authors.forename: B
authors.initials: B
authors.lastname: Kumaravel
authors.forename: M O
authors.initials: MO
authors.lastname: Bachmann
authors.forename: N
authors.initials: N
authors.lastname: Steel
authors.forename: M
authors.initials: M
authors.lastname: Capehorn
authors.forename: K
authors.initials: K
authors.lastname: Cheema
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D009767:Obesity, Morbid / Q000178:diet therapy / Q000628:therapy*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D006113:United Kingdom; D015431:Weight Loss; D055815:Young Adult
keywords: Adult; Tier 3; obesity; primary care
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