The prevalence of obesity in the UK in 2001 reached 21% in males and 23.5% in females.1 As a result, widespread consequences include an impaired quality of life, increased social support and disability allowance for the social services budget, and an increased impact on healthcare resources. Despite consistent evidence for major clinical benefits from moderate weight loss and weight maintenance in large-scale and long-term studies,2–5 few resources are allocated to fund weight management in the primary care setting. Difficulty in establishing efficacious obesity management in primary care has been highlighted by the Brief Intervention Obesity (BIO) project, which recently reported the failure of a 4.5-hour training programme for GPs and practice nurses to achieve weight loss in participating patients.6
How this fits in
As healthcare costs continue to rise, much attention has been placed on ensuring good prescribing practice to optimise patient care within available resources. Previous estimates have given an indication of the influence of obesity on healthcare costs but none has documented evidence on the full impact this disease has across clinical areas including those not normally associated with being obese. This study has used a new approach based on defined daily doses to begin to clarify the extent of the problem.
Potential obstacles to providing weight management within normal health care include a lack of awareness of the extent of ill health attributable to obesity and of the multiple benefits of modest weight loss (5–10% of body weight), plus a perceived cost of intervention. Costs of some experimental interventions have been high, but the marked health benefits may be achievable by well-designed, cheaper interventions within routine care.3,4,7,8 The economic case for incorporating weight management within a healthcare service will depend on the balance between the costs of intervention versus potential cost savings from the reduced need to treat obesity-related comorbidities.
The costs of obesity in a variety of countries have been estimated at 4–8% of total healthcare budgets, mainly from the increased prevalence of comorbid conditions and general costs of their management.9–12 Direct costs of obesity were estimated at around £500 million plus indirect costs of around £2.1 billion in 1998 in England.13 A large proportion of these healthcare costs arise from drug prescriptions: around 25% of primary care trust (PCT) budgets have been spent on prescribing14 and drug costs absorb most of the non-fixed costs of primary care. As pressure builds on NHS resources, a number of recommendations have been made, which aim to benefit patients and generate savings in prescribing budgets;14 the balance of costs around obesity and weight management, however, have not been included.
The World Health Organisation (WHO) system of defined daily dose(s) (DDD[s]) reliably measures drug volume15 (Supplementary Appendix 1). Other studies assessing prescribing volume have used this method.16,17 The Counterweight Project7 included a baseline survey of medical practice that aimed to establish: