Last week NICE laid down the foundations for this by recommending obesity drugs be considered for patients with a BMI greater than 27, and surgery for those with a BMI greater than 50. However, PCT managers seem more keen on punishing the obese than helping them. In East Suffolk, PCTs have decreed that patients with a BMI over 30 will be denied joint replacement therapy, not for clinical reasons but to save money. So patients with limited mobility will use up other NHS and social care resources, while getting fatter because their worn joints mean they cannot exercise. When the PCT allows doctors to consider operating, they might be clinically unfit and require long-term support. Either way, the PCTs will have spent money they did not need to.
The government wants to tackle obesity because it has realised that inaction will create future problems. From April, practices will be rewarded under the GMS quality framework for producing a register of patients whose BMI is above 30. In Scotland, where CHD is the biggest problem, there will be a directed enhanced service for collecting data on cardiovascular risk factors for patients aged 45-64. This data will pave the way for targeting overweight and obese patients.