‘We cannot underestimate the scale of the challenge’: tackling the Welsh government's obesity strategy 

It is now traditional for every article, every opinion piece, every commentary and every editorial about obesity to begin with something like, ‘obesity is a growing problem’. It is a ‘serious global public health challenge’. It is even, according to some reports, ‘an epidemic’ or ‘a crisis’. Even the RCP is getting in on the act: our president recently announced that the college now considers obesity to be a ‘chronic disease caused by health inequalities, genetic influences and social factors’.  

So at what point do we acknowledge that the message is drifting over most people’s heads? The National Survey for Wales 2017-18 found that 60 per cent of adults in Wales were classified as overweight or obese, including 22 per cent who were obese. Only 23 per cent of us eat 5 portions of fruit and vegetables every day. A third of us do little to no exercise. We also know that the number of adults who are overweight or obese increases with the level of area deprivation. Faced with such an overwhelmingly bleak outlook, it is all credit to the Welsh government that they chose January – traditionally a month of grey, wet days, and dark, cold evenings – to launch their first obesity strategy.

The RCP first called for a national obesity strategy for Wales in our 2015 action plan for the next Welsh government. As the political parties jostled for position and drafted their 2016 Senedd election manifestos, we asked them all to ‘develop a cross-governmental obesity strategy’, pointing out that obesity ‘puts patients at high risk of developing conditions such as diabetes, high blood pressure and stroke … without action to develop level 3 and 4 obesity services, hospital admissions will continue to rise.’ As a side note, it is worth noting that the cost to the Welsh NHS is projected to reach £465 million per year by 2050, with a cost to society and the economy of £2.4 billion.

When the re-elected Labour government passed its 2017 public health act, we, along with many other third sector organisations, welcomed the Plaid Cymru amendment that required ministers to produce an obesity prevention and reduction strategy. It could even justifiably be called a policy win for the RCP! And after two years of waiting for the detail, the consultation document finally landed in my overflowing inbox in mid-January. So, will it make any difference?

Well, if there is one truism that gets repeated too often by weary policy wonks in Cardiff Bay, it is that the Welsh government is extremely good at turning out policy which is admirable, well-meaning and has its heart in the right place – but far less good at turning that policy into results. It doesn’t matter how laudable the intention is, there’s often a disappointing sense that any real achievement which makes a difference to people’s lives is just out of reach. Unfortunately, it is hard to shake exactly that feeling after reading through the new strategy.

Don’t get me wrong: there’s a lot of good stuff in there. To start with, a commitment to ‘shift focus and resources to prevention and early intervention … [which] will require co-ordinated action and integration … across … health, social care, planning, housing, transport and business’. The document pulls in reference points such as the Wellbeing of Future Generations Act 2015 and the Active Travel Act 2013. It’s good to see the government thinking and talking outside of the box – something that the RCP pushed hard for during the drafting of this strategy. Obesity must be owned by everyone, across the whole of government. If it’s seen as purely a health issue, we will fail to make any kind of progress.   

Turning obesity strategy into action

It is also encouraging that the Welsh government acknowledges that ‘barriers faced by those trying to change their lifestyles can be psychological, practical or environmental’. This is exactly the sort of complex situation that clinically-led specialist weight management services are designed to address. However, it is less promising that the first and only time clinically-led medical and bariatric services are discussed in a 35-page document is in the final chapter, on page 27 – and even worse, the only firm commitment in the strategy is to ‘review and implement a clinical obesity pathway’.

This is not good enough. The Welsh government signed off on a national obesity pathway in 2010; nine years later, almost nothing has changed. By now, every single health board should have a level 3 multi-disciplinary weight management service which feeds into a level 4 bariatric surgery service.  But in 2019, only one health board has a full level 3 service; thousands of people are falling through the gaps, unable to undergo life-saving surgery because they haven’t gone through a specialist level 3 service that doesn’t exist in their area. It is even more disappointing that before the strategy’s launch, we were repeatedly told that a review was already underway; that the proposals for a new pathway would be published alongside the new strategy; and that we would finally see concerted action to help those most chronically ill and obese.

Obesity is still seen by many people as the result of poor choices made by an individual; but that’s not the whole picture. This strategy clearly recognises the complex nature of obesity, which should be welcomed. But it doesn’t go far enough. There are lots of promises to ‘review’ and ‘consider’ things; there are too few measurable objectives and activities. It’s not ambitious: there are no clear targets, and no reassurance that health boards will be held accountable in any tangible way.

Politically, there are some fairly major concerns. The next Senedd election is due in 2021, but the Welsh government has already ruled out any legislation on obesity for the rest of this term, blaming Brexit. Is this strategy doomed to look good on paper but go nowhere, with no concrete enforcement mechanisms in place? What’s to stop the next Welsh government – and maybe even a new health minister in 2021 – kicking this strategy into the long grass?

So what’s the final verdict?

Well, overall, this strategy is a good start, but it lacks detail and ambition, and it strikes a well-meaning, if worryingly vague tone for much of the document. Prevention and early intervention are vital, but not at the expense of those who are already overweight and obese, who also need our help. Wales has the highest childhood obesity rates in the UK – and overweight children tend to become overweight adults. At the risk of sounding trite, we genuinely are at crisis point.

In the coming weeks, the RCP will publish a formal response to the consultation document. In the meantime, we’ll continue to work with Obesity Alliance Cymru and other stakeholders to keep attention focused on our policy calls. We’ll also be engaging directly with the Welsh government and Public Health Wales during the consultation period, and we’ll be talking to our fellows and members about what they’d like to see in the final strategy. Please do get in touch if you’d like to be involved.

Lowri Jackson is the RCP head of policy and campaigns in Wales, where she works to influence change and improve patient care in the country. You can follow her work on Twitter at @RCPWales.