A quarter of the adult population of the UK are now obese and nearly 2% are morbidly obese. The co-morbidities associated with obesity include type two diabetes, sleep apnoea, cancer, depressions and arthritis (NHS Information Centre 2010). The impairment to quality of life and the disability caused by these conditions carries an enormous human, social and financial cost; in 2007 these costs to the wider health economy were estimated to be in the region of £3.2 billion. Obese patients are proven to have a higher prevalence of limiting, longstanding illnesses, and obesity is also known to decrease life expectancy by seven years in a 40-year-old, increasing up to the age of 75 years.
The National Obesity Forum was established in 2000 to raise awareness of the epidemic of obesity and seeks to help clinicians understand both the causes of obesity and how to manage this complex, debilitating and multifactorial condition.
Treating patients with obesity in the NHS is a complex and costly undertaking. Outside of bariatric surgery departments, many hospitals are ill-equipped to provide care for severely obese patients (Butcher et al, 2012). Obese patients have increased hospital stays equating to an increased use of hospital services. Mobilising patients after trauma presents particular issues, and failure to provide adequate and appropriate equipment can lead to suboptimal treatment of, and injury to, both patients and staff. Manual handling of high-risk patients can carry further difficulties; 10% of claims reported to the NHS Litigation Authority were related to injuries sustained while caring for obese patients.
Moving and handling obese patients requires particular skills, but there are also medical concerns to surmount. Peripheral IV access is more difficult in an obese patient and even taking a blood pressure becomes a more complex procedure for which the equipment is not always available. Larger blood pressure cuffs, scales which take extra weight, ambulances built to take extra weight and beds with extra weight limit and wheelchairs, commodes, and extra large dignity gowns are not yet standard throughout the NHS. Training is also an issue because staff need to experience the problems they may encounter as realistically as possible but with minimal risk. Safety and dignity of the patient is always paramount when considering the moving and handling of any patient or client, but especially one who is considered to be morbidly obese.
When diet, exercise, pharmacology and talking therapies have failed to address weight issues, bariatric surgery is very helpful in these cases, often offering the additional resolution of accompanying type two diabetes in up to 70% of cases. Body contouring surgery, which 80% of these patients will need following bariatric surgery, is however, not currently offered on the NHS.
Obesity is a long-term condition becoming increasingly prevalent in the UK today. Human and financial costs are set to rise, affecting all sections of society and those who care for them.