Reclassifying obesity in the UK: the importance of language around weight management

Obesity is not currently classified as a disease in the UK. Why is this significant? Because it allows obesity to be viewed as a behavior that individuals could change but choose not to, placing the emphasis on personal responsibility (such as eating differently or exercising more) rather than on external factors. These include: genetic predispositions; the availability of fresh versus processed food; access to green spaces; or financial constraints that make gym memberships and exercise classes unattainable. A parallel can be drawn with the discussion around cigarette use – do we see individuals as smokers or as nicotine addicts? When considering this, does it change your view of those who smoke?

Plus how we measure whether someone is obese is problematic. The Body Mass Index (BMI) which uses your height and weight to calculate how underweight or overweight you are is the tool of classification in the UK. However, it does not take account of where in the body fat is stored; the type of fat (white or brown); or weight of muscle mass, often leading to a simplistic outcome. For example, using this tool means most rugby players would be classed as obese because of their high muscle mass.

In America obesity was labelled as a disease in 2013 to recognise the impact on overall public health, potentially increasing funding into research and reduce the stigma attached.

And it’s important to recognise there is a stigma. We have recently been awarded funding from the National Institute for Health and Care Research (NIHR) to undertake a three-year study to determine the clinical and cost-effectiveness and implementation of a digitally enabled tier 3 weight management platform in south-east London. As part of this application, we included views from patient and public representatives where they were clear about the emotional impact of obesity.

We also know by talking to partners that others are looking to test digital care in weight management, and of course, there is the increase in new GLP-1 weight loss drugs (such as Ozempic). The MHRA approved the use of semaglutide (Wegovy) for the treatment of obesity and weight management, and the NHS is already seeing a surge in people contacting clinicians for what was once a treatment for type 2 diabetes only.

In our view, not classing obesity as a disease - keeping the focus at an individual level - harms our ability as a system to look at the overarching factors which make people obese and leaves individuals open to abuse. We welcome the discussion on how obesity should be reclassified at this crucial point, and our role in how digital innovation and pathway redesign can help.