Limited access to weight loss services in England

An investigation by The BMJ has revealed significant gaps in access to comprehensive obesity treatment across England.

Key findings concluded that nearly half of the country lacks appointments with specialist weight loss teams, leaving many patients without access to crucial care such as weight loss medications like semaglutide and bariatric surgery.

Local healthcare services are facing severe financial constraints, which has led to cuts in obesity care. Approximately one in five local health areas no longer offers bariatric surgery, and many patients are unable to access specialist support. According to experts, obesity management services are not being prioritised, often being the first to suffer when budgets are tight.

The investigation found that only 24 out of 42 Integrated Care Boards (ICBs) across England provide comprehensive tier 3 and tier 4 services for obesity. Tier 3 services, which involve multidisciplinary support including access to weight loss drugs, are closed to new patients in some areas. In seven ICB regions, bariatric surgery services are not available at all. Despite recommendations from the National Institute for Health and Care Excellence (NICE), many local areas further restrict access, accepting only patients with extremely high body mass index (BMI).

Stigma surrounding obesity plays a role in limiting access to services. Experts argue that misconceptions about obesity, including the belief that it is solely the patient’s responsibility, lead to bias in healthcare decisions. Nicola Heslehurst, chair of the UK Association for the Study of Obesity, stated that this bias often results in patients with obesity being viewed as less deserving of care compared to those with other conditions.

Bariatric surgery, a proven intervention for severe obesity, remains underused in England. Around 5,000 surgeries are performed annually, far fewer than in countries like France, where 50,000 operations are performed each year. Despite the benefits, including long-term weight loss and improvement in obesity-related health conditions, access to surgery remains restricted.

With obesity costing the NHS around £6.5 billion annually, experts argue that expanding obesity services would benefit both patients and the healthcare system. Investing in bariatric surgery, along with other interventions, could significantly reduce the long-term costs associated with obesity, including its role as a leading preventable cause of cancer. Without radical improvements to service access, the rising rates of obesity in England are likely to continue unchecked, exacerbating health inequalities and increasing the financial burden on the NHS.