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Obesity: England’s most pressing healthcare challenge?

Jul 09, 2022
kovid 19 has highlighted the impact of

obesity

on health in the uk the situation of people living with

obesity

is one of the biggest future health

challenge

s we have your sickest patients are those under 60 who are obese even boris johnson was admitted to the hospital with coronavirus when i went into the icu when i was really was was was was was was very conscious but this is not a new problem only one in three of us is at a healthy weight there have been 14 obesity strategies since 1992 but since then the obesity rates have nearly doubled Why have these different anti-obesity strategies failed?
obesity england s most pressing healthcare challenge
How can we change our focus before it's too late? I'm Dr. Rachel Batterham, Lecturer in Obesity at University College London. To put this in perspective, there are more children ages 11 to 15 who are obese. in

england

than in the usa and this situation is getting worse we need to do something urgent i am going to meet with leading experts and visit people across the uk living with obesity t or find out why we as a nation have such a problem with our weight and in a month I will bring my findings to a group of my peers and decision makers to discuss what to do if you don't have to be a doctor to know that some people struggle with their weight I want to ask the scientific community why hello staff hi rachel good to see you sadaf i am trying to understand why more and more people in the uk are affected by obesity does your research give us any insight into this?
obesity england s most pressing healthcare challenge

More Interesting Facts About,

obesity england s most pressing healthcare challenge...

We have known anecdotally that there are some people who always struggle with their weight. There are some people who are very skinny and can eat what they like and not gain weight like us. What I can see now is that it is the genes that explain that difference between people in families. If you look at twins, identical twins are 90% identical in body weight to adults, even if they are separated at birth. There are clear factors that lead to obesity. It comes from genetics there. It's a whole system to regulate our weight that has been discovered through the discovery of different genes and if any of those genes are faulty then the system doesn't work and people gain a lot of weight so weight genes are being discovered that explain why we fight.
obesity england s most pressing healthcare challenge
With our weight, this is only one contributing factor, but it explains why families follow the same weight trends. Being overweight can lead to many other diseases, including heart disease, cancer and type 2 diabetes. What is the NHS doing to try to treat and prevent obesity from becoming a life-threatening problem too much emphasis has probably been placed too much emphasis on the personal responsibility angle i think we have to conclude that that approach alone is insufficient in recent years it has been realized that we spend a lot on health and rightly so somewhere in the region the annual nhs budget of England it's something like 130 or 140 billion a year if you look at what we've traditionally directed the money at the vast majority is reacting to what's in front of us there are very real cases and powerful cases that can be made not just from profitability but also cost savings long-term return on investment through a focus on prevention we launched the national disease prevention program type 2 diabetes the flagship prevention program within the nhs and we recently launched our digital weight management program supports people through behavior change enabling them to lose weight exercise more and eat healthier a really positive step refer people to evidence-based weight management services that will improve their health rather than patients having to guess what to do for themselves, but does this digital approach exclude some patients? jonathan, is there a danger that digital lifestyle interventions will exclude people from the

most

deprived areas? it's been a concern with digital modes of delivery for some time now reassuringly actually dimensions deprivation and ethnicity didn't negatively impact attendance in any way so overall the pilot work we did as part of the diabetes prevention program was quite reassuring in that regard.
obesity england s most pressing healthcare challenge
I am happy to see the prevention of diabetes. The program plays out, but many people don't even see gaining extra pounds as a medical issue to take to their GP because of how we view overweight and obesity as a society. Now I'm going to see Nadia, who after her own lived experience advocates for people living with obesity and for the eradication of weight-related stigma, has a health professional ever talked to you about their way of offering you help? ? around 25 stones i asked the GP if he could do some blood tests to assess my health and that GP told me that it was not important or necessary to have these blood tests because it was just about my weight and I hardly I had those blood tests done and to my horror found out I was prediabetic.
I think support is critical in this weight loss journey and I would have felt that it would have been very important to have community involvement in reducing the stigma attached to weight loss. The Wirral, which is one of the

most

deprived areas of the UK, unsurprisingly has some of the highest obesity rates. I also sent Nadia to find out if community support can help in an area like the world. visiting a soccer league called man versus fat her slogan is lose weight together, could you tell me a bit more about man versus fat and what she actually does? it is a football league it is a league accredited by fa the idea is that we appear we weigh ourselves and if we have lost weight, we score half a goal, have you found that it has helped you and your weight loss and have you been losing weight, yes, I think we've all tried to lose weight every week so we're off to a good start before we even play the game and we all show up every week.
We all lose weight in general. There are a lot of guys who have maybe struggled with weight all their lives and have discouraged me from playing football and it's a good way. to get them back in too i'm a father of two kids and i just recently moved out into the world like the last couple of years and i had no friends and it was kind of like what can i do as a 30-something man and go out and meet new friends and new people is doing something we all love even though alex bought spurs for example he is still teammates with nicholas pickering one of the man vs fat players has kindly invited us to visit him and his family for talk about their own experiences and what they see as the causes of obesity in the world when i was about six years old my parents separated at that time i started to gain a lot of weight i didn't feel like i did very well, i lost a lot of weight , I lost about six or seven stones, but the n I have not managed to maintain that the last 10 years have been spent going up and down yo-yo I went on vacation to Turkey I went for a horse ride and in the end you know we were introduced the photograph afia they have taken and this is me on the horse when i got it back that was the first time i saw myself in a photograph for a long time when i saw that was when i knew i had to do something about it how did you do it?
Did you go to your doctor and tell him that I need to lose weight? You can help? I had to take care of it myself because I didn't even know there was any support. What I would do is I was pretty embarrassed. my size and stuff obviously, i lived in my local area with a lot of these kids i went to school with and i didn't want them to see me running around and stuff, you know, my chest bounces up and down the sides . and all that kind of stuff I actually started running pretty late at night on nearby country roads so I could go down there late at night it's still lonely I would say in the last couple of years I actually run I've been able to running on main roads people say oh you need to exercise but when you want to go out and exercise they look at you and maybe laugh and joke on my own example i was told to exercise and eat less and i bravely went to the gym and they laughed at me in the gym because of my size for me obesity is a medical condition just like high blood pressure or diabetes it makes sense to treat it because we can and we really can improve people's health and make them live longer I think now, after you've done that, you know that I'm talking to yourselves. -Me for the last 10 years, can you help me stabilize that?
Yes, Nick and others don't know where to turn for help and often back off when their weight begins to regain. I suggest Nick talk to him. gp before he yoyos again, but with gps under increasing pressure, are they in a position? ion to be able to support every patient with a weight issue i am going to visit dr frances barrier a gp at brandensbury medical center in kilburn we have registered almost 21,000 patients here because we are on kilburn high road we are bordering camden and brent we have outbreaks quite significant deprivation in all practice. Do you think that overweight and obesity are more common in people with social deprivation?
Definitely, in addition to social deprivation, it's also about access to

healthcare

and I think ethnicity, so when a patient joins your practice, then they have their BMI calculated, so that could be kind of an opportunity to score this when a patient arrives with a problem. I have 10 minutes to ask about it, try to diagnose it, examine the patient and talk. what we are going to do and when we are going to meet again it is very difficult for gps to fit into everything else we have to do. There is a patient who highlighted to me that her body mass index is 60.
We are in a situation where it seems like no one has had this conversation with her, so this is really quite concerning because this young woman is severely obese, so what a body mass index of 60 puts you in the top one to two percent of the population in terms of your weight we really need to do something different here you're a new patient here and i've been going through your records i checked your body mass index and we noticed it was elevated i think probably the last time i went to the doctor before as an adult was when i was about eight or nine years old and every time they mentioned i'm overweight i never told my bmi they never said that you should do this you should do that now i got to a point where i'm 30 and i'm like you know 28 stone the higher your body mass index the harder it is to lose weight because your body tries to return to the highest weights you have ever reached when you diet you have changes in your hormones that then make it more difficult to lose more weight someone with your BMI should see a weight control specialist in red the reality is that getting down to a BMI below 50 through diet alone is going to be incredibly difficult without a great deal of expert support no one has ever told me that yeah I'm like well actually it's kind of shocking almost as if, like a doctor bedside within a practice you know this makes me think about God we need to think about these things because we don't have chairs in our waiting room do we have enough scales for example had you covered it in February? and i ended up getting really sick and i had covered pneumonia and sepsis i ended up in the hospital that's why i got to this point now so you were really sick with cover and that's a direct consequence of the weight you really have need specialist support because in reality, on your own it will be incredibly difficult, almost impossible, we need to intervene now on people like Katie before they have developed all the complications of obesity, we need to be more active and really make sure that gps has the equipment and knowledge to help to people like katie, we also need more access to dedicated weight management clinics that people can self-refer to at a time when we only often react when it's too late, which ends up costing the nhs more money and many people their lives one of

england

's most comprehensive weight management services is in liverpool at aintree university hospital and is run by led by professor john wilding what we know from research is that even if you do a lot of physical activity on your own without diet restrictions it doesn't really result in much weight loss at all the key to helping people to lose weight is actually restricting energy intake how the nhs is currently treating overweight and obese people in liverpool we have a fairly comprehensive service people with obesity have access to a doctor dietitian physiotherapist in some cases psychology and occupational therapy also for some people have access to medication and finally we also have access to bariatric today we will be meeting with ken claire who is a patient of mine who has had bariatric surgery which has helped him greatly with his weight over the years.
He told me about his clinic. and I arrived I did not knowwhat to expect and it was the first time anyone took my weight seriously i lived with obesity all my life even from early childhood thats me and my daughter you can see in that photo that i hurt we had gone to euro disney she was running around the park doing my best i couldn't get on any ride one of the things that bothered me the kids were yelling insults at me for being big and fat horrible moment i decided to seek help they gave me the word of a clinic at aintree hospital run by john wilden they finally referred me they offered me bariatric surgery it was incredible i think that in the first three months i lost six stones i think it's important to point out that i don't think so rgery is for everyone, but for those people for whom it is indicated and who won it.
I really think it should be much more accessible. I wouldn't want anyone to do that. I have to get to it like I did before they got the treatment they needed with an operation like bariatric surgery. We would expect most people to be able to lose up to about a third of their body weight with the most effective operations so it is a highly effective operation the pounds or stones or kilos matter a lot but what has really improved is my health the quality of my life and the way I have lived much longer and much better than it would have been.
I have done it because before the surgery I was in a terrible state. Ken's experience is just one in thousands, except he is one of the lucky few who has been taken seriously by a doctor in terms of treatment. I think there's still a big gap because we. If you know that there is at least a third of the country that does not have access to services for people with severe obesity, then what you are effectively saying is that there is a lottery of zip codes in terms of access to treatment for people living with obesity. it's going to need a pretty substantial investment in services over the next few years if we're really going to be able to treat obesity as a serious disease that's really good to see.
I know from the work you have done for different charities you have helped many people affected by obesity to access information and care do you think the nhs is doing enough for people affected by obesity the short answer would be i don't think so they're doing a great job but i think there's going to be a lot more access to treatment it's a big problem rachel on many levels in the media the public some health professionals i'm sorry to say and it all feeds the internalized stigma that has prevented me from and many other people I know Seeking help to talk to Ken makes me feel that while many of the steps we are taking are positive, we are not moving fast enough.
Part of the problem is that people with obesity are often blamed for their weight, but we know that one of the key reasons for weight gain is genetics, but the big question is how does this help us manage patients? in the future. I am going to ask Professor Farooqi if she can answer this question for me. How will genetics impact the management of people with obesity? we are finally starting to see the potential of genetics for treating patients so what we are already seeing is that there are few disorders where a particular gene is faulty and people definitely become very heavy from a young age and now we can treat a number of those disorders because we understand how the gene is driving their weight problem now in what we hope will be in the fairly near future and we're talking about in the next few years we'll be able to roll out those treatments to a broader group of people that they have a large genetic contribution to their weight, many people say they simply eat less and move more, but genetics surely gives us the biggest argument against this, that is very true, there is clear evidence that families run people who struggle with their weight and then there are other families where people don't struggle with their weight and they can eat whatever they want and stay slim and the reason we differ is because of our genes Who is the person who may have the greatest impact on the prevalence of obesity?
Arguably, it's Chris Whitty, the chief medical officer, so I'm going to see him to find out what he thinks are the solutions to reduce our obesity epidemic for many people who are obese. they experience weight stigma, which is really detrimental to them psychologically and in terms of access to

healthcare

. How do you think we can try to reduce weight stigma? Well, I think we need to be very clear, people shouldn't be ashamed or embarrassed. obesity is something that should be seen as a medical issue and only a medical issue and anything that reinforces the stigma that we should avoid at all costs when it comes to advertising ic health messages when it comes to the way we as individual doctors and other healthcare professionals we interact with people to see this as a stigmatizing issue is really medically detrimental and completely wrong is your kind of take home message that you think we can actually reduce obesity levels in the future is something and I really want to emphasize that this is something that is not inevitable and that we can improve.
There's a concept in public health called the ladder of state intervention where you start with things that really have almost no intervention with the powers of the state, so things like doing research and going a little further informing people going a little further that it's starting to engage with the industry saying, look, could you really help us with this and then go a little further? like pushing taxes and the right path at the top of the range to ban things and make things impossible and I think most people would say pro-obese So we should aim to do a lot of things but in the lower end of that intervention scale, blood sugar is a good example.
This was in 2018 and was a relatively small additional tax for higher sugar soft drinks when it came in the amounts of sugar consumed dropped substantially sales of the products did not drop but increased people got the drinks they wanted but the number of calories went down so that's a no loser situation in a sense the thing worked extremely well that's an example of the kind of thing the government can do but we have to do things throughout the system, but certainly to say that it is a personal responsibility is doomed to failure. I will present what we have learned so far. about genetic treatment and the impact of deprivation and inequality on obesity to a group of my peers and decision makers we are seeing the number of people affected by overweight and obesity increasing so what can we do the royalty?
The medical college called on the government to establish an intergovernmental strategy to address health inequalities because this must have an impact on housing, employment, planning, transport and health. We all know someone whose life is affected by obesity, but the vast majority of these people are unable to access any treatment for their condition people with obesity experience stigma in every part of their life obesity is not a lack of willpower it's not just personal responsibility i mean if this is a problem for doctors and healthcare staff the answer is yes then it is a medical problem yes is it a disease?
I think you need to think about the unintended consequences of saying it that way. I think that if we pay the same attention to obesity as to other things, we would not be in the situation we are in. of people don't really know and don't think about how little some people have to spend a week on food and what you can actually buy for that, even to this day it still upsets me to find out how many of my colleagues don't recognize obesity as a problem, we need to change the narrative, obesity is not simple, it is not due to a lack of willpower, it is a complex multifactorial disease that is driven by health inequalities and people living with obesity deserve treatment based on evidence and empathy for their condition no stigma this is not an insurmountable problem we can reverse the year-over-year rise in obesity let's be the first nation to reduce obesity together

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