Comment: Without action, the obesity bill will just keep rising

By Dr Matt Capehorn

Britain has one of the most enviable GP networks in the world – tens of thousands of highly educated specialists. This elite group are in the frontline of the UK's health. They meet patients daily; patients trust them, and will be guided by them.

So it is only logical that the government is motivating this ready-made army to counter the largest current single threat to Britain's health – obesity.


Instead, what do they do? Through the Quality and Outcome Framework (QOF), GPs are rewarded financially for recording the number of obese patients – yet, ironically, not for doing anything about it.

So, while individual surgeries are pioneering 'best practice', they have no incentive to do more than tick boxes.

A National Obesity Forum campaign, backed by a parliamentary reception and early day motion, has cross-party support, led by Justin Tomlinson (Conservative), Rt Hon. Kevin Barron (Labour), and Dr John Pugh (Liberal Democrats).

Thanks to their backing, a growing army of MPs is becoming aware of the scale of the problem, but some of their (often more senior) colleagues need persuading.

About one in four adults today is obese and that number is rising. A morbidly obese person can expect to live nine years less than the rest of us, due to a range of conditions, including type-2 diabetes, cardiovascular problems, some cancers, hypertension and premature death.

This takes an appalling toll on individuals and their families, but it also carries a massive price tag.

Unless bold action is taken quickly the predictions of the Foresight Report (2007), will come to pass.

This report suggests that obesity will cost the exchequer some £50 billion per annum by 2050, through prescriptions, appointments, hospital admissions, benefits and reduced productivity.

Government needs to urgently identify ways of treating obesity as opposed to merely recording its prevalence. A good place to start is reforming the QOF, the GP incentive scheme, in a way that will encourage primary care doctors to take a lead in such treatment.

Encouraging GPs to engage with weight management services may be difficult given other pressures on their time, but the QOF itself is already there, as a mechanism, to do just this.

As we have seen, the only QOF indicator that directly targets obesity rewards GPs for registering the number of obese people that they see. Just collecting figures will not prevent a single overweight person from developing type-2 diabetes or a single obese person from having a heart attack.

That is why the National Obesity Forum is seeking to reform the QOF to reward GPs who guide overweight and obese patients into clinically proven weight-management programmes.

We recognise the obesity epidemic is not easy – tackling it needs action across government departments.

But because the QOF system fails to encourage and reward doctors for taking the right actions, it needs to change.

Highlighting the additional impetus for change, as if it were needed, comes from new research which has revealed the higher costs of treating two groups – the morbidly obese, with a body mass index (BMI) of 40+, and the super obese, at BMI 50+.

This research has shown that as weight increases into the realms of severe and complex obesity, so does the associated expenditure. These costs have not, to date, been quantified in official estimates.

Thus, Britain's true medication bill for obesity could be billions of pounds more than realised – and a fast growing 'super obese' group could be eating up £496 million in their own right.

Compared to the non-obese, the medication costs (for heart, joint, gut, chest problems and diabetes) are doubled for those with BMI over 40 and are an extraordinary £6,100 per annum (3.5 times higher) for those with a BMI over 50.

And before you think "surely this doesn't involve many people", around 110,000 Britons are already morbidly or super obese, and the priority is to stop more joining them.

Still not a large enough problem?

Well, 13,000,000 people are already potentially en route – they need to lose 10-30kg 1.25 – four stone) to gain health benefits and, for many, stop their downward spiral.

While there are many factors in weight management, several commercial diets have been proven to break this cycle. But oddly for the coalition government – normally keen to work with the private sector – they won't grasp the nettle.

Trials in GP surgeries have featured major brand names, like WeightWatchers, Slimming World and Cambridge Weight Plan, more often than you have had diet shakes, and hundreds of patients have lost weight, and kept it off.

But, despite the clinical evidence, the government refuses to entertain them.

So against this background, where do we go from here? Well, regardless of your views, the evidence is clear – the current system is simply not working.

And, just like the QOF, it's time for a new look.

Nothing radical, just totally logical.

Dr Matt Capehorn is the National Obesity Forum's clinical director and is clinical manager of the Rotherham Institute for Obesity

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