The Government announcement this week of an investment from pharmaceutical company Eli Lilly to increase access to new weight loss medication has added further speculation as to what the future holds for treating overweight and obesity in this country[1]. Jack Doughty, Senior Policy Officer at Diabetes UK, discusses the implications:
Supported by a range of leading healthcare professionals and people with lived experience, the OHA report into overweight and obesity treatment looks across the evidence and current provision of services in England. The report finds that there is a strong evidence base for a range of weight management interventions but there are currently significant issues with service provision and access that need to be overcome. The report calls for decisive action from the Secretary of State for Health and Social Care, Wes Streeting, to use the public and political interest in the new drugs to tackle the issues with the entire overweight and obesity management treatment pathway.
The report found that there is strong evidence for many behavioural change services, NICE approved medications, and metabolic and bariatric surgery for supporting weight reduction and associated weight related health conditions. The evidence review also found that there are a number of challenges that need to be overcome in terms of the stigma experienced by those seeking support, and the inequalities experienced in those who are most likely to living with overweight and obesity and how support services are tailored to their needs. Overall overweight and obesity management services were found to be underfunded, with too often patchy provision, and often not joined up.
In the media we are seeing frequent discussion about the potential role of weight loss medications in treating obesity, but these options are subject to the same challenges as the wider range of treatment options. For example, Wegovy, approved by NICE for treating people with a BMI over 30kg/m2 and at least one weight related health condition has been estimated as having an eligible population of over 4 million[2]. However, the NHS currently only have capacity to treat people (with the required wraparound support to make the treatment safe and effective) in the tens of thousands. The latest weight loss medication currently in the process of being approved by NICE, Tirzepatide, requires significant changes to be made to the overweight and obesity pathway before it can be accessed by those who are eligible[3]. NHS England have laid out a draft implementation plan (currently being consulted on) which proposes that it could take 12 years to provide access to the necessary services for 1.6 million of the 2.8 million people who could meet the criteria for access in the draft NICE decision.
It is positive that NHS England are highlighting the scale of the changes needed to provide access to weight loss medication but the unprecedent length of the implementation plan just goes to show how far away the NHS currently is from what is required. More worryingly, is the news this week that the Government are interested in potentially prioritising people most likely to return to the workforce for treatment. As called for in the report, overweight and obesity management services should be available to all who could benefit but where prioritisation has to be made, this must be done based on clinical need not the potential economic output of the patient.
The OHA report makes a series of pointed recommendations for stakeholders including Government, the Department of Health and Social Care, NHS England, Integrated Care Boards, and healthcare professionals to address challenges across the treatment pathway, these include:
- An independent full review of existing NHS obesity services to identify current challenges and present an economic case for expanding access to treatment.
- Introduce urgent NHS interventions to help clinicians prioritise access to weight-loss drugs, as demand continues to surge.
- Ensure every Integrated Care System (ICS) provides comprehensive obesity treatment services, eliminating the current “postcode lottery”.
- Develop new weight-loss support strategies tailored to groups that are traditionally underrepresented in existing services, including older men and individuals from ethnic minority backgrounds.
These represent some of the urgent actions backed by over 200 healthcare professionals in a letter to Wes Streeting that need to be taken to improve the overweight and obesity management treatment pathway.
Diabetes UK have played a lead role in coordinating this report and support the recommendations, click here for further details.
[1] https://www.telegraph.co.uk/news/2024/10/14/weight-loss-jabs-get-britain-working-wes-streeting/ [paywall, accessed 16th Oct 2024]
[2] Semaglutide for managing overweight and obesity https://www.nice.org.uk/guidance/ta875
[3] Tirzepatide for managing overweight and obesity https://www.nice.org.uk/guidance/indevelopment/gid-ta11156