Time to act? Is the new era of gut hormone-based pharmacotherapy an opportunity to rethink the tier-based UK obesity care model?
DOI:
https://doi.org/10.15277/bjd.2024.464Keywords:
obesity, tier 3, weight-loss pharmacotherapyAbstract
Obesity, like type 2 diabetes, is a complex, often life limiting disease influenced by genetics and modern environment. However, unlike diabetes, the provision of integrated, holistic care for people with obesity in the UK remains underdeveloped, despite the growing prevalence of obesity and increasing availability of effective treatments for weight loss. The current tier-based approach to obesity management, although based around a multidisciplinary model, can be fragmented with significant geographical variations in care. The recent approval of new pharmacotherapies by the National Institute for Health and Care Excellence offers an opportunity to rethink and reshape the approach to obesity management. This article provides a review of the current tier-based system for obesity care in UK and proposes alternative models aimed at improving efficiency, promoting equity, and enhancing person-centred outcomes.
References
Obesity and overweight fact sheets. World Health Organization. 1 March 2024 [cited 2024, 25 November]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024;403 (10440):2133-61. https://doi.org/10.1016/s0140-6736(24)00757-8.
Official Statistics Obesity Profile: statistical commentary, November 2023. Published 7 November 2023. GOV.UK. [cited 2024 25 November]. Available from: https://www.gov.uk/government/ statistics/obesity-profile-november-2023-update/obesity-profile-statistical-commentary-november-2023.
Henshaw L. Empowerment, diabetes and the national service framework: a systematic review. J Diabetes Nurs 2006;10:128-35.
Papamargaritis D, le Roux CW, Holst JJ, Davies MJ. New therapies for obesity. Cardiovasc Res 2024;119(18):2825-42. https://doi.org/ 10.1093/ cvr/cvac176
NICE. Obesity: identification, assessment and management (2014) [CG189]. Last updated 26 July 2023. [cited 2024 25 October]; Available from: https://www.nice.org.uk/guidance/cg189.
Hazlehurst JM, Logue J, Parretti HM, et al. Developing integrated clinical pathways for the management of clinically severe adult obesity: a critique of NHS England policy. Curr Obes Rep 2020;9(4):530-43. https://doi.org/10.1007/s13679-020-00416-8.
Mahase E. Obesity: Integrated care boards close lists for weight management services as demand skyrockets. BMJ 2024;385:q1356. https://doi.org/10.1136/bmj.q1356.
Official Statistics. Obesity profile: short statistical commentary published 8 May 2024. Office for Health Improvement & Disparities; [cited 2024 25 October]. Available from: https://www.gov.uk/government/ statistics/update-to-the-obesity-profile-on-fingertips/ obesity-profile-short-statistical-commentary-may-2024#:~:text=In%202022%20to%202023%2C%2064.0,to%20be%20living%20with%20obesity.
New position statement: a way forward for the treatment of obesity. Obesity Health Alliance. Published 16 October 2024. [cited 2024 25 November]. Available from: https://obesityhealthalliance.org.uk/2024/ 10/16/treatment/.
Coulman KD, Margelyte R, Jones T, et al. Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): an observational cohort study. PLoS Med 2023;20(9):e1004282. https://doi.org/10.1371/ journal.pmed.1004282.
NHS Diabetes Prevention Programme (NHS DPP). NHS England. [cited 2024 25 November]. Available from:
https://www.england.nhs.uk/ diabetes/diabetes-prevention/.
The NHS Digital Weight Management Programme. NHS England. [cited 2024 25 November]. Available from:
https://www.england.nhs.uk/ digital-weight-management/.
Guidance on implementation of changes to the Endocrinology and Diabetes curriculum. JRCPTB. [cited 2024 25 November]. Available from: https://www.thefederation.uk/sites/default/files/Guidance%20on%20implementation%20of%202017%20changes%20to%20E%26D%20curriculum.pdf.
Treatment of overweight and obesity position statement & evidence review. Obesity Health Alliance, October 2024. [cited 2024 25 November]. Available from: https://obesityhealthalliance.org.uk/wp-content/uploads/2024/10/OHA_Treatment_2024.pdf.
Mahase E. Obesity: only half of England has access to comprehensive weight loss services. BMJ 2024;386:q1950.
https://doi.org/10.1136/bmj.q1950.
Finer N, Seager S, Linda P, Cecilia P. Tier 3 obesity services in England - ongoing failure to meet need. Obesity Abstracts 2024;4(OC1). https://doi.org/10.1530/obabs.4.OC1.
NICE. Digital technologies for delivering multidisciplinary weight management services: early value assessment. HTE14. Publised 26 October 2023. Last updated 06 March 2024. [cited 2024 25 October]. Available from: https://www.nice.org.uk/guidance/hte14.
Brown TJ, O'Malley C, Blackshaw J, et al. Exploring the evidence base for Tier 3 weight management interventions for adults: a systematic review. Clin Obes 2017;7(5):260-72. https://doi.org/ 10.1111/cob.12204.
Melson E, Ashraf U, Papamargaritis D, Davies MJ. What is the pipeline for future medications for obesity? Int J Obes (Lond) 2024. https://doi.org/10.1038/s41366-024-01473-y.
NICE. Tirzepatide for managing overweight and obesity [ID6179]. In development [GID-TA11156]. Expected publication date: 14 January 2025. [cited 2024 25 October]. Available from: https:// www.nice.org.uk/ guidance/indevelopment/gid-ta11156.
Venditti EM, Bray GA, Carrion-Petersen ML, et al. First versus repeat treatment with a lifestyle intervention program: attendance and weight loss outcomes. Int J Obes (Lond) 2008;32(10):1537-44. https://doi.org/10.1038/ijo.2008.134.
Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA 2024;331(1):38-48. https://doi.org/10.1001/jama.2023.24945.
Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018;391(10120):541-51. https://doi.org/10.1016/s0140-6736(17)33102-1.
Astbury NM, Aveyard P, Nickless A, et al. Doctor referral of overweight people to low energy total diet replacement treatment (DROPLET): pragmatic randomised controlled trial. BMJ 2018; 362:k3760. https://doi.org/10.1136/bmj.k3760.
Valabhji J, Gorton T, Barron E, et al. Early findings from the NHS Type 2 diabetes path to remission programme: a prospective evaluation of real-world implementation. Lancet Diabetes Endocrinol 2024; 12(9):653-63. https://doi.org/10.1016/s2213-8587(24)00194-3.
Very low calorie diet: total diet replacement options. Know Diabetes. [cited 2024 25 November]; Available from:
https://www.knowdiabetes.org.uk/know-more/type-2-diabetes/ type-2-remission/very-low-calorie-diet-vlcd/.
Zuberi S, Egiz A, Iqbal H, et al. Characterizing barriers and facilitators of metabolic bariatric surgery tourism: a systematic review. Br J Surg 2024;111(3): znae060. https://doi.org/ 10.1093/bjs/znae060.
Aggarwal R, Ahmed AR. The rising trend of health tourism in bariatric surgery. The Bulletin of the Royal College of Surgeons of England 2024;106(6):312-14. https://doi.org/10.1308/rcsbull.2024.105
Rigby E. Making complication from excess weight (CEW) clinics work for children, young people and families – messages from engagement and recommendations for practice. Association for Young People's Health (AYPH). June 2024. [cited 2024 29 November]. Available from: https://ayph.org.uk/wp-content/uploads/2024/07/ AW_7227_AYPH_CEW-Toolkit_Single.pdf
Published
Issue
Section
License
Copyright (c) 2024 British Journal of Diabetes
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Manuscripts published in the June 2024 edition and after in the BJD have been published in open access under a Creative Commons Attribution 4.0 International License and available at https://www.bjd-abcd.com. Prior year articles are available free of charge via our website.