The Bow Group concludes that obesity cannot be tackled by government intervention alone

Tom Kelley is an academic foundation doctor and a member of the Bow Group Health & Education Policy Committee.  Stuart Carroll is a senior health economist and Chairman of the Bow Group Health & Education Policy Committee.  Gary Jones is a public affairs consultant and Editor of Crossbow.  Here they summarise the research paper they have written for the Bow Group focusing on the issue of obesity and public health, which is published today and can be downloaded here from the Bow Group website. 

Tackling obesity must be at the centre of the Coalition’s public health plans. In the recently published public health White Paper ‘Healthy Lives, Healthy People’, the Government committed itself to publishing a separate follow up policy document specifically looking at the issue of obesity.  Our report highlights some of the key things that need to be done and should be included in this document.

In 2004, 67% of men and 69% of women were classified as overweight or obese.  Current predictions forecast that a staggering 60% of the UK population will be clinically obese by 2050.  Although holistic definitions that transcend the technical confines of the Body Mass Index (BMI) and properly account for individual medical history are important, there is little doubt that obesity has reached increasingly epidemic proportions.  There is also little doubting the need to stop and reverse this trend.

Multiple reports and strategies have been published, but the fact remains that obesity rates continue to rise.  Restrictions on advertising, increasing physical activity and healthy eating in schools, the 5-a-Day Campaign, and the Change4Life Campaign are some of the initiatives introduced and promoted by the previous Labour administration.  Despite this, the obesity problem has not gone away – it has got worse and become more ingrained – and so clearly a new strategy and policy direction is needed.

The policy recommendations in our report focus on six key areas:

1.    Obesity in society and the general population
2.    Obesity and other diseases
3.    Obesity and medical training
4.    Obesity in schools
5.    Obesity in the workplace
6.    Obesity and the UK economy

1.    Obesity in society and the general population

Society has evolved, with transport, food production and work patterns having all changed.  Consequently, obesity is now seen as a passive phenomenon that is a gradual process resulting from our day to day lives.   However, it is important for all of us to remember, as Antony Worrall Thompson commented in our report, that “we can use all of the excuses in the world, but if you eat too much, without compensating with exercise, you will become obese.”  The Quality Outcomes Framework (QOF) incentivises GPs to register obese patients, but it does not incentivise them to do anything about it. 

We strongly endorse greater powers and greater freedom to local government to tackle factors that affect health and wellbeing in their area, for example, access to shops, sports facilities and green areas.  Furthermore, as Professor Haslam, Chairman of the National Obesity Forum, explains in our report, the QOF must change to incentivise GPs to manage their patients so that they lose weight.  The current system is not working and therefore needs to be reformed. 

2.    Obesity and other diseases

Obesity is a significant risk factor for many different types of cancer, for type 2 diabetes, and for complications in patients undergoing surgery.  How many patients realise this?  Probably very few.  Although 13 years of Labour Government proved that lecturing people achieves next to nothing, the population at large must be educated through public health campaigns so that people are empowered and thereby made aware of the enormous health risks associated with being heavily overweight.   There must be improved access to supermarkets, green and open space and leisure facilities in poor areas. 

However, in isolation these measures are inadequate.  Improved access must be accompanied by improved education from health, social and education services so that people are not only made aware of the obesity-associated health risks, but also so that they understand how they can tackle these issues effectively and sustainably.

3.    Obesity and medical training

Effectively training our future doctors and healthcare professionals in the causes, management and prevention of obesity is essential.  After all, if medical professionals do not have a full and proper understanding of the underlying causes of obesity, and the best available treatment pathways for people struggling with their weight, there is little chance and hope for the wider population.  

Despite being recognised as a primary public health challenge, it is shocking that obesity currently receives very little attention in undergraduate curricula.  The General Medical Council’s document “Tomorrow’s Doctors” sets the outcomes that medical students must learn at medical school, and unbelievably there is only one mention of obesity – and this is in a section obscurely entitled “discussing sensitive issues.” 

“We haven’t received specific teaching on obesity,” is a familiar comment we received, not surprisingly, from a number of medical students and junior doctors.  We therefore strongly recommend that diet, lifestyle and levels of physical activity should become key components of a standard medical history.  We also advise that obesity features more prominently in the undergraduate curricula.  Students and practitioners in all healthcare professions must be aware of the causes and consequences of obesity, and the best management options available.  Finally, obesity management is multi-disciplinary and so this, we believe, should be reflected by establishing innovative multi-disciplinary obesity programmes where healthcare professionals are educated together.  The promotion of public health cannot be monopolised by one healthcare profession, but rather must be an integrated imperative that is collectively advanced.  

4.    Obesity in schools

Parents are crucial in the fight against childhood obesity from day one.  They are critical in providing an environment both in the womb and in the home that supports, enables and encourages a healthy lifestyle.  Antenatal classes, postnatal care, health visitor and family nurse partnership programmes are all essential for educating mothers and fathers on the importance of providing a healthy diet and a healthy environment for their children and in empowering them to achieve these goals.  These programmes must continue.  In addition, programmes that aim to reduce childhood obesity must target both children and parents as either in isolation will struggle to be successful.  Finally, we believe that physical education and sport must remain core subjects for all pupils in all years without political correctness rearing its ugly head over “competitive sport” and after hours sports clubs. 

5.    Obesity in the workplace

It is clear that reducing the prevalence of obesity could ultimately lead to significant savings for employers, as obese individuals have been shown to take more sick leave.  We call on all businesses and organisations to promote healthy living amongst their employers by encouraging walking and cycling to work, by ensuring that healthy food and drink is always available, and by establishing clubs that promote physical activity, like lunchtime running clubs.  As emphasised previously, putting mechanisms in place is vital, but equally important is the workplace educating their employees about why a healthy lifestyle is needed, how they as individuals can lead a healthy lifestyle, and how the workplace can support these outcomes.  We believe all workplaces should create healthy living champions who are charged with seeing through this agenda.  The NHS itself should lead by example, as this would not only improve healthy living amongst NHS staff, but would potentially help to improve compliance rates amongst their patients.

6.    Obesity in the workplace

Finally, there is the UK economy.  The estimated cost to the NHS of obesity-related conditions is £4.2 billion every year.  Public health, and therefore the issue of obesity, is not just a health imperative. There is also an economic imperative.  This is particularly important against the backdrop of the UK’s yawning budget deficit and the current economic climate.

Successful public health interventions can help improve the health of the nation at large.  This is inherently good for individual wellbeing, but it is also good for society. If people are healthier and fitter, they are less likely to lose their jobs through ill health and more likely to be able to enter the workplace if out of work. They are also more likely to deliver greater productivity in the workplace. All of this is good for the economy and for business, particularly in the current economic climate and given that the UK needs to maximise “injections” rather than “withdrawals”.

This has recently been highlighted by the Employment and Learning Minister in Northern Ireland, who explained that achieving a healthy workforce is essential to achieve higher business growth, better productivity and international competitiveness. He also stated that obesity costs the Northern Ireland economy approximately £500 million each year and that it causes the loss of approximately 260,000 working days. It is this value-based argument that Andrew Lansley and Co. must continue to make to their Treasury colleagues to ensure public health, and tackling obesity, is given appropriate financial backing.

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In summary, we have highlighted the importance of empowering local government, of educating the population and healthcare professionals, and of incentivising GPs if we are to buck the trend and ultimately win the fight against obesity. 

However, the problem cannot be solved by Government intervention alone and will ultimately need individuals to take more personal responsibility if society is to turn the tide. “Nannying” will not work and has not worked. It is also contrary to Conservative principles. The key is to nudge and educate to improve people’s awareness, and the decisions and actions they take as a direct consequence. Those on the far right-wing tend to argue “do nothing” as anything other is an apparent erosion of personal freedom. Those on the far left-wing argue for full scale intervention claiming that people are incapable of making proper decisions. The truth is that neither perspective is particularly helpful or insightful, and does very little to advance a genuinely important public health challenge.

Andrew Lansley is right to focus the frontline obesity drive away from a Government campaign to more of a social movement, utilising and maximising the important contributions of charities, local authorities and the commercial sector where possible. It is from this perspective that tackling obesity confers an important opportunity for the “Big Society”; an opportunity the Prime Minister would do well to take as his “mission in politics” continues to be challenged and doubted.

The early sounds from the Government have been positive, but it is absolutely essential that strong rhetoric is backed up with clear detail and a strategy for implementation. With something as delicate, difficult and complicated as public health, this is not always easy. This is the challenge for the Government’s soon to be published obesity strategy, and something interested stakeholders will be following closely.

The Government is right to put early intervention at the centre of its policies and as such it logically follows that it would make sense to urgently prioritise the tackling of childhood obesity. This will be particularly important given that evidence suggests obese children are likely to go on to become obese adults, and the associated escalation in obesity related health problems with age.

In the end, obesity is neither attractive from a health point of view nor affordable from an economic standpoint. Tackling it not only constitutes good health, but also good business.