GPs will quiz obese on exercise to battle ‘pandemic’
OVERWEIGHT and unfit patients who visit their GPs will be urged to take more exercise under an intervention scheme designed to tackle Scotland’s obesity crisis.
Thousands of Scots who turn up for a routine appointment with their doctor face being asked how much exercise they do and told to step up their efforts if they are failing to meet government activity guidelines.
The pilot scheme, due to begin in January, will be rolled out in 20 NHS clinics across Ayrshire and Arran, the Borders, Grampian, Lothian, Tayside and the Western Isles and overseen by specially trained doctors and nurses.
Patients who are overweight, suffer from diabetes, heart disease or depression are likely to be targeted first. Experts warn the move is vital because the diseases caused by sedentary lifestyles are now at “pandemic” proportions.
But obesity charities say they are dubious about whether it will work.
Two-thirds of Scots are overweight or obese and just 39 per cent of adults meet the government’s minimum guidelines on weekly activity. For adults, this means at least 30 minutes of moderate activity, such as walking, cycling or gardening on most days, adding up to a total of at least two-and-a-half hours a week.
There has been no improvement in the number of Scots meeting exercise targets in recent years, which is why the Scottish Government’s public health agency, NHS Scotland, has chosen to tackle patients directly.
The exercise intervention scheme follows a similar project aimed at encouraging patients with potential alcohol problems to drink less.
Yesterday senior academics said they thought it was vital to get more Scots moving.
Professor Nanette Mutrie, chair in physical activity for health at Edinburgh University, said: “Physical inactivity has now been listed as a pandemic health issue. Recent research shows that the risks of lack of activity are worse than smoking, obesity and diabetes put together. Previously, we were not aware of this.
“People should be getting advice about physical activity and this pilot is simply trying to make that happen. Patients are already asked about smoking and weight when they visit their GP. This will put physical activity on the same level.”
Mutrie, who helped develop the scheme, said the pilot will initially target those who are overweight or have health problems that might be helped by getting more active.
A typical scenario would see a doctor or nurse asking a patient who was coming in for a routine appointment how much exercise they did over the past week.
If this falls below two-and-a- half hours, the patient would be given a 20-minute “brief intervention” – probably carried out by the practice nurse – which involves explaining that exercise will help their weight and general wellbeing.
Patients will be asked to think of at least one activity they might enjoy and get advice on local exercise classes. They will also be told how to be more active. They are likely to be given a 12-week “walking plan” aimed at building up their walking until it meets the recommended levels.
The pilot will receive government funding although the amount has yet to be decided. It is not yet known whether GPs’ surgeries will be given extra money in the future to provide the service. However, the move has met with a mixed reaction from experts who say doctors and nurses don’t have enough spare time to carry it out.
Tam Fry, spokesman for the National Obesity Forum, said: “I am dubious about whether this will work. I do give it a cautious welcome, but I believe it will be very labour- intensive as there are so many people needing advice and there’s not enough time in the health service for follow-up to see whether people are doing as they are told.”
Margaret Watt, chairman of the Scotland Patients Association said: “This may be what we need as a nation but some people will have underlying health conditions that might not even have been picked up, and that could create problems if they try to do anything strenuous. So this might not be appropriate for everyone.
“Anyone with a health problem such as a heart condition might have to be monitored to make sure they don’t overdo it and make things worse.”
Dr Alan McDevitt, chairman of the BMA’s Scottish GP Committee, said: “This type of structured ‘brief intervention’ can be useful to find out whether an individual is ready to change their lifestyle to live a healthier life. However, within a ten-minute consultation, there would only be time to do this if the patient’s main problem had been dealt with in a short time. It is more likely this way of bringing up the subject of exercise will be most appropriate within a health promotion consultation by a practice nurse or, particularly, by a healthcare assistant.”
A spokeswoman for NHS Health Scotland said: “We know from evidence that physical activity brief interventions are both clinically and cost effective for delivery by the NHS.
“The pilot is an opportunity for us to put this into practice, recognising the benefits and importance of simply being more active as a key clinical intervention in primary care.”
• THE Scottish Government has set guidelines on physical activity which outline the minimum each individual should do each week to maintain a healthy lifestyle, and avoid the risks of heart disease, obesity, high blood pressure and cancer.
Adults should accumulate at least 30 minutes of moderate activity (walking, gardening, climbing stairs, cycling) on most days of the week.
This should total two and a half hours a week of moderate activity.
Children should accumulate at least one hour of moderate activity on most days of the week.
Alternatively, adults can meet the guidelines by accumulating 75 minutes a week of vigorous exercise (eg running).
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