Northern Ireland has announced the country’s first obesity management service. Its phased and cautious approach chimes with a new report from the Tony Blair Institute for Global Change.
How to tackle obesity has been one of the themes of the year so far. The high costs of treatment mean that a third of NHS Trusts in England and many health boards in Wales have even gone so far as to block patient access based on their body mass index. At the same time, horror stories of unlicensed weight-loss jabs dominate the newspapers.
But there is good news.
The Department of Health in Northern Ireland has announced the country’s first obesity management service with its first phase scheduled to start early next year.
This phase will focus on the development of a community-based service where patients will have access to lifestyle support as well as obesity medication, if clinically appropriate.
Currently, health service patients in Northern Ireland do not have access to specialist weight management provisions – including weight loss injections and medications.
This service will support access to weight loss medication in line with NICE guidance. Rollout will be carefully managed in a phased manner to ensure that treatment is provided in a safe and effective manner.
Further phases of the Regional Obesity Management Service (ROMS) will develop – subject to funding – other interventions such as weight loss surgery.
“This is a very significant step forward. I have many competing demands on a seriously overstretched budget but I was determined to prioritise this area,” said health minister Mike Nesbitt.
Targeted intervention
Obesity is a significant public health issue in Northern Ireland, with 65% of adults and 26% of children living with obesity or overweight. A 2015 study which focused on estimating both the healthcare and productivity costs of overweight and obesity in Northern Ireland put this at around £414 million a year.
In November 2023, the Department of Health launched a consultation seeking views from the public on the introduction of an obesity management service. The outcome of the consultation, which received just under 19,000 responses, was overwhelming in favour of introducing this service.
News of the service was welcomed by the British Medical Association (BMA).
“Targeted intervention is key to tackling obesity as it causes significant additional health issues for those who struggle with their weight. An obesity management service will have the potential to help make life-changing, long-term health gains for these patients and, most importantly, free up an enormous amount of resources for health services in the future,” said BMA’s Northern Ireland council chair, Alan Stout.
Phased and cautious
The phased and cautious approach of Northern Ireland rather than jumping straight to the solution of drugs like Wegovy, Mounjaro and Ozempic is the one preferred by healthcare professionals.
As Rachael Joy, chief clinical officer at SheMed, pointed out in Healthcare Today recently, GLP-1 treatment is a “welcome shortcut for overweight Brits, but it also increases the risk of health complications by allowing medications to be taken by the wrong cohort”.
This chimes with the recent report from the Tony Blair Institute for Global Change (TBI) which addressed the economic impact of obesity on Britain as a whole. “While the cost of treating obesity may be high, the cost of not treating it is higher,” it says.
Obesity, the report estimates, costs Britain around £98 billion a year and that treatment could boost economic growth by £52 billion.
While the headlines have focused on sending weight-loss jabs through the post, the report encourages a more holistic approach to weight loss with weight-management services available to citizens through the NHS App, the expansion of the UK’s Health Check programme as well as the wider use of weight-management services as well as wider access to medication.
The approach of the report has been welcomed. Richard Donnelly, emeritus professor of medicine at the University of Nottingham is strongly supportive of digital-first care models and the commissioning of accredited private sector providers to deliver weight management services.
“Requiring extensive in-person care is unsustainable for the NHS and worsens inequities in access. Digital solutions can help with rapid, equitable, and cost-effective rollout of weight loss medications, while also maintaining high standards of clinical and data governance,” he said.
Certainly, a broader approach to obesity is needed. As Kevin Joshua, superintendent pharmacist and clinical lead at Juniper, wrote in Healthcare Today: “Preventing obesity-related diseases requires more than just identification and monitoring – it demands greater government action and a shift towards early intervention.”
