Fewer than one in 30 eligible patients had access to publicly funded weight management programs in England over the past decade, according to an analysis of nearly two million health records.
Research led by the University of Bristol found "patchy" provision of services and "striking regional inequalities", despite national guidance. Also, referrals did not improve between 2007 and 2020, despite rising rates of obesity.
"Improved access to weight management interventions is needed to reduce obesity levels," said the authors of the study, published in PLOS Medicine.
Few Referrals Even Though Obesity Costs Billions
The researchers noted that according to the Health Survey for England (HSE), an estimated 64% of the English adult population is overweight or obese. The cost to the NHS has been put at £6.5 billion annually, with the full annual cost to the whole of the UK at around £58 billion.
Effective clinical interventions to reduce associated morbidity and healthcare costs are needed, they said.
In England, the National Institute for Health and Care Excellence (NICE) recommends publicly-funded community weight management services for people with a body mass index (BMI) of 30 kg/m2 or more, and lower in certain groups. Adults with severe and complex obesity may be considered for bariatric surgery if they have been unable to achieve adequate or sustained weight loss through nonsurgical interventions alone. However, the number of referrals to these services was not known.
The researchers accessed primary care data on 1,811,587 adults (54.62% female) who had overweight or obesity recorded in their notes during the study period between January 2007 and June 2020.
Overall, only 56,783 (3.13%) of the total population of overweight or obese individuals had been referred for weight management interventions. Referral rates were highest among adults with a BMI of 40 kg/m2 or above (8685 of 87,031 - 9.98%), yet even so only 3701 (1.09%) of the 340,502 eligible patients with severe and complex obesity had undergone NHS bariatric surgery. Patients who had been diagnosed with severe and complex obesity for the longest, or who had the greatest number of comorbidities, were most likely to have received bariatric surgery.
"Large Regional Differences"
The team also uncovered "large regional differences" within these results. Patients from the West Midlands had the highest percentage of referrals to a weight management programme recorded (13,235 of 249,143 - 5.31%), and were more than twice as likely to have been referred as those from the North West (RR 2.17, 95% CI 2.10-2.24, p<0.001). Those from the East of England had the lowest number of referrals (1860 of 172,177 - 1.08%) and were only half as likely as those in the North West to have been referred (RR 0.43, 95% CI 0.41-0.46, p<0.001). Patients from London were more than three times as likely to undergo bariatric surgery as those from the North West (RR 3.29, 95% CI 2.88-3.76, p<0.001).
The researchers said that during the study period, "a very small percentage of the primary care population eligible for weight management referral or bariatric surgery according to national guidance received either". The reasons for the low rates of intervention might include "lack of consistency in the availability of weight management services and access criteria across the country".
The authors noted that since their study was undertaken, various new national initiatives to tackle obesity had been launched. However, as Medscape News UKreported in August this year, these include new digital weight management programmes to try to widen access to newly-available weight loss drugs, following NICE's acknowledgement that traditional services were "unable to keep up with demand".
Under-recording of Obesity and BMI in Primary Care
In addition, the authors said that not everyone with overweight or obesity has their weight recorded in their primary care record, so "the true percentage receiving a referral may be even lower". The proportion of patients with recorded overweight and obesity in the Clinical Practice Research Datalink (31%) represented only about half that estimated by the HSE (64%), so their findings could translate to only 1.5% of the truly eligible population receiving a weight management referral.
Lead author Dr Karen Coulman PhD, a research fellow in the Department of Population Health Sciences at the University of Bristol, said: "This study suggests that access to weight management interventions in England needs improvement. Little has changed over the past decade, yet obesity rates rise." Attention and investment were also needed to address the "marked regional differences in access to weight management programmes, including surgery", she said.
The team concluded: "Together with strong population-wide obesity prevention strategies, how to improve equity in weight management provision across the country should be an important focus of national policies related to obesity going forward."
Asked to comment by Medscape News UK, Katharine Jenner, director of the Obesity Health Alliance, said: "Everyone should be able access weight management services if they need them, regardless of circumstances and where they live." Access to treatment for obesity should be no different than it is for other health issues such as high blood pressure or smoking cessation, she said.
The Government though should not rely solely on treatment. Instead, it was essential to address the root causes of obesity, such as "the flood of unhealthy food and drink" that is "constantly marketed and promoted", she said. "Weight management services [and/or] medical procedures alone will not be the answer to the UK's extremely high levels of excess weight, Ms Jenner added. "We need to take action to ensure that as few people as possible reach the stage of needing treatment."
Editor's note: This article was updated on 02 October 2023 to include a comment from the Obesity Health Alliance.