Return to home page
The Pharmaceutical Journal Vol 263 No 7073 p879
November 27, 1999 Forum

United Kingdom Clinical Pharmacy Association

The forthcoming "epidemic" of obesity

Progress in practice - The UKCPA autumn symposium was held in Blackpool on November 19-21, 1999

The prevalence of obesity in the UK adult population was 16 per cent in men and 18 per cent in women, said Dr MARTIN DUERDIN (National Prescribing Centre). In addition, 35 per cent of men and 45 per cent of women were overweight.
Dr Duerdin said that an "epidemic of obesity was on the way", with levels of obesity predicted to double in the next 10 years. The World Health Organisation had accepted obesity as a disease in 1998. Different lifestyles and beliefs contributed to a variation in levels of obesity around the world. For example, in Holland and Sweden there was a culture of exercise, and levels of obesity were correspondingly low. In the United Arab Emirates, where it was thought attractive for women to be overweight, levels of obesity were very high among women. In the UK, there had been a year on year increase in body mass index (an indicator of obesity) from 1994 to 1997 which resulted in a "frightening change in the population's characteristics".

photo of Martin Duerdin
Healthy lifestyles should be encouraged, said Martin Duerdin

It was difficult to treat obesity, so preventing it at an early stage was the best policy. From age 20, people tended to put weight on, but for those who put on more than three pounds a year, there was a danger of becoming obese. Obesity would need to be tackled from many angles, including education, encouraging participation in sport and exercise and healthy eating.
Weight fluctuation was also detrimental, Dr Duerdin said. It was much better for a person to stay at a constant weight (even if it was high) and adopt lifestyle modifications, such as increasing exercise and stopping smoking.
The pharmacological methods of treating obesity included methylcellulose (a bulking agent), phentermine (which was less suitable and not recommended by the British National Formulary) and orlistat. Fenfluramine and dexfenfluramine had been withdrawn after reports of cardiovascular side effects.
Orlistat was a lipase inhibitor. Consuming too much fat while taking orlistat led to unpleasant side effects (steatorrhoea and anal leakage) which led to either the patient not taking the drug or, more positively, it made them adhere to a low fat diet which they should have been on already. Dr Duerdin said that orlistat did have a place in therapy for some highly motivated patients.
The number of items prescribed in the UK for anti-obesity drugs had dropped by a third after the withdrawal of the fluramines; however, the cost of prescribing had seen a dramatic increase following the introduction of orlistat. There was an 18-fold variation between health authority spending on orlistat, with the highest levels of spending seen in the north west region.
In a group discussion following Dr Duerdin's presentation, pharmacists suggested that the NHS could not ignore the problem of obesity because it would cost so much in the long term. However, whether it was a priority in view of limited NHS resources was questionable, particularly as obesity was viewed as a social problem which was not an NHS cost.
Concerns were raised about the cost effectiveness of drugs and the long term effects of taking them.