Background
Obesity is a major health issue associated with many health problems costing the National Health Service (NHS) billions. Public health programmes are very important to prevent overweight and obesity but for those who are already living with obesity, effective treatments are needed to improve health. Weight management (WM) services available in the NHS include community-based lifestyle programmes, specialist medical WM services, and surgical treatment (bariatric surgery) for those living with the most severe and complex obesity. These NHS services, however, are not consistently available in all areas of the country, and the number of bariatric surgery operations undertaken nationally is lower than other European countries. We know that not everyone who is eligible for NHS WM services are able to access them, but we dont know which groups of people are more likely to get access.
Purpose of the study
This study will 1) describe the characteristics of people with overweight and obesity in England, and 2) determine which groups within this population are more/less likely to get access to NHS WM services including bariatric surgery.
Potential importance of the findings
Given the current obesity problem, its associated health risks and healthcare costs, it is important that strategies to reduce overweight and obesity levels are available and delivered. This research will provide information about which groups are most under-served by NHS WM services. This will help to inform future planning of services to improve fairness of access.
Aims and Objectives
This study aims to describe the characteristics of people with overweight and obesity in England who are eligible for NHS weight management (WM) services including bariatric surgery, according to national guidance, and determine predictors of access to these services. We will also investigate trends in bariatric surgery before and after the transfer of commissioning responsibility from NHS England to Clinical Commissioning Groups in April 2017.
Exposures and Outcomes
The primary exposure is people with a diagnosis of overweight and obesity in England during the study period (January 2007-latest CPRD update), and the outcomes are a) referral to NHS WM services and b) undergoing NHS bariatric surgery.
Methods
This study includes both descriptive and hypothesis-testing elements using retrospective cohort and cross-sectional designs. Hospital Episode Statistics (HES) will be used to cross-check bariatric surgery recorded in CPRD.
Data analyses
Descriptive statistics will summarise demographic and clinical characteristics of the overall study cohort. The provision to need ratios for outcomes a) and b) will be descriptively calculated (number within the cohort with each outcome compared with the total number eligible for these services according to national guidance), and stratified by demographic and clinical characteristics. Proportions and Confidence Intervals will be calculated using a Poisson model. Cox regression will estimate time to event data including predictors for both outcomes a) and b). An interrupted time series approach will investigate the trend in bariatric surgery levels before and after the transfer of commissioning responsibility. Segmented linear regression will estimate changes in levels and trends after the transfer. Cox regression will be repeated on two separate cohorts of patients a pre-intervention and post-intervention cohort.
a) Referral to weight management services (primary care-based or hospital-based)
b) Undergoing bariatric surgery
Karen Coulman - Chief Investigator - University of Bristol
Karen Coulman - Corresponding Applicant - University of Bristol
Amanda Owen-Smith - Collaborator - University of Bristol
Andrew Judge - Collaborator - University of Oxford
Helen Parretti - Collaborator - University of East Anglia
Jane Blazeby - Collaborator - University of Bristol
Jialan Hong - Collaborator - University of Bristol
John Macleod - Collaborator - University of Bristol
Richard Welbourn - Collaborator - NHS England
Ruta Margelyte - Collaborator - University of Bristol
Theresa Redaniel - Collaborator - University of Bristol
Tim Jones - Collaborator - University of Bristol
Jialan Hong - Collaborator - University of Bristol
Jyoti Goyal - Collaborator - NIHR ARC West
2011 Rural-Urban Classification at LSOA level;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation