29 Jan 2024 Guest blog: Weight management services – What are the barriers?
In our latest guest blog, we hear from Jack Doughty, Senior Policy Officer at Diabetes UK, discuss the various challenges with weight mangaement support in England, the Government’s focus on weight loss medications and the need to tackle the root causes of obesity.
While the modern-day food environment can make maintaining a healthy weight a challenge for us all, a person’s social economic status, genetics, ethnicity, and mental health all have an impact on their weight management. Societal wide preventative interventions are needed to enable more people to live healthier lives and reducing obesity levels in the UK but it is also essential that we have access to services which can provide person centred weight management support.
As part of the Obesity Health Alliance, Diabetes UK are currently working with a group of experts to review the evidence as to what weight management options work best for different people. This review will inform a set of recommendations for what needs to happen to improve weight management support in England.
Diabetes and weight
In England 64% of adults are currently living with overweight or obesity, 11% of those living with obesity are also diagnosed with type 2 diabetes, compared with 5% of those living with overweight. For people at high risk of developing type 2 diabetes, getting the right support can help to prevent it. For those who are already living with type 2 diabetes, weight loss can result in better management of their condition, reducing the risks of complications. And for some, significant weight loss can result in their type 2 diabetes going into remission. It is for these reasons that there are a number of weight management support offers in England for people at risk of and living with type 2 diabetes.
The weight management pathway
On the one hand the range of support options for weight management is greater than ever. The introduction of the Diabetes Prevention Programme, the Digital Weight Management Programme, and the Complications from Excess Weight (CEW) clinics (to name a few), offer support for people living with different weight related comorbidities. However, substantial barriers remain for people who could benefit from these services.
A recent study of access to weight management services in England found that only 3.13% of people with a recorded BMI that met the criteria for a referral to support services received one between January 2007 and June 2020. Of those eligible for bariatric surgery only 1.09% underwent the procedure. Significant issues which include inconsistent access to services, inadequate information provided, and the stigma experienced by many in healthcare settings means those who could benefit from weight management support are often unable to.
It has been disappointing to witness the Government delay many of the policy pledges to prevent obesity laid out in the 2020 Obesity Strategy. Instead an increased focus has been put on the importance of weight loss medications in providing support for people to lose weight. The attention that drugs such as Semaglutide (commonly referred to as Ozempic but only licensed to treat obesity under the brand name Wegovy) are receiving in the press and on social media platforms has resulted in many questioning what this means for existing initiatives to prevent and treat obesity.
New weight loss medications have been shown to be effective in supporting people to lose weight but are only licensed to treat over a certain BMI (usually 30kg/m2 and over) and at least one weight related health condition. They should only be accessed with the support and guidance of specialist multi-disciplinary teams.
In June 2023, the government announced funding of a new £40m pilot scheme to access weight loss medication in England which will provide some areas with further digital support offers for accessing multi-disciplinary care. While this funding is welcome, in terms of potential for treating the over 4 million people who are eligible for drugs like Wegovy, it is not even the tip of the iceberg (currently weight management services see around 35,000 a year).
New guidance on best practice
New draft guidance, on overweight and obesity management from the National Institute for Health and Care Excellence (NICE)7 has proposed recommendations for best practice in supporting people to manage their weight. Key new developments in the draft guidance include an increased focus on the impact of weight stigma and being aware of the range of complex factors that can contribute to a person’s weight.
What’s next for the weight management pathway?
As the weight management pathway evolves in response to new recommendations, treatments and funding, obesity and diabetes management need to ensure they are not treated in isolation. The updated NICE guidance will be important for supporting HCPs to deliver the best, evidence-based care possible but with limited provision of services across the country, people with diabetes will struggle to consistently access the same level of support. Leadership in commissioning teams should provide clear oversight of the pathways with management and referrals from services effectively coordinated.
Effective weight management support services are part of a much wider approach that is needed to tackle the root causes of obesity in our society. Treatment of obesity needs to go hand in hand with action to prevent obesity through action to change our obesogenic environment and reduce inequalities. The Obesity Health Alliance will be bringing out new recommendations for Government, commissioners, and healthcare professionals on how to improve weight management support shortly.
Jack Doughty is a Senior Policy Officer at Diabetes UK, weight management services is one of his key policy focuses. He has a background in health and science policy, with experience working in the third sector, academia, and local government.
 White MG, Shaw JAM, Taylor R: Type 2 diabetes: The pathologic basis of reversible beta-cell dysfunction. Diabetes Care 2016;39:2080-2088.
 M. Lean et al. 2019 ‘Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial’ Lancet Diabetes & Endocrinology 7(5): 344–55 https://doi.org/10.1016/S2213-8587(19)30068- 3 and N.M. Astbury et al. 2018 ‘Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial’ BMJ 362: k3760 https://doi.org/10.1136/bmj.k3760