The NHS is restricting access to obesity care across England, leaving patients in almost half the country unable to access specialist teams for support and treatments such as weight-loss vaccinations.
Research from the British Medical Journal has found that cuts to local services have disproportionately targeted care for people with obesity, a condition often seen as less worthy of care than others.
According to one expert, the restrictions amounted to ‘rationing’ of obesity care by the NHS, leading to a ‘postcode lottery of care’.
Patients in one in six local health care areas did not have access to bariatric surgery, one of the most clinically effective treatments for obesity, according to the researchwhich analysed responses to disclosure requests from all 42 integrated care boards (ICBs) in England.
Dr Nicola Heslehurst, professor of maternal and child nutrition at Newcastle University and chair of the UK Association for the Study of Obesity, told the BMJ that weight management services were “in no way meeting the need”, adding that “radical” action was needed to prevent rising obesity and healthcare costs, increasing inequality and “setting children up for a lifetime of ill health”.
Obesity is estimated to cost the UK NHS £6.5 billion each year and is the second biggest cause of cancer after smoking.
ICBs are funded by NHS England to provide healthcare to their local populations, but budget cuts have left many under huge financial pressure. When money is allocated, services that are seen as less important may not receive funding, and obesity services are often the first to be cut.
Just over half (24) of English health boards commissioned the full range of adult weight loss services and were open to new referrals. Services range from local diet and lifestyle classes to weight loss injections containing semaglutide, sold as Wegovy, and gastric bypass surgery.
More than a third of ICBs reported restrictions on tier 3 obesity services, where patients are seen by multidisciplinary teams who can provide weight-loss medications. Six said their services were closed to new patients, seven covered only part of their catchment area and four had no tier 3 services.
The research found that level four services, which include gastric bypass surgery and more intensive weight management services, are restricted in many parts of England. For example, seven ICBs do not perform bariatric surgery.
John Wilding, a professor of medicine at the University of Liverpool, told the BMJ that obesity care “wasn’t seen as a priority”. “I think there’s an unconscious bias that says, ‘This is mainly their fault, so they should just get on with it, diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that,” Wilding said.
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The BMJ’s findings echo those of a recent report by research agency Future Health. The report found that many of the NHS’s ICBs in England had not produced detailed plans to tackle obesity and treat people with obesity, despite the UK an estimated £98 billion per year in health costs, lost productivity and other costs.
Richard Sloggett, the author of that report and a former special adviser at the Department of Health and Social Care, said the new revelations showed the NHS was “rationing” treatment for obesity. “These findings support our Future Health research which shows that many ICBs are not currently seeing obesity as a priority. In some parts of the country, there is no access to Level 3 and 4 services at all.
“This rationing is leading to a postcode lottery of care. Given the scale of the obesity challenge facing the country and the wider health and economic costs and consequences that this has, there is an urgent need for new action by government and the NHS. This should start with a clear timeline for reviewing NHS obesity services and ensuring that a minimum service specification is agreed and in place in every ICB.”
An NHS England spokesperson told the BMJ that the NHS “is working with the Department of Health to support improvements in the obesity pathway”.