On World Obesity Day 2022, the Royal College of Physicians is calling for ‘a National Obesity Prescription for England’ to improve care and reduce prevalence.
The prescription we are calling for is the national delivery of effective weight management interventions to prevent people developing serious illness. We need to build on existing services and fund them across England, particularly focusing on socioeconomically deprived areas where rates of obesity in children and adults are highest.
The scale of the challenge
Obesity is one of the UK’s most pressing public health challenges. In 2018, over 11,000 hospital admissions were directly attributable to obesity, but it was a factor in over 875,000. Over a quarter of adults and 1 in 5 children leaving primary school are living with obesity.
The World Obesity Federation found that 30% of COVID-19 hospitalisations in the UK’s first wave were directly attributed to overweight and obesity. Three quarters of all critically ill patients in the first wave of 2020 were classified as living with overweight or obesity.
We now understand much better the role of genetics in the control of weight. Some people have genes that predispose them to put on weight and others have genes that do the opposite. While this has always been the case, the deluge of cheap, unhealthy food and drink that has inundated our society has arrived relatively recently, leading to the current crisis.
Ending the postcode lottery
Provision of specialist weight management services is patchy across England. A third of the population does not have access to these services and, where they do exist, waiting times are unacceptable.
Integrated care systems (ICS) are well-placed to co-ordinate the identification and referral of patients from primary to secondary or tertiary care. In the long run, every ICS should have a weight management centre that is able to support and treat children, young people and adults. In the short term they need access to one. Government must commit funding to increase capacity in existing centres and to develop services where they do not exist.
Clear guidance and pathways will help healthcare professionals understand who to refer to which weight management services. For people with severe obesity, new effective, evidence based medical treatments such as semaglutide are emerging and bariatric surgery is highly effective.
Each ICS should also ensure that every service has the right understanding and equipment to treat people with obesity. This includes the basics, such as equipment that can weigh people with severe obesity in GP surgeries and hospital equipment that is size appropriate.
Making every contact count
Given the significant impact of obesity on health, all healthcare professionals need to make every contact count. Talking about weight - in an empathetic, non-stigmatising way - should become a standard element of healthcare interactions, in the same way we deliver advice to stop smoking. Eighty per cent of people will accept an NHS weight loss referral if it is suggested in the right way.
All healthcare professionals should receive training in obesity, developed and delivered by professional bodies and NHS employers, with support from government. It must
- tackle the resistance to referral by healthcare professionals who believe that patients should be able to lose substantial amounts of weight on their own
- help them to discuss someone’s weight in an empathetic manner
- equip them with weight management skills, such as supporting patients on surgical waiting lists to ‘wait well’ by losing weight and increasing physical activity in advance of elective surgery.
Expanding the role of digital solutions
Finally, NHS England has extensively trialled digital tools to deliver weight loss interventions and found them to be effective in adults, leading to the NHS Digital Weight Management Programme. NHS England should evaluate similar interventions in young people and adolescents.
A chance to turn the tide
Over the past 30 years, there have been 14 government obesity strategies, yet rates have increased. In 2022 we have a chance to change that, but we must make the commitment to treatment and support. Likewise, the government must retain its commitment to restricting the advertising of unhealthy food and drink to children and young people. Together, these measures will turn the tide, improving health and reducing the demand for health services.