The
silent killer
Globally
Britain already has one of the highest levels of obesity. By the end of the decade it is predicted that
one in three adults will be classified as obese. The health consequences of such a rise are
staggering, as obesity is directly correlated with a myriad of diseases. The
obese population are nine times as likely to suffer from Type 2 Diabetes, three
times as likely to develop hypertension and twice as likely to have a heart
attack; the incidence of these conditions is set to rise by 146%, 61% and 43%
respectively between 2006 and 2050.
Deaths attributable to excess weight have increased from 8.7% in 2003,
to 11% in 2011. That is equivalent to
over 2000 more deaths annually now than 8 years ago.
The Weighty Cost
The
NHS footed a bill of over £2 billion for treating obesity and related
consequences in 2007; this figure is expected to double by 2015, and triple by
2035. Significant though these figures
are, the major financial cost of obesity lies in the indirect costs. Each year, overweight and obese full-time
workers are estimated to cost the UK £14.5 billion in lost productivity through
absenteeism. Obese workers, for
instance, with three or more chronic conditions, account for over 10% of the
full-time workforce and report an average of 60 unhealthy days and 18 missed
work days per year. This compares to 4
unhealthy days and 1.5 missed work days a year for workers with normal weight
and no chronic conditions. Obese people live, on average, nine years
less than their non-obese counterparts, and the lost output was estimated
in 2002 to be over £1 billion. These
indirect consequences and are expected to reach £23 billion in 2015.
Adding
together the direct health costs (treating obesity and obesity-related diseases)
to the indirect costs (lost output due to attributable sickness and premature
mortality) the combined obesity bill is set to rise from £16 billion in 2007 to
£50 billion by 2050 . That is equivalent
to over £400 of additional costs per person in the UK.
Lightening
the load
There
is, therefore, a compelling argument to tackle obesity. Three modes of
treatments currently exist:
·
Community-based interventions,
·
Pharmacological interventions,
·
Surgical interventions.
Community-based
interventions cover population based
regulation and fiscal measures, health education and promotion, as well as more
individual based therapies in primary care.
These are tend to be the most cost-effective interventions.
Pharmacology interventions include prescriptions for
the anti-obesity drug Orlistat. Orlistat works by preventing fat absorption,
however, the drug does has side effects and it is often not a permanent
solution, as weight is frequently regained after the medication is stopped.
Surgical interventions aim to limit the amount of
food eaten and digested by altering the digestive system’s anatomy. This is done via bariatric surgery. Surgical procedures have risen sharply, with
an annual growth rate of 24% over the past 10 years (though from a very low
base). Publicly-funded surgical
treatment is restricted to those with BMIs over 40 (or 35, with comorbidities),
making it available to only a small subset of the obese population. Unfortunately, access to bariatric surgery is
very inconsistent across Primary Care Trusts (PCTs), and this has led to a
‘postcode lottery’ as to who gets offered this as a treatment option.
What
can be done?
Nationally,
the enormous costs associated with obesity mean that treatments represent a key
‘spend to save’ opportunity for the coalition government. Following the 2011 NHS reforms,
commissioners’ will focus attention on payment by outcomes and their effectiveness
in reducing chronic disease makes obesity treatments a prime candidate for
funding – especially in the community. Pharmacological and surgical treatments will
continue to be used, but perhaps in conjunction with more a more integrated
care pathway. Currently community
obesity services vary significantly across the UK; this is very different from
a more standardised treatment approach for anorexia nervosa.
Here
we suggest a unique opportunity for local areas to develop and deliver a
community obesity treatment service (COTS).
Tailoring a specialist obesity service around the individual brings
together the three disciplines of diet, exercise and psychological therapies
all under one umbrella. Currently GPs
tend to make three separate referrals, so COTS would be a way of making
community provision for obesity more joined up.
It would also allow for the various levels of talking therapy to be
offered; stepping up from basic advice and counselling to more specialist forms
of talking therapy for eating disorders such as Cognitive Behaviour Therapy
(CBT), Cognitive Analytical Therapy (CAT) and Acceptance Commitment Therapy
(ACT). The estimated cost of such a
service would be £64 per patient per month.
Although there is a start-up and delivery cost, it should not be
forgotten that all three main political parties have already nailed their
colours to the talking therapy community mast.
Labour Party leader Ed Miliband has pledged to make access to talking
treatments a legal right under any Labour NHS Constitution. Liberal Democrat Deputy Prime Minister Nick
Clegg has said “..much more can be done, more usefully using personal services
including counselling and group therapy” and Conservative Prime Minister David
Cameron has targeted his parties efforts and has offered Government money to
increase talking therapy availability.
COTS could also take advantage of having many different funding streams,
sourcing income from the public, private and third sector.
This is discussed further in Health Investor magazine December 2012 and was written by myself and Gerald Templer, an analyst at Candesic’s London office.
