Understanding the cost of obesity to the NHS

Measures to prevent and treat obesity have received considerable interest in recent years as the prevalence of obesity has increased and clear commitments have been made by the government to curb its rise. However, in order to treat obesity we need to not only identify its characteristics, we also need to understand the costs so that we can plan appropriately.

Obesity is a growing problem in the UK, with data from the NHS Information Centre suggesting that nearly a quarter of adults in England in 2009 were classified as obese. Furthermore, 16 percent of boys and 15 percent of girls aged 2 to 15 were classified as obese. Also in 2009, 1.45 million prescription items were dispensed for the treatment of obesity.

The issue is of particular concern when viewed from a European perspective – as the Organisation of Economic Co-operation and Development (OECD) has reported that the UK has the highest rates of obesity in Europe. Also, in England rates have increased faster than in most OECD countries.
    
Adapting to change
As society changes and obesity becomes more commonplace, the health service has to adapt to meet the needs of these individuals. One interesting example, featuring in a BBC1 documentary, is the launch of the so-called supersize ambulance equipped with apparatus capable of manoeuvring patients of up to 70 stone between home and hospital. Granted, the Thames Ambulance Service, which operates the service, is a private company and therefore likely to secure contracts from a variety of clients, including NHS Trusts.

Whatever the funding sources, it is clear that there must be a demand for bariatric services if a private company (whose priorities are likely to include the need to be profitable) is operating in this area. Furthermore, this trend to provide specialist transport services to accommodate obese patients is seemingly growing as reports are emerging suggesting that every ambulance service in the country is obligated to purchase bariatric equipment.

The costs of obesity extend much further than specialist transport services to and from hospital. It is well documented that obesity increases the risk of individuals suffering from a range of health problems, including high blood pressure, heart attacks, and respiratory problems, at least compared to people with average BMIs. Further, as obesity can make surgery more complicated and dangerous, the potential solutions to health problems can be limited and/or more risky for the patient.

There are also considerable costs associated with weight management surgery, such as gastric bands. Obese patients are able to secure funding for weight loss surgery through the NHS, which places pressure on the NHS budget.

Future cost predictions
So, what is the actual cost of services for obese patients to the NHS? The Foresight Review contains perhaps the most commonly-quoted estimate of costs and projected future costs. This suggests that the 2007 costs to the NHS attributable to overweight and obese individuals were £4.2 billion, with the total annual costs of all obesity-related diseases reaching an estimated £17.4bn. Future costs were also projected within the report predicting that by 2050 the cost to the NHS of overweight and obese patients may have more than doubled to £9.7bn, and with the total annual cost for all related diseases potentially rising to £22.9bn.

The report highlights that costs include:
• obesity surgery (including maintenance of gastric band)
• obesity treatment
• treating obesity related conditions such as stroke, coronary heart disease and diabetes

Since then the National Obesity Observatory has produced a briefing paper to identify any updated figures that can be used to estimate the costs of obesity. It identifies a number of other studies that have considered alternative calculations and reached differing estimates.

The report does, however, highlight a number of further considerations. Firstly, the publication of the NICE obesity guidelines in 2006 estimated that implementing the guidance would cost £63.3 million nationally in the first year and £35.5m in year ten, with identified savings of £55.6m. Secondly, that there may also be an average spend of £60,000 on specialist hospital equipment that has a larger weight capacity (a finding from a survey of 150 hospital trusts in England in 2008). Projecting this figure to all trusts in England and Wales was reported to equate to a spend of £10 million per annum on larger capacity hospital equipment.

Funding is also directed towards weight management programmes and prevention programmes – often targeted at schoolchildren to try to stop or reduce the need for subsequent medical treatment for overweight and obesity related illnesses.

These initiatives hold promise as a more sustainable approach and one that is more likely to curb the rise in obesity, especially when programmes target the attitudes and behaviours of both children and their parents, and focus on the benefits of having a healthy diet and exercising regularly.

What is not yet clear is the sum of the impact of non-clinical measures to prevent and tackle obesity and overweight in individuals. A review of the long term effectiveness of weight management schemes for adults found that while weight management programmes generally promote weight loss, changes are small and weight regain is common. It also found that interventions were likely to be cost-effective. However, no UK based programmes (with randomised control trials) were included in the review highlighting the need for research to evaluate the impacts of these interventions in a UK setting.

This article has briefly considered some of the challenges that the NHS faces in terms of meeting the needs of obese patients and ensuring they receive the best care possible. Obesity is placing increasing pressure on an already stretched NHS budget. As spending on obesity related diseases and surgery are predicted to rise considerably, it is clear that current reactive approaches to obesity and related health problems are not sustainable in the long term. The proposed re-structuring of the NHS by the coalition government, which in today’s economic climate is likely to bring with it considerable budget cuts, will only add to the challenge.

About Perpetuity
Perpetuity provides research in the areas of health, community safety, transport, security and education. It provides bespoke services to international companies, central and local government, public service providers, and private businesses as well as charities and voluntary organisations. The company combines a scholarly approach with a broad range of practical experience.

Recent and ongoing work on health related topics include drug and alcohol needs assessments, evaluations of adult and children weight management programmes, and an evaluation of an obesity prevention programme.

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