14 Jul Obesity: Promoting a scientific solution
July 14th was the timetabled release date for the Life Sciences Vision Roadmap – the delivery plan was due to set out funded activity for this spending review cycle to deliver on the Life Sciences Vision’s “great healthcare challenges”. Political circumstances have shelved the policy document but not the challenges it seeks to address. OVID Health Senior Account Director, Tom Doughty, and Associate Director, Andy Jones, share their analysis of what the Roadmap needed to contain on obesity.
A new approach to obesity
Obesity is widely recognised as one of the country’s greatest health and care challenges. It is estimated that 28% of adults in England are living with obesity, with a further 36% overweight. The numbers are alarming.
The easy and traditional answer to managing obesity is to ‘eat less and move more’. But the science around obesity is advancing, and over recent years evidence has shown that obesity is the result of a complex web of environmental, behavioural and genetic factors. Managing obesity is just as complex. For a person living with obesity, losing weight triggers physiological signals that increase appetite and reduce energy expenditure. In other words, we are scientifically designed to put weight back on after we’ve lost it.
The one-size-fits-all approach taken to date by the UK health system has simply not succeeded in reducing obesity levels. A range of solutions across prevention, multidisciplinary support, and sometimes medical treatment, are needed to manage obesity at a population level.
So, the Life Sciences Vision, with its focus on a multi-disciplinary approach to obesity, backed by research and supported by new treatments and devices, showed a step in the right direction. It highlighted a new approach in the Government’s thinking on obesity which finally matches the advances made by the scientific community and industry.
Could the Life Sciences Vision’s promise deliver for people with obesity?
Developing and supporting new solutions for obesity is one thing, but ensuring they reach patients is another.
Currently, weight management services in England are provided in tiers. Tier 1 takes the form of public health campaigns, Tier 2 provides support such as fitness classes, dietary advice, weight loss classes, and some behavioural change advice. Tier 3 provides intensive multi-disciplinary medical management and Tier 4 services are based around surgery.
The concept of the tiers is to provide the right support depending on the need of the individual. It also appears ideal from an NHS resource perspective. People can only access the most serious forms of intervention if they have already attempted the previous Tiers.
But in practice the system comes before the individual. Dig a little deeper and it makes little sense that a person with a BMI over 40 should have to start with NHS commissioned fitness classes when they would clearly benefit immediately from bariatric surgery. This just delays the type of treatment that is most likely to have an impact.
Putting the tiered system aside, weight management services in England are disjointed and geographically fragmented. Many weight management services were decommissioned over the past decade as commissioning responsibility for weight management services moved from NHS England to CCGs and Local Authorities. More recently, £100m of funding for weight management services, announced in March 2021, was scrapped entirely. The services need to exist and perform well if the Life Sciences Vision’s goal is to succeed.
What should the Life Sciences Vision Roadmap have committed to?
The Life Sciences Vision Roadmap provided the opportunity to build on the original commitments and set out a blueprint for a more scientific approach to obesity management. The ambition focuses on trialling different combinations of interventions that could be rolled out at scale, recognising the huge opportunity for innovative companies to develop solutions and products to transform how obesity is managed. The Roadmap would need to show what success looks like and how these solutions would be scaled up.
At the same time, cost-effective pharmaceutical interventions and bariatric surgery are already available, but their potential is not being maximised. Surely, to encourage further innovation, the first step is to ensure what we have already is being used optimally. To facilitate new innovations coming into the system, the Government and NHS need to show they are serious about obesity management by ensuring good quality weight management services are available and accessible.
The Government, through the Life Sciences Vision Roadmap, has missed out on the opportunity to show how innovative solutions would be integrated into new and existing weight management services as part of a holistic, integrated package of support.
To find out more about OVID’s take on the Life Sciences Vision healthcare challenges and how to deliver them, check out our series here.