ABERGAVENNY woman Pam Bland weighed more than 25 stones when she was referred to a Welsh obesity specialist late in 2010.
Eighteen months later, she was down to 13 stones, a weight she has maintained with support and advice from the specialist service, and a transformed lifestyle and diet.
Her treatment could become more common as Wales tries to fight an epidemic of obesity with more weight loss surgery and specialist clinics recommended, to help treat obese people in Wales. (See bottom of page for full story)
Proposals follow hot on the heels of a medical profession report warning that action must begin now to tackle a multi-billion pound epidemic. But it cannot be solely the responsibility of the NHS. Health reporter ANDY RUTHERFORD reports.
WEIGHT loss surgery on the NHS in Wales could quadruple, and intensive multi-disciplinary help be made more widely available for severely obese people, following a specialist services review.
The Welsh Health Specialised Services Committee (WHSSC) announcement paves the way for more bariatric surgery in Wales, and for more specialist obesity services to be developed.
Should Wales’ health boards decide to act on the review’s findings, this would be good news for increasing numbers of people whose lives are blighted by obesity.
Warnings of the health and financial consequences of an obesity epidemic are a regular feature of newspaper and broadcast media headlines, and they should be well heeded.
Obesity-related illness costs the NHS in Wales around £73 million a year. UK-wide that tops a staggering £5 billion.
An estimated 60 per cent of us are overweight or obese. The latest Welsh Health Survey reported that 57 per cent of people in Wales consider themselves overweight or obese, with 22 per cent obese.
Given the scale of the problem, the prospect of increased help is well-timed.
Wales currently has only one NHS consultant-led specialist weight management clinic, at Ysbyty Aneurin Bevan in Ebbw Vale.
Over 12 years it has become a magnet for referrals from an ever wider area. Consultant physician Dr Nadim Haboubi, who runs it, welcomes the WHSSC’s review and recommendations but says the health sector alone cannot tackle obesity.
“It’s not caused by simply one problem, therefore the solution will not be found by tackling one issue,” he said.
“Obesity is caused by a combination of food, physical inactivity, lack of facilities, poverty, unemployment, deprivation.
“It is everybody’s business, not just down to doctors.
Agriculture, food, education, housing, environment, all sectors must work together. When and how I don’t know, and sadly I don’t think it will be any time soon.
“There are lots of guidelines and reports published, but none is supported with money.
Nobody wants to pay the bill.”
Dr Haboubi believes a government- created body should liaise with all sectors just to tackle obesity.
“But it needs long-term planning and people here are probably looking only to the next election,” he said.
“We would save a lot of money by planning long term. Obesity costs £5bn a year, and by 2050 it will be £10bn if something is not done.”
● THE review by the WHSSC found that the All Wales Obesity Pathway, launched in 2010, has yet to be fully implemented.
The pathway has four levels, ranging from primary prevention and early intervention at level one, to bariatric surgery at level four, and the shortfall in implementation is particularly apparent at level three – intensive, specialist, non-surgical, mutli-disciplinary obesity services for people failing to maintain a healthy weight.
More clinics like that at Ebbw Vale would help boost level-three provision.
The WHSSC, independent of the Welsh Government, is required to advise health boards on how to make best use of resources for specialised services, and has asked them to consider the review findings while developing plans for such services in 2013/14.
It is for health boards, however, to decide which, if any, of the options regarding bariatric services they will adopt.
A revision of bariatric surgery criteria is under consideration.
Wales has stricter criteria than England for surgery, with only patients with a Body Mass Index (BMI) of 50 or greater, with health problems, eligible at present for options such as a gastric bypass or band. Eligibility could be reduced to those with a BMI of greater than 35.
Tax fatty foods – doctor
DR Haboubi is an advocate of taxes on fatty foods, a measure suggested by the recent Measuring Up report from the Academy of Medical Royal Colleges.
It paints a stark picture of obesity and its consequences, setting out a range of recommendations, including a tax on fatty foods and sugary drinks. “It would be fantastic if we taxed such things, but unless we also subsidise healthier foods – lean meats, fruit, vegetables – we are not tackling the issue in a rounded way,” said Dr Haboubi.
“Our clinic is in Blaenau Gwent, a deprived area.
Many healthy foods are just not affordable for many people in areas like this. But it is not all about food, it is also about being inactive, sedentary.
“Demand at the clinic is rising. We get referrals from Cardiff, Pontypridd, Haverfordwest, Brecon, Rhayader.
“It is a long way to ask people to travel and they need a lot of regular follow- up, a lot of motivation and support.”
THE Measuring Up report contains a range of facts and figures, and recommendations for action: ● Almost one-third of nineyear- olds are overweight or obese. Figures for adults – currently just over a quarter of men and women – are on the rise.
● A tax on fizzy drinks would follow the example of a ‘soda tax’ in several US states.
● Most obesity is the result of slow weight gain.
● Obesity has psychological causes and consequences, for instance, unhealthy lifestyles can be associated with depression, anxiety and severe mental illness.
● Marketing, increasingly through social media, promotes foods high in calories, fats and sugars.
● Hungary already taxes foods high in salt, fat and sugar; France recently introduced a tax on soft drinks; Denmark has long taxed sugary sweets and drinks, and banned trans-fats.
● Some evidence suggests that increased taxation of 20 per cent is needed for a sufficient impact on consumption, with a minimum price increase of 20 per cent on sugar-sweetened drinks, trialled for at least one year.
● Major food manufacturers and supermarkets should agree by the end of this year a unified system of traffic-light food labelling, based on percentages of calories for men, women, children and adolescents, and visible calorie indicators for restaurants, especially fast-food outlets.
Abergavenny woman lost 12 stones
FITNESS FIRST: Pam with trainer Michael Jones
WHEN Pam Bland was referred to Dr Haboubi’s clinic late in 2010 she weighed more than 25 stones.
Eighteen months later, she was down to 13 stones, a weight she has maintained with support and advice from the clinic, and a transformed lifestyle and diet.
Last October she completed the Cardiff half-marathon, and intends to tackle a full marathon this year.
“I need to lose another stone because of that, and I’m waiting for an operation to remove loose skin due to my weight loss,” said the 46-year-old, from Abergavenny, whose weight had built gradually over more than 20 years.
She found the clinic through an anaesthetist involved in an operation she had, which due to her weight and associated complications was much more complex than it should have been.
“It’s a fantastic place, I’ve had great support,” she said.
“I didn’t have a normal healthy diet, and the whole thing has been a learning process.
“I had to reassess my whole diet, get used to eating normally.
At first I was given a tablet to make my body have an adverse effect if I had too much fat.
“I was very good at maintaining my diet, but I’m very highly motivated.
I kept a record of everything I ate.
“I’m still learning a lot about nutrition, still making mistakes.
“I have a personal trainer outside the clinic and do a lot of different exercise. You also need to educate yourself about emotions, and mindset. In our relationship with food, our biggest weapon is the mind.”