Evaluating the management of obesity in UK primary care

研究背景：由于大多数英国人都患有肥胖症及其并发症，体重管理是公共卫生和初级保健的一项重大任务。自2004年以来，其他与生活方式相关的慢性病的监测和管理一直受到结果质量框架指标的激励，而肥胖的管理并没有以类似的方式得到及时的优先考虑。尽管英国医学协会（British Medical Association）在2020年表示不愿意，但英国国家卫生服务体系（NHS）现在已于2021年推出了一项政策，将转诊到初级保健机构的体重管理项目货币化。其目的和目标：该项目的目的是了解国家强化服务激励（NESI）对英国普通外科体重管理的影响。采用混合方法，通过观察在实施NESI后转诊数量、提供的体重管理建议、体重、血糖、血压、心理健康发生率的变化，以及初级保健人员对体重管理的看法、态度和想法的变化，来衡量影响。它的潜在应用和好处：这个项目的一个最近的好处是与关键利益相关者合作，同时进行评估和实施。通过这项工作，我们将与NHS的实施团队密切合作，在评估政策时向NHS提供直接反馈，以便在计划推出时对其进行潜在的完善。更重要的是，这项工作将深入了解旨在鼓励体重管理的国家方案的效用，这可能会影响未来的政策。此外，该项目与MRC-UKRI的七个战略重点中的四个相关联；1)预防和早期发现，2)多种疾病，3)精准医学和4)心理健康，这些共同支持优秀的发现科学，以改善人类健康。从前两个主题开始，体重管理属于预防的范围，通过针对不健康的上游原因，可以预先预防肥胖的风险因素，如糖尿病、心血管疾病和某些癌症，我们将使用大数据评估对合并症的影响。第三，NESI方案认识到患者的个性，允许选择体重管理方案以满足他们独特的需求，我们希望从患者的角度理解这一特征的重要性。最后，我们在评估中采用生物心理社会方法，并认识到心理健康与肥胖之间的相关性。我们将好奇地看到增加体重管理的影响，以及这将如何影响心理健康，即焦虑和抑郁。

The context of the research: With the majority of the UK population living with obesity and its complications, weight management is a momentous task for public health and primary care. Unlike other lifestyle related chronic conditions whose monitoring and management have been incentivised through the Quality of Outcomes Framework indicators since 2004, the management of obesity has not been promptly prioritised in a similar fashion. Despite reluctance from the British Medical Association in 2020, the National Health Service (NHS) has now introduced a policy in 2021 to monetise referrals to weight management programmes in primary care. Its aims and objectives: The aim of this project is to understand the impact of the National Enhanced Service Incentive (NESI) on weight management in UK general surgeries. Using a mixed methods approach, impact will be gauged by observing changes in the number of referrals, weight management advice given, weight, blood sugar, blood pressure, incidence of mental health, and changes in the perceptions, attitudes, and thoughts on weight management by primary care staff on the heels of the implementation of NESI. Its potential applications and benefits: A proximal benefit of this project is the collaboration with key stakeholders for simultaneous evaluation and implementation. Through this work, we will provide direct feedback to the NHS as we evaluate the policy in close collaboration with their implementation team, to potentially refine the scheme as it is rolled out. More distally, this work will provide insight into the utility of national programmes aiming to incentivise weight management, which may influence future policy. Additionally, this project ties in four of the MRC-UKRI's seven strategic priorities; 1) prevention and early detection, 2), multimorbidities, 3) precision medicine and 4) mental health, which collectively support excellent discovery science to improve human health. To begin with the first two themes, weight management falls within the remit of prevention, by targeting an upstream cause of ill-health, which can pre-empt the risk factors of obesity such as diabetes, cardiovascular disease and certain cancers, and we will evaluate the impact on comorbidities using big data. Thirdly, the NESI scheme recognises the individuality of the patient, allowing for choice in selecting the weight management programme to meet their unique needs, and we hope to understand the importance of this feature from the patient perspective. Finally, we assume a biopsychosocial approach in our evaluation, and recognise the correlation between mental health and obesity. We will be curious to see the influence of increased engagement with weight management, and how this may influence mental health, namely anxiety and depression.