Epidemiology of adult overweight recording and management by UK GPs: a systematic review

BACKGROUND: Primary care guidelines for managing adult overweight/obesity recommend routine measurement of body mass index (BMI) and the offer of weight management interventions. Many studies state that this is rarely done, but the extent to which overweight/obesity is recognised, considered, and documented in routine care has not been determined. AIM: To identify the epidemiology of adult overweight documentation and management by UK GPs. DESIGN AND SETTING: A systematic review of studies since 2006 from eight electronic databases and grey literature. METHOD: Included studies measured the proportion of adult patients with documented BMI or weight loss intervention offers in routine primary care in the UK. A narrative synthesis reports the prevalence and pattern of the outcomes. RESULTS: In total, 2845 articles were identified, and seven were included; four with UK-wide data and three with regional-level data. The proportion of patients with a documented BMI was 58–79% (28–37% within a year). For overweight/obese patients alone, 43–52% had a recent BMI record, and 15–42% had a documented intervention offer. BMI documentation was positively associated with older age, female sex, higher BMI, coexistent chronic disease, and higher deprivation. CONCLUSION: BMI is under-recorded and weight loss interventions are under-referred for primary care adult patients in the UK despite the obesity register in the Quality and Outcomes Framework (QOF). The review identified likely underserved groups such as younger males and otherwise healthy overweight/obese individuals to whom attention should now be directed. The proposed amendment to the obesity register QOF could prompt improvements but has not been adopted for 2017.