How can the NHS get weight management services right?

When Thomas Barber considers recent referrals to the NHS obesity service he runs, one trend is exceedingly clear: there are an awful lot more of them than ever before.

“The numbers of referrals have tripled since the end of lockdowns,” says Dr Barber, honorary consultant endocrinologist at University Hospitals Coventry and Warwickshire Trust.

He suspects the reasons are multiple. One is that covid raised the profile of obesity, given that carrying excess weight is a risk factor for a poor outcome from the virus. Then there is the reality that many people gained weight during extended periods of being confined solely to home or work. Finally, there is the growth of novel pharmaceutical treatments to support weight loss – many of them gaining significant coverage in the mainstream as well as specialist press.

It all means that weight management services across the country are now dealing with significant demand. The picture is complicated by patchy levels of provision. The existence of so-called tier 3 weight management services – which involve the provision of specialist support by a multidisciplinary team – is described by Dr Barber as “very sporadic” with “vast swathes of the country” unable to offer such support.

Tackling the demand

How best to meet demand – ensuring good outcomes for service users at the same time as efficiency and value for money for the system – was the question on the agenda for a recent HSJ webinar. Run in association with Oviva, the event brought together a small group to consider just how the NHS might get weight management services right.

It is a complicated issue, not least because the issue of excess weight is in itself far from simple. “What we’ve known from the research – what we’ve known for more than 15 years now – is that obesity is complex,” said Claire Griffiths, reader at Leeds Beckett University’s Obesity Institute.

“It’s much more complex than the simple ‘eat a little bit less and do a little bit more’,” she continued. “We know there are all these factors that contribute to obesity: economic factors, environmental factors, social factors, cultural factors.”

Each factor is important but each has often largely been considered in isolation. “If we’re ever going to achieve effective, equitable and – most importantly – person-centred care for obesity, it’s going to require a transdisciplinary team working with all stakeholders, including those with lived experience.”

Need for a multidisciplinary approach

“Services must be multidisciplinary,” agreed Lucy Jones, head of dietetics and vice president clinical at Oviva. “They need to tackle people’s weight from a variety of areas, so dietetics, physical activity, psychology, and there needs to be medical input there as well where people are living with co-morbidities or conditions that are contributing to their challenges with weight.”

Also crucial, she suggested: having services that are flexible enough to support properly personalised care. This is a core part of Oviva’s focus. The company provides tier 3 weight management services on behalf of the NHS via digital means, including virtual clinical consultations and an app.

“The ability to triage and personalise pathways, enabling people to access the care they need from different professionals, is incredibly important,” Ms Jones argued. “I think we’ve really got to think about how we build that in rather than having a one size fits all approach for all people.”

A more personalised approach to obesity is one Tracey Carr said she would greatly value. An advocate for the better care and understanding of larger people, she reported that “the kind of help that I would like to access to reduce my weight isn’t really available”.

“The things I would like most are things like prescribed exercise; a safe space where I feel I can swim or go to the gym without feeling like the eyes of the public are on me and judging me.

“We should accept that obesity can happen to anyone, it’s highly complex, it’s genetic, it’s not simply a lifestyle choice, it’s not down to human vice”

“As a larger person when you’re out in society, you’re constantly judged on your appearance and your weight and that’s quite a burden – literally a burden – to take with you everywhere you go. But it’s especially difficult when you’re trying to access exercise and healthcare and trying to make yourself healthier.

“Weight is the one thing where every healthcare practitioner brings their own experience into it,” she continued. “Clinicians may not have had experience of drug addiction, alcohol addiction, childbirth, any number of complications and ailments that they treat, but absolutely every person eats three times a day and has an attitude about food. And I’d like us to try and be a bit more empathetic about other people’s experience of food and weight and health, and less judgmental.”

“We should be more compassionate as a society,” emphasised Dr Barber. “We should accept that obesity can happen to anyone, it’s highly complex, it’s genetic, it’s not simply a lifestyle choice, it’s not down to human vice.” And that’s an understanding that increasingly needs to be embedded across healthcare.

An on-demand version of this webinar is available.

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