Confronting Obesity: Addressing a Systemic Challenge

Written by Andrew Fraser, Chair of Obesity Action Scotland

“Obesity is an issue in every ward, in every acute hospital, in almost every primary care setting and clinic.”

Societal context

Obesity, on a scale of harm, is on a par with smoking and excessive alcohol consumption. Recent UK estimates place the cost of obesity to the NHS at £11bn in 2021, rising to £19bn as overweight numbers increase.

Obesity is an issue in every ward, in every acute hospital, in almost every primary care setting and clinic. Obesity leads to a greater risk from other co-existing diseases, a greater risk for medical and surgical intervention, longer stays to treat complications, musculoskeletal risks, and adjustments to equipment and facilities in healthcare settings. As we approach 2040, projections in England for the most rapid rises in morbidity are anxiety and depression, chronic pain related to musculoskeletal problems, and type 2 diabetes. All are closely linked to obesity as a cause or a consequence.

The extent of harm associated with obesity in the UK and international contexts is well documented –affecting physical health, mental wellbeing and social wellbeing; many experience stigmatisation. There are new pharmacological interventions to treat obesity where it exists – but it is only effective as long as people take it.

We don’t need to mass-medicate for a healthy weight if we get the conditions right to prevent it.

Obesity is socially patterned – fundamentally influenced by factors including poverty, wealth and access to healthy food. Therefore, we must incorporate a systemic and common factors approach. We cannot blame the individual when so much in terms of food and calorie consumption, and opportunities for physical activity, are determined by where people live, work and go to school. A person with obesity will often struggle to lose weight because the environment they live in offers more barriers to healthy eating than opportunities. We must move urgently to implement what we know, to effectively prevent the condition, and resolve the epidemic.

What can we do?

First, face the challenge; take obesity and healthy weight as seriously as the most worrying epidemics in the non-communicable disease world.

Second, emphasise the need for a healthy weight environment by highlighting links to other non-communicable diseases such as cancer, cardiovascular disease, musculoskeletal problems and mental health. Creating a healthy weight environment requires obesity to be a key consideration in action to tackle inequalities and climate sustainability as well as investment in health, clinical safety and realistic medicine –implementing effective measures based on evidence of what works.

Third, think of ways that core, societal institutions such as the NHS and health-care suppliers, schools, and local and national government, can support a sustainable culture of healthy weight without stigmatisation. Support government action that would create a healthy weight society, and then continually evaluate this process to identify what more needs to be done.

We know enough to act. There is good evidence that these approaches work. We know there are opponents – particularly commercial interests and their backers – that will seek to slow and frustrate progress. But a conference to confront the challenge, identify prevention and treatment opportunities, like the President’s Conference on 14 November, is an important springboard.

Obesity Action Scotland is hosted by the Royal College of Physicians and Surgeons of Glasgow.

References

The Scottish Health Survey 2022 –volume 1: main report, (December 2023) Scottish Government

The rising cost of obesity in the UK, (November 2023) Frontier Economics

How can the next government take prevention from rhetoric to reality? (June 2024) The Health Foundation

The Health Foundation – Health in 2040 WHO – Obesity and overweight fact sheet