Obesity: when is specialist referral needed?

Abstract

Obesity is a chronic progressive condition affecting 27% of the UK adult population. Obesity underlies much of primary care workload: 44% of type 2 diabetes (T2D) cases, 23% of ischaemic heart disease, and 41% of certain cancers are attributable to excess BMI.1 Worryingly, the number of adults with severe obesity, which significantly reduces life expectancy, has doubled to approximately 2.6 million over the past decade. Obesity and related illnesses lead to significant healthcare costs, estimated at £6.1 billion per year in the UK, with additional societal costs of £27 billion from reduced productivity secondary to obesity-related ill-health.2 Obesity is a complex issue with no single or simple solution. Preventing incident obesity is crucial but for those people already affected we need to provide optimal, evidence-based care. Multidisciplinary weight management programmes that encompass changes in diet, behaviour, and physical activity need to be established and readily accessible across the UK. Prescription medications and bariatric surgery where indicated should be seen as adjuncts to facilitate such programmes rather than standalone alternatives. Bariatric surgery offers the most effective method for substantial and sustained weight loss, while significantly improving obesity-associated comorbidities and improving quality of life. Responsibility for commissioning bariatric surgery was devolved from NHS England to clinical commissioning groups (CCGs) in April 2017 with the primary aim of increasing consistency in obesity care pathways nationwide. However, commissioning of medical weight management services (Tier 3) across the UK is variable and, in some areas, absent, while less than 1% of people who fulfil National Institute for Health and Care Excellence (NICE) eligibility criteria for bariatric surgery (Tier 4) are able to access it. Greater awareness of the evidence supporting bariatric surgery health outcomes and the NHS weight management …