Friday, December 15, 2006

A heavy financial burden

According to one leading obesity specialist, our expanding waistlines could spell financial disaster for the NHS. Professor Naveed Sattar, writing in this week's British Medical Journal said, 'The problem of rising prevalence in obesity may get much worse - rates could climb still further, bankrupting the health system and leading soon to reductions in life expectancy.' This remark is part of an article, co-written with other health academics, that suggests a range of measures to try to prevent obesity including improved training for medical professionals and a single government agency with responsibility for the problem. Suggestions that have received a lot of attention in media reports include putting a helpline number on all clothing over a certain size and putting warning labels on food products with more than 700 calories (or 250 calories for snacks).

While this issue of health costs may be a serious one, it's simply not the subject of the BMJ article - although it is the headline in the BMJ's press release. The possibility of obesity overwhelming health services is merely asserted. In any case, the NHS has always faced the problem of matching limited funds to almost unlimited possible ways to spend it. The worst case scenario is that the obesity 'epidemic' becomes so bad that resources are pulled away from other fairly serious conditions to meet demand. That's quite a different idea to the health system collapsing.

However, we've been here before. There have been numerous claims in the past that a particular health problem was going to swamp health services without ever happening. For example, in the nineties, we were told that hundreds of thousands of people would die from variant-CJD contracted from cattle with 'mad cow disease'. Total deaths since the disease was identified over 10 years ago have been measured in the dozens - so few, in fact, that they have always been out-numbered by deaths from the older 'sporadic' form of CJD which was generally regarded as 'rare'. More recently, there have been fears that a bird flu pandemic would cripple health services - but no such pandemic has occurred while millions of pounds have been spent on drugs which, in all likelihood, will have little impact on the progress of any such disease.

It is true that people in the UK are getting fatter and that above a certain weight, the fatter you are the more likely you are to suffer from certain chronic conditions. However, the fears of financial disaster seem to be based on the assumption that people will just carry on getting fatter and fatter, and an over-estimation of just how much ill-health will result. Already, US health researchers have greatly lowered their estimates for ill-health arising from 'excess' weight because those categorised as 'overweight' seemed to have a higher life expectancy than those in the 'normal' category.

The estimates also understate the degree to which medical interventions may improve treatment of obesity-related problems in the future, in ways which do not cost an arm and a leg. For example, some research suggests that taking even quite moderate exercise can substantially reduce the risk of health problems in the very overweight, regardless of whether they actually lose weight.

What the article really illustrates is that the people with the greatest knowledge of how to treat a patient with obesity-related health problems may not be the best people to comment on politics, economics or society's attitude to food and health more generally. But as the media coverage of obesity shows us time and again, the authors are not alone in needing some perspective on the issue.

Read on:

'Obesity- can we turn the tide?', British Medical Journal, 16 December 2006

spiked-issue: Obesity