HSE has lost €56M by not implementing national obesity treatment policy, experts warn

IrSPEN (Irish Society for Clinical Nutrition & Metabolism) launches Obesity is a Chronic Disease requiring Treatment: A Call to Action for European Obesity Day

Dublin, 17^th May, 2017 – Ahead of European Obesity Day, 20^th May, IrSPEN (Irish Society for Clinical Nutrition & Metabolism) has launched Obesity is a Chronic Disease requiring Treatment: A Call to Action. Obesity experts are calling on the government to implement a national obesity treatment programme to reduce the financial and societal burden from obesity-related diseases like type 2 diabetes, heart disease, sleep apnoea, cancer and fertility issues. By recognising obesity as a disease of the brain and treating people with personalised treatment programmes, including diet, exercise, weight loss medicine, cognitive behavioural therapy, and surgery the HSE could have saved millions. For example doing a minimum of 400 operations per year on patients with obesity and difficult to control diabetes would have saved €56 million over a 10-year period from a reduction in diabetes medication costs alone. * This call to action is supported by The Royal College of Physicians in Ireland (RCPI) and The European Association for the Study of Obesity (EASO).

Ireland has one of the highest obesity rates in Europe and it affects more than one million people here: one in four adults are obese and one in four children are overweight or obese making them highly likely to become obese adults. Every year in Ireland approximately 2,000 deaths are attributable to obesity.[i] According to the WHO, 65% of the diabetes burden, 23% of the heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.[ii] The current cost of treating obesity-related diseases here is approximately €1.16 billion per annum: 35% of this cost is allocated to hospital care and medication costs and 65% is from indirect costs including productivity losses from absenteeism.[iii]

Mortality associated with obesity are treatable with a 10% loss in body weight.[iv] In Ireland, approximately one in 20 adults have an obesity-related disease such as type 2 diabetes, heart disease, sleep apnoea or subfertility which will improve if they can lose and sustain 10% reduction in their body weight. Treatment of obesity is now relatively straightforward as a result of several evidence based and effective treatments that work alongside diet and exercise programmes.

“Failing to accept obesity as a disease contributes to stigma, shame, stress and ultimately the worsening health of patients. Complications from obesity are common, they are costly to manage and have severe effects on a person’s wellbeing”, says Professor Francis Finucane, Consultant in Obesity and Endocrinology, Galway University Hospital. “I have seen the benefits of dedicated obesity treatment programmes in my clinic – these programmes provide a personalised holistic approach that help patients lose 10% or more body weight, remain compliant with their weight loss regime and lower their risk of death from heart disease and stroke. By taking this personalised approach, we can greatly reduce the costs of obesity-related diseases in Ireland and drastically improve people’s quality of life”.

Obesity surgery offers the most successful and cost effective treatment option for the treatment of severe obesity, with more than 90% of patients who seek the procedure (and for whom it was felt to be a suitable therapeutic option) achieving significantly more than 10% weight loss[v]^,[vi]. Research shows that up to 40% of patients with type 2 diabetes who undergo obesity surgery can achieve remission from their disease. Additionally, there is a mortality benefit and a two to three-year return on investment for the healthcare provider.^6,[vii] Yet, in Ireland, less than 0.1% of patients for whom it would be effective over the longer term have access to obesity surgery. Treatments for obesity in general are severely under-resourced in Ireland at the two publicly funded regional obesity centres in Galway and Dublin.[viii]

“Through extensive medical research, we now know that only two in ten patients will respond to diet and exercise alone to achieve more than a 10% body weight loss. Eight out of ten need other therapies: three of these patients will respond to weight loss medication and five will respond to obesity surgery”, says Professor Carel le Roux, Diabetes Complications Research Centre, Conway Institute, UCD and IrSPEN board member. “While prevention of obesity remains key, funding also needs to be allocated to mitigate and treat the disease itself. Given the cost effectiveness of treatment programmes and the potential for net savings, the failure to invest in these treatments for suitable patients is a false economy.”

The obesity call to action, supported by European and Irish expert bodies and patient organisations, urges immediate and decisive government action to address the gaps in our healthcare system that prevent those affected by the complications of obesity from accessing effective therapies that will help them achieve and sustain more than 10% loss in body weight.

Key recommendations:

1. Gain recognition that obesity is a primary disease

The Department of Health in Ireland, World Health Organization (WHO), American Medical Association (AMA) and Food & Drug Administration (FDA) have all acknowledged that obesity is a disease. This is an important action to focus attention on the obesity problem and help improve services for the management of obesity 

2. Implement existing government policy that obesity is a disease that requires treatment

• Provide treatment interventions that can help people with obesity lose at least 10% of their body weight to enable them to reduce their mortality and improve their quality of life
• Provide access to treatments within the HSE to provide maximum benefit to the largest number of people that will obtain value while still being cost effective for the HSE

3. Establish a national obesity treatment programme

• Establish a national obesity programme in Ireland that delivers regional specialist weight management services as part of an integrated model across primary, secondary and community care
• Ensure access to specialist diet and exercise programmes, weight loss medication, cognitive behavioural therapy and obesity surgery for people who will have significant health benefit from a 10% loss in body weight. Centres should have well-integrated pathway from primary care services to secondary care and back
• Develop care pathways that complement existing preventative care and community based interventions
• Broaden the expertise of the obesity multidisciplinary teams so integrated services can deliver intensive diet and exercise programmes, medication or obesity surgery to at least 400 patients per year while being geographically located in such a way as to optimise access nationally
• Establish obesity treatment centres in each of the six hospital groups alongside one national paediatric obesity centre, with full multidisciplinary teams and access to associated assessment clinics within each of the HSE Hospital Groups
• Multidisciplinary teams need to be fit for purpose and could include upper gastrointestinal surgeons, an obesity physicians, a dietitians, a specialist nurses, a clinical psychologists or psychiatrists and physiotherapists or exercise physiologists

4. Education of healthcare professionals

• Educate healthcare professionals that a) obesity is a disease, b) obesity can benefit from treatment. Healthcare professional-initiated discussions can motivate patients to lose weight and change behaviour. As patients are less likely to start the dialogue about their weight it is important that healthcare professionals are educated as to how they can take the initiative to discuss obesity as a disease

5. Public awareness and education

• Empower individuals to take responsibility for their weight by educating the public that obesity is a disease and that treatments range from diet and exercise to medications and surgery
• Provide clear and accessible nutritional health information to the public, through our education system, community and primary care centres and through targeted media campaigns

The full IrSPEN call to action can be downloaded HERE .

Further details of how to support European Obesity Day and where to find more information on obesity, and obesity prevention and treatment, are available on the European Obesity Day website: www.europeanobesityday.eu. Activities can also be followed on Twitter (@EOD2017 and #EOD2017) and on Facebook https://www.facebook.com/EObesityD/)