Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with obesity, 2016.
Obesity is defined as the excess accumulation of body fat. It is a major public health issue and is associated with a range of health problems including type 2 diabetes, cardiovascular disease and cancer.
In Leicester, the estimated annual cost to the NHS for diseases related to overweight and obesity in 2015 is £96.1 million and for diseases related to obesity alone is £55.9 million. There has been a rapid increase in the prevalence of obesity amongst adults in England. The prevalence of obesity rose from 15% in 1993 to 26% in 2014.
Who’s at risk and why?
The health risks for adults with obesity are stark.
- Men and Women who are obese are at higher risk of developing other illnesses such as diabetes, stroke, heart disease and cancer of the colon.
- Obesity rates are higher for certain minority ethnic groups – Black African, Black Caribbean women, Irish men and Pakistani women.
- People with disabilities are more likely to be obese and have lower rates of physical activity, than the general population.
- Obesity prevalence significantly increases with deprivation in women in England, but there is no apparent, statistically significant relationship between deprivation and obesity in men.
- People who are obese are more likely to develop type 2 diabetes.
- Mother and child are at higher risk of developing health conditions during and after pregnancy, if the mother is obese. Nationally, around half of women of childbearing age are currently either overweight or obese and this proportion has been increasing steadily over recent years.
The level of need in the population
The level of excess weight in adults in Leicester in 2012 is estimated to be 57% (37.4% overweight, 19.6% obese) compared to a national value of 64%. According to the Leicester Health and Wellbeing Survey 2015, the overall prevalence of obesity (adults aged 16+) in Leicester is 20%.
Local estimates of obesity show levels are higher in women compared to men, highest in the 35-64 age group and those in Black/Black British ethnic groups.
The impact of the inter-relationship between obesity, diabetes and cardiovascular disease is demonstrated in The Diabetes Health Profile 2015, which states that among people with diabetes in the NHS Leicester City Clinical Commissioning Group (LC CCG) area, the risk of a stroke was 71.7% higher and the risk of a heart attack was 110.9% higher, compared to the population without diabetes.
In 2010/11, 25% of Leicester City women booked with University Hospitals of Leicester were recorded as being overweight and 19% were obese (higher than the national rate of 15.6%).
Current services in relation to need
Weight management services are organised by tiers and available to adults in Leicester. Tier 1 covers universal services (such as open access services and health promotion); tier 2 covers lifestyle interventions; tier 3 covers specialist weight management services; and tier 4 covers bariatric surgery.
There are a number of related lifestyle services that include improving healthy eating and increasing physical activity alongside other health behaviours.
Projected services use and outcomes in 3-5 years and 5-10 years
The prevalence of obesity and overweight in adults is predicted to reach around 70% by 2034. In the UK, past trends predict that between 2010 and 2030, the prevalence of obesity will rise from 26% to 41–48% in men, and from 26% to 35–43% in women.
This equates to 11 million more obese adults by 2030, 3.3 million of whom would be older than 60. Obesity-related diseases are projected to add to healthcare costs by £1·9–2bn a year in the UK by 2030.
Unmet needs and service gaps
There is an absence of a coordinated approach across the healthy weight agenda, there are many smaller scale projects being undertaken, with less clarity on the larger strategy.
Some of the services provided are lacking in scale and evidence of effectiveness and cost effectiveness is limited. Despite requiring commissioned services to use the Standard Evaluation Framework for weight management interventions, there is a lack of high quality monitoring and evaluation data available for many interventions, making drawing conclusions or comparisons challenging.
There is a gap for people who require tier 3 specialist multidisciplinary teams, which is the responsibility of Clinical Commissioning Groups.
Recommendations for consideration by commissioners
Recommendations for commissioners include the development of a partnership healthy weight strategy and action plan; the development of an integrated obesity pathway led by the Leicester City Clinical Commissioning Group lead; and a review by the Leicester City Council of its public health lifestyle services.