GPs and other health professionals have called for an urgent review of ‘insufficient’ obesity management services in light of increased public demand for new weight-loss drugs.
Over 200 doctors and specialists, including an RCGP representative, warned Wes Streeting today that new obesity drugs are putting ‘immense pressure’ on ‘already overstretched’ weight management services in England.
This follows the Government’s recently-announced £279m collaboration with Lilly, the pharmaceutical giant behind the weight loss jab tirzepatide, who will launch a real-world study into the effects of the drug which could inform the NHS pathway for obesity.
Today’s letter was coordinated by the Obesity Health Alliance (OHA), a group representing 60 medical royal colleges, charities and campaign groups, which has also published a report setting out key recommendations for the Government.
Its principal demand is for the health secretary to commission a ‘comprehensive independent review’ of existing overweight and obesity management services within the next six to 12 months.
This would establish the ‘cost-savings case for expansion of treatment services’ and also identify best practice, according to the alliance.
OHA’s own review of the current treatment services in England found ‘strong evidence’ of their clinical effectiveness but pointed to barriers such as the ‘unprecedented financial implications’ of NICE-approved drugs or the ‘variable provision’ of bariatric surgery.
The letter to Mr Streeting said that weight management services in England have faced ‘chronic funding and workforce challenges, unequal access to services across the country and a disjointed patient pathway’.
On drugs such as tirzepatide, the Obesity Health Alliance – which includes the BMA – said in its report: ‘New pharmaceutical treatments have resulted in unprecedented public demand for services and added enormous pressure on already stretched commissioning structures.
‘As acknowledged by NHS England in their proposed implementation plan for Tirzepatide (October 2024), action to address longstanding issues and establish a system for clinical prioritisation across the entire scope of treatment services is an immediate and unavoidable priority.’
NHSE recently wrote to NICE setting out proposed plans for a phased approach to the rollout of tirzepatide in primary care, to ensure GPs were not overwhelmed.
It said it would need longer than the 90 days usually required for health services to implement NICE guidelines because the impact on general practice would be ‘profound’.
The OHA has also urged the UK Parliament to ‘use the NHS Mandate’ to require every ICB and local authority to ‘provide the entire range of effective overweight and obesity management services’.
These services should have a ‘minimum guaranteed funding term of at least three years’.
The health secretary was also asked to address the ‘major inequalities’ in the access to and uptake of weight management services, based on geography and socio-economic status.
‘Action to address this via targeted outreach and specialist programmes commissioned to encourage uptake from identified groups must be a priority,’ the OHA report said.
In response, the Department of Health and Social Care (DHSC) highlighted that obesity costs the NHS ‘more than £11bn a year’ and places a ‘significant burden’ on the economy.
A spokesperson continued: ‘With obesity-related illness causing people to take more days off sick, obesity drugs can be part of the solution. By tackling obesity, we can ease demands on our NHS and help improve Britain’s productivity.
‘As well as backing the next generation of medicines, this government is also taking action to prevent ill health in the first place and help people live well for longer.
‘We’re tackling the obesity crisis head-on – restricting junk food advertising on TV and online, along with banning the sale of high-caffeine energy drinks to children under the age of 16.’
DHSC also said that local authorities and ICBs are responsible for arranging weight management services, taking account of local needs.
Tackling obesity is good preventative measure on many fronts, but not so sure about plan to get these people back to work. The idea that spending money on these drug is to get these people back to work by making them loose weight is not likely to work as it requires change of mind set & people who are used to not working and happy to claim benefits are not going back to work even after loosing weight.
Instead of calling for another urgent review which will take forever and conclude the square root of zero, we should call for an urgent DES and let us get on with delivering this service in our surgeries effectively for remuneration, rather than referring to providers who should really be focused on doing stuff that we cannot do.
Michael Green is correct- what is the point in another review?
Properly funded DES. Start immediately, full scope of the NICE guideleines for Mounjaro (Wegovy harder in primary care). Activelty promoted in deprived areas.
If the funding is adequate there should be few or no concerns about the ability of General Practice to cope as there is slack in the system with GPs unemployed or underemployed – as long as the DES is funded well enough and backed up by properly funded exercise and nutrition advice.
Exercise and nutrition advice can be filled with a private-public partnership.
A phased roll out might be needed if there is issues with regards to drug availability – but it makes it more complex and expensive for General Practice so should only be a last resort. Tackling obestiy should be seen as more important than the covid vaccine rollout.
And the DES needs a good guarantee period – as likely to involve significant investment.
NICE has already demonstrated there is an economic case for it’s use. Just get on with it.
Pradeep – I agree the getting back to work thing is only a hypothesis at the moment. But the big announcement this week was a trial to demonstrate this (funded by the drug company), not a policy – so it sounds like they are taking an appropriate approach. I’d imagine trial data showing it resulted in a lot more people getting back to work would be a bit of a golden ticket to the drug company to flog their product to every developed country in the world .
These drugs are tool, not the solution. Many patients do superbly well improving their health and losing weight without the need for drugs. The key is the right information (versus the 1980s wrong information of “eat less move more “) +/- health coach support. Taking a metabolic health focus works.
The best role I have seen for these GLP-1 drugs is when a person knows and wants to change their eating habits but despite trying they are probably addicted to sugary/ultra-processed foods. The GLP-1s seem to switch off interest.
Also, if they are used let’s make sure they are part of a wider programme. E.g. with a resistance exercise routine to try to mitigate some of the muscle seen with these drugs. And make sure there is informed decision making to acknowledge the risk of the gastroparesis, which seems a particularly miserable persisting side effect for some people.
*muscle loss seen with these drugs