There is a wide recognition of the need for a co-ordinated approach to obesity management and currently most PCTs are involved in developing a strategy to meet the needs of their individual population group. Once strategies have been agreed upon the challenge remains of how to effectively implement such programmes. Initially key individuals need to be identified to take a lead on coordinating obesity management programmes across diabetes, CHD and other relevant services.

It is not practical for GP practices to take on the full responsibility of managing the problem of obesity.⁴ Therefore, there needs to be an integrated approach involving schools, local and national government, the media, transport agencies, the food industry, planning authorities, commercial slimming groups and sports/leisure facilities. Nevertheless, because of the unique link that primary care has with individuals and families, they are in a pivotal position to influence and initiate management strategies.

The National Audit Office survey of GP practices in England confirmed that there are many advantages to a ‘whole practice’ approach in the management of obesity. This responsibility could be shared by all members of a PCT including:

It is important to clarify the different roles and responsibilities of healthcare professionals in order to achieve a co-ordinated and cohesive approach. The gate-keepers are likely to be GPs and practice nurses.

However, regardless of the strength of a team, it is unlikely to succeed if the patient or in the case of children, their families, are not a central component. Unlike other diseases, obesity does not lend itself to the classic medical model, where the doctor diagnoses the problem, prescribes the treatment and is then accountable for the outcome. It is the patient who ultimately exerts the greatest control over the decision to proceed and, eventually, the success of any therapy.⁵ Weight loss is not easy for obese patients, many of whom will have already experienced a great deal of frustration in trying to control their weight. Therefore, the primary care team can play an important role in recognising this and facilitating treatment in a very supportive and encouraging manner.