Weight-loss drugs just one part of the puzzle

There has been a lot of talk in the press after Wes Streeting’s comments about ‘obesity jabs’ being used to help people get back into work. The remarks came shortly after the Government announced a new partnership with pharmaceutical giant, Lilly, one of the major manufacturers of the new GLP-1 weight-loss drugs.

The drugs, first licenced for use in the UK last year, were rolled out as part of a £40 million pilot to tackle obesity last June. They are currently available on the NHS through referral to specialist weight management clinics and this week’s news appears to herald a much wider treatment programme. Inevitably, it has renewed the debate around obesity treatments and to be honest, gives me cause for concern.

Before we get to my views on weight-loss drug treatment, I will just touch on the partnership with big pharma. I am well known for my views on this, but I will say it again; there is no place for industry influence in policy. We have seen the impact on the nation’s health that partnerships with the tobacco industry caused and, while pharmaceutical companies are manufacturing treatments as opposed to harmful products, the message, for me at least, remains the same: policies should be made free from any industry influence with the population’s long-term interests at their core, and whether or not treating obesity is in our long-term interests is not clear cut.

I am definitely in favour of helping individuals and I have no doubt that these drugs will help a number of individuals – and lessen the risk of the wide range of diseases that can be caused by obesity for those individuals who are given treatment. However, we don’t yet know the long-term effectiveness of these treatments.

It also seems unlikely there will be a significant population impact and my job, as a Director of Public Health, and as President of the Association of Directors of Public Health, is to promote and protect the health of the populations I serve. I’m just not convinced that weight-loss drugs are going to do that.

Obesity levels are rising. The UK has the fourth highest level of people living with obesity in Europe and around a third of children in their final year of primary school are overweight or living with obesity.

Let’s be clear. Obesity kills. It is responsible for at least 200,000 cancer cases annually, makes people five times more likely to develop type two diabetes and puts immense strain on cardiovascular health. Living with obesity also increases the risk of breathing problems, musculoskeletal disorders and complications in pregnancy, and can adversely impact mental health.

It is important too to remember that obesity disproportionately affects people from lower socioeconomic backgrounds, which is then compounded by the fact that unhealthy food is three times cheaper than healthier alternatives.

Importantly though, these issues make life difficult not just for the individuals involved, not even just for their families, but also for the wider community, and the economy, through increased pressure on our health and social care services and, as the Government has recognised, days missed at work.

To be truly effective though, any strategy to tackle obesity needs to focus on preventing obesity in the first place. We know what to do. Interventions must be framed in regulating harmful product industries, and take a cue from the World Health Organisation’s best buys, based on reducing availability of unhealthy foods, advertising and marketing or price. Doing this will reduce health inequalities, lessen the burden on the health and social care system, and improve productivity – not just now, but in the future as well.

To do that, we of course need to support people now, but we also need to create an environment that promotes good health and enables healthy eating, and positive attitudes to food – and that requires both national and local policy action as opposed to a reliance on individual behaviour.

My concern about making GLP-1 drugs more accessible is that this may weaken resolve to regulate harmful product industries, which will leave people more exposed to obesogenic environments. It will also create a society where people have no incentive to make those changes, either individually or at a population level.

Aside from being logistically and financially impossible to treat everyone living with obesity, it firmly places the emphasis on individual action, taking that all important focus away from the need to create a healthier environment.

These treatments should therefore be seen as part of a much broader strategy – and this should be reflected by investing adequate resources and funding into preventative measures.

Directors of Public Health and their teams provide healthy weight services which support individuals, but also the wider community. However, while money has been found for NHS treatments, public health funding has been consistently cut over the last decade, despite the huge increase in demand.

Earlier this month, ADPH coordinated an open letter to the PM and Chancellor which garnered support from over 40 other health experts and organisations, urging the Government to commit to increased, and more consistent, funding for public health.

More adequate funding would allow us to expand our provision of healthy weight services while at the same time, enabling us to engage effectively with businesses, schools, communities, as well as individuals, to create healthier places for us to live, learn and work in.

It would also allow us to develop and implement more measures to tackle the commercial determinants of health, measures that reduce the extent to which industry influences our consumption of harmful products. There is a lot that can be done through local planning and advertising policies – and working positively with business – to influence urban planning, improve access to green spaces and active transport, and improve the availability of affordable, healthy food.

We’ve seen for example the positive impact banning junk food advertising on transport in London has had, and many LAs are implementing their own advertising restrictions. Similarly, LAs are using planning law to stop new take aways being opened near schools and many local places are taking action.

We need to see acceleration of this local action but we also need national policy to be able to apply regulations and restrictions consistently across the country. We very much welcome the Government’s commitment to tackling these issues with for example, the proposed restrictions on energy drink sales and ban on unhealthy food and drink advertising, but it is vital that these are made a reality, and backed up with mandatory labelling, and product reformulation.

So, while treatment is very much part of the jigsaw, it is just one piece, and I very much hope to see equal investment (not to mention press coverage) to support all the other pieces we still need to fit to be able to truly tackle obesity.