Rock-Solid Wallet

NHS: Waistlines and Wallets vs Hoops and Hurdles

In the UK, the National Health Service (NHS) is coming to terms with the impact of obesity and diabetes. Chief executive Simon Stevens says:

The NHS is now going to be ramping up practical action to support hundreds of thousands people and avoid obesity-induced heart attacks, strokes, cancers and type 2 diabetes. Because what’s good for our waistlines is also good for our wallets, given the huge costs to all of us as taxpayers from these largely preventable illnesses.

An Ambitious Study of Meal Replacements

So the NHS is launching an ambitious study of very low calorie diets (VLCDs) to reverse or prevent diabetes. The pilot aims to enroll 5,000 patients in England.

This builds upon prior research that shows promise for this strategy. A bit less than half of patients in the DiRECT programme achieved a remission in diabetes. This was a one-year study of a VLCDs led by primary care.

Hurdles and Hoops

However, the reality of getting effective obesity care in the NHS right now is quite different. A recent qualitative study of patient experiences documents a dismal experience. GPs would prefer to focus on the complications of obesity. Patients with severe obesity had to fight for referrals to more intensive care. Over the three-year course of the study, few of the patients were successful in obtaining surgical care.

Participants described years of “hoop jumping and box ticking” to obtain care they urgently needed. “I had to do all the digging, I had to do all the researching,” said one patient.

Systemic Bias at Work

A physician, surgeon, and advocate for better obesity care in the UK, Zaher Toumi sees systematic bias at work:

It is very interesting. Clearly, NHS England’s policies put hurdles and hoops  to reduce access to bariatric surgery – despite strong data supporting its efficacy and low cost.

It’s nice that the NHS is looking for ways to engage GPs in evidence-based obesity care. VLCDs can be helpful to some people. But long-term data on diabetes remissions is lacking. By contrast, we have five-year data on remissions with bariatric surgery.

It will take more than diets and diatribes about how this problem is “preventable” to turn it around. We like the perspective that Susan Jebb offered recently in the BMJ:

A raft of evidence from trials and observational cohorts tells us that treating obesity is one of the best hopes we have of reducing the burden of avoidable ill health, attenuating rising healthcare costs, and improving quality of life for people whose health and wellbeing is marred by excess weight.

Yet raising the topic of weight loss in routine consultations is rare.

Thirty years ago doctors rarely raised the issue of smoking cessation, now it is a “normal” part of medical practice. When we achieve similar levels of engagement from health professionals in treating obesity we will all have something to celebrate.

Click here for more from the Guardian and here for more from the BBC.

Rock-Solid Wallet, photograph © Aaron Shumaker / flickr

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December 2, 2018

One Response to “NHS: Waistlines and Wallets vs Hoops and Hurdles”

  1. December 02, 2018 at 8:57 am, Jaime Fivecoat said:

    Thanks Ted,