Comment: The nanny state can’t fix our obesity crisis
By Dr Matt Capehorn
Two months into the new government and all politicians' eyes are on Europe, but rushing up to hit them about the head, ears and waistline is obesity, one of our biggest health epidemics.
Obesity could cost £50 billion a year by 2050, through treatment of diabetes, hypertension, cardiovascular disease and cancer, while reducing productivity and increasing reliance on the welfare state.
Most of the UK population are overweight, and a quarter are obese. Shamefully, one in five children are obese by the time they leave primary school.
The economic case is clear – treatment costs are more than saved in the long-term by reducing the consequences. But there is no comprehensive care throughout the UK – treatment is a postcode lottery.
So how should politicians address this? First, the 'don'ts':
Weight management success relies on motivation. No magic wand can make someone lose weight if they don't want to. Simply sending people to do it won't work unless we accept a nanny state which is happy to starve them.
Focus too much on prevention
While there is a role for public health initiatives, there is scant evidence some of them work. Yet there is evidence for successful treatments, so a better balance is needed.
Tax food and drink
Taxing food and drink is a popular proposal even from within the medical profession. But will it work?
Taxes will penalise the poor (who struggle to eat healthily because of their finances already) disproportionately, and further discriminate against the healthy with the occasional treat.
And will a proposed 20% levy on high sugar/fat foods really alter eating behaviour? Vending machines don’t deter purchases.
Sugar has no nutritional value (despite being an excellent source of energy for those needing it), but this is not the way to reduce intake. This nanny state approach doesn't educate the public on why they should reduce sugar intake and calories, eat more healthily and exercise more. More public health – and school – education is needed.
Indeed, revenue-earning food groups might create a financial incentive to increase sales. The parallels with tobacco are obvious – allowing the sale and consumption kills hundreds of thousands but makes billions of pounds in tax revenue.
Work with industry
We are quick to criticise sponsorship from companies associated with causing obesity, even when a programme promotes physical activity or better diet and health. The Public Health Responsibility Deal has not been given enough time. Yes, quick service restaurants can improve, but changes must be slow to avoid losing their customer base.
Bring back practical cooking in schools
As Jamie Oliver showed in his ‘Ministry of Food’ programme there are many who don't even know how to boil an egg. We can't encourage people to cook more healthily and from fresh ingredients from behind a GP's desk, but need to incorporate cooking into school, and in weight management clinics.
Under the Quality Outcomes Framework, my fellow GPs are rewarded financially for recording numbers of obese patients but, ironically, not for doing anything about it. They need to be encouraged to address obesity, screen for comorbidities and refer to weight loss services.
Obesity is not a mandated service for the NHS or local authorities. MPs need to ring-fence money, leaving commissioners no option.
The best place to halt serious obesity lies in the comprehensive 'Tier 3' weight loss centres, to avoid patients progressing to highly expensive, and invasive 'Tier 4' (gastric surgery). But these centres are as rare as hen's teeth. Why?
Empower the public
The vast majority want to help themselves, and spend billions of pounds on diets each year, most of which have no clinical basis whatsoever, and can be a waste of money. Just as we only prescribe drugs which are clinically proven, so we should publish a list of similarly tested weight loss plans, so consumers can choose the one that works for them and will motivate them. This alone would save families and the NHS massive sums at a stroke.
Get them signed up to help and motivate their own workforces. Employers will not only have more healthy employees (fitter and with fewer absences due to ill health), but their public-facing staff will be more active and motivated.
Remove the shackles from those who can help
Ironically, the weight loss industry is currently banned from advertising to the obese, the very people who need their help. We should be working in partnership with the commercial sector as we will all benefit from helping to get more people to a healthy weight.
And the cost of all this? If done shrewdly, through re-allocation of budgets, and helping patients take control of their own lives, then very rapidly it would save a fortune.
Even surgeons admit that people don't really want surgery – so why don't we do more to stop patients getting there in the first place?
Dr Matt Capehorn is clinical director of the National Obesity Forum
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