Finding the right way to manage obesity

An expert in childhood obesity says fruit and vegetables must be made more accessible to poorer families.

Dr Carolyn Summerbell, Reader in Human Nutrition with the University of Teesside's School of Health & Social Care, says price and accessibility is restricting the effectiveness of health promotion campaigns to encourage more healthy diets.

Dr Summerbell recently took part in trials to find out whether the management of obesity could be improved by providing specialist training to family GPs.

The trial was carried out by a team of nine North East and Yorkshire medical practitioners and academic researchers and involved 44 general practices and 843 obese patients.

The surgeries and the patients were split into two groups. GPs and practices nurses in one of the groups were given three 90 minute training sessions covering information on reducing dietary energy intake, increasing physical activity and pharmaceutical intervention. The approach to obesity management entailed practitioners seeing patients regularly - the aim being about every two weeks until they had lost ten per-cent of their original body weight.

The second group of GPs and patients acted as a control group. After 12 months, there was little difference in weight between those patients attending trained practices and the control group.

The researchers report their findings in a paper published in BMJ (Volume 327) 'Improving management of obesity in primary care: cluster randomised trial'. Dr Summerbell and her colleagues say the training programme resulted in only limited implementation of the approach to obesity management and did not achieve improved patient weight loss.

Several general practitioners taking part in the trial expressed misgivings about the need to devote so much time to obesity management; and according to Dr Summerbell this is part of the problem.

"Although cases of obesity are shooting-up and reaching epidemic levels, it is not considered a medical priority at the moment. It doesn't attract the same amount of research as heart disease or diabetes.

"I think this is partly because some people feel it is their own fault if people are obese and it doesn't get taken as seriously as it should by health professionals," said Dr Summerbell.

She feels the media also has a major role to play and that a few hours advice from the family doctor on treating the problem has to be weighed against the mass of publicity about this kind of diet or the 101 alternatives.

"It doesn't help when the media talks about 'fatties' and then prints pictures in adverts of nice slim people eating high calorie foods. It also doesn't help when they write feature articles about this or that easy diet. If dieting was easy then people wouldn't be suffering from obesity," said Dr Summerbell.

She is joining forces with the University of Teesside's Professor of Public Health, John Wilkinson, to address this and other important public health issues.

One example is to encourage supermarkets and other shops to stock fruit and vegetables at prices everyone can afford.

"We already have the example of one of the Scandinavian discount supermarkets offering a third off all fresh fruit and vegetables; but people still need a car to get to most of their stores which are usually situated just outside main shopping centres.

"The presence of obesity is more likely to be found in areas where people don't have access to a car and have to rely on a corner shop that probably only stocks a limited range of fruit and vegetables and at prices that many people simply can't afford. So whatever family GPs and newspaper articles say, they can't get hold of fruit and vegetables at prices they can afford. That's one of the major problems in tackling obesity."

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