In conversation with Professor Rachel Batterham
We are pleased to meet with Rachel Batterham, Professor of Obesity, Diabetes and Endocrinology at University College London, who leads on obesity services at University College London Hospital. In conjunction with Royal College of Physicians (RCP) she has developed a fascinating and highly watchable video highlighting the challenges of obesity in the UK, which has come into clear view during the COVID19 pandemic.
Rachel, you have expert voices at the highest level here describing the challenge of obesity as critical, “one of the biggest future health challenges we have”. Yet obesity care and treatment seems to lag and we still face a challenging narrative around “eating less and moving more” as a “solution” to obesity, which ignores the science and is insulting to people with lived experience of obesity and our collective intelligence.
As part of the documentary, I interviewed the Chief Medical Officer, Professor Christopher Whitty, and the National Clinical Director for Diabetes and Obesity, Professor Jonathan Valabhji, two key people who hold the power to change the narrative from “eat less and move more” to obesity being a complex multifactorial medical condition and to influence the establishment of evidence-based treatment pathways.
You present stark and startling statistics on childhood obesity in the documentary which will likely be surprising to viewers.
In 2018, more children were classed as living with obesity in the UK than in the USA. Obesity rates in both reception-aged and year 6 school children increased by around 4.5 percentage points between 2019-20 and 2020-21 – the highest annual rise since the National Child Measurement Programme began in 2006.
The National Child Measurement Programme 2020/21 showed that 14.4% of reception age children had obesity. This rises to a quarter of children aged 10-11 (25.5%). This is more common in boys than in girls in both age groups. Obesity prevalence among children living in the most deprived areas (20.3%) was more than double that of those living in the least deprived areas (7.8%). These data highlight the need for action in terms of prevention, addressing health inequalities and offering weight management to children and young people who are currently living with obesity.
It is outstanding to see and hear insights from people living with obesity feature prominently in the video. The challenge of weight stigma and obesity stigma, particularly in health care settings, arises again pointing to the general lack of understanding about key drivers of obesity — particularly genetics, but also deprivation and inequality.
Historically healthcare professionals have received little, if any training regarding the complex drivers of weight gain, the biological compensatory mechanisms that make weight loss maintenance so difficult or about evidence-based treatments for obesity. This lack of knowledge coupled with the idea that being tough with people about their weight will motivate them to lose weight drives weight stigma. It is critical that all healthcare professionals, both those in training and already qualified receive training regarding the causes of obesity, obesity management and the harmful effects of weight stigma both on physical and psychological well-being. This is where the voice of people living with obesity with lived experience of weight stigma can be so powerful in changing behaviours. The Obesity Empowerment Network UK (https://oen.org.uk/) is a charity formed by a partnership between people affected by obesity and healthcare professionals and one of their key missions is to eliminate obesity stigma through education.
With two thirds of us currently at an unhealthy weight and a shocking 14 National Obesity Strategies since 1992, what do experts suggest we need to do to move the dial on obesity? Will targeted treatments based on our genetics help?
We need a multi-pronged approached. We need policies that impact upon our food environment so that healthy food is the easy, affordable choice and policies that tackle food poverty.
We need pathways for weight management that are accessible to all with implementation of NICE guidance. Changing the narrative to obesity being a chronic complex multifactorial medical condition is key to move the dial. Going forward, individualised treatment strategies agreed in partnership between the person living with obesity and their healthcare providers, including treatments targeted to specific genetic causes of weight gain, will become the norm.
Acknowledging the complexity of obesity, what do your colleagues and key decision makers suggest is the likelihood we will make a serious and sustained multi-lateral investment in obesity prevention and management as has been recommended?
COVID-19 has shone a spotlight upon the impact of obesity upon health that cannot be ignored. The government committed an additional £100 million towards obesity prevention and treatment in 2021, which is a positive start and hopefully there will be ongoing additional funding. However, what’s really needed is cross-government year-on-year investment focused on targeting health inequalities. Professional bodies such as the RCP, which is calling for a cross-government strategy to reduce health inequalities, need to keep the pressure upon government to deliver this.
I believe this documentary will have a real impact. Thanks so much for taking the time, and we look forward to seeing you in Maastricht!
Thank you for highlighting this documentary and thank you to all the people with lived experience of obesity who shared their experiences.