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Government Rejects Recommendations to Regulate Non-Surgical Cosmetic Procedures

The Government rejected many recommendations in a report aimed at tackling and preventing body image-related mental and physical health problems, leading some experts to criticise the response described as "badly thought through" and a "missed opportunity".

The published response addressed the 21 recommendations made in the House of Commons Committee's The impact of body image on mental and physical health second report of session 2022–23.

In the report, the committee highlighted that "how people think and feel about their bodies and the steps they take to make perceived improvements has changed significantly in recent years". They pointed out that the advent of social media and rise in online advertising have both "increased exposure to certain idealised body types", and emphasised the "potential harm" that can result from online content that "promotes an idealised, often doctored and unrealistic" body image, and its link to developing low self-esteem and related health conditions.

The Committee said that a Mental Health Foundation report in 2019 had found that almost 1 in 3 (31%) teenagers and 35% of adults felt ashamed or depressed because of their body image, and found that "these pressures are directly impacting the health of the population". They said that in the survey, 80% of respondents agreed or strongly agreed that their body image had a negative impact on their mental health, with 61% agreeing or strongly agreeing that their body image negatively impacted their physical health.

Certain groups were most vulnerable to suffering from body image dissatisfaction, they pointed out, including:

  • Adolescents
  • Underweight and overweight individuals
  • LGBT individuals
  • People with disabilities or living with a visible difference

Body image issues can result in increased health risks for specific groups, from the increased risk of suicide in those suffering from body dysmorphic disorder (BDD), to the total suppression of testosterone and its cardiovascular risks in those taking long-term anabolic steroids, they alluded.

However, there was “little evidence that the Government is doing enough to understand the scale of these risks or to provide the necessary services for those seeking help”, they criticised.

Asked to comment by Medscape News UK, a Government spokesperson said: "We know body image can have a significant impact on mental and physical health. We welcome the Committee's recommendations and are committed to taking necessary action to address the issues identified."

A 'Missed Opportunity' for BDD and Eating Disorders

The report's committee urged the Government to ensure more is done to make the diagnosis and treatment of BDD a priority. This would include making training in BDD "compulsory for all mental health practitioners", and ensuring that BDD is included in the PSHE (personal, social, health, and economic) education curricula within the section on body image. In response, the Government agreed with the committee that the diagnosis and treatment of BDD is a priority, but said that "this prioritisation is best achieved through the current training, referral routes, and curriculum".

The report also recommended that the Government develop a national eating disorder strategy, to which the Government responded: "We are developing a major conditions strategy, which will include prevention through to treatment for mental ill health."

Health and Social Care Committee Chair, Steve Brine MP said: "Eating disorders among young people are increasing and if not dealt with early can become extremely serious even leading to lengthy acute admissions. We wanted a dedicated eating disorder strategy to tackle it for good reason, based on solid evidence," he said. "Rolling it into other areas of Government work represents a missed opportunity to give it the priority it needs," he grieved.

The Committee recommended that the Department of Health and Social Care, along with the National Institute for Health Research (NIHR), commission and fund new research to understand the causal pathways that are leading to a rise in body image dissatisfaction across the population and the impact of social media on body image.

"The NIHR welcomes funding applications for research into any aspect of human health, including body image," the Government said, and added that the NIHR will continue to explore ways to address this recommendation.

Government's Approach 'Badly Thought Through'

After hearing evidence of the dangers to vulnerable groups posed by non-surgical cosmetic procedures (such as Botox injections, chemical peels, microdermabrasion, and non-surgical laser interventions) the committee called for ministers to "speed up" the introduction of a licensing regime.

"We will consult on the procedures to include in the introduction of a licensing scheme for non-surgical cosmetic procedures in England," reassured a Government spokesperson. However, in their response to the Committee’s recommendation, the Government said that "the scale of the work required" meant it would "not be able to meet the recommended timeframe".

Mr Brine expressed sadness at the Government’s response. "It is extremely disappointing that the Government has failed to recognise the urgent need for greater protection for vulnerable groups seeking non-surgical cosmetic procedures," he said. The delay leaves people "at risk of exploitation" he warned, and urged the Government to deliver the regulation, which he stressed was "necessary now".

Ministers also rejected recommendations to make dermal fillers available as prescription-only substances, in line with Botox. The Government explained that the Medicines and Healthcare products Regulatory Agency (MHRA) was responsible for the regulation of medical devices, and intended to bring in more stringent rules for certain aesthetic and non-medical products, including dermal fillers, under the UK medical devices regulations. However, it said that there were "no current plans" for the MHRA to make dermal fillers prescription-only, and that the Government "strongly" encouraged anyone considering dermal fillers to take the time to find a "reputable, insured, and qualified practitioner".

Another recommendation rejected by the Government was that to ensure specific premises standards for all premises, such as beauty salons and non-Care Quality Commission registered premises, that provide non-surgical cosmetic procedures, after hearing about such procedures regularly being carried out in places which some characterised as 'filthy'. To this, the Government said: "There are currently no specific premises standards for beauty salons and non-CQC-registered premises providing non-surgical cosmetic procedures." It went on to say that it will consider whether specific premises standards are needed and what they should include, but highlighted that it did not want to "duplicate inspection regimes".

"We strongly encourage anyone considering a cosmetic procedure to take the time to find a practitioner who is operating from a premises that is compliant with hygiene standards and infection control measures," it advised.

"The Government's approach in putting the onus on an individual to find a 'reputable' provider of non-surgical cosmetic procedures in place of regulation and legislation that would protect the consumer is badly thought through," exclaimed Mr Brine.

To the recommendation that a nationally required annual holistic health and wellbeing assessment for every child and young person be introduced, the Government said that they had no current plans to introduce this.

"Issues like this are too important to ignore and the Government's response here runs contrary to the Secretary of State's stated determination to get serious about prevention," said Mr Brine. "Our major new inquiry into the prevention of ill-health will give the Committee the opportunity to return to subjects like eating disorders and Ministers can be sure we shall do that."

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