Reducing overweight and obesity: closing the gap between primary care and public health.

BACKGROUND Although overweight and obesity are major risk factors for ill health and premature death, leading to significant increases in workload and prescribing costs, primary health care providers continue to find managing overweight and obesity a difficult business. OBJECTIVES Six questions are addressed in an attempt to close the gap between primary care activities and public health goals to reduce overweight and obesity: what is overweight and obesity; what is the health impact of overweight and obesity; is individually directed advice effective in reducing overweight and obesity; can we increase the involvement of primary care in reducing overweight and obesity; how can public health actions complement the role of primary care; and how do we chose cost-effective interventions? METHOD Systematic reviews and key texts were identified from literature searches to provide a narrative summary to answer the six questions. RESULTS Overweight is defined as a body mass index (BMI) of > or = 25 and obesity as a BMI of > or = 30 where BMI = weight (kg)/height (m(2)). There is a positive relationship between the level of BMI and a wide range of conditions, including cancers and cardiovascular diseases. There is evidence that individually directed advice can reduce overweight and obesity or its risk. There is mixed evidence for the effectiveness of strategies in increasing the involvement of primary care in reducing overweight and obesity. There are many examples of public health actions that complement the role of primary care in reducing overweight and obesity. Overall cost-effective policy analyses have not been done per se for overweight and obesity but have shown that a combination of personal and non-personal interventions can be effective and cost-effective in reducing cardiovascular events. CONCLUSION The gap between primary care and public health in reducing overweight and obesity can be closed, but it requires sustained political support and investment.