The big issue
The rising tide of obesity shows no sign of slowing down. The number of adults in England who are overweight or obese is up from 52.9 per cent (obese 14.9 per cent) in 1993 to 64.3 (28.0) per cent today. Some 75 per cent of people aged 45-74 are overweight or obese, while one in seven children are obese by age five, rising to a quarter by age 11, according to NHS Digital. In England, men are more likely to be overweight than women overall, although among 16-24 year olds, the position is reversed.
According to Sport England’s Active Lives survey, excess weight varies among social groups. In the most deprived areas of England, prevalence is 13 per cent higher than in the least deprived. People with disabilities are 11 per cent more likely to be overweight. Black people have the highest rate of excess weight (68 per cent), followed by white British people (64 per cent).
The latest National Child Measurement programme figures are more positive. Obesity prevalence in reception age children is down from 14.4 per cent in 2020/21 to 10.4 per cent in 2021/22; in school year six, it’s down from 25.5 per cent to 23.5 per cent. Boys have a higher prevalence than girls in both age groups.
A new report by the Nuffield Trust on child obesity found that children are more likely to be overweight when there is more poverty, lower breastfeeding rates and when fewer adults take physical exercise. Poorer access to places to do physical activities is another factor.
"men are more likely to be overweight than women overall, although among 16-24 year olds, the position is reversed"
Nuffield Trust senior fellow Dr Liz Fisher says: “Despite many previous initiatives, levels of childhood obesity have remained constantly high over recent years. Our recent analysis has shown that higher childhood poverty rates are associated with higher levels of obesity. Food and drink promotions, which make products cheaper, are more likely to be used for unhealthy food and drinks and do influence what people buy and lead to people buying more than expected. The Government faces a difficult decision in balancing tackling the childhood obesity crisis versus supporting those struggling financially.”
The report’s authors argue that as obese children today are developing health problems that once only affected adults, tackling obesity early is even more urgent. The pandemic has impacted on socioeconomic inequalities, which may increase levels of overweight and obesity among more deprived children.
NHS Digital Weight Management programme
Community pharmacies can refer customers living with obesity and also diabetes or high blood pressure to the free NHS Digital Weight Management programme. To be eligible, customers must be: Age 18+; BMI of 30+ or 27.5+ for Black, Asian or minority ethnic; have diabetes, high BP or both; have a smartphone, tablet or computer with internet access.
The picture across the UK
Latest available figures report 27.5 per cent of adults as obese and 34.7 per cent overweight. Some 77 per cent of Scottish men aged 65-74 are overweight or obese. The Scottish Health survey found that, among children, 30 per cent of children aged two to six, 25 per cent of the seven to 11s, and 33 per cent of those aged 12-15 are obese.
The National Survey for Wales data for 2020/21 found that 26 per cent of women and 22 per cent of men were obese, while some 66 per cent of men were overweight or obese compared with 56 per cent of women. Obesity was highest in the 45-64 age group at 28 per cent.
"The Government faces a difficult decision in balancing tackling the childhood obesity crisis versus supporting those struggling financially"
Child Measurement Programme for Wales 2020/21 data from two health boards – Swansea Bay and Aneurin Bevan – found a significant rise in obesity in four to five year olds compared with 2018/19. Swansea Bay reported 16.4 per cent of children as overweight and 17.6 per cent as obese, compared with 13 per cent in 2018/19. In Aneurin Bevan, 14.2 per cent were overweight, while 18.3 per cent were obese, up from 11.8 per cent in 2018/19. The Health Survey Northern Ireland found that 27 per cent of adults were obese and 38 per cent overweight. Some 71 per cent of men were overweight or obese, compared with 60 per cent of women. In children, 20 per cent were classed as overweight and 6 per cent as obese.
An obesity strategy?
The Government’s decision to delay some of its planned measures to tackle obesity due to the “unprecedented global economic situation and in order to give industry more time to prepare for the restrictions on advertising” has met with widespread criticism.
Rules limiting the location of unhealthy foods in shops went ahead as planned in October 2022. Unhealthy products are no longer promoted in key locations, such as checkouts and store entrances. However, rules banning multibuy deals on foods high in fat, salt or sugar (HFSS) and restrictions on free refills for soft drinks have been delayed for a year. The restrictions banning adverts for HFSS foods and drinks on TV before 9pm and paid for adverts online have been delayed until January 2024.
An opinion piece in the BMJ criticised the Government’s u-turn, suggesting its justification for the delays does not withstand scrutiny. “It is undoubtedly a challenging time for many people, and the crisis is hitting the poorest in the UK hardest,” it said. “Obesity is no different. People in deprived areas face the greatest barriers to healthy and affordable foods and much needed medical support. So where is the help for access to healthy food now?… The UK should be delivering joined up, visionary and thoughtful action, like subsidising fruit and vegetables and real ingredients, and putting taxes on junk food, as is the case with sugary drinks.”
An article in the journal Obesity also condemns the decision. “The delay is a step back on progress tackling obesity amid rising and record levels in UK adults and children,” the authors say. “The ambition of these policies – a first for the UK food industry – was to fundamentally change those retail food environments that are promoting less healthy products more than those considered healthier. Without regulation, commercial retail food environments will be difficult to change.”
The British Dietetic Association believes: “Action at a national level could ensure that people can afford food now, and also that healthy food choices are affordable in the future. The causes of overweight and obesity are complex, yet we know that access to healthier food choices, and an environment that makes these choices affordable, are important elements in helping people manage their weight and live healthier lives.”
Restricting HFSS products by location in stores is a positive step, says the BDA Obesity Specialist Group, but it’s only one measure: “We can’t expect this change to be a silver bullet, but it is a positive step. What we also need to see is change going much further with support for people living with obesity being vital. We need more funding into weight management services.”
Hannah Poll, senior policy officer at Diabetes UK, adds: “It’s hugely disappointing that the Government is delaying its obesity strategy measures. These are part of a vital toolkit to rebalance health inequalities and delaying them undermines the Government’s own commitments to halving childhood obesity by 2030. Promotions have been found to increase the total amount of household food and drink purchased by over 20 per cent. Evidence suggests that multibuy promotions don’t save people money – they encourage people to spend more. The recent report on the sugar reduction programme showed that we can’t rely on voluntary measures to drive reformulation.”
Community pharmacy’s role
An NPA roundtable event last year with public health experts, community pharmacists and those living with obesity came up with seven action points that would enable better NHS services for those living with obesity:
- People living with diabetes should have access to weight management services, with a focus on community pharmacy provision
- Focus weight management and obesity services on children and young adults
- Talk about people that are living with obesity to help stop blame and stigma
- Promote community pharmacy as the setting for person-centred services that can help people living with obesity
- Use Health Champions, social prescribing and localised health services to enhance the community pharmacy service across the UK
- Improve pharmacy teams’ knowledge, skills, understanding and practical application of obesity and obesity services, including the pharmacy undergraduate curriculum
- Seek opportunities that are likely to emerge from the genetic and digital revolutions to improve services to those living with obesity.
The report is being shared with policy makers and commissioners, says Helga Mangion, policy manager at the NPA. “The recommendations should be used as a guide for patient-tailored commissioned services through community pharmacy that would provide support to those living with obesity. These may include developing lifestyle plans through to pharmacological intervention, all worked up around the individual and their families.”
Numark service development pharmacist Emily Temple says: “As a community hub, pharmacists and their teams often already have a good relationship with their customers, helping with positive line of communication and boosting customers’ confidence in speaking to a healthcare professional. Currently, weight management services are only offered privately. It would make it more accessible for customers if, in future, community pharmacy was in a position to provide NHS funded services.”
Stuart Gale, managing director of Oxford Online Pharmacy, says: “There is huge potential in community pharmacies. Pharmacists and their trained staff could support many more patients in their weight loss, but the service must be funded properly.” He says many weight loss patients have had negative experiences of NHS services, so instead use an online doctor service to get access to orlistat and liraglutide.
Ms Poll says: “Community pharmacists are often an untapped source of information for people with type 2 diabetes. They can offer healthy lifestyle advice on how to improve diet and nutrition, information on reducing alcohol consumption, stopping smoking and increasing physical activity.”
The BDA Obesity Specialist Group advises: “Developing knowledge and skills to support people living with or at risk of developing obesity will be key to helping your customers. We know that people experience stigma and discrimination in healthcare settings and this has significant consequences. Community pharmacies can support people to lead healthier lives and be aware of what holistic support is available in their local area.
“People living with obesity may also live with serious physical and psychological conditions. A key area of support would be to work in partnership with patients and prescribers to identify the potential for medications to affect activity levels and weight gain and by providing education on weight sensitive alternatives.”
Improve your weight management category
Catherine Webster, Numark OTC development manager, has this advice: “Pharmacists should consider this a healthy lifestyle and nutrition category, covering a variety of nutritional matters including weight management, nutritional deficiencies, intolerances, cholesterol, diabetes and lifestyle. The category should be clear to browse, presenting definition between the different sections using well known brands and signage.” Having a variety of products to support customer needs including weight management products, health foods, blood pressure monitors and blood glucose tests is important.
Views of the P3pharmacy category panel
“Our GPs prescribe orlistat, and our Lipotrim programme was pulled. We don’t get many customers asking for our advice on weight management, which may be due to people not wanting to discuss it in the shop, but we do occasionally get asked about what might be available to take and what is safe. We don’t have weight management products in branch. However, we always suggest increasing dietary fibre and drinking more fluids throughout the day.”
Marisa Maciborka, Well Pharmacy, Hirwaun
“This category has become more important as people are more conscious of looking after their health. The nutritional side is important to our customers, so we have nutritionists who can advise them. We do get asked about supplements that can help with weight loss, and energy supplements that can boost the efficiency of a workout. Good sellers are Solgar supplements, Viridian and Nature’s Plus. We stock at a range of price points and tend to spread products around the pharmacy.”
Sarina Mughal, Day Lewis, Knightsbridge
“Weight management is always important, as poor management can have negative health complications. Questions are rare; like smoking, unless motivated to make a change, patients tend to avoid the topic. Indirectly, purchases of blood pressure monitors have increased, which may be due to weight-related high blood pressure diagnoses. However, with pressure on the cost of living, peoples’ priorities may have changed, pushing weight reduction to the back of the list.”
Ellis Nugent, Davies Chemist, Gurnos, Swansea