Obesity: The big problem 

With budget cuts, The British Dietetic Association explains the future difficulties likely to be faced by the NHS

The prevalence of obesity in the UK has proceeded at a doubling rate in the past 25 years, and it has been projected that about 40% of UK adult population will be obese by 2025.

Obesity is associated with a number of negative mental, physical and social consequences and substantially raises the risk of morbidity from a number of diseases coronary heart disease, hypertension, dyslipidemia, stroke, sleep apnoea, type 2 diabetes, and certain cancers.

Obesity has the highest impact on the budget of the NHS (although the figure differs depending on how it is calculated), followed by alcohol consumption, smoking and physical inactivity. According to Scarborough et al 2011, ‘in 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion with overweight and obesity costing £5.1 billion of this (Scarborough et al 2011)’, The Foresight report states that ‘In 2007, the total annual cost to the NHS of diseases for which elevated BMI is a risk factor is estimated at £17.4 billion, of which overweight and obesity is estimated to account for £4.2 billion’ (McPherson et al. Foresight report, 2007).

The Foresight report also uses a model to predict rates and costs of elevated BMI in 2050 and the results are: ‘If the ratio of total costs of overweight and obesity to health service costs of obesity remains similar to 2001 (i.e. 7 to 1), by 2050, an overall total cost of overweight and obesity per annum of £49.9 billion at today’s prices can be anticipated’.

Cost burden
The cost burden of obesity on the NHS is not just treating obesity and the sequelae of disease, but also cost for specialised equipment, e.g. beds, wheelchairs, chairs, imaging machines etc, and also the health cost to staff. Medical staff face enormous challenges when caring for the obese patient. Simple tasks such as turning the patient can cause an injury. Injuries to neck, shoulder and back as well as other musculo-skeletal injuries being the most common.

There is extensive documentation on the prevalence and consequences of obesity; however, evidence for the causes and treatment are not clearly understood. There are a plethora of factors that contribute to the emerging epidemic. These include increasing sedentary lifestyles, urbanization, and the so-called ‘obesogenic’ environment in which we live.

The ‘obesogenic’ environment is the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations. Social, economic, political and technological changes or advances are also likely to have contributed to the increased prevalence in obesity, increased automated services (domestic and industrial); fast and convenient transport services; multiple electronic entertainment media which discourages physical activity and social contacts; mechanized farming, biotechnology and improved food processing technologies that have significantly increased food supply (and accessibility) with high calories at reduced cost, particularly in developed countries, as well as safety concerns for physical activity participation, due to 'unfriendly' road designs for recreational walking and cycling, and poor facility maintenance etc. in parks and recreational facilities.

Multi-disciplinary approach
So what can be done to reduce the burden of obesity on the individual and society as a whole? In 2009 NHS information centre called on health professionals to find ways of cutting obesity levels. Health professionals, especially those working in the community or primary care setting are in a unique position to help assist people to lose weight. However, healthcare professionals can only do so much, at some point people do have to take responsibility for own lives.

There has been little evidence so far to prove the success of current interventions to combat this problem. It is recommended that obesity is managed with lifestyle advice, and in certain circumstances, medication and surgical treatment (NICE, 2010). This is not a problem which can be solved by generalised diet and exercise advice. Individual circumstances require specific advice and treatment. The NICE guidelines for management of obesity recognise this, and state that treatment and care should take into account individual needs and preferences, thus health professionals must use a patient-centred approach and understand that patients are individuals with hugely diverse circumstances. The complex nature of obesity means that each person will have different reasons and influencing factors for their weight, and these must be explored in order to tackle the problem. It is therefore recommended that a MDT or multi-disciplinary team approach is used in the care of patient with obesity. General practitioners, specialist doctors and nurses, physiotherapists, occupational therapists, psychologists and dietitians all play a vital role. A patient-centred approach will allow effective communication and co-ordination of services to ensure the patient has access to all the services that are available to them.

However, with more cuts being made on NHS budgets, it is difficult to predict how the NHS will cope with the health problems that obesity will create. and be able to provide the best, appropriate care to their patients. If obesity levels rise by more than double, as predicted, it is unlikely that the NHS will be able to produce the resources needed to effectively manage obesity and the health problems it creates.

There is a need for the government to recognise the part they play in this increasing epidemic and the role they can play in halting, or even reducing it. For example, creating safe and appropriate physical environments that encourage physical activity through every day living. Economic modeling commissioned by Cycling England has calculated that a 20% increase in cycling by 2015 would save £107 million in reducing premature deaths, £52 million in lowered NHS costs and £87 million by decreasing absences from work (SQW (2007). However, to increase cycling the roads must be made safer for cyclists and appropriate cycle paths implemented. Free bus passes for the young and old mean that people travel one or two stops by bus rather than walking. There appears to be a lack of strong political will in converting research findings into actions owing to unbridled economic interests, and top-down approach in programme implementation.

Tax on foods
In response to the relationship between food and economic environments, use of fiscal policies such as taxation, on fatty and sweetened food are being exploited in some countries such as Denmark, Romania, Canada and Australia; given the experience of it’s use in other areas e.g. reduction in the prevalence of tobacco smoking. However, any initiative like this must be accompanied by appropriate health education on healthy food choices in order to promote its effectiveness, as well as subsidising healthy food options (particularly fruits and vegetables), if it is to be economically sustainable.

At this time, the obesity epidemic in one that continues to increase. It appears that there is a failure of current public health interventions from health professionals and the government, and failure of people as individuals taking responsibility for their own lives that means that it is unlike to reverse in trend any time soon. It is therefore important for individuals and communities to come to realisation that they can modify and influence their environments in complement with the government and the health care sector to achieve reasonably healthy and sustainable livelihood.

Further information
Established in 1936, The British Dietetic Association is the professional association for dietitians. One of its aims is to advance the science and practice of dietetics and associated subjects. For further information visit www.bda.uk.com