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Paul Gately, chief executive of Obesity UK and Morelife, argues that current care pathways, policy frameworks and funding of resources have not kept up with how obesity is managed.
Obesity is one of the most prevalent and costly health conditions in the UK, affecting almost a third of adults in England. The consequences go beyond the health and wellbeing of individuals – there is a significant societal and economic impact, costing the UK economy £126 billion annually, including an £8.3 billion loss due to obesity-related sick days.
Moreover, the burden the condition places on communities is not evenly distributed across the nation. Analysis of more than 113,000 patients from digital health provider Voy, in partnership with the Health Foundation, found people in the most deprived areas access 32% fewer GLP-1 prescriptions, despite up to 70% more people suffering from obesity.
All of this points to the significant inequalities in how obesity management is prioritised by local health systems, leaving many in the most pressing need of support without access to care – even as newer treatments, like the GLP-1 pill, emerge.
The obesity care landscape has advanced considerably, and private organisations like Voy are instrumental in widening access to impactful weight-loss treatment for people who have historically struggled. However, the current care pathways, policy frameworks and funding of resources have not kept up in order to maximise the groundbreaking tools now at the system’s disposal, for fairer delivery of care nationwide.
Failing through inaction
The current system is failing through inaction. Under NICE guidance, the eligible population for access to tirzepatide is estimated at 3.4 million people. NHS England has mapped out the first three years of implementing the new treatment, aiming to treat 220,000 patients by 2028 – with full roll-out expected to take up to 12 years. This leaves the majority of people who could benefit waiting years for treatment, allowing the disease to progress into other associated health concerns and increasing the financial and operational burden on a system that is already under strain.
Slow progress is largely due to systemic underinvestment in obesity care. Despite prevalence growing significantly over the last three decades (in 2024, cases had almost doubled compared to the early-1990s), a clear and intentional approach to funding care has been severely lacking. Examples include the withdrawal of a £100 million government fund for weight-management services in April 2022, just one year after it was announced, and the continued lack of investment identified in an APPG report on access to Tier 3 services this year.
Further barriers to consistent and effective care result from a lack of clear frameworks or guidance for healthcare professionals. Current pathways suffer from a lack of training, time and confidence among clinicians – resulting in low rates of referral from primary care to specialist weight-management services. Access to support remains a postcode lottery, determined by a stark disparity in how obesity treatment is prioritised and funded on a local level. Particularly as new treatment options, such as oral GLP-1s, come into play, addressing these gaps will be critical to ensure equitable delivery of care.
There is an important role for private providers to expand access to advancing solutions, reducing the burden on public healthcare and reaching communities that otherwise have limited access. By drawing on modern digital and pharmacological capabilities, there is an opportunity to reduce prevalence on a population level, moving towards a comprehensive approach to treatment, grounded in early intervention and ongoing support.
Full obesity care pathway
Three organisations – registered charity Obesity UK, digital health provider Voy, and NHS community partner Morelife – collectively span the full obesity care pathway: through advocacy to delivery. Drawing on first-hand experience of the care barriers, we published a white paper as a call-to-action for MPs, with our recommendation for the DHSC to commission a ten-year obesity strategy aimed at improving access and equality in obesity care.
As a first step, chronic recognition of obesity should be embedded in policy documents. NICE’s clinical guidance, recognising obesity as a disease that requires ongoing treatment and monitoring, has not been consistently reflected in DHSC policy. This gap between clinical guidance and government policy has real consequences, as care approaches do not reflect the ongoing, relapsing nature of the condition.
What must follow is a national standardisation for equitable access to care, with clear eligibility criteria and service standards. These must apply across the full care pathway, and consistently across the UK, to remove the current biases and variation that exist in prescribing and referral practices.
Transparency will be key to ensuring providers deliver on commitments to equitable care and long-term support. We propose that NHS England should publish figures of programme uptake, completion and outcomes; monitor for variation across regions and incentivise positive outcomes. Crucially, the maintenance phase should be commissioned and funded as a core element, integrated into long-term treatment programmes – otherwise the benefits of investment elsewhere in the pathway could be lost.
To deliver effectively for people suffering from obesity, the ten-year strategy we propose should set out explicit, funded commitments that address the full pathway, to reduce prevalence and burden of obesity, and improve access to treatment across England. Part of that strategy must prioritise the shift from analogue to digital management of care, and from hospital to community-led programmes – reflecting a wider shift that should cascade across a full NHS 10 Year Plan.
