Comment

Time to tackle obesity

Professor David Haslam chairs the National Obesity Forum, which leads National Obesity Awareness Week (www.noaw.org.uk), taking place between 12 and 18 January. He also sits on NHE’s Editorial Board.

It’s no secret that the UK has an obesity problem.

The evidence speaks for itself. HSCIC data shows obesity rates amongst adults have nearly doubled between 1993 and 2012. Currently around a quarter of the population is considered obese. The story is no better for children. The National Child Measurement Programme determined in November that 33.5% of children aged 10-11 years are overweight or obese. And the chief medical officer, Professor Dame Sally Davies, warned in her 2014 annual report of the increasing ‘normalisation’ of obesity.

The problem is evident, and it’s putting increasing pressure on the resources of the NHS. The McKinsey report of November 2014 suggested that obesity cost the UK approximately $70bn (£44.7bn) in 2012. And when you consider how that translates into patients requiring support in hospitals and GP practices for their weight or weight-related conditions, the scale of the public health crisis we face is brought into stark reality.

For this reason, Simon Stevens’ intervention and commitment in his Five Year Forward Plan of NHS England to hard-hitting action to tackle obesity is very welcome and much-needed. But positive sentiment alone will not redress the balance. What is needed is concerted action.

This begins on the frontline. Evidence suggests that GPs often struggle to engage their patients on the subject of weight. This is because it a difficult and emotive topic to raise. But it also because many GPs have never been given the training and support needed to best manage patients, meaning GPs do not necessarily have knowledge of or access to weight management support services. They might not make the correlation between the condition patient presents and the underlying issue of weight.

Because conversations about weight aren’t taking place, the symptoms not the problem are being tackled. This presents longer-term issues for the NHS. Because in not identifying weight as an issue at an early stage, and addressing that issue, the likelihood is increased of patients needing multiple visits to health services and potentially even admissions to hospital.

This increases demand for NHS beds and adds to the cost of obesity.

This is a cost we can no longer afford to bear. In implementing Simon Stevens’ commitment to tackle obesity, we must recognise that there is low-hanging fruit that will help improve patient outcomes and reduce the cost of obesity to the health service and ultimately the taxpayer.

Critical to this is the concept of making every contact with patients count. As noted above, this is not something that is currently done to best effect. The RCGP called for greater training of GPs on obesity in 2014: this call must be heard and acted upon alongside an impetus to ensure weight management is central to GPs’ consultation.

This means a long-overdue reform of the Quality and Outcomes Framework. While a voluntary initiative, the QOF requires only that GPs register their obese or overweight patients. It does not require that any action must be taken.

Changing this structure, and introducing an indicator that encourages more activity to actually tackle for obesity within the QOF – or an alternative GP incentive scheme – would achieve two things. First, it would ensure the concept of making every patient contact count – which was set out in the Department of Health’s obesity strategy in 2011 – is realised. And, as importantly, it will help fundamentally change the mindset in relation to weight management. It will help show that this problem can only be addressed with early action. The alternative is continued unacceptable pressure on hospital wards and health service resources.

Tweaking GP incentive schemes will not resolve obesity in the UK, but will be a useful step that must be accompanied by other concerted action, including easy access to weight management services. It means the intelligent use of bariatric surgery when appropriate, which is proven to deliver value for money. And it means supporting the work of the Responsibility Deal and Change4Life that are having a proven effect on the nation’s health outcomes.

As the McKinsey report noted, tackling the problem of obesity will not be an easy or quick task. It will require great effort and a variety of initiatives. But there is potential to manage this problem and help improve the health of the population, which in turn will benefit the NHS.

FOR MORE INFORMATION

http://www.noaw.org.uk/

Above: Dr David Haslam, a GP and chair of the National Obesity Forum