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Clinical practice

National Obesity Database

The Society for Endocrinology, in partnership with Somerset NHS Foundation trust, has been awarded a Novo Nordisk Healthcare Organisation Grant to develop, set up and rollout a Tier 3 National Obesity Database.

This online database will collect data on the composition and delivery of each service, as well as patient level data on weight, previous weight loss attempts, drugs and comorbidities, treatments offered and response to these treatments. Initially this database will be set up in Tier 3 clinics but then will be rolled out to GP and Community weight loss services.

Obesity is an increasing problem in the UK, where the obesity rate is one of the highest in Europe [1]. 27% of the UK adult population are obese and obesity underlies much of primary care workload with 44% of Type 2 diabetes cases, 23% of ischaemic heart disease and 41% of certain types of cancer being attributed to obesity [2]. In addition, the number of adults with severe obesity, which significantly reduces life expectancy, has doubled to approximately 2.6 million over the last 10 years [2]. Obesity and its related illnesses lead to significant healthcare costs, estimated at £6 billion per year in the UK, with additional societal costs of £27 billion from reduced productivity secondary to obesity-related ill-health. The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year [3].

The 2008 Department of Health's ‘Call to action on obesity’ in England set a target to reduce the prevalence of adult obesity by 2020 and acknowledged the need to provide clinical services for obese adults in addition to public health preventative interventions [4]. Currently a four-tier model for managing obesity is recommended [5] See Figure 1.

 

Figure 1. Four–tier model for obesity management

Tier 1 primarily concentrates on preventing obesity and is commissioned by Public Health. Tier 2 services tend to be based in the community and offer referral to evidence based lifestyle intervention such as weight watchers and the counterweight programme [6, 7]. People seen in Tier 2 have a BMI of 28-35 and do not have any complex medical problems. The Tier 3 service is a multidisciplinary specialist service that can be based in the community or secondary services. People with a BMI>35 (or >30 if they have diabetes) and complex medical problems are seen in this service and offered pharmacotherapy, low-energy liquid diets and pre and post bariatric surgery care. Tier 4 services are based in secondary care and offer bariatric surgery. Detailed guidance on what a Tier 3 and Tier 4 service should look like have been developed.

Data on rates of obesity are collected by the National audit office so we are able to monitor whether
Tier 1 is being effective. Data on how much bariatric surgery is being done, the characteristics of those people having bariatric surgery and the effectiveness of bariatric surgery are also available through the National bariatric database that now has data on over 27,000 patients [8] (although this does not capture all the data). There is very little data available on tier 2 and tier 3 services with data only available from a few centres. This means that at the moment we are unable to say whether all areas offer tier 2 and 3 services, how many people are referred to these services, what the demographics of individuals referred to these services are and what happens to them whilst they are in the service. It is thus difficult to know if there is fair and equal access to these services across the UK, whether the right people are being referred to these services and how effective these services are.

The overarching aim of this project is to develop a National Obesity Database that will collect data from Tier 3 services.

This project will be overseen by the Society of Endocrinology and Somerset NHS Foundation Trust collectively, led by Rob Andrews, Associate Professor at the University of Exeter and an Honorary Consultant Physician at Musgrove Park Hospital Taunton.

Study Management Group
Dr Ahmed Ahmed
Dr Rob Andrews
Dr Jennifer Logue
Professor Barbara McGowan
Dr Alexander Miras
Dr Helen Parretti
Dr Emma Stapley
Professor John Wilding

Steering Committee
Professor John Wass (Chair)

We are seeking to recruit the following healthcare professionals with a specialist interest in obesity:

A physician
A dietitian
A psychologist
A nurse

The database will be built in two phases. Phase 1 will make the online platform for hospital  healthcare workers to enter data and also allow pulling of data from other sources. Phase 2 will allow linkage of data from the National Bariatric Surgery database and also enable patients to see their own data and complete questionnaires sent to them.

The database will be built by Hicom, a specialist healthcare software development company with over 30 years’ experience in the design and deployment of patient care and electronic medical record solutions. The database will be online, with secure log in, on a secure server owned by Hicom. Hicom own and manage their own data centre in the UK with 24-hour security and off-site disaster recovery provision. They are also a Microsoft Certified (Silver) Partner, have Investors in People accreditation and are certified under the ISO-9001 quality assurance and ISO-27001 information security standards. The online database will have national coverage with the ability to be accessed on a European and/or global level, if necessary.

There are 8 steps to completion of the database, and these are as follows:

Step 1 – Development of the specifics of the Database - This has been completed.

Step 2 – Phase 1 building of the database

Step 3 – Piloting phase 1 of the database

Step 4 – Roll out of the phase 1 database to Tier 3 services

Step 5 – Phase 2 build of the database

Step 6 – Piloting phase 2 of the database

Step 7 – Roll out of phase 2 of the database to Tier 3 services

Step 8 – Working with commissionaires and the Department of Health (DOH)

Step 9 – Working to link research projects into the database.

The collection of national data will ultimately help us to improve services. We expect to be able to determine:

  1. Which areas are not offering a Tier 3 service and help to ensure that these are set up.
  2. Who works in Tier 3 services and what services they offer to overweight and obese patients. Those not currently conforming to specification will be offered support.
  3. Whether there is equal access to treatment based on sex, age, social class and ethnicity. If not, this will be addressed.
  4. The characteristics of the people attending the 3 services. This data will give an insight as to how unwell this population is and how many people are being referred into these services. This will in turn inform service planning.
  5. How effective these services are and whether this varies from area to area. Centres with proven effective services can offer guidance and support to those not as effective.
  6. Some insight into the “real world” effectiveness of different types of interventions.
    The local data that each centre receives will also be helpful in planning their services and enable them to look at how adaptions to their service affect their outcomes. This will enable them to improve the effectiveness of their service.

Finally, we expect that by building this database we will stimulate research in this population. The data from the database will be available on request for research. Researchers will be able to apply to use the database to identify patients for research, which should help to increase the number of people with obesity involved in studies. Results from these studies in the longer term will improve our understanding and treatment of obesity.

 

  1. https://ec.europa.eu/eurostat/statistics-explained/pdfscache/12376.pdf (accessed 8.12.2020)
  2. Moody A (2016) Health Survey for England 2015 Adult overweight and obesity (accessed 8.12.2020)
  3. Public Health England (2017) Health matters: obesity and the food environment (accessed 8.12.2020)
  4. Department of health and Department for Children, Schools and Families. Healthy weight, healthy lives; a toolkit for developing local strategies. 2008 (accessed 8.12.2020)
  5. NHS Commissioning board. Clinical commissioning policy: complex and specialised obesity surgery (accessed 8.12.2020)
  6. McCombie L, Lean ME, Haslam D Counterweight Research Group. Effective UK weight management services for adults. Clin Obes. 2012; 2:96–102.
  7. Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract. 2008; 58:548–554.
  8. Small P, Mahawar K, Walton P, Kinsman R on behalf of The United Kingdom National Bariatric
    Surgery Registry (NBSR) (2020) Third Registry Report 2020 (accessed 8.12.2020)