Issue:

Obesity has existed ever since civilisation has been recorded. The Venus of Hohle Fels, a crude statuette of a naked obese woman, is estimated to be 35000 years old - 10000 years older than her more famous cousin, the Venus of Willendorf. The recorded history of the treatment of obesity goes back thousands of years: in 500 bc, the ancient Indian surgeon Sushruta described "obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushion" (Bhishagratna, 2006).

Developed in response to the growing concerns about obesity, the National Obesity Forum's State of the Nation's Waistline 2015 report sets out a suite of recommendations that aim to help reduce the incidence of obesity and offer solutions for management of this disease, which is vital before this condition cripples an already ailing NHS.

In a recently published study, van Jaarsveld and Gulliford (2015) have used primary care electronic health records to evaluate the prevalence of overweight and obesity in 2–15-year-old children in England and compared trends over the last two decades (1994–2003 and 2004–2013). Height, weight and BMI data of 370 544 children were accessed from 375 general practices in England that contribute to the UK Clinical Practice Research Datalink.

Weight management in primary care remains an area of controversy owing to inadequate mechanisms to define roles and responsibilities and to fund work done in this area, as well as an uncertain evidence base for the effectiveness of management by primary care clinicians. However, there are clear areas in which weight management is closely related to primary care, including risk assessment and signposting to self-help and tiered weight management services, plus an evolving role in long-term follow-up after bariatric surgery. This article summarises some of the methods whereby GPs can support weight management in primary care and explores limitations and barriers to carrying out those responsibilities, as well as emerging solutions. It also outlines the work of the Royal College of GPs Nutrition Group in developing new resources to support training in obesity management for primary care clinicians.

Obesity stigma is reported across population groups, impacting the wellbeing of obese people. Perhaps counterintuitively, healthcare professionals have stigmatising attitudes and, in some cases, fail to provide advice and treatment to obese patients. The reports summarised in this review suggest that intervention is required to improve treatment and to reduce adverse patient behaviours such as avoiding appointments and not reporting concerns to healthcare providers.

The NHS Commissioning Board has recommended the introduction of medical, multidisciplinary, multicomponent weight management services (Tier 3 services) for obese patients requiring specialised management, including assessment for bariatric surgery. Unfortunately, these have not yet been commissioned in many areas. Barriers identified include obesity being a low commissioning priority, therapeutic nihilism, medical workload constraints, a lack of trained staff, financial barriers to developing new services, and challenges of evaluation. A particular challenge is the lack of long-term funding and the complex tendering processes used in some areas. However, patients value these services, and the sparse academic literature shows encouraging results. Nonetheless, more robust evaluation of these services, including additional outcome measures and longer follow-up after discharge, is required to demonstrate cost-effectiveness to the NHS.

The costs of obesity and its related comorbidities to healthcare systems are well known, yet the effects on obese people individually are equally devastating. Obesity is now seen in people of all ages, even children, and it has widespread effects on physical health, reproductive health, employment, mental health, stigma and mortality risk. These effects are described in this article, and the urgent need to begin tackling the condition in primary care is highlighted.

An extension of the National Child Measurement Programme (NCMP), one of the key initiatives in the current battle to bring childhood obesity in the UK under control, has been deemed by a recent House of Commons Health Select Committee report as being an issue not worthy of consideration by May’s incoming administration (House of Commons, 2015). Seemingly against the advice of its Chair, and former GP, Sarah Wollaston, who very publicly called for such a move last year (Chorley, 2014), the opportunity to make a real advance in the battle has been lost.

The Annual Conference of the National Obesity Forum 2014 took place on 26 November 2014 and was titled From broad horizons to individual focus: Offering personalised care through quality local services supported by national guidance. Key topics included bariatric surgery, psychological aspects, obesity in pregnancy and children, and diet and exercise.

In this regular section, Matt Capehorn picks out recent key papers published in the area of obesity. To compile the digest, a PubMed search was performed for the 3 months ending January 2015 using a range of search terms relating to obesity. Articles have been chosen on the basis of their potential interest to healthcare professionals and are rated according to readability, applicability to practice and originality.