Kevin Joshua, superintendent pharmacist and clinical lead at Juniper, argues that preventing obesity-related diseases requires more than just identification and monitoring.
According to the NHS, global obesity rates have tripled since 1975, with the UK ranking among the worst in Europe. Obesity is a national epidemic that is putting increased strain on and costing the NHS an estimated £11 billion annually. With 64% of UK adults overweight or living with obesity and an upward trend predicted, 40% of the population could have obesity by 2040, leading to an uptick in serious health conditions like diabetes, cancer, and cardiovascular disease.
As weight-loss medicines shift health officials’ focus towards obesity, there’s a growing opportunity to reform this niche area of the health system. The National Institute for Health and Care Excellence (NICE), a non-departmental public body of the Department of Health and Social Care, recently recommended routine body mass index (BMI) checks across England and Wales for some patients. This is a valuable step, but it must be part of a broader, long-term strategy.
Preventing obesity-related diseases requires more than just identification and monitoring – it demands greater government action and a shift towards early intervention. While BMI can serve as a useful screening tool, it is necessary to look beyond a single health indicator in diagnosing obesity. Now is the time to change the way we look at obesity to ensure stigma and outdated misconceptions don’t prevent people from seeking or getting the help they need.
Limitations of BMI
BMI – defined as weight in kilograms divided by the square of height in metres – was dubbed by the World Health Organization as the official screener for obesity in the 1990s. While BMI provides an indication of unhealthy weight gain, it doesn’t capture the full picture of an individual’s overall health or weight-related health risks.
BMI can misclassify individuals with high muscle mass as overweight or obese, despite good physical health. It also fails to account for fat distribution – two people with the same BMI may have vastly different health risks depending on where fat is stored, and therefore their overall metabolic health.
For change to take effect, it must be understood that obesity is not simply a matter of willpower or lifestyle choices – it is a complex condition influenced by genetics, environment and metabolic factors. The guidelines from NICE need to be supported by additional metrics. Waist circumference, waist-to-hip ratio, or waist-to-height ratio alongside BMI would offer a broader and more accurate view of a person’s weight-related health.
By combining these with direct body fat measurements, healthcare professionals can take a more personalised and thorough approach to supporting individuals with weight management.
The role of tailored support
Obesity is often not addressed with the same level of nuance or individualised care as other health conditions. With NICE reinforcing the need for healthcare systems to prioritise consistent, long-term support for weight management across all settings, the time has come to change the way we treat obesity.
In reforming and updating how weight is assessed and managed, a holistic, personalised approach combining lifestyle changes is proving an extremely effective route, including healthy eating and exercise, administering weight loss medication alongside support from clinicians, psychologists and peers. GLP-1 medications, like Wegovy and Mounjaro, can be integrated as part of a personalised care plan based on an individual’s unique health profile.
However, increased funding is needed for the NHS to offer a holistic treatment approach to obesity. Currently, only five of England’s 42 Integrated Care Boards (ICBs) have included obesity or the importance of a healthy weight among their priorities, meaning access to treatment is very limited, including for higher priority cases.
As the NHS continues engaging with ICBs to determine the most effective delivery models for healthcare, digital platforms are being considered as a viable option alongside community-based approaches. Continued investment in more effective, targeted approaches has the potential to ease long-term pressure on the NHS and improve overall system efficiency.
Combatting stigma and driving systemic change
Further to changes in how we treat obesity, it’s important we also reassess how we view the disease. Progress in updating weight management systems rests in driving systematic change. With an active conversation occurring around weight management across the UK, the current sentiment is typically that obesity is an individual problem, with lifestyle changes seen as the only solution. However, the chronic nature of obesity means that lifestyle changes do not always deliver long-term progress in losing weight.
Addressing stigma always begins with education. Misconceptions surrounding obesity contribute to fewer people seeking help. The complex interplay of genetics, environment, and metabolic factors related to obesity are all important in challenging these mindsets. Implementing educational initiatives in schools and workplaces is important in creating clear awareness around weight health, alongside workplace health models providing comprehensive care. Ongoing healthy living education to people living in deprived areas is vital, with strategies ensuring respect and support for individuals living with obesity.
As the healthcare system develops to meet the demands of an ever-evolving population, a wider conversation must take place discussing how we view and treat obesity. The NICE recommendation is welcome as a first step but reducing stigma around the causes and realities and the treatment options for obesity, such as GLP-1 medicines, is crucial if the weight crisis is to be effectively addressed.
