War on obesity a success in England, but not for England

The Information Centre’s latest Health Survey for England report, Statistics on Obesity, Physical Activity and Diet: England, January 2008, has just been released. It provides evidence that the war on obesity has been enormously successful ... for its corporate sponsors.

The number of prescriptions for weight loss drugs in England increased 800% from 1999 to 2006, to 1.06 million. Those skyrocketing figures show no sign of abating — the first half of 2007, the latest period data is available, were another 25% over the same period in 2006.

The costs of these diet drugs alone, born by the already financially strained national healthcare system, increased from £4.9 million to £47.5 million (that’s $94.5 million in U.S. dollars) from 1999-2006, while the price per prescription rose from £38 to £45. Orlistat costs rose the most.

Most of these prescriptions were for two drugs: Orlistat (73% of prescriptions) and Sibutramine (25%). What makes this so disturbing, besides the fact that the effectiveness of these drugs for weight reduction has been nominal, at best, in short-term trials, is that there is no evidence these drugs are safe for long-term use. Worse, these drugs have been approved for use with no evidence that they reduce premature deaths or reduce actual health problems. Nor is there evidence of long-term effectiveness or safety.

Their use is controversial and has been called into question by doctors and independent medical advocacy organizations around the world, as recently reported here. For example, a systematic review of fourteen randomized, placebo-controlled trials among adults with type 2 diabetes led by Dr. Susan Norris, M.D., of the Centers for Disease Control and Prevention; as well as a review by doctors at the University of Alberta Hospital in Edmonton, Canada, both expressed concern about the short-term trials, all of which have shown only minimal temporary weight loss; the lack of long-term safety data; and the significant adverse effects already seen with short-term use. Those include gastrointestinal problems with orlistat and high blood pressure and heart rate problems with sibutramine.

The U.S. Federal Trade Commission convened an expert panel to review the evidence for its 2003 investigation into deceptive weight loss advertising. Concerning orlistat (Xenical), the panel’s scientists concluded: “The biological facts do not support the possibility that sufficient malabsorption of fat or calories can occur to cause substantial weight loss.”

Diet drugs have a universally poor history of effectiveness and an even worse one for long-term health problems. But, sadly, it’s not hard to understand why people have come to feel so desperate to lose weight that they would consider risking their health to take drugs with such poor evidence. Nonstop threats directed at fat people have saturated media for years, reporting frightening stories of premature deaths and disease, denial of needed healthcare, and discrimination in consideration for jobs to adoption of children.

It’s also not hard to understand why doctors have come to believe that these drugs are effective and advised, because such information fills the medical literature. The pharmacological management for obesity has also been incorporated into the National Institute for Health and Clinical Excellence (NICE) guidelines — the clinical practice guidelines that doctors in the British National Health Services (NHS) must follow as part of their national contracts. It tells physicians: “Drug treatment should be considered for patients who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes alone.” And, as we know, that describes all fat people because ...diets don’t work.

Those same NICE obesity guidelines similarly advise bariatric surgery. And, not surprisingly, the Health Survey for England report found that bariatric surgeries had soared from 121 in 1996/7 to 997 in 2005/6 (all but 19 were on were women) — costing the NHS another £45 in 2006 ($89.53 US. dollars) — an increase of 823%.

Incidentally, diet drugs and bariatrics were among those rising “costs of treating obesity” that the report also accounts. But it pointed out that the increases were also due to a number of reasons, including higher NHS and drug costs, more detailed information (mandatory reporting) and the inclusion of more “comorbidities” into the figures.

As the report explains, the Quality and Outcomes Framework for 2006/07 included a mandate which rewards doctors for maintaining an obesity register of patients (aged 16 and over). “In England, in 2006/07, nearly 4 million people aged 16 and over had been recorded by GPs on obesity registers.”

Sponsors of the obesity crisis

As JFS readers will remember, the creation of the NICE guidelines, like the EU’s Public Health Action Programme, countless public obesity initiatives and this Health Survey report, have involved a range of stakeholders. Prominent among them are the Association for the Study of Obesity (ASO), Obesity TaskForce (IOTF) and the National Obesity Forum.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE who led the development of the NICE obesity guidelines said: “Obesity is the most serious threat to the future health of our nation. Its risks are as serious as smoking and urgent action is needed to tackle this problem now. For the first time we have brought together all the people that can help solve the obesity problem – not just health professionals, but also local councils, employers and schools – to produce a piece of work that sets out the steps we must take as a nation in order to tackle the obesity epidemic.” The EU Commissioner for Health said nearly the identical thing in a 2003 issue of Eurohealth: “Obesity is the major emerging threat to public health in Europe,” he wrote. “Obesity is an issue on which the EU needs to pool its intellectual resources. Addressing obesity is a priority of the EU...Beating the obesity epidemic will require governments, stakeholders at all levels, local, national, European and international, to work together.”

National divisions of these same organizations are here in the United States. These international groups are not independent obesity advocacy or professional organizations, however, as their names might suggest.

The sponsors of the obesity crisis, explained Peter Marsh and Simon Bradle in an investigative report for the Social Issues Research Centre, are pharmaceutical companies whose campaigns are aimed at increasing “obesity awareness” but are nothing but “thinly disguised marketing” for diet drugs:

Dr. Ian Campbell, chair of the UK National Obesity Forum... includes a number of pharmaceutical companies in its list of sponsors who manufacture the drugs that he suggests can play a significant role in stemming the obesity 'epidemic'. Dr Campbell has also been listed on a help line advertised in Roche's 'Obesity Awareness Campaign' materials — a poster campaign criticised by GPs as being a thinly disguised marketing exercise for Xenical.

International Association for the Study of Obesity, of which the International Obesity Task Force (IOTF) is a major part... appear as joint 'working names' in the UK Register of Charities. Both the national organisations and the umbrella international bodies receive extensive financial support for conferences and other activities from the major pharmaceutical companies... The chair of IOTF, which shares offices and funding sources with IASO, is Professor Philip James — a well-known anti-obesity campaigner and a specialist adviser to the Health Committee's inquiry into obesity... was the lead researcher in trials of sibutramine, a weight-loss drug manufactured by the Knoll Pharmaceutical Company, and orlistat (Xenical) made by Roche, and is regularly engaged in what can only be described as PR activities for Roche....

The Health Survey for England report shows just how effective their campaign for an “obesity crisis” has been. Profitable for them, but considerably costly for the public.

© 2008 Sandy Szwarc