Examination of Witnesses (Questions 1035-1039)
18 DECEMBER 2003
DR IAN
CAMPBELL, DR
COLIN WAINE,
DR NICK
FINER, PROFESSOR
JOHN BAXTER
AND MS
DYMPNA PEARSON
Q1035 Chairman: Can I ask you each to
introduce yourselves briefly to the Committee?
Dr Campbell: My name is Ian Campbell.
I am a general practitioner in Nottingham, a hospital specialist
in weight management, and I chair the National Obesity Forum.
Dr Waine: Colin Waine. I was a
GP for 34 years, and am currently Visiting Professor of Primary
Care at Sunderland.
Dr Finer: I am Nick Finer. I am
a senior research associate at Cambridge University, and an Honorary
Consultant both at Addenbrooke's and Luton & Dunstable Hospital.
I am past Chairman of the Association of the Study of Obesity.
Professor Baxter: I am John Baxter,
a consultant surgeon in the Swansea NHS Trust in Wales, Professor
of Surgery in the University of Wales and also Secretary of the
British Obesity Surgery Society.
Ms Pearson: I am Dympna Pearson,
Chair of Dieticians in Obesity Management UK and representing
also the British Dietetic Association. I work in training dieticians
and other healthcare professionals on the nutritional and behavioural
aspects of obesity.
Q1036 Dr Naysmith: There is a lot of
evidence to suggest that obesity could soon become the greatest
cause of premature death in this country, and it looks as if it
is heading that way. I want to ask two questions, and I will start
with Dr Campbell, if I may, but other people can come in. I know
Dr Campbell has been very active in Parliament in pushing this
matter up the agenda and we want to hear what he wants to say
about it, because he has been involved in some of the politics
of it. To what extent does the National Health Service give obesity
priority, and would you welcome a national service framework with
specific targets?
Dr Campbell: I think the National
Health Service give insufficient prioritisation to weight management,
and it has done historically. We have seen a shift towards improvement
over the past five years, but a recent report by the independent
Dr Foster Organisation, showed that there was very patchy provision
of weight management across the country, and some primary care
trusts offer none whatsoever. There has been a slight sea change
over the past two years with primary care trusts taking an added
interest, but it is very rarely backed with any significant resources,
and they are encouraging some clinicians to provide weight management
services but not giving them the resources to back it up. By some
coincidence, two days ago I received a letter from my own primary
care trust saying that as a PCT we were quite high in our use
of weight-loss medication, and we were to reconsider our practice
policies. I cannot recall, in 15 years in general practice, receiving
a letter questioning our prescribing of heart disease medication
or diabetic medication; and this really typifies the prevailing
attitude at the moment. The national service framework would go
a long way to making it acceptable, and making it able to attract
increased resources, and to almost compel clinicians to offer
weight management. The difficulty I have had is in convincing
people of that. Although we are very active in managing diabetes
and heart disease, we fail to go a few steps backwards to look
at the causes of these. Weight management would improve the quality
of care of diabetics and heart disease, and to not offer weight
management is almost neglectful. So a national service framework
which set government-directed standards would go a long way to
helping us, I believe.
Q1037 Dr Naysmith: I notice you carefully
distinguished, in answering both questions, between obesity and
weight management. Is there a significant difference that you
would like to draw our attention to?
Dr Campbell: No, "weight
management" is just a term we use to describe the whole concept
of treating obesity.
Q1038 Dr Naysmith: But it could mean
treatment for people before they get to the obese stage, could
it not?
Dr Campbell: Absolutely. You have
got two-thirds of the population who are overweight and who need
to start by taking some personal responsibility, and then utilising
what resources are available, perhaps even outwith the National
Health Service, to help themselves; but many of them then come
from help from their doctor, and they should be able to get the
treatment they need. The overweight and the obese, but particularly
those approaching obesity—there are more than 10 million
of them who need treatment within the National Health Service,
and currently they are not getting it.
Q1039 Chairman: Dr Campbell, you run
an obesity management clinic at a local hospital, as well as your
general practice. Did you initiate that? What was the background
to the establishment of that clinic?
Dr Campbell: I do not run the
clinic; I work at it. I have been there for five years. It was
initially set up by a consultant who was interested in endocrinology
and under-nutrition, and I was asked to be part of it five years
ago. We continue to offer obesity management, weight management
services to the very morbidly obese across Nottinghamshire.
Dr Waine: It has to be said that
obesity has been trivialised by the media and marginalized by
the Health Service, and to a large extent it still is. It is associated
with up to 43 co-morbidities. It is a major influence in the current
epidemic of type 2 Diabetes. In terms of childhood obesity, there
are so many cardiovascular risk factors present in children with
serious obesity that we are in danger of breeding a generation
that will die before its parents.
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