The British Obesity & Metabolic Surgery Society and Obesity UK have responded to the UK government’s recently announced obesity strategy to get the nation fit and healthy, protect themselves against COVID-19 and protect the NHS.
In June, the BOMSS broadly welcomed Prime Minister Johnson’s call for a more robust approach to tackling obesity during them COVID pandemic and his reported desire to broaden the NHS’ focus to include more treatment was most welcome. However, it was disappointed with the content and scope of the new obesity strategy.
“Unfortunately, the Government’s obesity strategy published today contains no concrete proposals for increased patient access to what is indisputably the best treatment available for those living with severe and complex obesity, bariatric surgery. The focus (once again) is on prevention,” the BOMSS statement notes. “We are not arguing that treatment should be at the expense of the obesity prevention and lower level weight management interventions announced; these are entirely appropriate for the majority of UK adults with less severe obesity (BMI<35). The gaping hole in the PM’s policy is his complete failure to provide for those most in need, namely the two million adults afflicted by obesity so severe as to qualify for bariatric surgery. It is these patients who are the most vulnerable to death and ICU admission if we face a second wave of COVID-19. And it is treatment of these very patients that will pay back the NHS the millions Mr Johnson seeks to save.”
The statement highlights that before the second COVID wave and winter influenza arrive, there is a real need to start treating the most vulnerable people with obesity now.
“Waiting lists are full of patients who have already been assessed and are good to go ahead with bariatric surgery as soon as beds and theatres become available. Thus, the easy, no-cost option for Mr Johnson would have been to instruct NHSE to direct Trusts and contracted ISP Hospitals to prioritise admissions for bariatric surgery – immediately. If we delay, it will be too late for many patients living with obesity who will contract COVID-19.”
Furthermore, such a policy would actually save money – as BOMSS noted that multiorgan support typically costs the NHS about £1800 per day but, avoiding the cost of one week in intensive care would fund two NHS bariatric procedures in addition to averting an avoidable personal and national tragedy.
Therefore, BOMSS is requesting that Mr Johnson urgently re-considers an immediate increase in funding to allow CCGs to increase commissioned bariatric surgery activity from 5,000 per annum to 10,000 over the next 12 months (just 0.4% of those eligible).
“It is time to move away from the dominant narrative that tells people they just need to exercise and meat healthily. While individual responsibility is and always will be important, this narrative fails to recognise that obesity is a disease (or at the very least, it directly results in physiological changes that underpin a plethora of chronic diseases) and not a personal choice. The causes of obesity are complex and vary from person to person and there is unequivocal scientific evidence that some people are particularly susceptible to obesity in our current obesogenic environment (while others are more resistant) as a result of their biology, not their willpower.”
BOMSS hopes that this is stage 1 of a more comprehensive strategy and more about the Government’s plans for improving access to surgical treatment of severe and complex obesity well before a second wave of COVID-19 will be announced shortly.
Obesity UK also welcomed the government’s announcement and hopes that this will reflect a long term commitment to supporting people living with obesity, and in particular supports the new laws that will ban the advertisement of food high in fat, sugar or salt (HFSS) on television and online before 9pm, and the ‘buy one, get one free’ offers on these foods.
Nevertheless, the new strategy does not go far enough in terms of supporting people living with obesity, and does not reflect the complex, chronic, multifaceted nature of obesity that was highlighted in the UK Government Foresight Report published in 2007, they add.
“This report highlighted that there are over 100 different factors that can contribute to overweight and obesity, and whilst the environment plays an important role, so does genetic, biological, social and psychological factors. Many of these factors have not been addressed in this strategy,” the statement noted. “We are keen to see what expanding NHS services will look like and we hope that this will include an increase in access to all tiers and for people across the UK. Before, COVID-19 only ~45% of the country had access to weight management services, and we would like to see nationwide access to these services, with an expansion into more mental health support for people living with obesity and bariatric surgery procedures.”
Obesity UK is committed to changing the narrative around obesity, from the simplistic rhetoric of ‘eat less, move more’, so that society can understand the true complexities of obesity. Unfortunately, they state, a large part of the government’s strategy plays into this narrative and as a consequence may lead to further stigma and discrimination that people living with obesity experience on a daily basis.
“We are calling for the media to improve the portrayal of obesity. Stigmatising headlines, imagery, fat jokes and in many instances, promotion of weight stigma are seen all too often, and this has been evident throughout the COVID-19 pandemic. When will the Government step in and stop these harmful stigmatising and discriminatory experiences from happening?”
Obesity UK is asking the government to reconsider the strategy and ensure that they include measures for people living with obesity, especially those with a BMI above 40 and above, including:
- Increased access to effective treatment options, including bariatric surgery, for people living with obesity, especially those with severe and complex obesity
- Legislation to prevent weight stigma and discrimination
- A public awareness campaign around the complexities of obesity
In a joint statement, Obesity UK and BOMSS said they are concerned that the new strategy contains no concrete proposals for increased patient access to what is indisputably the best treatment available for those living with severe and complex obesity, bariatric surgery.
Given the pressing timescale resulting from the coronavirus pandemic there are two measures the Government should consider implementing immediately.
- Firstly, to prioritise admission of patients on the bariatric surgery waiting list who are currently being left to wait as ‘routine’ admissions, despite their urgent need to lose weight quickly.
- Secondly, to authorise a short-term expansion of bariatric surgery over the next 12 months to enable as many patients with severe and complex obesity to be moved out of harm’s way whilst we await an effective coronavirus vaccine.
To access the BOMSS statement, please click here
To access the Obesity UK statement, please click here
To access the joint statement, please click here