Time for Foresight 2.0? the health and economic case for new action in tackling obesity – Event summary

Introduction

The following is a summary of the Future Health event: Time for Foresight 2.0? the health and economic case for new action in tackling obesity. The event was held virtually on 5 March 2024 between 09.00-10.30, chaired by Vivienne Parry OBE and sponsored by J&J.

Panellists for the event included:

• Steve Brine MP, Chair, Health Select Committee
• Preet Gill MP, Shadow Minister for Primary Care and Public Health
• Professor Susan Jebb OBE, Professor of Diet and Population Health at the University of Oxford, (co-author of original Foresight report)
• Professor Naveed Sattar, Professor of Cardiometabolic Medicine, University of Glasgow (Head of UK Government Obesity mission)
• Matthew Bell, Director, Frontier Economics

The following provides a summary of the main discussion areas during the session. Please note that this is a summary overview of the discussion areas, written by Future Health and does not confer all panellist agreement on the statements and conclusions.

Discussion summary

Complexity – Obesity is a significant issue – but not a purely British one – as evidenced by the recent Lancet study showing over 1 billion people globally are living with obesity.[1] One of the concerns we have in the UK is that public health issues such as obesity are making the national health system unsustainable and these must be a call to action.

Tackling obesity though is a complex challenge. The original Foresight report demonstrated this through its complexity map. The levers for change are spread across Government departments and obesity is not just the responsibility of the Department of Health. It is important though to ask whether obesity will ever be a number 10 priority given the competing issues and agendas it faces. If not, then it needs to be a Cabinet Ministerial responsibility that brings different departments together.

Policy implications: Adopt a mission based Government approach to tackling obesity that binds together the different departments and levers of Government. Assign obesity as a Cabinet level Ministerial responsibility

Evidence and implementation – Politics has been a major barrier to policy implementation. Whilst policies in some cases have been taken forward and implemented (e.g. Soft Drinks Industry Levy), many have not, limiting progress.

The evidence for action from the original Foresight report is clear and consistent with today, it is unclear what an update to the report would add.[2] It would instead be better to focus on unblocking barriers to policy implementation through a co-ordinated strategic system-wide approach.

When developing obesity policies within such a framework we need to be clear about the tests and evidence they need to pass for inclusion.

Policy implications: Adopt a systems-wide, population health based approach to developing an evidence based Government obesity strategy and associated policies

Prevention – Prevention is clearly a critical part of tackling obesity. Whilst this should include a focus on children, it needs to be population wide. There are a great number of people who are overweight today or at risk of overweight who could be prevented from obesity with the right interventions.

Most prevention interventions cost very little financially, but they do cost political capital. Interventions such as those on banning certain adverts on children’s television and restricting advertising on the London Underground have not cost money and have been effective.

We also need to factor in physical activity. Physical activity can help prevent weight gain and have wider positive benefits linked to improved quality of life and better mental health.

We need to demonstrate the wider value of prevention and how it can help reduce the significant economic and NHS costs of obesity and support wider Government objectives around economic growth, labour market activity and productivity.

Policy implications: Efforts to prevent overweight and obesity should include targets to improve child health but also include efforts across the population to reduce obesity rates

Voluntary vs mandatory approaches to food industry regulation – In the twentieth century the food industry has successfully delivered more food, more cheaply. But we now have a market failure. Voluntary based approaches to regulating the food industry will not deliver the reductions in obesity we want to see. The Responsibility Deal made some limited progress when it was operating, but also showed that more mandatory approaches are fundamentally needed.[3]

Reformulation as a policy lever works well in certain areas, such as salt, but in other areas such as sugar and fat, we will have to go beyond reformulation.

Government action is now needed to correct this market failure. Government should set targets and Key Performance Indicators for businesses to produce and promote healthy foods. Such an approach will avoid Government micro-management and instead enable businesses to work through how to deliver on these targets. Businesses should then publicly share their data on their performance against such metrics.

Policy implications: Government should adopt mandatory reporting requirements for the food industry in relation to the production and promotion of healthy and unhealthy foods. This should include the setting of targets and key performance indicators that businesses must publicly report against

Treatment – Healthcare systems are not set up to treat obesity. In primary care one of the challenges through and post the pandemic has been less face to face appointments which has resulted in missed opportunities for weight measurement and referrals.

It is going to take time to get health systems readily prescribing the new obesity drugs. Alongside the new drugs you will need digital wrap-around support. The move from injectable to oral anti-obesity drugs should make prescribing easier and help reduce costs.

We need to look at clinical pathways to get people the interventions they need at the right time. Currently we do not do enough obesity-related surgery in the UK when compared with other countries such as France and Sweden. The arrival of the new drugs and the development of new pathways should see this change and help us integrate interventions more around patient needs. This could include combining interventions more closely such as surgery, new drugs, effective dietary interventions and digital support.

Policy implications: NHS England should build a new service specification for obesity services that helps re-design clinical pathways around the needs of patients and improves access to interventions for patients

Health inequalities – Obesity rates are linked to higher rates of economic deprivation.[4] The first Foresight report did include a focus on inequalities, but it is always important to note that obesity is not confined only to more deprived groups and needs to be seen as a population wide issue.

Tackling health inequalities was a major theme of the recent responses to the Health Select Committee prevention inquiry.[5] Recent research has highlighted the prevalence of unhealthy food advertising in more deprived communities. This raises money for local authorities who are facing financial challenge, whilst on the other hand creating a costly and unhealthy food environment.

Linking the piloting of new drugs and obesity service models in areas where obesity rates are higher could help tackle health inequalities and the major conditions associated with obesity.

Policy implications: Focus greater attention and new investment in changing and expanding obesity services, treatment and support in areas of the country where obesity rates are higher. Ensure a baseline level of obesity service is available within each NHS Integrated Care Board

Cultural change and tackling stigma – There is a need for a culture change to reconnect people with food, mobilising community assets and initiatives to do so and prevent the erosion of healthy food cultures by big businesses. As a society we need to win hearts and minds and ask why for example our empathy for those we know with obesity does not extend more widely to other citizens.

Within the medical profession many clinicians are still not bringing up discussions about weight with patients, despite the impacts this is having on increases in chronic diseases such as diabetes. There is a clear comparison between obesity and high blood pressure in this regard. For high blood pressure there are a range of interventions and treatments offered to patients, for obesity patients do not have the same offers and level of support. In some cases, clinicians still see weight as purely an issue of personal responsibility.

Policy implications: Develop place based strategies for developing healthy food environments and communities. Build public and medical professional facing campaigns that tackle stigma associated with overweight and obesity

Medical education and training – Whilst great medical progress has been made in reducing deaths from cardiovascular disease and keeping people with cancer alive longer, we have not tackled issues of excess weight. This is leading to people developing multiple chronic diseases. Medicine is not structurally organised to deal with obesity – obesity does not belong to any one medical specialty – and obesity needs to be seen as a risk factor for a range of other diseases. Effective treatment can help deliver secondary prevention and has wider benefits for patients including improved quality of life. There is a need to educate clinicians about these linkages, on how to talk to patients about their weight and make services, support and treatments more easily accessible.

Policy implications: National bodies and representative groups should develop new medical education and training programmes on the benefits of obesity treatment not only in relation to reducing obesity but the wider risk factors, conditions and impacts associated with it

 March 2024

[1] https://www.openaccessgovernment.org/the-world-health-organizations-plan-to-tackle-global-obesity/174329/#:~:text=A%20recent%20study%20published%20in,aged%205%20to%2019%20years

[2] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf

[3] https://www.gov.uk/government/news/public-health-responsibility-deal

[4] https://www.futurehealth-research.com/new-research-highlights-economic-impacts-of-obesity-and-calls-for-policy-turning-point/

[5] https://committees.parliament.uk/work/7205/prevention-in-health-and-social-care/