title: Obesity Treatment in the UK Health System.
abstract: In the UK, as in most other countries in the world, levels of obesity are increasing. According to the Kinsey report, obesity has the second largest public health impact after smoking, and it is inextricably linked to physical inactivity. Since the UK Health and Social Care Act reforms of 2012, there has been a significant restructuring of the National Health Service (NHS). As a consequence, NHS England and the Department of Health have issued new policy guidelines regarding the commissioning of obesity treatment. A 4-tier model of care is now widely accepted and ranges from primary activity, through community weight management and specialist weight management for severe and complex obesity, to bariatric surgery. However, although there are clear care pathways and clinical guidelines for evidence-based practice, there remains no single stakeholder willing to take overall responsibility for obesity care. There is a lack of provision of adequate services characterised by a noticeable 'postcode lottery', and little political will to change the obesogenic environment.
authors.affiliation: Rotherham Institute for Obesity (RIO), Rotherham, S65 1DA, UK.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Capehorn
authors.affiliation: Luton and Dunstable Hospital, Luton, LU4 0DZ, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Haslam
authors.affiliation: Department of Bariatric and Upper Gastrointestinal Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK. Richard.Welbourn@tst.nhs.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Welbourn
mesh_terms: D050110:Bariatric Surgery / Q000191:economics / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D055317:Evidence-Based Practice; D006291:Health Policy; D054625:Healthcare Disparities; D006801:Humans; D008483:Medical Assistance / Q000458:organization & administration* / Q000706:statistics & numerical data; D009313:National Health Programs; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D011634:Public Health; D012959:Socioeconomic Factors; D006113:United Kingdom
keywords: Clinical commissioning group; Commissioning; Multidisciplinary team; National Health Service; Obesity; Tier 3; Tier 4 health; Tier model