NHS restricting access to obesity services across England, BMJ finds

The NHS is restricting access to obesity services across England, leading to patients in nearly half the country being unable to book appointments with specialist teams for support and treatments such as weight-loss jabs.

An investigation by the British Medical Journal found budget cuts to local services fell disproportionately on obesity care, with patients living with the condition often deemed less worthy of care than others.

The restrictions amounted to the NHS “rationing” obesity services, one expert said, leading to a “postcode lottery of care”.

Patients in one in six local healthcare areas could not access bariatric surgery, one of the most clinically effective treatments for obesity, according to the investigation , which analysed responses to freedom of information requests from all 42 of England’s integrated care boards (ICBs).

Dr Nicola Heslehurst, a professor of maternal and child nutrition at Newcastle University and chair of the UK Association for the Study of Obesity, told the BMJ that weight management services did not “in any way meet the need”, adding that “radical” action was needed to avoid rising obesity and care costs, worsening inequalities, and children “being set up for a life course of poor health”.

Obesity is estimated to cost the NHS in England £6.5bn a year and is the second biggest cause of cancer after smoking.

ICBs are funded by NHS England to provide healthcare services for their local population, but budget cuts have left many under huge financial pressure. When money is allocated, services seen as less important may not receive any funding, and obesity care is often the first to face the axe.

Just over half (24) of England’s care boards commissioned the full range of adult weight loss services and were open to new referrals. Services range from local classes on diet and lifestyle to semaglutide weight-loss injections, sold as Wegovy, and gastric bypass surgery.

More than a third of ICBs reported restrictions on tier three obesity services, where patients are seen by multidisciplinary teams that can provide weight-loss drugs. Six said their services were closed to new patients, seven only covered part of their catchment area, and four did not have any tier three services.

Tier four services, including gastric bypass surgery and more intensive weight-management services, are restricted in many parts of England, the investigation found, with seven ICBs not providing any bariatric surgery.

John Wilding, a professor of medicine at the University of Liverpool, told the BMJ that obesity services were “not deemed a priority”. “I think there is an unconscious bias which says: ‘This is mostly their fault, so they should just get on with it, go on a diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that,” Wilding said.

The BMJ’s findings echo those of a recent report by the Future Health research agency. It found that many of the NHS’s ICBs in England had not set out detailed plans to tackle obesity and treat those with it, despite it costing the UK an estimated £98bn a year in health costs, lost productivity and other costs.

Richard Sloggett, the author of that report, and a former special adviser in the Department of Health and Social Care, said the new disclosures showed the NHS was “rationing” obesity treatment. “These findings back up our Future Health research showing that many ICBs do not currently see obesity as a priority. In certain parts of the country there is no access to tier 3 and tier 4 services at all.

“This rationing is leading to a postcode lottery of care. Given the scale of the obesity challenge facing the country and the wider health and economic costs and impacts associated with it, there is an urgent need for government and the NHS to commit new action. This should start with a clear timeline for reviewing NHS obesity services and ensuring there is a minimum service specification agreed and in place in each ICB.”

A spokesperson for NHS England told the BMJ that the NHS was “working with the Department of Health to support improvements in the obesity pathway”.