Introduction
On 1st March, at the invitation of Kate Forster, I attended the All-Party Parliamentary Group (APPG) on Obesity meeting at Portcullis House in Westminster, to represent Lipoedema UK. The meeting was chaired by Mary Glindon MP and brought together clinicians, policymakers, patient advocates and representatives from digital weight-management services to discuss the current landscape of obesity treatment and prevention in England.
The discussion took place as part of wider conversations around World Obesity Day and focused on the growing scale of metabolic disease, the structure of obesity services within the NHS and the rapid emergence of new pharmacological and digital treatment models. After the panel discussion, the floor was opened to questions and comments from clinicians, charities, patient groups and healthcare providers, adding further perspectives to the debate.
Chair and Panel
The meeting was chaired by Mary Glindon MP.
The three panel members were Dr Vipan Bharadwaj, GP and Executive Partner at Modality Partnership, one of the largest NHS GP partnerships in the UK; Professor James Kingsland OBE, GP and national leader in digital primary care; and Sarah Le Brocq, obesity patient advocate and founder of All About Obesity.
The Scale of the Obesity Challenge in the UK
Obesity now affects around two-thirds of adults in the United Kingdom and is associated with more than 200 physical and mental health conditions. These include type 2 diabetes, fatty liver disease, cardiovascular disease, gastrointestinal disorders, sleep apnoea and at least thirteen different cancers.
The economic impact is also substantial. Estimates suggest that the wider costs of obesity reach approximately £126 billion per year when healthcare expenditure, lost productivity and broader societal costs are taken into account. NHS spending alone is estimated to be around £11–12 billion annually, while lost productivity contributes roughly £31 billion.
Obesity is also closely associated with deprivation and multimorbidity. Communities already experiencing socioeconomic disadvantage often face the greatest burden of metabolic disease, meaning the distribution of obesity across the UK is not simply a matter of lifestyle but is deeply intertwined with social determinants of health.
Dr Vipan Bharadwaj: Obesity and the Obesogenic Environment
Dr Bharadwaj opened the discussion by emphasising a message that clinicians increasingly recognise as essential: when speaking to people living with obesity, the starting point should be “It’s not your fault.”
He described obesity as the product of an obesogenic environment, where everyday systems, food availability, urban design and social structures shape behaviour and health outcomes. In such environments, individual choices are heavily influenced by factors that sit well beyond personal control.
Dr Bharadwaj also drew a comparison with previous public health crises, highlighting that major health challenges have rarely been solved through clinical medicine alone. Cholera and tuberculosis were addressed through improvements in housing and sanitation. Respiratory disease declined with cleaner air policies. Smoking-related illness only began to fall once regulatory and legislative measures were introduced.
His central argument was that challenges of this scale cannot be resolved through individual consultations in primary care. Instead, they require structural change across society, including policy interventions that reshape the environments in which people live and make decisions about food and health.
Addressing the Obesogenic Environment
Several examples were discussed of how policy might influence food environments and public health outcomes. One suggestion raised during the meeting was the possibility of taxation on ultra-processed food manufacturers, with revenues potentially directed towards prevention and treatment services.
Other proposals focused on the retail environment. These included reducing the prominence of confectionery and snack foods positioned at child eye level in supermarkets, as well as giving local authorities greater powers to limit the density of fast-food outlets near schools.
Hospitals were also mentioned as an area where public health messaging and reality often diverge. In many cases, traditional hospital canteens have been replaced by retail outlets selling largely ultra-processed sandwiches and convenience food, while vending machines offer sugary drinks and snacks. It was suggested that healthcare settings themselves should model healthier environments by providing fresh fruit and nutritionally balanced food options.
Professor James Kingsland OBE
Fragmented Services and Lack of Data
Much of Professor Kingsland’s presentation focused on the current structure of weight-management services within the NHS. The APPG briefing drew on Freedom of Information responses from all forty-two Integrated Care Boards across England.
One of the most striking conclusions was the degree to which obesity services remain fragmented across the healthcare system. Eighty-five percent of Integrated Care Boards reported that they do not hold referral data broken down by deprivation, ethnicity, age or sex. More than seventy percent were unable to provide clear information about funding levels for adult weight-management services. No Integrated Care Board reported ring-fenced funding for obesity services, and several confirmed that they do not operate a unified adult obesity care pathway.
Despite the scale of the problem, the system is therefore difficult to map, evaluate or improve because the necessary data simply does not exist. As Professor Kingsland noted during the meeting, “What isn’t measured cannot be fixed.”
Obesity as a Chronic Disease
Professor Kingsland also emphasised the importance of recognising obesity as a chronic, relapsing disease rather than a short-term lifestyle issue. Like other chronic conditions, it requires long-term management and continuity of care. However, the current system frequently fails to provide this level of sustained support.
Patients can wait up to eighteen months simply to be triaged into specialist services, moving through fragmented referral pathways and often repeating their history to multiple clinicians.
Current Provision
The scale of NHS treatment provision remains limited. Current programmes account for approximately 220,000 treatment cycles over a three-year period. Eligibility criteria typically require a body mass index of forty alongside four additional comorbidities.
This means that treatment is largely reserved for people with very advanced disease. The concern raised during the meeting was that focusing intervention only at this stage risks creating a system that continually manages late-stage illness rather than preventing progression earlier in the disease pathway.
Digitally Enabled Weight Management Services
Professor Kingsland also discussed the rapid growth of digitally enabled weight-management services. These programmes combine behavioural support, pharmacological treatment and ongoing clinical monitoring through digital platforms.
Such services may align with the NHS’s developing neighbourhood health models, which aim to deliver care closer to home and provide earlier intervention for chronic disease.
Data discussed during the meeting suggested that in one programme approximately 13,000 patients had accessed treatment, with reported outcomes including a lower incidence of diabetes and reduced attendance at Accident and Emergency departments.
However, data collection across the system remains inconsistent, making it difficult to fully assess the impact of these programmes. Without clearer commissioning frameworks, transparent funding structures and improved data capture, these innovations risk being layered onto an already fragmented system.
GLP-1 Agonists and Gut Hormone Therapies
A major theme of the meeting was the rapid development of gut hormone therapies. These include GLP-1 agonist medications such as semaglutide (Wegovy) and dual agonist therapies such as tirzepatide (Mounjaro). Currently, approximately 2.5 million people are taking these medications, with around 95 percent accessing them privately and only about 5 percent receiving treatment through NHS pathways.
This indicates that public demand is already driving widespread uptake outside the NHS.
Professor Kingsland also challenged the narrative that people are commonly obtaining these medications through so-called “rogue providers.” In practice, many patients access treatment through regulated digital healthcare services and licensed pharmacy providers, including national pharmacies such as Boots, where prescribing is undertaken by qualified clinicians and pharmacists.
He also questioned the claim that these medicines are readily available through the NHS. When access within the health service is extremely restricted, patients inevitably seek alternatives. Where genuinely unregulated providers exist, that becomes a matter for regulatory enforcement. However, the broader point raised was that demand for treatment is already being met through regulated independent healthcare services because NHS provision remains limited.
Sarah Le Brocq: The Importance of the Patient Voice
Sarah Le Brocq highlighted the importance of embedding the patient voice within obesity services. She emphasised that effective care must be built around genuine patient engagement rather than automated systems delivering scripted responses.
Many people living with obesity report experiencing stigma when interacting with healthcare systems. They may repeatedly recount their experiences to different clinicians while feeling that their perspectives are not fully heard.
Her central message was captured in a phrase that has become widely recognised within patient advocacy: “Nothing about us, without us.”
She also pointed out that weight-loss medications have been available for approximately two and a half years but remain inaccessible to many people who could benefit from them. Postcode lotteries in access to care remain a major concern. She emphasised the urgent need for better data from deprived communities to ensure that inequality does not translate into invisibility.
Questions and Contributions from the Audience
During the audience discussion, Paul Gately from Obesity UK, representing an organisation with around 35,000 members, reflected on how dramatically the policy conversation around obesity treatment has shifted. Five years ago, discussions centred largely on bariatric surgery. Today the focus has moved toward pharmacological treatments, particularly GLP-1 medications.
He also described reports that some parents obtain medication for themselves online and administer it to their children after being unable to access treatment through clinical pathways. Semaglutide is licensed in the UK for patients over the age of twelve, yet clinicians are often reluctant to prescribe it to those under eighteen.
A representative from Cancer Research UK highlighted emerging evidence suggesting that improvements in metabolic health may reduce the risk of cancer recurrence. In some cases, patients with improved metabolic profiles appear to experience fewer side effects from chemotherapy.
Vanessa Longley from the eating-disorders charity BEAT emphasised that obesity must be understood as a public health issue rather than purely a weight-management problem. Treatment approaches must remain sensitive to individuals across the full spectrum of body size and health conditions.
A representative from Boots Digital raised concerns about terminology, arguing that obesity should be clearly described as a disease rather than a condition. She also noted that when legitimate access to treatment is restricted, unregulated providers can emerge to exploit public demand.
Speakers repeatedly emphasised that medication alone cannot solve the problem. Around 190 new gut-hormone therapies are currently in development and are expected to reshape the treatment landscape. However, historically approximately twenty-five weight-loss drugs were withdrawn between 1964 and 2008, highlighting the importance of long-term monitoring and cautious implementation.
Another audience member raised concerns about the potential long-term consequences of widespread gut-hormone therapy without adequate support. Effective treatment requires wraparound care, including nutritional guidance, physical activity support and strategies to preserve muscle mass.
Since muscle tissue accounts for approximately 80 percent of glucose uptake, preserving muscle mass through nutrition and resistance exercise is essential. Without this, there is a risk that patients could lose weight yet develop sarcopenia, malnutrition or long-term frailty.
A nurse with thirty-five years of clinical experience also reflected on how dramatically metabolic disease has changed. Earlier in her career, what is now known as type 2 diabetes was often referred to as “elderly-onset diabetes.” Today metabolic disease, hypertension and diabetes are increasingly seen in much younger patients.
Looking Ahead
The overall message emerging from the meeting was that obesity cannot be understood simply as an issue of body weight or individual behaviour. It represents a complex metabolic and societal challenge shaped by environment, deprivation, healthcare structures and public policy.
Addressing the problem will require coordinated action across healthcare systems, public health programmes and government policy on a scale comparable to the structural interventions that addressed previous public health crises.
Implications for Lipoedema
These discussions also have implications for women living with lipoedema. As obesity policy and metabolic services develop within the NHS, new care pathways, digital weight-management services and pharmacological treatments are being developed at scale.
Within this evolving landscape, it will be increasingly important to ensure that adipose tissue disorders such as lipoedema are recognised and properly differentiated from obesity. Without clear clinical understanding, there is a risk that women with lipoedema could be absorbed into generic weight-management pathways that do not address the underlying condition.
Ensuring accurate diagnosis and appropriate care pathways will therefore be essential as metabolic health services expand within the NHS.