The costs of obesity

Institute for Fiscal Studies

Policies that aim to reduce the prevalence of obesity have been high on the policy agenda for many years. Understanding the costs associated with obesity is important for informing policy. Bell and Deyes (2022) have recently produced what are, to date, the most detailed estimates of the costs of adult obesity in the UK.

This report puts those estimates in context, discusses what costs are missing from their analysis, and which of the costs included are most relevant for policymaking.

Full detail: The costs of obesity

New drugs pilot to tackle obesity and cut NHS waiting lists

via Department of Health & Social Care

More people living with obesity will have access to the newest and most effective obesity drugs to help cut NHS waiting lists, following the announcement of a £40 million two-year pilot.

Earlier this year, the National Institute for Health and Care Excellence (NICE) recommended the use of Semaglutide (Wegovy) for adults with a Body Mass Index (BMI) of at least 35 and one weight-related health condition – such as diabetes or high blood pressure. Other drugs are currently under consideration in clinical trials.

There is evidence from clinical trials that, when prescribed alongside diet, physical activity and behavioural support, people taking a weight-loss drug can lose up to 15 per cent of their body weight after one year. Taking them alongside diet, physical activity and behavioural support can help people lose weight within the first month of treatment.

The £40 million pilots will explore how approved drugs can be made safely available to more people by expanding specialist weight management services outside of hospital settings. This includes looking at how GPs could safely prescribe these drugs and how the NHS can provide support in the community or digitally.

Full detail: New drugs pilot to tackle obesity and cut NHS waiting lists

Tackling obesity: Improving policy making on food and health

Institute for Government

This report reveals how every government since 1992 has missed targets to reduce obesity – with the UK’s rising obesity rates harming people’s health and life opportunities, burdening the NHS and damaging the economy. It exposes the reasons behind this policy failure – and sets out how to make progress.

The report shows that tackling obesity has repeatedly suffered from ministers fearing the perception of nanny statism, despite there being strong public support for ambitious measures. Over three decades there have been at least 14 strategies, hundreds of policies, and a succession of institutional reforms, with key agencies and teams created and then abolished.

The report shows that:    

• The UK has the third highest obesity rate in Europe, behind only Malta and Turkey. Almost one in three adults are now classified as obese – an increase from one in 10 adults in 1970.
• Obesity is heavily concentrated in the poorest areas, with the gap between rich and poor areas widening significantly in the last decade.   
• Obesity is set to be a major driver of inequalities in future generations. In the most deprived areas almost a third of primary school leavers have obesity compared with just 13.5% in the least deprived areas. 
• Obesity costs the NHS around £6.5bn every year – and its wider societal costs, including in reduced productivity, are estimated at 1–2% GDP.

Full report: Tackling obesity: Improving policy making on food and health

Quarter of adults in England are obese

Around a quarter of adults in England were obese in 2021, according to the latest Health Survey for England | via NHS Digital

Published by NHS Digital, the Health Survey for England, 2021 reports on the nation’s health and surveyed 5,880 adults about a variety of topics including cigarette smoking, e-cigarette use and alcohol consumption. The report found that 26% of adults in England were obese- with obesity increasing with age from 8% of adults aged 16-24 to 32% of those aged 65-74. Obesity prevalence was lowest among adults living in the least deprived areas (20%) and highest in the most deprived areas (34%). A higher proportion of men were either overweight or obese (69%) compared with women (59%).

Further detail: Quarter of adults in England are obese, new survey of public health shows

Full report: Health Survey for England, 2021

Latest obesity figures show a strong link between children living with obesity and deprivation

This report presents findings from the Government’s National Child Measurement Programme (NCMP) for England, 2021/22 school year. The report contains analyses of Body Mass Index (BMI) classification rates by age, sex, deprivation and ethnicity as well as geographic analyses | via NHS Digital

Published by NHS Digital, the National Child Measurement Programme, England – 2021-22 report found that the prevalence of reception-aged children living with obesity in England during 2021-22 was over twice as high in the most deprived areas (13.6%) than in the least deprived areas (6.2%). This difference is also seen in year 6 children – with 31.3% living with obesity in the most deprived areas compared with 13.5% in the least deprived areas.

The report found that the prevalence of reception-aged children living with severe obesity was over three times as high for children living in the most deprived areas (4.5%) than for children living in the least deprived areas (1.3%). Similarly, the prevalence of year 6 children living with severe obesity was over four times as high for children living in the most deprived areas (9.4%) compared with those living in the least deprived areas (2.1%).

Further detail: Latest obesity figures for England show a strong link between children living with obesity and deprivation

Full report: National Child Measurement Programme, England, 2021/22 school year

New weight loss support on the high street

People struggling to lose weight will now be offered help from their local high street pharmacy as part of the NHS’s radical action to tackle rising obesity levels and type 2 diabetes | NHS England

Community pharmacy teams can now refer adults living with obesity, and other conditions, to the twelve-week online NHS weight management programme. People are being urged to come forward and community pharmacies are expected to make hundreds more referrals in the coming weeks in addition to the several hundred already made.

GPs have already referred over 50,000 adults living with obesity at risk of developing weight-related conditions.

People will be able to start the programme within 10 days of visiting their local pharmacy, with support for some people including one-to-one coaching from a weight loss expert. Adults living with obesity plus hypertension or diabetes will qualify for the service, which people can access via an app on their smartphone or online. People from Black, Asian and Minority ethnic backgrounds can join the programme at a lower BMI of 27.5, due to an increased risk of type 2 diabetes.

Three in five adults in England are overweight, with more than one in four living with obesity.

Recent research found that people seeking NHS help to lose weight during the pandemic were on average five pounds heavier than those doing so during the previous three years.

Full detail: New weight loss support on the high street

See also: High Street pharmacies in England to help people lose weight | BBC News

Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss Among Patients With Obesity in Rural Clinical Practice

Question  Does behavioral obesity treatment delivered in rural primary care settings via in-clinic group visits or telephone group visits improve weight loss compared with the fee-for-service model with in-clinic individual visits?

Findings  In this cluster randomized trial that included 1407 participants, in-clinic group visits, compared with in-clinic individual visits, resulted in significantly greater mean weight loss at 24 months (–4.4 kg vs –2.6 kg, respectively), and the difference between telephone-based group visits and in-clinic individual visits was not significantly different (–3.9 kg vs –2.6 kg).

Meaning  In rural primary care practices, behavioral weight loss therapy delivered via in-clinic group visits resulted in statistically significantly greater weight loss than in-clinic individual visits, although the difference was small and of uncertain clinical importance.

Reference: JAMA. 2021;325(4):363-372.

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear.

METHODS

We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population.

RESULTS

In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.

CONCLUSIONS

Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population. (Funded by the Swedish Research Council and others; SOS ClinicalTrials.gov number, NCT01479452. opens in new tab.)

Reference: N Engl J Med 2020; 383:1535-1543

Weight Loss in Underserved Patients — A Cluster-Randomized Trial

BACKGROUND

Evidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking.

METHODS

We conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months.

RESULTS

All 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, −4.99%; 95% confidence interval [CI], −6.02 to −3.96) than in the usual-care group (−0.48%; 95% CI, −1.57 to 0.61), with a mean between-group difference of −4.51 percentage points (95% CI, −5.93 to −3.10) (P<0.001). There were no significant between-group differences in serious adverse events.

CONCLUSIONS

A high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months. (Funded by the Patient-Centered Outcomes Research Institute and others; PROPEL ClinicalTrials.gov number, NCT02561221. opens in new tab.)

Reference: N Engl J Med 2020; 383:909-918

Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies

Objective To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations.

Design Systematic review and meta-analysis.

Data sources PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews.

Eligibility criteria for selecting studies Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included.

Data synthesis A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves.

Results Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I²=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I²=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I²=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I²=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I²=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I²=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I²=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I²=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index.

Conclusions Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

Reference: BMJ 2020;370:m3324