Obesity: An ever-increasing problem

I hope you all had a good Christmas and New Year, and are looking forward to 2013. I am sure everyone indulged in a slightly richer and more abundant menu over the festive period – it goes without saying really! Have you started to think of ways to shed those extra pounds gained over Christmas yet?

Well, even though the Christmas decorations were still up, the local government information unit (LGiU), in collaboration with Westminster Council, was launching its report “A Dose of localism: The role of councils in public health” (Local Government Information Unit, 2013). The responsibility for public health has now passed from the NHS to local councils. Local government is receiving responsibility for public health at a challenging time. On the one hand, local government faces a significant increase in demand. Cases of diabetes, dementia and heart disease are set to increase rapidly. On the other hand, councils face a significant reduction in resources, as local government experienced a 28% reduction in resources over the current spending review period. This is compounded by the Government’s proposals for allocating the £2.2 billion public health budget that could see deprived areas receiving less resource.

Though the recommendations in the report were wide-ranging, such as improving the supply of fresh fruit and vegetables and promoting use of public transport, the one that attracted attention was the suggestion that local authorities could consider varying local benefit levels in an effort to reward and incentivise individuals who sign up to exercise programmes (Carrwest, 2013).

The news clip that appeared on the BBC teatime slot suggested that the overweight or unhealthy people who refused to attend exercise sessions prescribed by their doctor could have their benefits reduced. The clip included responses from various members of the public, all carefully chosen, no doubt, to give their opinion on such a suggestion. As you would expect, there seemed to be as many outraged by the suggestion as those who agreed with it. Any intervention, whether it be a carrot or a stick, has to evoke long-term behavioural change to be considered a success; unfortunately, we instinctively want “quick fixes” with minimum effort.

As a prequel to this report, Professor Nick Finer, Consultant Physician at UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, was speaking a couple of days earlier on the BBC about the current situation concerning obesity in the UK (BBC, 2013). A total of 25% of the current adult population of the UK is obese, that is with a BMI of more than 30 kg/m². This is expected to rise to 50% by 2050. We are also second in the table for childhood obesity in Europe. The NHS is spending £5 billion per year on obesity.

According to Professor Nick Finer, by restricting surgery for obesity we are wasting NHS resources. He suggests that the cost of bariatric surgery can be recouped within 3 years by the prevention of costly consequences of obesity, such as diabetes, cardiovascular events and cancer. I know that many primary care trusts have shelved any requests for bariatric surgery in order to save money but it seems that this is a false economy.

The Government are suggesting that the medical profession should be leading the way in the fight against obesity, and by example too. I totally agree with this sentiment – how can we expect obese people to take healthcare professionals seriously if they are obese too? Practice what you preach, eh?

However, all the support and information available will not make someone lose weight if they are not motivated to do so. I believe the biggest challenge we have is trying to motivate obese people to change their lifestyle and maintain the changes – maybe hypnosis could be on prescription as well as exercise? Does anyone have any ideas?