Obesity Abstracts

Background: A brief intervention in which physicians opportunistically endorse and facilitate an NHS-funded referral to a weight loss programme is clinically and cost-effective. In some areas physicians are unable to make NHS-funded referrals, but could recommend weight loss programmes at the patient’s expense. The aim of this study was to test the acceptability of a brief intervention and attendance at a weight loss programme when physicians endorse and facilitate a referral that requires patients to pay for the service.

Methods: This was an observational study of the effect of a physician encouraging attendance at a weight-loss programme, requiring payment by the patient, to compare with a previous trial where the service was funded by the NHS. In addition, patients were randomised to receive information on the cost of the programme in one of two ways. Sixty patients with obesity who consecutively attended primary care appointments were enrolled and received an opportunistic brief intervention by their GP to endorse and offer a referral to a community weight loss programme at the patient’s own expense. Participants were randomised to physicians stating either the weekly monetary cost of the programme (basic cost) or comparing the weekly cost to an everyday discretionary item (cost comparison). Participants were subsequently contacted by a researcher and asked to report whether they had attended a weight loss programme.

Results: Overall 47% of participants accepted the referral; 50% in the basic cost group and 43% in the cost comparison group. This was significantly less than previously when the programme was funded by the NHS (77%, P<0.0001). Immediately after the consultation most participants reported the physicians intervention to be helpful and appropriate, but these scores were significantly lower than when the programme was funded by the NHS (P=0.004). One person attended the weight loss programme (2%), significantly less than when the programme was funded by the NHS (40%, P<0.0001).

Conclusion: GP referral to a weight loss programme that requires patients to pay rather than offering an NHS-funded programme lowers agreement to attend and leads to almost no attendance, even though it is acceptable.