The NHS is restricting access to obesity services across England, reports the BMJ

The NHS is restricting access to obesity services across England, resulting in patients in almost half the country unable to make appointments with specialist teams for support and treatments such as weight loss.

A study by the British Medical Journal found that funding cuts to local services fell disproportionately on obesity treatment, as patients living with the condition are often seen as less worthy of care than others.

The restrictions amounted to the NHS “rationing” obesity services, one expert said, leading to a “postcode lottery for care”.

Patients in one in six local health care areas were unable to access bariatric surgery, one of the most clinically effective treatments for obesity, according to the study, which analyzed responses to freedom of information requests from all 42 of England’s integrated care boards (ICBs).

Dr Nicola Heslehurst, professor of maternal and child nutrition at Newcastle University and chair of the British Association for Obesity Research, told the BMJ that the weight management service was “by no means meeting the need”, adding that “drastic” action was needed to avoid rising obesity and care costs , worsening inequality and that children “will be set up for a life course of poor health”.

Obesity is estimated to cost the NHS in England £6.5 billion a year and is the second biggest cause of cancer after smoking.

ICBs are funded by NHS England to provide healthcare for their residents, but budget cuts have left many under severe financial pressure. When money is allocated, services deemed less important may not receive any funding, and obesity treatment is often the first to face the axe.

Just over half (24) of care councils in England operated a full range of adult weight loss services and were open to new referrals. Services range from local diet and lifestyle classes to semaglutide weight loss injections, sold as Wegovy, and gastric bypass surgery.

More than a third of ICBs reported limitations in obesity care at level three, where patients are seen by multidisciplinary teams that can provide dietetics. Six said their service was closed to new patients, seven only covered part of their catchment area and four had no tiered service.

Four categories of services, including gastric bypass surgery and intensive weight management services, are limited in many parts of England, according to the study, with seven ICBs providing no allergy services.

John Wilding, professor of medicine at the University of Liverpool, told the BMJ that obesity services were “not considered a priority”. “I think there’s an unconscious bias that says, ‘It’s mostly their fault, so they should just get on with it, diet and lose weight.’ But we know from genetics and other factors that it’s much more complicated than that,” Wilding said.

The BMJ findings echo those of a recent report by the Future Health research institute. It found that many of England’s NHS ICBs had not set out detailed plans to tackle obesity and treat those with it, despite it costing the UK around £98bn a year in health costs, lost productivity and other cost.

Richard Sloggett, the author of this report, and a former special adviser at the Department of Health and Social Care, said the new information showed the NHS was “rationing” obesity treatment. “These findings support our future health research which shows that many ICBs do not currently see obesity as a priority.” In certain parts of the country there is no access to 3rd and 4th class services at all.

“This rationing leads to a care lottery. Given the scale of the obesity challenge facing the country and the wider health and economic costs and impacts associated with it, there is an urgent need for government and the NHS to take new action. This should start with a clear timeline for reviewing NHS obesity services and ensuring that a minimum service specification is agreed and in place in every ICB.

A spokesperson for NHS England told the BMJ that the NHS was “working with the Department of Health to support obesity process reform”.