Citerank: (46) 3523581 in 5 UK children aged 10-11 are obeseThe National Child Measurement Programme (NCMP) figures for 2013/14, show that 19.1% of children in Year 6 (aged 10-11) were obese and a further 14.4% were overweight. Obese children and adolescents are at an increased risk of developing various health problems—such as asthma, cardiovascular disease and type 2 diabetes (as well as low self-esteem and depression)—and are also more likely to become obese adults.648CC79C, 352454What is obesity?Obesity is a medical condition in which excess body fat has accumulated to the extent that it may result in increased health problems and reduced life expectancy. As central obesity (excess ectopic fat stored around major organs and abdomen) is the most dangerous form to health, waist measurement can be a key indicator of risk. Generally, men with a waist circumference of 94cm or more (and women of 80cm or more) are more likely to develop obesity-related health problems.82AECCD8, 352559Weight management services in the UK are poorly developedAlthough the prevalence of obesity in adults and in children in the UK is amongst the highest in the developed world, the multidisciplinary services necessary to manage patients with an established problem of excess weight and its clinical consequences are poorly developed within the UK. Some prevention and intervention strategies are provided in primary care, but secondary care and specialist services remain underdeveloped or unavailable to meet the need.555CD992, 352560Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 352562Multidisciplinary teams to cover severe and complex obesity across UKCommissioning of specialist obesity services should be for multidisciplinary care of ‘severe and complex obesity’ and not directly for rather than just bariatric surgical treatment. Need multidisciplinary teams (MDTs) available to cover severe and complex obesity throughout the UK.109FDEF6, 352563Increase investment in obesity research565CA4D9, 352564Every local authority should have an obesity champion565CA4D9, 352565Better weight management resources for obese healthcare workersBetter weight management resources for healthcare workers who have an obesity problem.565CA4D9, 352566Set up a specialist group of bariatric nursesThe Royal College of Physicians in conjunction with the Royal College of Nursing should up a specialist group of bariatric nurses who are trained in the specialist aspects of bariatric medicine and surgery, including post-surgery follow-up.565CA4D9, 352569Develop a patient charter for those with obesity problems109FDEF6, 352570Undertake a systematic review of specialist obesity servicesUndertake a systematic review of specialist obesity services between the Royal College of General Practitioners community leads and the Royal College of Physicians (RCP) and learned societies, including the Society for Endocrinology, Diabetes UK and the Association of British Clinical Diabetologists565CA4D9, 352589RCP oversee the development of multidisciplinary bariatric servicesThe Royal College of Physicians (RCP) should oversee the development of multidisciplinary bariatric services to cover the population in the UK.109FDEF6, 352590RCP should provide courses to train doctors in MDT formationThe RCP should promote the provision of these multidisciplinary groups by developing and providing courses that advise, encourage and train doctors (and other healthcare professionals) on their formation.109FDEF6, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 352714Pharmacological treatment can be cost-effectiveA systematic review of pharmacological treatment in primary care (orlistat, sibutramine and rimonabant– the latter two now withdrawn) has shown all were effective at reducing weight and BMI, and cost effective when using a threshold of £20,000 per QALY. 1198CE71, 352716Bariatric surgery can be cost effectiveAnalysis by the Office of Health Economics estimated that between around 10,000 and 140,000 of patients could receive bariatric surgery based on the assumption of between 1% and 25% of patients eligible for surgery choosing to take this option. Overall the economic benefit ranged between £382m and £1,295m savings after three years to the NHS after surgery if 25% of patients potentially eligible for surgery chose this option.1198CE71, 352718Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 352913Royal College of PhysiciansIn addition to supporting physicians in their daily practice, our public health activities include campaigning for change, advising government and parliament, and taking part in national debates on medical, clinical and public health issues. The RCP has supported and represented physicians for nearly 500 years. Our roots stretch back to Henry VIII, but our 29,000 members today work in the fast-paced, ever-changing, highly technological world of medicine in the UK and across the globe.58D3ABAB, 362143Appoint an obesity champion or tsarAppoint a government obesity champion to drive a coordinated obesity strategy between and across central government departments which include Health, the Treasury, Sport, Education, Agriculture, the Department of Work and Pensions, and local government for the local environment. This person should have a strong but politically independent status (e.g. a member of the House of Lords) with the skills and authority to address issues which need multiple government departmental involvement.565CA4D9, 370326Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 370327Understand the ten essential facts about obesityAll healthcare professionals should know and understand the ‘Ten essential facts about obesity’.109FDEF6, 371613Strong business case for investment in employee health and wellbeingInvesting in the health and wellbeing of employees makes business sense. It has been estimated that working age ill-health costs the UK £100 billion per annum, more than the annual budget for the NHS. In 2009–10, 23.4 million days were lost due to work-related ill-health.1198CE71, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399548Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399564Better weight management resources for obese healthcare workersBetter weight management resources for healthcare workers who have an obesity problem.565CA4D9, 399569Strong business case for investment in employee health and wellbeingInvesting in the health and wellbeing of employees makes business sense. It has been estimated that working age ill-health costs the UK £100 billion per annum, more than the annual budget for the NHS. In 2009–10, 23.4 million days were lost due to work-related ill-health.1198CE71, 399585Undertake a systematic review of specialist obesity servicesUndertake a systematic review of specialist obesity services between the Royal College of General Practitioners community leads and the Royal College of Physicians (RCP) and learned societies, including the Society for Endocrinology, Diabetes UK and the Association of British Clinical Diabetologists565CA4D9, 399593Increase investment in obesity research565CA4D9, 399605Existing training is inadequate and ineffectiveTraditional methods of training for healthcare professionals are inadequate and ineffective with respect to obesity.1198CE71, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399619Appoint an obesity champion or tsarAppoint a government obesity champion to drive a coordinated obesity strategy between and across central government departments which include Health, the Treasury, Sport, Education, Agriculture, the Department of Work and Pensions, and local government for the local environment. This person should have a strong but politically independent status (e.g. a member of the House of Lords) with the skills and authority to address issues which need multiple government departmental involvement.565CA4D9, 399699Set up a a specialist group of bariatric nursesThe Royal College of Physicians in conjunction with the Royal College of Nursing should up a specialist group of bariatric nurses who are trained in the specialist aspects of bariatric medicine and surgery, including post-surgery follow-up.565CA4D9, 399713Improve support for people with severe and complicated obesityGreater focus needs to be devoted to strategies supporting individuals who are already obese. Current government policy is focused largely on prevention, which is vital in ensuring the scale of the obesity problem and its associated costs do not increase. It does not, however, address the problems of those people already obese or morbidly obese and the costs associated with their health conditions. Moreover, obesity treatment is often cost effective.109FDEF6, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399742Every local authority should have an obesity champion565CA4D9, 399792Multidisciplinary teams to cover severe and complex obesity across UKCommissioning of specialist obesity services should be for multidisciplinary care of ‘severe and complex obesity’ and not directly for rather than just bariatric surgical treatment. Need multidisciplinary teams (MDTs) available to cover severe and complex obesity throughout the UK.109FDEF6, 399793Develop a patient charter for those with obesity problems109FDEF6, 399794Pharmacological treatment can be cost-effectiveA systematic review of pharmacological treatment in primary care (orlistat, sibutramine and rimonabant– the latter two now withdrawn) has shown all were effective at reducing weight and BMI, and cost effective when using a threshold of £20,000 per QALY. 1198CE71, 399795Bariatric surgery can be cost effectiveAnalysis by the Office of Health Economics estimated that between around 10,000 and 140,000 of patients could receive bariatric surgery based on the assumption of between 1% and 25% of patients eligible for surgery choosing to take this option. Overall the economic benefit ranged between £382m and £1,295m savings after three years to the NHS after surgery if 25% of patients potentially eligible for surgery chose this option.1198CE71, 399833Understand the ten essential facts about obesityAll healthcare professionals should know and understand the ‘Ten essential facts about obesity’.109FDEF6, 399859RCP oversee the development of multidisciplinary bariatric servicesThe Royal College of Physicians (RCP) should oversee the development of multidisciplinary bariatric services to cover the population in the UK.109FDEF6, 399860RCP should provide courses to train doctors in MDT formationThe RCP should promote the provision of these multidisciplinary groups by developing and providing courses that advise, encourage and train doctors (and other healthcare professionals) on their formation.109FDEF6, 399892What is obesity?Obesity is a medical condition in which excess body fat has accumulated to the extent that it may result in increased health problems and reduced life expectancy. As central obesity (excess ectopic fat stored around major organs and abdomen) is the most dangerous form to health, waist measurement can be a key indicator of risk. Generally, men with a waist circumference of 94cm or more (and women of 80cm or more) are more likely to develop obesity-related health problems.82AECCD8, 399931Weight management services in the UK are poorly developedAlthough the prevalence of obesity in adults and in children in the UK is amongst the highest in the developed world, the multidisciplinary services necessary to manage patients with an established problem of excess weight and its clinical consequences are poorly developed within the UK. Some prevention and intervention strategies are provided in primary care, but secondary care and specialist services remain underdeveloped or unavailable to meet the need.555CD992, 3999751 in 5 UK children aged 10-11 are obeseThe National Child Measurement Programme (NCMP) figures for 2013/14, show that 19.1% of children in Year 6 (aged 10-11) were obese and a further 14.4% were overweight. Obese children and adolescents are at an increased risk of developing various health problems—such as asthma, cardiovascular disease and type 2 diabetes (as well as low self-esteem and depression)—and are also more likely to become obese adults.648CC79C

Long-term multicomponent weight management interventions were generally shown to promote weight loss in overweight or obese adults. Weight changes were small however and weight regain was common. There were few similarities between the included studies; consequently an overall interpretation of the results was difficult to make. There is some evidence that weight management interventions are likely to be cost-effective, although caution is required as there were some limitations in the two cost-evaluation studies described.

Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.

Citerank: (7) 366449Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 366452No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 366453Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 399561Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 399613No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 399614Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 399713Improve support for people with severe and complicated obesityGreater focus needs to be devoted to strategies supporting individuals who are already obese. Current government policy is focused largely on prevention, which is vital in ensuring the scale of the obesity problem and its associated costs do not increase. It does not, however, address the problems of those people already obese or morbidly obese and the costs associated with their health conditions. Moreover, obesity treatment is often cost effective.109FDEF6

In an attempt to contain rising trends in obesity and associated chronic diseases, many governments have implemented a range of policies to promote healthy lifestyles. These efforts have been hindered by the limited availability of evidence about the effectiveness of interventions in changing lifestyles and reducing obesity. Evaluations of the cost-effectiveness and distributional impacts of such interventions are even fewer and narrower in terms of numbers of options considered.

An economic analysis was developed jointly by the OECD and the WHO with the aim of strengthening the existing evidence-base on the efficiency of interventions to tackle unhealthy diets and sedentary lifestyles. The analysis was broadly based on the WHO-CHOICE (CHOosing Interventions that are Cost-Effective) approach, and it aimed at assessing the efficiency of a range of policy options to tackle unhealthy lifestyles and related chronic diseases. Additionally, compared to the traditional CHOICE framework, the analysis assessed the distributional impacts of preventive strategies on costs and health outcomes.

Most of the preventive interventions evaluated as part of the project have favourable cost-effectiveness ratios, relative to a scenario in which no systematic prevention is undertaken and chronic diseases are treated once they emerge. However, since the determinants of obesity are multi-factorial and affect all age groups and social strata, interventions tackling individual determinants or narrowly targeted to one groups of individuals will have a limited impact at the population level, and will not reduce significantly the scale of the obesity problem. Although the most efficient interventions are found to be outside the health sector, health care systems can have the largest impact on obesity and related chronic conditions by focusing on individuals at high risk.

Interventions targeting younger age groups are unlikely to have significant health effects at the population level for many years. The cost-effectiveness profiles of such interventions may be favourable in the long-term, but remain unfavourable for several decades at the start of the interventions. Preventive interventions do not always generate reductions in health expenditure, when the costs of treating a set of diseases that are directly affected by diet, physical activity and obesity are considered.