Expert seeks strategy of total war on endemic obesity

A leading doctor has claimed the Scottish Government's anti-obesity strategy needs to be broadened to look at psychological issues, cultural pressures and improving Scotland's weight loss services.

Dr David Blane says the overweight should be given the same priority as smokers and alcoholics with emphasis on psychological and cultural pressures involved. Picture: Jeff J Mitchell/Getty

Dr David Blane also believes more emphasis should be placed on training doctors in working with overweight patients and that obesity should be given the same priority as tackling smoking and drinking.

Speaking to Scotland on Sunday, Blane said he thought the government’s strategy is too narrowly focused on the link between diabetes and obesity and more should be done to look at other complex health issues relating to being overweight.

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Although he believes treating diabetics is an important strand of Scotland’s obesity crisis, Blane said more should be done to look at other complex health issues linked to being overweight, such as heart disease and breathing problems.

Blane, who specialises in tackling obesity, will address a conference in Edinburgh this week titled “Policy Priorities for Tackling Obesity in Scotland” which will be attended by public health minister Aileen Campbell.

“For me the main criticism of the strategy is that its focus in terms of weight management services seems to be on people either with diabetes or at risk of diabetes,” said Blane. “That is clearly important, but there are a large number of adults with obesity and other health problems related to their weight, which aren’t necessarily diabetes.

“It is probably less than one third, less than a quarter even of patients that have diabetes. So there is quite a large number of adults with complex health needs and often there are large psychological components to obesity. Often there are situations of adversity in childhood or other stresses that someone has been under which has led to over eating as a coping mechanism.

“I think what I consider a narrow focus on diabetes neglects some of that more complex health problems and particularly the psychological issues relating to obesity. So I am talking about heart disease, high blood pressure, obstructive sleep apnea, other breathing problems plus a range of psychological issues like stress, anxiety, depression, tied up with the societal stigma surrounding obesity.”

He added: “It is about social and cultural attitudes. In the society we live in there are lots of mixed messages. You are getting bombarded with images of what it is to be healthy and beautiful. The fashion industry partly drives that. There are other stereotypes of people with obesity being lazy. It’s a tough nut to crack.”

The Scottish Government is working on an anti-obesity strategy which includes proposals to clamp down on promotions on food that is high in fat, salt and sugar. It is also looking at the introduction of portion limits on takeaways and pub and restaurant food. Much of it is concerned with preventing type 2 diabetes, a condition that takes up NHS resources and which obese people are at seven times higher risk of contracting.

Scotland has some of the highest obesity levels among the OECD countries. The latest statistics suggest that 29 per cent of Scotland’s children are at risk of becoming overweight (including obesity) and 14 per cent were at risk of becoming obese.

Around two thirds of adults (65 per cent) are classified as overweight, a figure that includes 29 per cent who are obese.

The risk of obesity is higher for those living in poorer areas with 28 per cent of men in the poorest areas classified as obese compared with 22 per cent in the more affluent areas. The gap between rich and poor is more pronounced amongst women, with 37 per cent of females in deprived areas classified as obese compared with 21 per cent in richer areas.

Last week fresh statistics found that thousands of children, including some as young as two, have been referred to specialists amid concerns over their weight in the past three years.

Health board weight management services have seen more than 5,000 youngsters since 2014-15, with at least 1,600 referrals of under-18s last year alone. Hundreds of those referred were aged between two and four.

With NHS weight management services facing huge demand, Blane said the treatments available were patchy across the country.

Blane, who is a GP and Glasgow University academic who works with some of the most deprived communities in Scotland, cited a study demonstrating that weight management services vary from health board to health board.

“Obesity has not really had the same attention to weight management services that we have had to other problems like smoking or alcohol,” Blane said.

“The funding put towards the services side of thing has been minuscule in comparison and I think that has knock-on effects, because partly there is the issue of availability of services and that varies across Scotland. Even the services looking at simple diet and physical activity stuff in a co-ordinated way is variable across the country. Bariatric surgery [including gastric bypasses and gastric bands] is extremely variable.”

He added that health professionals do not get the training required to treat obesity effectively.

“The Royal College of Physicians and the Academy of Medical and Royal colleges have both done reports in the last few years saying that obesity is under-represented in training curricula so actually professionals are not getting the training they need to talk about weight,” he said.

A Scottish Government spokesman said: “We have put forward a package of bold measures designed to help people make healthier choices, empower personal change and show real leadership. Improving the food environment is the single biggest change we want to see in terms of public health. Our strategy includes world leading proposals to restrict the marketing of foods high in fat, salt and sugar.

“As with our ground-breaking strategies on alcohol and tobacco, this is the start of a progressive plan of action, learning from our experience in Scotland and further afield, that will make a real, lasting difference to the country’s health. We are currently considering all of the comments received to our consultation which closed at the end of January.”