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Fortuitously Fat

NHS must step up to obesity challenge

The healthcare system in Britain must adapt to the demands of an increasingly obese nation, concludes a new report from the Royal College of Physicians (RCP).

News & media

01 January 2013

Whilst health promotion campaigns and other preventative measures attempt to stem the tide of obesity, the NHS must better manage the large numbers of patients presenting with severe complex obesity.

The rate of obesity in the UK is amongst the highest in the world, exceeded only by the USA.

Approximately 25% of UK adults are obese and it is estimated that the majority of Britain’s population will be obese by 2050.

The cost of dealing with the adverse consequences of obesity is estimated to be £5 billion per year.

The RCP working party found that despite the strain put on the NHS by obesity, the delivery of healthcare to patients with an established obesity problem is ‘extremely patchy’.

There are large variations in the way obesity is treated across the country, with the rate of hospital bariatric procedures, such as gastric banding, ranging from 0.4 per 100,000 in some Primary Care Trusts, to 41.3 per 100,000 in others. The figures constitute a 93 fold variation.

In many patients, their obesity leads to other complications such as coronary heart disease, diabetes, arthritis, sleep disorders and gynaecological disorders.

Despite this, the report authors found that there are few ‘joined up’ services for people who are overweight.

Professor John Wass, chair of the working party and academic vice-president of the RCP, said:

Britain is getting bigger and whilst we try to prevent the increase in obesity, we must also prepare the NHS for the influx of patients presenting with severe complex obesity.

A patient may arrive at my hospital with coronary heart disease, but if the root cause of their condition is obesity, we must be equipped to deal with that root cause.

The report, titled Action on obesity; comprehensive care for all, makes a number of key recommendations, including the creation of a new government role to coordinate the work of departments that could have an impact on obesity.

Other recommendations from the report include:

The appointment of a lead physician for obesity at every hospital trust.

The appointed doctor should interact with commissioning groups, be a source of patient information and act as a link between the hospital and the community.

Multidisciplinary teams made up of physicians, surgeons, nurses and other health professionals must be available to cover severe and complex obesity throughout the UK.

General practitioners should, where possible and appropriate, deal with weight issues as part of their agenda to address risk factors.

Professor Nick Finer, co-author of the report and obesity specialist at the UCLH centre for weight loss, metabolic and endocrine surgery, said:

We need to see improved leadership on obesity at every level; from the appointment of a lead physician in every trust, to the creation of a cross- governmental role.

Professor Lindsey Davies, president of the Faculty of Public Health, said:

We welcome this report’s emphasis on the vital role that physicians play in tackling this public health crisis.

The Faculty of Public Health supports the call for a single government lead on obesity, who would co-ordinate government action across every department – but every government department must play its part. The only way we will ever tackle the problems caused by obesity is by everyone working together.

Obesity is not only caused by how much we each eat or drink: if tackling it were as simple as telling people to eat less and move more, we would have solved it by now.

Our chances of being obese are also affected by factors like whether we have easy access to affordable fruit, veg and other healthy foods, and if it safe to let our kids play outside.

That’s why if governments focus on personal choice alone it is, at best, a red herring and, at worst, a dereliction of duty for everyone’s health.

Obesity definition

The most widely used measure of obesity is body mass index (BMI), defined as a person’s weight in kilograms divided by the square of their height in metres.

The threshold BMI for Caucasians for obesity is 30 (kg/m2).

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