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Policy: Weighing in
Weight loss drugs are about to hit the mainstream, creating competition and opportunity for the sector, as Liz Terry reports
The UK government has announced a £40m two-year pilot study to help people living with obesity access the newest and most effective weight loss drugs.
Earlier this year, the National Institute for Health and Care Excellence (NICE) recommended the use of the drug Semaglutide (trading under the brand name Wegovy) for adults with a Body Mass Index (BMI) of at least 35 and one weight-related health condition, such as diabetes or high blood pressure. Other drugs are currently under consideration in clinical trials.
When prescribed alongside diet, physical activity and behavioural support, there’s evidence that people taking weight-reduction drugs can lose up to 15 per cent of their body weight in one year, with changes seen within the first month of treatment.
Obesity is one of the leading causes of severe health conditions such as cardiovascular disease, diabetes and cancer and the UK government reports it costs the National Health Service (NHS) £6.5bn a year. To illustrate the extent of the challenge, there were more than a million admissions to NHS hospitals in 2019/2020 where obesity was established as being a factor.
Using these new drug treatments to tackle obesity is expected to contribute to cutting waiting lists by reducing the number of people who are suffering from weight-related illnesses, who often end up needing operations linked to their weight – such as gallstone removal or hip and knee replacements.
Opportunity for the industry
NICE originally advised that Wegovy should only be made available via specialist weight management services, which are largely hospital-based. However, following this course of action would have meant that only around 35,000 people would have had access to the drug.
Realising that tens of thousands more people could be eligible to get Wegovy if it could be dispensed more widely, the NHS has developed the new pilot to explore the expansion of specialist weight management services outside of hospital settings.
No final announcement has been made as to how this will be implemented, leaving the way open for health clubs to step forward to work with the NHS on delivery.
NHS England is leading on the design and development of the pilots, liaising with stakeholders to explore opportunities to make these drugs available to more eligible people once they’re launched in the UK.
The UK’s health and social care secretary, Steve Barclay, said: “Obesity costs the NHS around £6.5bn a year and is the second biggest cause of cancer. This next generation of obesity drugs have the potential to help people lose significant amounts of weight, when prescribed with exercise, diet and behavioural support.
“Tackling obesity will help to reduce pressure on the NHS and cut waiting times. This pilot will also help people live longer, healthier lives,” he said.
NHS medical director Professor Sir Stephen Powis said: “Pharmaceutical treatments offer a new way of helping people with obesity reach a healthier weight and this new pilot will help determine if these medicines can be used safely and effectively in non-hospital settings.”
The arrival of weight loss drugs presents a complex set of opportunities and threats to the health and fitness sector.
Many people who come to us to help with weight control may now think all they need to do is take a pill, so we must be skilful in our messaging to ensure both the NHS and consumers understand that reductions in body fat alone will not lead to optimal health, and that being fit is also a vital part of the equation.
We can do this from a very positive perspective, being mindful of the rich body of research that has been done over many decades which shows fitness is the greatest determinant of health and longevity and also being aware of the mental health issues – including the triggering of eating disorders – that can occur if the subject of weight loss is not tackled skilfully and language around this used mindfully.
There are undoubtedly people who struggle to control their weight and suffer health issues as a result. Being overweight prevents some people from feeling they can participate in exercise, so if the sector is able to be involved with the delivery of this drug, and wrap around other exercise interventions – as the NHS programme requires, then it could be a great outcome for consumers, for the NHS and for the sector.
NICE has said that exercise is a vital part of the success of the use of such drugs, making health clubs ideal partners for this £40m pilot.
GLL’s mission is to improve people’s health and wellbeing through helping them lead more active lives.
We see ourselves as an integral part of the wider health sector and could have a role to play in the Government’s proposed weight loss pilot – which, importantly, not only has the involvement of clinicians, but also involves the delivery of nutritional and lifestyle interventions. We would expect the lifestyle element to include increases in physical activity and that is where we could assist.
This is very similar to the Healthwise ‘exercise on prescription’ services we already run with the heaIth sector, which are supporting people with chronic issues – from pain management and rehabilitation, to weight loss and cardiac disease – to make that important first step into living a more active and healthy life.
In Greater Manchester UK we have over 3,500 staff and around 100 facilities that activity body GM Active wants to position as being part of the ‘army’ at the disposal of the NHS and Public Health colleagues across local authorities.
We have a strong desire to be part of the solution and contribute to people living healthier, happier, longer live (www.hcmmag.com/P4C).
It frustrates me immensely when I read numerous articles about how the NHS does not have the people-power to carry out many tasks that would – relatively easily – fit so well with our vision.
Whether this is helping to administer the new weight loss drugs that are coming to market, or carrying out health checks, we’re overlooked time and time again, even after being heavily involved in the vaccination programme very recently.
We can also add value to many of the services GP surgeries and pharmacies are paid to deliver because we can wrap around packages that they simply can’t. Using this approach people wouldn’t just get an NHS health check and be sent on their way – our highly qualified staff could offer a motivational interview and give advice on how to get more physically active, for example.
So why are we so obviously disregarded by the government and NHS? For me it’s all about credibility. We’re not viewed as being part of the ‘health system’ despite our best efforts to date.
I’ve recently argued that we need to reposition our sector, rebrand it to ‘Active Wellness’ and see it being moved from the DCMS to the Department of Health and Social Care. Look at the priorities for the DCMS and also for the Office of Health, Inequalities and Disparities (a health department) and tell me where you think we should sit?
‘Leisure’ is synonymous with ‘pleasure’ and arguably evokes thoughts of pubs and bars – a pastime, not an essential element of people’s lives related to their health and quality of life.
As a result, that’s how we were treated during the lockdown stages of the pandemic.
As we only touch about 18 per cent of the population through our facilities then maybe that’s fair enough, and I find myself asking some hard questions: is our claim to currently being a big part of the population health agenda flawed? What is our combined vision and purpose going forward? Can we write a national Population Health Wellbeing Plan that speaks to the recent paper by Labour’s Kim Leadbetter A New Approach to Health and Wellbeing Policy (www.hcmmag.com/leadbetter) and be an integral part of the potential new Labour Government’s manifesto? Can we move away from being ‘facility-centric’ and agree that we need fewer but better facilities, combined with more outreach that will see us collaborating with the voluntary sector and health and social care teams, combining our efforts to be more relevant to communities?
• Introducing calorie labelling on menus, which are expected to bring health benefits of £4.6bn and provide NHS savings of £430m
• Restrictions on the location of unhealthy foods in shops, which are expected to bring health benefits of over £57bn and provide NHS savings of over £4bn over the next 25 years
• Introducing the Soft Drinks Industry Levy which has seen the average sugar content of drinks decrease by 46 per cent between 2015 and 2020
• Investment to boost school sport to help children and young people have an active start to life (www.hcmmag.com/schoolsport).
• £20m investment in the Office of Life Science’s Obesity Mission. This is exploring innovative ways to best utilise promising medicines and digital technologies to help NHS patients achieve a healthy weight.
• The Better Health: Rewards App is being piloted in Wolverhampton (www.hcmmag.com/Wolverhampton), offering incentives such as vouchers for shops, gym discounts and cinema tickets for people who eat healthily and exercise more.
• The 2019 Health Survey for England estimated that over 12 million adults were living with obesity – 28 per cent of the population in England – while a further 16 million (36 per cent) were overweight. This means that around two-thirds of the adult population were above a healthy weight – defined as having a BMI of 25 or above.
• The Department of Health and Social Care launched a call for evidence in May to inform the Major Conditions Strategy (www.hcmmag.com/MCS), including further work to tackle obesity.
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