Empowering primary care to tackle the obesity epidemic: the Counterweight Programme

Objective: To improve the management of obese adults (18-75 y) in primary care. Design: Cohort study. Settings: UK primary care. Subjects: Obese patients (body mass index >= 30 kg/m(2)) or BMI >= 28 kg/m(2) with obesity-related comorbidities in 80 general practices. Intervention: The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Main outcome measures: Proportion of practices trained and recruiting patients, and weight change at 12 months. Results: By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months. Conclusion: The Counterweight programme provides a promising model to improve the management of obesity in primary care.