Statements Archives - Obesity OPEN

The data released by NHS Digital which highlights that one million people living with obesity were admitted to NHS hospitals in 2019/20 reinforces the need for improved support and access to appropriate weight management and obesity services for people living with obesity. Additionally, we believe that the prevalence of obesity in England, is likely to mean that the figure for obesity hospital admissions is an underrepresentation due to reporting issues.

The lack of access to weight management and obesity services is a longstanding issue with a wealth of evidence demonstrating that people living with overweight and obesity may not have suitable services in the region that they live. For instance, less than 50% of people have access to either a tier 3 or 4 weight management service in England and analysis published in the BMJ in 2016 suggests that less than 1% of people have access to bariatric surgery. Improving access can have beneficial long term impacts for people living with obesity and health service resources. Ensuring that people living with overweight and obesity have access to suitable weight management and obesity services, as well as implementing public health policies that can prevent weight gain, will support improved health outcomes and subsequent reductions in the number of people admitted to hospital.

The data shows that women account for higher numbers of hospital admissions, with many female admissions linked to maternal care. This demonstrates a need for healthcare systems to reach women at an earlier stage before the need for hospital admission. The higher female admissions reinforce the evidence that more women seek and receive weight management support, a trend which has been demonstrated consistently for some time. This highlights the continued need to better understand how to engage men in weight management as well as other, often underrepresented, groups of society. This may require a shift in the narrative around obesity which is often stigmatising and has been shown to affect engagement and healthcare seeking behaviour.

We are supportive of the UK Government’s proposed actions as part of the new Obesity Strategy such as supporting the ban on TV and online adverts for food high in salt, sugar and fat before the 9pm watershed, as well as ending ‘buy one, get one free’ deals on these foods. We believe both represent measures that can be effective at population level and will support people regardless of body weight and health status. However, we also believe that further efforts are required to support people living with obesity that go beyond these measures, with access to appropriate services that can support the often wide-ranging and complex needs of people living with obesity being critical.

We believe that taking a whole systems approach to obesity, which is tailored to local needs and works across the life course, and providing greater access to weight management services across all Tiers is required. This is more likely to support government ambitions of reducing the prevalence of obesity and associated health conditions, and positively impact on healthcare services.

The Obesity Policy Engagement Network (OPEN) UK is a partnership programme, bringing together different expertise across obesity to improve obesity care in the UK. Novo Nordisk has fully funded the secretariat of OPEN UK, but has no influence over the group’s activities. Novo Nordisk has had no influence over the content of this statement.

OPEN is a sustained global initiative aiming to achieve national support for improved obesity care.

OPEN is a network for national coalitions of public health, policy, patient representatives and other thought leaders in the field of obesity with representation in over 15 countries including the UK, Italy, Germany and Spain.

OPEN seeks to provide national policy advocates with the opportunity to share diverse perspectives on a common challenge, identify solutions and collaborate to address the current barriers and challenges to effective obesity care.

Through the global network, members obtain insights and tangible tools on how to put in place effective national obesity strategies which deliver workable, effective solutions that successfully address the obesity challenge.

* Data taken from the Hospital Episode Statistics dataset. Data released by NHS Digital as part of the Statistics on Obesity, Physical Activity and Diet; England, 2021, an annual compendium of data on obesity, including hospital admissions, prescription items, obesity prevalence among adults and children as well as physical activity and diet.

We welcome the Government’s renewed focus on obesity, with the actions suggested and the new ‘Better Health’ campaign reflecting population-level, preventative measures. For some of the population these measures may improve health related decisions, but for many people (especially those living with severe obesity), this strategy will not offer effective weight management support. Hence, we look forward to learning more about the Government’s proposed improvements to NHS weight management services.

We are supportive of the ban on TV and online adverts for food high in salt, sugar and fat before the 9pm watershed, as well as ending ‘buy one, get one free’ deals on these foods. At a population level these may prove effective measures and help support the health of people regardless of bodyweight and health status. Similarly, the inclusion of calories on menus and alcoholic beverage labelling may also prove useful in helping people make healthier food and drink decisions. There is, however, also a need to ensure that this doesn’t have unintended consequences for people with eating disorders and promote unhealthy relationships with food. Indeed, given the association between obesity and inequalities, it is imperative that new actions do not worsen health inequalities.

OPEN is committed to improving public awareness of obesity and supporting aligned actions reflecting the complex, chronic, multifaceted nature of obesity as highlighted 13 years ago in the UK Government’s Foresight Report. The Foresight Report highlighted that there are over 100 factors that contribute to weight gain that are, for instance, biological, genetic, social, and psychological. As such, while the changes referred to by the Prime Minister to ban advertisements and deals for foods high in salt, sugar and fat are important population health interventions, further decisions to implement a whole system approach to obesity are needed.

We believe that a more effective strategy would be to take a whole systems approach to obesity and providing greater access to weight management services across all Tiers, rather than focusing solely on individuals making changes. Counterintuitively, in 2019, Public Health England, the Association of the Directors of Public Health and the Local Government Association commissioned a whole systems approach to obesity programme. This programme concluded that a long term, system-wide approach to obesity, which is tailored to local needs and works across the life course are needed.

Obesity is defined and should be recognised as a chronic health condition. For some people living with obesity, lifelong support and treatment may be needed, which may vary over time depending on individual needs. Any support for people living with obesity must also have long term considerations and treated with equal opportunities to access support or appropriate treatment as any other health condition such as cardiovascular disease or Type 2 diabetes. Short term solutions for a long-term health conditions do not make sense and is likely to influence inaccurate and often stigmatising perceptions and unrealistic expectations. It is therefore key that the Government consider how the 12-week initiative will be enhanced after conclusion to ensure long-term weight loss maintenance.

OPEN UK has concerns that the focus on individual behaviour change rather than system wide actions is likely to fuel weight stigma and discrimination that is already pervasive in the UK. Focusing solely on individual changes not only overlooks the wider determinants of obesity but leads to beliefs that obesity is solely within an individual’s control. This is likely to lead to blame, perceptions that obesity is the result of a lack of willpower, and negative attitudes and behaviours towards people living with obesity.

There is an urgent need to end weight stigma and discrimination, across all settings including in healthcare settings and in media portrayal. Yet, there is also a need to address weight stigma in obesity related policies. In 2018, the All-Party Parliamentary Group on Obesity reported that weight stigma and discrimination was widespread in the UK and that experiences of stigmatising and inappropriate care leave people less likely to seek the healthcare.

We look forward to opportunities for transdisciplinary collaboration with the Government in developing longer-term, structural solutions. With this in mind, we call for the Government to reconsider the current obesity strategy and in doing so:

OPEN is a partnership programme and sustained global initiative initiated and supported by Novo Nordisk to improve obesity care internationally. It is a network for national coalitions of public health, policy, patient representatives and other thought leaders in the field of obesity with representation in over 15 countries including the UK, Italy, Germany and Spain.

London, 29th June 2020: As the UK Government prepares to release its obesity plans next month, we welcome the Prime Minister’s reassessment and prioritisation of obesity in the UK. The increased risk of COVID-19 on people living with obesity has illuminated the need for increased care.

Where in the past there has been a focus on intervening to prevent obesity in children and young people, we are encouraged by the early indication that a holistic approach may be taken which prioritises obesity along the full life course. As well as increased support with prevention and management, we must harness a full range of tools depending on individual cases, from supporting combined lifestyle behavioural changes to bariatric surgery. Action taken to make treatment available and accessible, needs to be supported by a system-wide approach to addressing obesity stigma, social inequalities, the built environment, food manufacturing and advertising and media portrayal among other environmental contributors to obesity.

Not only does obesity increase risk of more severe COVID-19 outcomes, it is also one of the UK’s clear health inequalities, disproportionately impacting many groups including some BAME communities, and those from areas of socio-economic disadvantage.

There is a short and long-term imperative to reduce obesity prevalence in the UK. We are pleased to hear the UK Government are making obesity a priority and expect that the renewed interest will be met with ambitious targets and resources.

The Obesity Policy Engagement Network (OPEN) UK is a partnership programme, bringing together different expertise across obesity to improve obesity care in the UK. The Secretariat of OPEN UK is funded by Novo Nordisk. Novo Nordisk has had no influence over the content of this press release.

OPEN is a sustained global initiative aiming to achieve national support for improved obesity care.

London, 8th June 2020: The latest data from PHE, which includes providing additional clarity on the increased risk of poorer COVID-19 outcomes for people with obesity and some of its complications¹, is a step toward building a clear evidence base of who is at increased risk.

The Equalities Minister has also outlined next steps to understand drivers of the disparities and relationships between risk factors. While we welcome these developments, it is clearer now more than ever, that we must go much further to increase support for people living with obesity in the UK. This will offer an opportunity to improve the health of the nation and improve COVID-19 outcomes, which will have further health and economic benefits.

In the House of Commons, the Health Secretary stated that COVID-19 had exposed huge disparities in the health of our nation. We absolutely agree; PHE disparities review confirms the anticipated trend, witnessed elsewhere, that people living with obesity in the UK are more likely to be diagnosed with, experience severe illness and to die of COVID-19. Similarly, people living in deprived areas were shown to be at greater risk, and the links between deprivation and obesity are well established.

Many Black, Asian and Minority Ethnic groups are also at high risk of obesity and associated comorbidities, and we agree with the Health Secretary that a continued and proactive effort to understand the drivers of these disparities is vital to understand why some groups are worse-affected and how this can be addressed. We fully advocate for the need for more research in these areas and we await the findings and outcomes of the Government’s Equality Hub with interest.

Despite the need for further investigation and analysis of the data, it must be recognised that we do not need to wait for this to begin to act. Weight management and obesity treatment services have long been under prioritised and as such access remains low or non-existent for many across the population.

The impact of COVID-19 on obesity and associated comorbidities, should ignite an increase in the support available. We need better funding and clear pathways for obesity care that ensure people receive weight management support, reduce comorbidity and lower risk. We can also combat weight stigma and discrimination, particularly in medical settings where it is experienced at alarmingly high rates. Experiences of stigma and inappropriate healthcare leaves people living with obesity less likely to seek the necessary care and may lead to increased feelings of anxiety around the pandemic.

Weight management must be prioritised across all care settings and the need to make multiple treatment options, from supporting lifestyle changes to bariatric surgery, available. As the evidence showing that people living with obesity are more vulnerable to COVID-19 increases, we strongly support and encourage action to ensure people living with obesity – and all those at disproportionate risk – are fully supported within the healthcare system, now and in the long term.

OPEN is a sustained global initiative aiming to achieve national support for improved obesity care.

References

¹Public Health England (PHE). Disparities in the risk and outcomes of COVID-19 [Online]. 02 June 2020. Accessed at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/889195/disparities_review.pdf