The evidence increasingly points to the system “failing” to offer people support for weight loss
The results of the DROPLET trial, published in The BMJ, are striking. GPs referred people who were obese to a provider offering a total diet replacement (TDR) programme and the average weight loss was 10.7 kg at one year. This is very similar to the 10 kg loss reported in the DIRECT trial among patients with type 2 diabetes who followed a similar programme with support from health professionals. These results are really encouraging and this is not the only option for successful weight loss.
Over the past few years a series of trials have shed light on effective treatments for obesity, which are suitable for use in routine healthcare settings. For example, there is good evidence that a 12 week referral to a weight loss group in the community leads to a weight loss of around 5 kg at one year. Different types of interventions may suit different people, but health professionals can be confident that there are a range of effective services that can be offered by generalist staff, without the need for an increase in workforce capacity, consultation time, or substantial additional training.
This is good news. A raft of evidence from trials and observational cohorts tells us that treating obesity is one of the best hopes we have of reducing the burden of avoidable ill health, attenuating rising healthcare costs, and improving quality of life for people whose health and wellbeing is marred by excess weight. So why am I not celebrating?
The sad fact is that most people who are obese are not offered treatment. There are a number of opinions that have become pervasive in the field. Views such as “patients won’t commit to losing weight” or a perception that if people were really committed, they would attend programmes of their own volition, or that treating obesity is not something where health professionals can make a difference. But these perspectives are not supported by the evidence. People can and do lose weight, more people lose more weight in formal programmes than those trying to do so alone, and more people take action when prompted to do so by a doctor.
Yet raising the topic of weight loss in routine consultations is rare. Some doctors feel that patients would not welcome the offer of support or that prompting people with no intrinsic motivation to lose weight would be ineffective. Evidence from the first trial of opportunistic screening for obesity should provide great reassurance. Only one in 500 patients who were obese had concerns about an unprompted brief conversation about their weight initiated by their doctor, and one in four of the people offered a referral to a 12 week community programme lost >5% of their body weight at one year.
For too long the narrative has been that people will “fail” in their weight loss efforts, but the evidence increasingly points to the system “failing” to offer people support for weight loss. We need to seize these opportunities to treat obesity and in so doing, to prevent subsequent disease. Firstly, we need to greatly expand the provision of cost effective services for weight loss around the country and, secondly, we need to change the culture of medical practice to make the offer of treatment for obesity a routine component of healthcare.
Thirty years ago doctors rarely raised the issue of smoking cessation, now it is a “normal” part of medical practice. When we achieve similar levels of engagement from health professionals in treating obesity we will all have something to celebrate.
Susan Jebb is a nutrition scientist and professor of diet and population health in the Nuffield Department of Primary Care Health Sciences, University of Oxford. She is a National Institute for Health Research (NIHR) senior investigator and a member of the Scientific Advisory Committee on Nutrition. She leads the NIHR Oxford Biomedical Research Centre (BRC) and Collaboration and Leadership in Applied Health Research and Care (CLAHRC) Oxford themes on diet and obesity. Her research programme focuses on dietary interventions that might be effective to help people lose weight or reduce the risk of obesity related diseases.
Competing interests: Professor Jebb’s salary is paid by the University of Oxford and she has no personal financial interest connected to any of the companies offering weight management products or services. She was the principal investigator of the DROPLET trial, which was jointly funded by a research grant from Cambridge Weight Plan UK Ltd to the University of Oxford and the NIHR Oxford CLAHRC. She was an investigator in the WRAP and BWeL trials where the weight loss interventions were provided free of charge to the NHS by WeightWatchers or Slimming World and Rosemary Conley.