Determinants and extent of weight recording in UK primary care: an analysis of 5 million adults’ electronic health records from 2000 to 2017

Abstract

BackgroundExcess weight and unexpected weight loss are associated with multiple disease states and increased morbidity and mortality, but weight measurement is not routine in many primary care settings. The aim of this study was to characterise who has had their weight recorded in UK primary care, how frequently, by whom and in relation to which clinical events, symptoms and diagnoses.MethodsA longitudinal analysis of UK primary care electronic health records (EHR) data from 2000 to 2017. Descriptive statistics were used to summarise weight recording in terms of patient sociodemographic characteristics, health professional encounters, clinical events, symptoms and diagnoses. Negative binomial regression was used to model the likelihood of having a weight record each year, and Cox regression to the likelihood of repeated weight recording.ResultsA total of 14,049,871 weight records were identified in the EHR of 4,918,746 patients during the study period, representing 26,998,591 person-years of observation. Around a third of patients had a weight record each year. Forty-nine percent of weight records were repeated within a year with an average time to a repeat weight record of 1.92 years. Weight records were most often taken by nursing staff (38–42%) and GPs (37–39%) as part of a routine clinical care, such as chronic disease reviews (16%), medication reviews (6–8%) and health checks (6–7%), or were associated with consultations for contraception (5–8%), respiratory disease (5%) and obesity (1%). Patient characteristics independently associated with an increased likelihood of weight recording were as follows: female sex, younger and older adults, non-drinkers, ex-smokers, low or high BMI, being more deprived, diagnosed with a greater number of comorbidities and consulting more frequently. The effect of policy-level incentives to record weight did not appear to be sustained after they were removed.ConclusionWeight recording is not a routine activity in UK primary care. It is recorded for around a third of patients each year and is repeated on average every 2 years for these patients. It is more common in females with higher BMI and in those with comorbidity. Incentive payments and their removal appear to be associated with increases and decreases in weight recording.

RETRACTED: Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study

“…We took the following steps to maximise the likelihood that the unexpected WL cohort was accurately defined. First we confirmed that insufficient weight measurements were recorded in UK primary care to define unexpected WL, with clustering of weight recording noted in women with higher body mass index and in those with comorbidity 2. We then conducted an internal validation study to identify which codes most consistently defined unexpected WL and investigated whether weight measurements could be used in preference to codes 2.…”

“…Patients were included if they were aged 18 years or older, registered with a CPRD general practice, eligible for linkage to NCRAS and Office for National Statistics data and the index of multiple deprivation, and had at least one code for unexpected WL and at least 12 months of data before the first recorded unexpected WL code (the index date). These unexpected WL codes equated to a mean weight loss of 5% or more within a six month period in our previous internal validation study of weight related coding in CPRD 2. Unexpected WL could be coded according to a range of clinical scenarios, including unexpected WL reported as the patient’s presenting condition, after targeted history taking, and after weight measurement as part of the clinical examination or as part of a routine health check or chronic disease review.…”

Improving prevention strategies for cardiometabolic disease

“…However, improvement in prevention (or even reversal) of disease via lifestyle changes has been lagging behind. Few individuals get formal assessment of their adiposity levels or ever asked about activity levels 24 , and even fewer receive any sensible advice on how to address either. Furthermore, few doctors have any training in these areas 25 and there is evidence that while patients think and say that they follow dietary advice, most do not.…”

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

“…We also adjusted for comorbidity that could cause weight loss as defined in our previous study of weight recording in primary care. 20 All code lists are available from the corresponding author.…”

“…Firstly, we relied on coded unexpected weight loss entries, as UK GPs do not weigh patients frequently enough to allow reliable identification of weight loss in the EHR. 20,27,28 Secondly, our internal validation study identified the codes which most consistently defined weight loss. 4,5,19 Thirdly, we excluded patients with a past history of cancer as they are at higher risk of cancer than the primary care population, 29 unlike several previous studies.…”