A new report from Future Health(Obesity ICB Audit 210524), sponsored by Johnson and Johnson, reveals that obesity is not a priority for 37 of the 42 NHS Integrated Care Boards (ICBs) across England. Only five included obesity or the importance of the population maintaining a healthy weight as part of their top priorities. This is despite obesity rates tripling since 1975 and with two thirds of the population now overweight or obese.[i]

To assess the level of prioritisation within the NHS in tackling obesity, Future Health undertook an audit of NHS ICB five year Forward Plans. The audit finds that:

• Only five of the 42 NHS ICBs in England included obesity or the importance of a healthy weight within their top priorities. ICBs including obesity as a priority were North Central London, Bath, North East Somerset and Swindon, Shropshire, Telford and Wrekin, Mid and South Essex and Bristol, North Somerset and Swindon
• Two NHS ICBs (Coventry and Warwickshire ICB; Herefordshire and Worcestershire ICB) included no references at all to obesity in their Forward Plans
• While 50% of ICBs did include an ambition or goal to reduce obesity just 16% set a measurable target
• Data on obesity rates was included in only 40% of NHS ICB plans
• Across all ICB plans there was a stronger focus on tackling childhood obesity over adulthood obesity

This variation in approach to obesity across the country reflects a well documented postcode lottery in access to NHS obesity related treatment. Obesity services are structured around four tiers of support from lifestyle interventions through to surgery.[ii] But only an estimated 35,000 people have access to tier 3 services providing weight management support out of four million who are eligible and the NHS carries out only 4-6,000 bariatric surgeries a year, less than 1% of those eligible.[iii]

As co-ordinating regional bodies with objectives for improving health outcomes, tackling inequalities and improving health system sustainability, the research argues that NHS ICBs could be a new platform for delivering a much needed multi-agency approach that can help reduce rising obesity rates and associated costs in England.

Obesity is one of the top five causes of premature death in England alongside smoking, poor diet, high blood pressure, alcohol and drug use.[iv] Having obesity can cause a range of related health conditions including a range of cardiovascular conditions such as type 2 diabetes and stroke as well as increased risk of respiratory, musculoskeletal and liver diseases. There is also a growing body of evidence about the link between obesity and certain types of cancer.[v]

Obesity disproportionately impacts those living in deprived areas with 34% of people from the most deprived communities living with obesity compared with 20% in the least deprived.[vi]

Studies have shown that obesity has a wider economic impact due to a loss of productivity, work absence and premature mortality.[vii] Obesity costs the UK £98 billion a year with NHS costs estimated to be £19 billion.[viii] The total cost is equivalent to 4% of GDP per year and £63billion of this total is directly attributable to shorter, unhealthy lives caused by weight-related conditions such as type 2 diabetes, cancer, stroke and musculoskeletal conditions. [ix]

Future Health is calling for the establishment of a new obesity service specification to replace the existing tier system and tackle variations in access to care across the NHS in England.

Richard Sloggett, the report author and former Special Adviser at the Department of Health and Social Care said: ‘With health system and economic costs from obesity rising, a new approach is needed from the NHS to ensure patients can access the treatment and support they need. However variations in access to services mean millions across the country are missing out on treatment and obesity remains an issue largely passed over when setting NHS priorities. Building and implementing a new properly funded service specification right across the country should be an urgent priority for NHS policymakers.’

[i] https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/obesity/#:~:text=Global%20obesity%20rates%20have%20tripled,respiratory%2C%20musculoskeletal%20and%20liver%20diseases

[ii] https://assets.publishing.service.gov.uk/media/5b8d54d2e5274a0bd7d11928/weight_management_toolkit_Let_s_talk_about_weight.pdf

[iii] https://www.bmj.com/content/353/bmj.i1472

[iv] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32207-4/fulltext

[v] https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer/does-obesity-cause-cancer

[vi] https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021/part-2-overweight-and-obesity

[vii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409636/

[viii] https://www.institute.global/insights/public-services/unhealthy-numbers-the-rising-cost-of-obesity-in-the-uk

[ix] https://www.institute.global/insights/public-services/unhealthy-numbers-the-rising-cost-of-obesity-in-the-uk