Chew the fat: the obesity epidemic15 May 2012
Despite rising worldwide obesity rates, there is a paucity of effective care and treatment available to sufferers. Matt Capehorn and Tam Fry of the UK’s National Obesity Forum talk to Ross Davies about the need for clearer strategies, and creating a greater public understanding of the causes and dangers of a condition threatening to become chronic.
When UK Health Secretary Andrew Lansley announced his "national ambition" to cut five billion calories a day from Britons' diets in October 2011, it was unlikely that he envisaged the subsequent backlash the plan received.
Forming part of the government's Public Health Responsibility Deal, also aimed at encouraging food and beverage companies to reduce calories in their products, the initiative has mainly been censured for its lack of clarity. Notable detractors included celebrity chef and campaigner Jamie Oliver, who deemed the declaration to be "worthless, regurgitated, patronising rubbish".
Such an unfavourable response only goes to highlight escalating concerns over today's obesity crisis, on local and global levels - according to data published last year by the World Health Organization, worldwide obesity has more than doubled since 1980.
Concomitant with rising diabetes, cardiovascular diseases and strokes, around 60% of adults in the UK are currently overweight or obese, with researchers forecasting the figure to rise by a further 11 million cases by 2030.
Yet, despite the disconcerting figures, there remains a conspicuous lack of clinical treatment on offer to obese patients. Hospitals still don't have adequate bariatric facilities and, although the NHS has made investments in anti-obesity drugs over the last decade, only one prescription pill is on offer to patients.
Media effect on obesity
The first step in tackling the scarcity of such provisions may come in addressing an age-old stigma, which continues to have an influence on public perception over obesity.
Take the following example. In February 2012, Mail Online - the world's largest online newspaper site - published a story about the plight of Keith Martin, believed to be the world's fattest man. Accompanied by an image of a bedridden Martin, the article carried the headline: '58st and a £500,000 bill: But I deserve NHS support says world's fattest man'. The website's message-board subsequently received 1,230 comments, mostly ranging from vitriolic to facetious.
Sift through any of today's tabloids, and there's a high possibility you will stumble across similar headlines, often with salacious subheadings documenting exorbitant eating habits; however, it was the article's mention of NHS treatment - subsidised by the taxpayer - that prompted the most incomprehension among readers. According to Dr Matt Capehorn, clinical director of the National Obesity Forum (NOF), a body established in 2000 by a team of medical practitioners to raise awareness of the emerging epidemic, the problem derives from an entrenched misconception that obesity refers to a social disorder rather than a valid condition requiring medical treatment.
"Unfortunately, there is a stigma associated with obesity in the general public that even extends to within the healthcare profession," he says. "While the NOF accepts that obesity is a social problem, it is important to remember that NHS treats lung disease patients as a result of smoking or those with liver conditions as a result of alcoholism - these are social problems, too. Why should it be any different with obesity?"
Obesity care and support
Despite the advances in weight-measurement equipment and technology - which can now detect how much of a person's weight percentage comprises bones, muscle, fat and water - hospitals are still underprepared and understaffed for providing care for the obese.
"Whichever angle you look at it, hospitals are not well suited for overweight patients," says Capehorn. "Whether we are talking about general equipment such as bigger and stronger beds, or better transport facilities for moving morbidly obese patients from one department to another, it requires more advanced equipment.
"This also goes for a lack of specialists, which stems back to the time when if a healthcare professional had an interest in weight loss, he or she would go into the field of dietetics. Until very recently, weight management wasn't taught to medical undergraduates or nurses during training."
This has seen the establishment of specialist weight-management clinics such as the NHS-affiliated Rotherham Institute for Obesity, of which Capehorn is the clinical manager. The clinic, which targets both adults and children, was opened in 2009 on the back of the Yorkshire town being dubbed the 'fat capital' of the UK. The NOF is hopeful of a proliferation of such clinics in the coming years as an integral means of support for obese communities.
"We haven't got enough of them yet, but they are on the increase," says Capehorn. "What weight-management clinics can offer is not just specialist equipment, but also a multidisciplinary team approach comprising obesity specialist nurses, health trainers and exercise therapists. Also, with a primary care-based specialist centre, patients can receive daily and weekly support, rather than a typical hospital clinic where patients are seen and asked to come back again in six months."
Cognitive therapy remains the most common form of treatment for obesity patients, mainly on account of it being the safest. Non-prescription diet pills - synonymous with insidious junk mail advertising - have been proven to have little impact on reducing body fat, while feared side-effects such as liver failure have seen the NHS withdraw medication in recent years. Consequently, Orlistat, which reduces intestinal fat absorption, is presently the only prescription pill UK GPs are legally able to prescribe to patients.
"Over the last ten years, we've had three medications licensed by the NHS, but regrettably, two have been taken off the market because of safety fears," says Capehorn. "Over the last year, we have been conducting a trial at Rotherham Institute with another drug called Victoza, which can only be prescribed to obese diabetic patients; however, we believe a separate licence to be used with non-diabetic patients would be very useful."
Family responsibility for obesity
While Capehorn looks to improved care and treatment, his colleague and head spokesperson for the NOF, Tam Fry, believes that the first step to obesity prevention starts at the family home.
"Most people would agree that responsibility lies with parents in ensuring that children grow up with a balanced diet," he says. "But, parents can only operate in the nutritional environment that society permits. Today, this is dependent on regulations within the food industry and the government."
Fry is also honorary chairman of the Child Growth Foundation, and an outspoken figurehead when it comes to tackling obesity in children. In light of figures published by the NHS in December 2011, which revealed that one in five children is obese by the end of primary school, he also believes a considerable portion of culpability falls at the feet of food advertisers.
"A large majority of food advertising is aimed at children," he says. "That is why governments across the world should ban food advertising. Despite the 'responsibility deal', if you walk into a supermarket anywhere in the country, you'll still see chocolate bars on sale at eye-level for children. The food industry, unsurprisingly, is always going to be focused on profit rather than helping people bring up children in a healthy way. Governments need to look into this."
To further curb the country's intake of fatty foods, many obesity specialists advocate following in the footsteps of Denmark, which last year introduced the world's first food fat tax. With a surcharge on foods that are high in saturated fat, officials hope it will - despite some disgruntled producers and a relatively low national obesity rate of 10% - reduce the country's level of obesity.
"A form of taxation on foods high in fat, salt and sugar would be at the top of my wish list," says Fry. "While the Food Standards Agency has aimed to get UK food and outlets to eradicate trans fats, not enough have signed up, and the few that have, have only done so to avoid legislation. So, I believe we need to do something similar to what the Danes have done."
While Capehorn shares a similar viewpoint to Fry that food standards agencies need to play a greater and more responsible role, as a clinician he is less convinced over the benefits of applying surcharges on foods. He believes that it will not facilitate a greater understanding and awareness of the proximate and indirect causes of obesity in society.
"I don't believe it is the best solution for the problem for several reasons, but mainly because it doesn't educate people in eating healthily, and adopting a balanced diet and better lifestyle," he says. "All it does is financially penalise people who indulge in these kinds of foods."
Capehorn and Fry are in unison in condemning Lansley's national ambition as being lacklustre. In addition to qualms over what five billion calories actually constitutes - Lansley claims it amounts to the equivalent of 16.9 million cheeseburgers spread across 20 football pitches - both cite it as being arbitrary and too broad-brush.
"It's unlikely to happen," says Capehorn. "It doesn't seem to take into account that childhood obesity needs to be tackled differently to how we deal with adults. Also, it's difficult to do without education and the support of a weight-management programme. And where's the public health campaign?"
Fry adds: "To me, it's nothing more than a piece of ill-advised Department of Health copywriting. It seems to be a figure plucked from out of the blue with no viable way of measuring this reduction. It also doesn't tackle the food producers, who are so important in all of this."
With the likes of the NOF lobbying for more weight-management clinics, as well as healthy eating campaigns endorsed by public figures such as Jamie Oliver and Michelle Obama, there's no doubt that attempts are being made to counter the status quo. Yet, as healthcare organisations, researchers and thinktanks continue to publish damning statistics, the endemic isn't displaying any clear signs of dissipating any time soon.