The announcement by the NHS that it would offer an 800 calorie diet to treat people with type-2 diabetes is its latest attempt to treat a disease whose incidence has doubled over the past two decades. Diets, typically associated with prevention, also have a vital place inside health systems as a tool to manage and treat obesity. But the best way to tackle type-2 diabetes, and other preventable noncommunicable diseases, is to prevent them in the first place.
Prevention will only happen by acting at the health systems level. Prioritising this is a political choice that requires the support of all leaders—political and otherwise—to succeed.
The NHS announcement speaks to the seriousness of the obesity epidemic in the UK, where two in three adults is now classified as overweight or having obesity. The UK is certainly not alone: there is not one country in the world that has reversed the obesity epidemic, with over 2 billion adults and children living with overweight and obesity. All are at a significantly higher risk of diabetes, heart diseases and cancer.
Compounding the challenges associated with these diseases are the associated costs which are estimated to be US$2 trillion annually. These costs are a combination of direct healthcare costs and lost economic productivity and are roughly equivalent to those of armed violence and war.
Exacerbating the issue with obesity further is its increasing prevalence among low-income and marginalised groups. In high-income countries this has been driven by an upsurge in areas where options for healthy food choices are limited, often accompanied by the absence of safe spaces in which to exercise.
The established narrative around obesity is one of blame, the disease misrepresented as a result of poor choices. The focus on individual responsibility can suit governments unwilling to regulate the marketplace, as much as it can big food companies who sell unhealthy products or who peddle ineffective solutions.
Fortunately, increasing recognition of the role played by the environments in which we live and work is resulting in preventive measures in food environments such as sugar taxes and front-of-pack labelling. It will take bold leadership to ensure that there is a collective effort to incentivise healthy diets and environments for all.
But addressing obesity effectively requires much more than just prevention, as the NHS has shown: overweight and obesity must be addressed in health systems throughout the life course.
The global health community is increasingly coalescing around universal health coverage (UHC), a commitment to provide everyone, everywhere with quality health services, without out of pocket expense. Health security no longer means just protection from diseases that are infectious in origin, but also from socially transmitted diseases like obesity.
Prevention is key, but the management and treatment of obesity all need to be included as essential health services within UHC. The current list of essential services is too limited in scope and omits important aspects of health including nutrition and wider indicators relating to the commercial and social determinants of health, such as education, marketing, and routine eating habits.
In making services available, providers must ensure that design of the health services and the training programmes for health professionals are sensitive to and do not perpetuate weight stigma, which has negative impacts on both physical and mental health, and which serves as a barrier to recognising that this is a disease like any other.
Targeting obesity is key to realising the health for all promise. To achieve the sustainable development goals, countries must prioritise global targets that have already been made for reducing adult and childhood obesity. Those living with obesity and its related diseases are our most credible and important messengers, as are young people, who live with the impact of the epidemic, but also its potential solutions every day.
UHC needs to be viewed as more than simply the provision of a service. We will be failing those who have successfully completed the 800-calorie diet if they then simply fall back into illness because the environments into which they return facilitate access to unhealthy foods and promote low levels of physical activity both in and out of work. Let us take this opportunity to include ensure that people living with obesity and diabetes are given the best possible chance to prevent, manage, and treat these diseases and truly demonstrate what health for all means.
Competing interests: None declared.