The way health institutions approach obesity management is rapidly changing. For decades, the medical management of obesity was considered invasive, comprising long waiting lists and a last resort with strict criteria for access. Now, around 1.5m people in the UK are using weight loss medicines – and the trajectory suggests this will increase. Whilst the vast majority of users access these medicines privately, the NHS access is also expanding its provision. This year has also seen two new weight loss medicines in tablet form being approved by the MHRA before the rest of Europe, leading the way in innovative weight management.
However, weight loss medicines do not address the behavioural causes or wider structural drivers of obesity and, if we are to continue to pioneer a successful and sustainable weight management offer, the system around the medicines must improve too. Local authorities should have a formal role in shaping what this new system looks like.
This was the overwhelming finding of the research in my report, The GLP-1 Population Health Project, which compiles the views of public health directors across England, examining the roll out of weight loss medicines through surveys and interviews. As former public health minister, Steve Brine, says in the foreword, these findings will help the Government navigate a rapidly changing situation using the insights of those who understand the impact these medicines have in their own communities.
This is already relevant to how councils are thinking about their services. Several local authorities are using the findings from the report as they review how their weight management services should adapt to the expansion of these medicines; that several local authorities had already begun a process to review these services underscores the timely nature of the research.
Current collaboration is rated poorly
Respondents consistently rated current collaboration between local authorities and the NHS poorly, scoring an average of just 4.44 out of 10. When asked about the barriers to this collaboration, the most common answers were capacity, funding and too frequent organisational restructuring.
Despite this, 65% of public health professionals said local authorities should have a formal role in evaluating population-level outcomes for weight loss medicines.
Involving local authorities will prove beneficial here. Councils understand their communities to an extent that a national organisation is unable to. They also have expertise in addressing the factors that contribute to an obesogenic environment at a local level and knowledge of the services that are already available, which can vary substantially across the country.
This becomes particularly important when we think about what happens after the prescription ends. Evidence shows weight regain is marked following treatment discontinuation, with the current offer of support after this being limited. Local authorities already commission many of the services that can support long-term behaviour change, so there is an obvious opportunity for these services to work in partnership with clinicians beyond the period in which the medicine is prescribed.
Redesigning a whole-system obesity strategy
The report sets out 12 recommendations designed to place weight loss medicines (including GLP-1 agonists) within a whole-system obesity strategy, alongside prevention. They target every stage of a patient’s journey accessing these medicines, from improving the confidence of professionals in having discussions about obesity prior to treatment initiation to expanding the support available on discontinuation. It also proposes new shared governance arrangements between local authorities and NHS organisations to create clear and accountable links, something which was consistently raised by survey participants.
The rapid expansion of weight loss medicines, and the evolution of their form, is an opportunity to improve how we manage obesity, but the system around the medicines needs to develop alongside the clinical offer. Obesity is a complex, multifactorial condition that medicines alone will not fully address. Local authorities already have a stake in their outcomes – for fairer and more sustainable results, they should have a formal role in their evaluation. If we can get that partnership right, we will have a much better understanding of how the wider system can help people keep the weight off.
