Obesity– it’s big news again, but what to tell our patients?

Last night the government announced a £40million programme to expand the use of new obesity treatment medications, to a pilot of community based GP led clinics. The details are yet to be clarified, but as so often happens, many GPs are reporting patients asking them for details already. As well as taking up time, many GPs do not yet feel confident in managing obesity or feel that this is another huge workload that they cannot manage. 

What is the reality of this unmet need? In the UK, 68.6% of adult men and 59% of adult women have overweight or obesity and in England, 37.7% of children in year 6 have overweight or obesity.  We are all too aware of the health risks associated with having overweight and obesity, but this knowledge, and all govt attempts to date have failed to reverse the increasing trend. 

To explain this requires a thesis, not a blog, but perhaps unrealistic expectations of the success of weight loss attempts are part of the issue, and healthcare professionals are not immune to these misunderstandings. 

The Canadian Obesity Guidelines explain that aiming for between 5-10% body weight loss will give health benefits but that loss of greater than 15% will require pharmacotherapy or metabolic bariatric surgery (MBS). Despite this, most people and health care providers often advise people to try to attain a normal BMI of between 20 and 25.  

This UK primary care based study showed that the annual probability of attaining normal weight through diet and exercise was: 

• 1 in 210 for men and 1 in 124 for women in Class 1 obesity 
• 1 in 1290 for men and 1 in 677 for women with Class 3 obesity  

The annual chance of achieving a 5% weight reduction was 1 in 8 for men and 1 in 7 for women with Class 3 obesity

So what should we do?

Healthcare professionals need to agree realistic targets with our patients. The Canadian Guidelines suggest that initially this could be:

1. stopping weight gain and stabilising at current weight 
2. a loss of 5%-10% of body weight and then stabilisation at this weight. 
3. For more significant sustained weight loss, referral for MBS surgery or pharmacotherapy is usually needed.

Unlike the message in glossy “before and after” pictures in advertisements for weight loss programmes and books selling the latest diet, the reality is that there is no one off intervention that will cure obesity. It is a progressive condition that needs lifelong management and understanding of this stops us setting our patients up to fail with unrealistic goals.

We await with interest the new plans from the government, but let’s hope that they allow us to treat our patients with obesity in a meaningful way, ideally in community hubs run by specialist GPs. 

If you would like to learn more, please join us for the Hot Topics Obesity course on the  24^th June .