The World Health Organization (WHO) defines obesity as a serious chronic disease associated with having excess body fat, to the extent that it may have a negative effect on a person's health (WHO, 2019). However, obesity is complex because it is influenced by many external and internal factors.
A crude measure of obesity, by way of the Body Mass Index (BMI) uses a person's weight in kilogrammes divided by the square of their height in metres, to create a BMI score which falls into one of six classifications:
As the classification and BMI increases, so does the risk of associated comorbidities, with excessive body weight being associated with multiple diseases and conditions and a reduction in life expectancy. The BMI classification of obesity has been amended recently so that, for example, a person with a BMI of 30 or more is considered obese, and in the category of obese there are now three different classes (one, two and three), which replaces previous terminology, which included the term ‘morbidly obese’.
In a House of Commons briefing paper published in March 2018, it was stated that 66% of men and 57% of women in the UK are either overweight or obese (House of Commons Library, 2018). Furthermore, the Foresight Report by the Department of Health and Social Care (DHSC, 2007) claimed that, without any action, nine out of every ten adults, and two out of every three children, will be overweight or obese by the year 2050. The charity Cancer Research UK has also produced publications that state that being overweight can cause 13 different types of cancer, including cancers of the breast, bowel, oesophagus, pancreas and womb (Cancer Research UK, 2018). All of this makes obesity a huge problem which needs to be addressed.
However, it is not all doom and gloom. A Rethink Obesity campaign by Novo Nordisk, Danish pharmaceutical company and manufacturer of Saxenda (Liraglutide), notes that there are benefits to health for overweight people by losing just 5% of body weight. This includes a reduction in the risk of type two diabetes and cardiovascular risk factors, improvements in blood lipid profile (triglycerides) and blood pressure, less joint pain, lowering of the severity of sleep apnoea, and general improvements in quality of life.
Treating obesity
In 2013, the DHSC embarked upon classifying services for weight management into a series of tiers:
Universal interventions, or tier 1, relates to many of the health promotion campaigns we see the government engage in from Your Health Matters and Change 4 Life to Five-a-Day.
Lifestyle interventions, or tier 2, are proactive steps taken by the public to address their weight concerns using solutions or programmes, such as Weight Watchers and Slimming World.
Specialist services, or tier 3, is where the medical profession start to get involved, usually with multidisciplinary teams looking at pharmacotherapy and the prescribing of prescription medicines to assist with weight loss. This tier also includes the input of psychologists, nutritionists, cognitive and behavioural therapists as part of the team.
Surgery, or tier 4, includes bariatric surgery options, such as gastric bands, sleeves and bypass, as a last resort.
Prior to April 2017, NHS England were the commissioners for weight management services in the UK. This meant that they made 100% availability for tier 4 or bariatric surgery services for those patients who met the correct criteria. However, in April 2017, responsibility moved to the Clinical Commission Group (CCG), and service provision figures fell to 73% by the end of 2017. These figures are expected to reduce further when further data is released later this year.
Tier 3 or specialist services, which were attached to many NHS hospitals, have seen a gradual erosion, with a number of clinics closing as a result of funding being pulled. This means that the NHS and many GPs are no longer able to fund the prescription of medicines to help patients to lose weight. This leaves a huge number of patients seeking treatment, and a gap in the market. Many people are living with obesity; however, with the decommissioning of services, they are left with nowhere to go for help, support and treatment.
National Medical Weight Loss Programme
The vision of the National Medical Weight Loss Programme (NMWLP) is to ensure that every person living with obesity has access to treatment. They are embarking on this venture by helping medical professionals to set up their own private medical weight management services within their existing practices, including within existing cosmetic clinics. Certified partners of NMWLP receive business, clinical and marketing support from the organisation.
Business support includes assistance with registration with the Care Quality Commission (CQC) in England, or other registration required for Wales, Scotland and Northern Ireland, to provide prescribable weight management services and an accredited training route. All of this is backed by a guarantee of insurance to practice.
Anyone prescribing a prescription medicine for the treatment of obesity must be registered with the CQC, as this falls under the scope of being a regulated activity for ‘services in slimming clinics’. NMWLP use an inhouse expert to assist with the completion and submission of application forms, the development of policies and procedures to meet CQC requirements and preparation for inspection.
Accredited training is written and delivered by Dr Matthew Capehorn, who is an expert advisor to the National Institute for Health and Care Excellence (NICE), part of the author group for the RCGP-accredited obesity educational courses and previously held the position of Clinical Directory of the National Obesity Forum.
Training modules look at an introduction to obesity; the physiology of obesity and the regulation of appetite; diet and nutrition; the psychology of eating; weight loss interventions; setting up a private weight management service; pharmacotherapy (Saxenda, Mysimba and Orlistat are the only licenced drugs which can be prescribed for people with obesity); working with your pharmacy; CQC (or equivalent) registration; and insurance.
All certified partners of the NMWLP, doctors, nurses, nurse prescribers or surgeons, will be guaranteed to get insurance, and NMWLP has negotiated a discount on the premiums from their partner insurer, which can be paid 10 months interest free. A discount on blood testing services is also provided.
Certified partners will have their clinic listed on the NMWLP website and will have an individual landing page, as well as customisable and personalised online consultation forms, which can be sent to patients prior to their face-to-face consultation. This provides an opportunity to identify any patients who do not meet the required criteria for prescribing weight loss medication, without causing a waste of clinic time.
Peer-to-peer and clinical support is provided via a closed Facebook group and access to a repository of clinical articles and evidence-based documentation. Marketing support includes patient leaflets, posters, banners logos, imagery, testimonials and other customisable marketing materials.
Setting up a weight loss clinic can be simple, allowing practitioners to run their own private medical weight loss service which helps patients to tackle obesity.