By Professor Tony Leeds
GPs and surgeons yesterday launched a campaign to combat obesity, saying current strategies were not working.
Around 30,000 Britons die prematurely each year of obesity-related conditions, and many more cope day-to-day with conditions including heart disease, diabetes, and osteoarthritis.
But attached to this appalling human cost is a financial one, and it's snowballing. For every month of inaction now, the cost will multiply, to the point where — in ten years —it could double.
Today's situation is grim enough. Almost a quarter of adults in England are obese (with a body mass index (BMI) of 30 or over). Around 800,000 are "morbidly obese" — with a BMI of 40 or higher, the level at which life insurance companies may decline cover. In short, we are moving towards a situation where a million Britons' lives are threatened daily. Again, a truly awful situation in human terms alone.
But what are the financial costs, and why should politicians act now?
An oft-quoted Foresight report predicted that the direct economic costs of overweight and obesity would be £6.4 billion a year by 2015.
But it put the wider costs of elevated BMI — e.g. related conditions as well as impact on the economy through sickness and absence etc — at a massive £27 billion by the same time.
The costs of effective treatment are rising: for bariatric surgery it is around £32.3 million per annum.
Look deeper at this single area of bariatric surgery. Just how many people would qualify for surgery right now and what would it cost if they all wanted it?
Guidance from the government's National Institute for Health and Clinical Excellence (Nice) sets the surgery threshold at a BMI of 40, or 35 if they have a related health complication like diabetes.
Clearly not everyone who is eligible for surgery will get it as not everyone is medically suitable, not everyone wants surgery, and individual primary care trusts apply their own criteria.
But the point here is that, if everyone who qualified actually had it, the cost to the NHS in the first year alone could jump from £32.3 million per annum, to £9.1 billion.
So the cost of obesity is already into the realms of billions of pounds, but potential solutions will cost billions too. This is a point at which alarm bells should start ringing.
How it could unfold
The long term trend in obesity prevalence has been relentlessly upwards. It may now be flattening off, but the prevalence of obesity related conditions is still rising, reflecting the delayed effect of obesity on the body's metabolism and mechanics.
There are also alarming signs of rising obesity in children too.
So how could Britain look ten years from now? Well, if our leaders don't grasp the nettle, here are some predictions:
• 35-40 per cent of the population could be obese
• There could be a 100% increase in knee replacement surgery, and a doubling of annual costs, to £1,500m (based on £803m costs in 2009/10 and 29% rise in four years)
• The number of people with diabetes could soar by 40 per cent , with a doubling of their medication bill, to £1,400 million
• Costs of treating high blood pressure could rise further. The three-fold increase in GP prescriptions for anti-hypertensives from 2000 to 2010 reflected better and more effective treatment of high blood pressure. A likely further rise over the next ten years could perhaps be attenuated by effective obesity management.
Speculation? Yes. But the figures are not beyond the bounds of possibility.
GPs hold the key to this spiralling situation. They could improve and save lives — and money - right now.
But they need two things.
Firstly, they need training in weight management — ironically, most GPs acknowledge that they have no specialist knowledge of the one subject which causes so many patient problems. If proper training was available, every local surgery could have an "obesity GP", with a strategy to drive down weight, and drive up health.
And secondly, GPs need to be able to offer patients more practical help.
At the moment, GPs can offer four options - "a healthy diet"; a community-based diet programme; a single drug therapy; or gastric surgery.
While the first three are fine for those who are modestly overweight, heavier patients could take many years to lose the weight, and in most cases, this is just not going to happen.
And yet at the other end of the scale, while the cost of surgery is proven to be recovered in three years through savings on diabetic drug costs, surgery cannot possibly be provided to everyone who might benefit. And it is, quite rightly, viewed by many as a last resort.
By far the greatest need for weight loss is in the "middle ground" of around three stone but there is a 'therapeutic void' in the middle ground where we have little to offer. If patients could lose two to three stone quickly, and maintain the weight loss, millions could be freed from miserable health conditions and expensive medication. And, vitally, it would halt the escalation of their obesity, which would otherwise lead to even greater problems.
Diet can in fact address the needs in this middle ground. A clinical trial, published in the British Medical Journal, demonstrated that three quarters of patients with sleep apnoea — the hidden killer — could be helped, while another showed how people with disabling osteoarthritis could lose weight, become more mobile and escape from social isolation at home.
I now declare an interest: I am in the privileged position of combining NHS practice with work within the private sector that includes commissioning research. I have been able to encourage key clinical scientists to undertake the clinical trials needed to demonstrate how effective weight loss and maintenance of one to two stone with formula diet can give sustained health benefits. I have also been able to use formula diet in NHS practice thereby developing a model for how this can be done in an ordinary clinical setting.
Surely it's time for this government — with its openness towards the private sector — to recognise that modern, safe, evidence-based, low-cost, diet solutions are now available, and actively encourage GPs to treat and manage obesity.
Professor Tony Leeds is a physician with a specialist interest in obesity at Central Middlesex and Whittington hospitals, London, and medical director of Cambridge Weight Plan.