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Fat chance: healthcare and the obesity crisis

 

 

 

The growing prevalence of obesity in the UK is set to cause a crisis in NHS healthcare provision. Steve Ainsworth looks beyond the headlines to the challenges facing the medtech industry.

Famine last visited Britain during Queen Victoria’s reign. In the 21st-century UK, however, the skeletal legs of Famine’s black nag are buckling under the weight of a less familiar rider. The fifth Horseman of the Apocalypse is Famine’s twin, Obesity.

What is obesity?

The recognised method of evaluating whether an individual is underweight or overweight is the Body Mass Index. This calculation divides the person’s weight (in kilograms) by twice their height (in metres). An adult who weighs 112kg and is 2m tall will have a BMI of 112 ÷ (2 X 2) = 28.

Someone with a BMI below 18.5 is classified as underweight. A BMI between 18.5 and 25 indicates a healthy weight. Anyone scoring 25 to 30 is overweight. Those with a BMI over 30 are clinically obese; those scoring over 35 are classified as morbidly (life-threateningly) obese.

Clinical consequences

The Government report Healthy Weight, Healthy Lives (2007) reports that nearly a quarter of adults in England are now obese. Based on current trends, levels of obesity will rise to 60% in men, 50% in women and 25% in children by 2050, with a further 35% of adults and nearly 40% of children being merely overweight.

The problems faced by the obese are not simply about finding new clothes or wider seats on public transport. Significant health and mobility problems are an inevitable consequence of obesity.

A tenth of all cancer deaths among non-smokers are related to obesity. The risk of coronary artery disease increases 3.6 times for each unit increase in BMI, whilst 85% of hypertension cases are associated with a BMI above 25.

The risk of developing type 2 diabetes is 20 times greater for people who are morbidly obese than in people with a healthy BMI. Nine out of ten obese people have ‘fatty liver’, and non-alcoholic fatty liver disease will be the leading cause of cirrhosis in the next generation.

Type 2 diabetes and non-alcoholic fatty liver disease are increasingly being reported in children. Obesity in pregnancy is associated with increased risks of complications for both mother and baby.

Nor are the problems limited to physical ill health. Social stigmatisation and bullying of the obese can lead to depression, adding to a syndrome of poor physical health by discouraging effective self-care.

Severely obese individuals are likely to die on average 11 years earlier than those with a healthy weight. In some cases, this is worse than the reduction in life expectancy from smoking.

Seeking solutions

The Government has responded to the impending obesity crisis with a £372 million strategic programme.

Ensuring healthy growth and development of children is a key aim. Families at risk will be identified as early as possible. Schools will also be targeted. Some £75 million is to be spent to inform, support and empower parents in making changes to their children’s diet and levels of activity.

A ‘Healthy Food Code’ is being developed in partnership with the food and drink industry. The ‘Walking into Health’ campaign aims to get a third of English people walking at least 1,000 more steps daily by 2012.

‘Sport England’ is to ensure that there is a clear legacy of increased physical activity leading up to, and following, the 2012 Olympics. In addition, £30 million is to be spent on ‘Healthy Towns’: an intensive programme focusing on selected localities.

These measures reflect the seriousness of the problem and the growing public awareness of it. But it is the health services and the medtech industry that are in the front line of the obesity war. In terms of individual support, the DH is developing the NHS Choices website to give personalised advice on diet and activity. On a broader front, the DH is committed to providing extra funding to NHS Trusts to commission more weight management services.

The health services and the medtech industry are in the front line of the obesity war. The balance between preventing obesity, treating it and treating its consequences may shift, but the issue as a whole will remain.

War on weight

The market for medical devices and equipment to prevent, monitor and treat obesity and its health consequences will continue to grow for the foreseeable future. The balance between preventing obesity, treating it and treating its consequences may shift, but the issue as a whole will remain.

Stomach surgery is one possible answer to obesity, but it is only suitable for a minority. NICE recommends bariatric surgery only if patients have a BMI over 40, or if they have a BMI between 35 and 40 and have a significant weight-related disease – and all other non-surgical measures have failed.

The promotion of health status monitoring in NHS hospitals and GP surgeries has been a major factor of UK healthcare for almost two decades. Diabetes screening, for example, has been a feature of standard GP services since 1990. But the obesity war will increase the demand for diagnostic services and equipment. The higher levels of screening will mean increases in demand for basic diagnostic tools: weighing scales, blood pressure testing equipment and ECG machines.

An increasing focus on obesity will also increase sales of equipment for weight loss and fitness as newly-terrified patients seek to lose weight. The linkage between sports and medical equipment will increase.

Sharing the load

Victory in the battle of the bulge is nowhere in sight. And given that obese children have a marked tendency to grow into obese adults, the war may not be won for another 60 years. It is therefore the demand for ways to cope with obesity, not counter it, that is likely to present the greatest challenge to the medtech industry.

Even simple objects such as chairs need to be considered. How long before NHS Trusts find themselves being sued when hospital chairs collapse under the weight of patients who are no longer rare exceptions but well within ‘normal’ expectations?

Two years ago, NICE recommended that every variety of equipment used by NHS patients be upgraded in this regard. The many hospitals that have only one heavy-duty wheelchair need to order more. Beds designed to accommodate the average patient need to be replaced with larger and stronger ones, as do operating tables, trolleys and couches, even scanners. The standard for patient hoists needs to be reassessed in the light of potential maximum loads.

Designers of mobility scooters and other assistive technologies for use in the community need to consider just how much power and strength they need to incorporate into their designs.

Suppliers who already manufacture such equipment now have an unprecedented opportunity to market their products to customers in the healthcare system and in the community. Those who have not yet upgraded their specifications urgently need to do so.

Lean times

  Meanwhile, in the developing world Famine still rides out. Ironically, the wellbeing of the affluent UK is more threatened by his chubby twin horseman. The healthcare industry has both opportunities and responsibilities in helping the NHS and the public to win the war against obesity.

Steve Ainsworth is a freelance health journalist. He can be contacted on SAinsworth@aol.com.

 

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