Around two-thirds of the UK population are overweight or obese, and this figure is rising rapidly. Preventing people becoming overweight in the the first place is, of course, essential, but so too is clinical treatment for those already obese. And it is this latter, strangely unfashionable approach that is in danger of being neglected by policy makers and the NHS.
There has been a strong media focus on cause and prevention of obesity in recent months. My concern is that this will lead to treatment being marginalised. My own experience as a GP is that the NHS generally regards obesity as a "lifestyle" problem, for which treatment is an optional extra. Certainly, many primary care trusts (PCTs) are reluctant to sanction approved treatments for obesity, in a way which would be unthinkable were the condition in question heart disease or diabetes.
This represents a huge missed opportunity. Obesity has grown by over 400% in the last 25 years and may soon surpass smoking as the most prevalent cause of premature death. Latest estimates suggest that obesity-related management costs in excess of £3bn per year. Obesity is a principal contributory factor in a number of potentially fatal conditions. Compared to their leaner counterparts, obese people are at significantly higher risk of contracting coronary heart disease, cancer, diabetes and depression.
The government is trying hard to reverse the rising obesity trend, and has committed extensive funding to drive cohesive exercise programmes for both adults and schoolchildren. It is also widely expected to target obesity in its forthcoming white paper, Choosing Health. Ministers are also reviewing the recommendations of the Commons Health Select Committee, calling for healthy-eating public-awareness campaigns, controls on juvenile-focused advertising, and the introduction of more affordable healthy foods.
This is commendable, but in order to maintain the momentum it is essential that all relevant obesity bodies work in tandem. For example, in the clinical sector, the National Institute of Clinical Excellence has approved two medications for the management of obesity. Sibutramine makes patients feel fuller sooner and therefore encourages them to eat less, while Orlistat reduces the absorption of dietary fat.
Despite this, some PCTs have instructed doctors not to prescribe these medications. This displays a lack of understanding and unethically disregards potentially fatal repercussions such as heart disease and cancer. Weight loss of only 10% can reap substantial health benefits, decreasing the likelihood of an obesity-related death by 40%. Clinical management can safely evoke weight losses of this magnitude, with data showing that weight lost can be sustained for at least four years.
It is therefore essential that as well as targeting obesity prevention, we focus on treating patients who are already clinically obese. To help facilitate this, plans are underway in several key organisations to develop an all-encompassing nutrition and activity task force. This umbrella organisation would oversee the development and implementation of a number of innovative obesity prevention and weight-management initiatives, providing a much-needed cornerstone for co-ordinating current and future initiatives.
Individuals must take personal responsibility for their health, but the NHS must play a leading role in making weight control a realistic possibility in those who want to regain control of their health in this way.
Decision-makers in the NHS must recognise both the need for, and the effectiveness of, weight management; and they must adequately resource this work. Not to do so is to fall short of our own responsibilities.
· Ian Campbell is a GP and president of the National Obesity Forum, an independent group of healthcare practitioners with a special interest in obesity.
