The Royal College of Physicians (RCP) has published an updated policy position on obesity in light of emerging therapies and following the RCP’s endorsement of the Lancet Diabetes and Endocrinology Commission on Clinical Obesity.
The Royal College of Physicians is committed to advancing the health and well-being of individuals affected by obesity. The Health Survey for England 2022 found that 28% of adults were living with obesity and a further 36% were living with overweight, making a total of 64% who were either living with overweight or obesity.
Children from deprived groups in England are more than twice as likely to be living with obesity than their more affluent counterparts. These inequalities are growing, as rates of children living with obesity are increasing significantly faster in communities with high, compared to low, deprivation levels.
Recent developments including The Lancet Diabetes and Endocrinology Commission on Clinical Obesity and the EASO framework for the management of obesity set out a clinically meaningful definition of disease in obesity, as well objective criteria for its diagnosis and management.
The RCP recognises obesity as a chronic, systemic illness characterised by excess adiposity which, when associated with alterations in the function of tissues or organs, results in a disease state or ‘clinical obesity’. These associated co-morbidities may be wide ranging and can have a profound and deleterious impact on physical and psychological wellbeing. The RCP also supports the concept of moving away from a weight-centric definition towards a more holistic, patient-centred focus on improving overall health and wellbeing.
Obesity is exacerbated by, and is often a symptom of, health inequalities, genetic influences, social determinants, lifestyle, stigma, behavioural and psychological factors and our environments. As such, obesity is a multifaceted problem that requires multiple solutions.
Government must deliver funding to ensure equitable access to weight management services and therapeutic interventions across the country. At a time when new weight management treatments are emerging, healthcare professionals must be empowered and supported to deliver compassionate and individualised care while following evidence-based guidance and ensuring access to treatment for those that need it.
To achieve this, we must ensure that treatment is provided on a health-needs basis, and that sufficient wraparound support is provided to ensure that once people have reached a healthy weight, they can sustain it without further treatment. This wraparound care needs to be flexible, tailored, and accessible to patients based on clinical need. It should be delivered in a range of community and clinical settings including - but in no way limited to - digital platforms alone. All assessment and treatment must be delivered without stigma or bias, in recognition that people living with obesity have complex needs that require a holistic and compassionate approach.
While there has been significant focus on emerging medical therapies, medication alone will not be enough to make meaningful and lasting progress on tackling obesity. Clinical interventions must be complemented with broad, bold action from government to tackle the social and environmental drivers of obesity. It is vital that legislation and national and local policies enable people to lead healthy lives to reduce the impact of obesity on the individual, the health service and wider society.
Policies should reduce aggressive marketing and advertising of foods high in fat, salt, and sugar, while increasing the availability and affordability of healthy foods from an early age. We must tackle our broken food system and ensure it is easier for all to choose to eat healthily. We need improvements in education around healthy eating, nutrition and budgeting. Community infrastructure should facilitate and promote physical activity, health, and wellbeing.
The RCP is renewing its call for a comprehensive, evidence-based approach to the prevention and management of obesity through clinical excellence, research, public education and demonstrable government action on the wider social and commercial determinants of health. The RCP will continue to monitor the obesity treatment landscape and advocate for equitable access to effective therapies based on clinical need that represent value for money. This will require substantial effort and attention from government and public health bodies across each of the four nations.
The RCP’s position statement on obesity was developed through the RCP’s special adviser on obesity, Dr Kath McCullough, Dr Lorraine Albon (deputising as special adviser on obesity) and the RCP Advisory Group on Nutrition, Weight and Health. The RCP Advisory Group on Nutrition, Weight and Health comprises RCP senior officers, the RCP special adviser on obesity, specialist society presidents, nutrition and obesity experts as well as representatives from the RCP Patient and Carer Network and the Royal College of Psychiatrists. The statement was approved by RCP Council prior to publication.