Prime Minister Keir Starmer and health secretary Wes Streeting have recently discussed plans to trial weight-loss injections for around 250,000 people with obesity who are unemployed in a bid to get them back into work, ease pressure on the NHS and boost the economy.
Obesity is estimated to cost UK society around £35 billion annually. This is due to lower productivity and higher NHS treatment costs.
Around 26% of the English adult population (approximately 15 million) are considered obese. However, it’s not known what proportion of unemployed people are obese.
While weight-loss injections have proven to be very effective in helping people who are obese to lose weight and lower their risk of certain chronic diseases, there are many reasons why these drugs alone won’t help tackle obesity and unemployment rates in the UK.
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1. Lack of capacity
The majority of UK people who are obese are likely to meet the National Institute for Health and Care Excellence’s eligibility criteria for weight-loss injections.
But prescribing these drugs is just one part of the equation. Eligible patients will require support from specialist services who provide guidance in making the appropriate lifestyle changes (such as to their diet) to successfully lose weight while on these drugs. This is crucial, as all of the weight-loss injection trials to date have involved a behaviour change component. This may potentially be key to the successful weight losses observed in these studies.
However, current demand for weight-loss services is already outstripping capacity. Nearly half of eligible patients in England are unable to get an appointment with a specialist team. Weight-loss injections can only be prescribed through such services currently. If the government is to roll out the proposed programme, they will need to rethink the way weight-loss services are delivered so all eligible patients can access support.
2. Won’t work for everyone
Weight-loss jabs don’t necessarily work for everyone. One study found that 9-15% of participants who took the drug tirzepatide (Mounjaro) did not lose clinically significant amounts of weight.
Weight-loss jabs may also cause intolerable side-effects for some. Trials have shown between 4-8% of participants couldn’t tolerate the side-effects, causing them to drop out of the study. Constipation, diarrhoea and nausea are some of the most commonly reported.
People with certain health conditions may be unable to use weight-loss injections – such as those with inflammatory bowel disease and pancreatitis. In such cases, weight-loss jabs may worsen symptoms or interact with the prescription drugs used to manage these conditions, increasing risk of harm.
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Additionally, some people may not want to take an injection – whether that’s simply due to personal preference or even fear of needles.
3. Obesity is a complex issue
There are many complex factors that contribute to weight gain – such as opportunities for physical activity, access to healthy foods and levels of deprivation in a community. Prescribing weight-loss jabs to help people lose weight may not be effective long-term if the rest of these factors are not also addressed.
A more effective way of seeing significant, sustainable reductions in obesity levels across a population is by using a “whole systems approach”. This would address to the multiple environmental, social and economic factors that contribute to obesity.
Where whole systems approaches have been embedded in healthcare design and delivery, they have led to improvements in services and patient outcomes – including obesity-related metrics (such as patients making healthier food choices and being more active).
However, one limitation to whole systems approaches is challenges in measuring impact. This can reduce political will to implement these approaches.
4. Obesity stigma
Obesity stigma in the workplace is a huge barrier to satisfactory employment and leads to poor wellbeing and burnout.
Obesity stigma in the workplace perpetuates harmful weight-based stereotypes that overweight and obese people are lazy, unsuccessful, unintelligent and lack willpower. As a result, people with obesity are more likely to be in insecure and lower-paid jobs than those who may be considered of a healthy weight.
It’s also well-evidenced that regular exposure to stigmatising, isolating and degrading prejudices has long-term consequences on physical and mental health – and may lead to problems such as binge eating and depression.This can lead to a loss of productivity, absenteeism and loneliness.
Prescribing weight-loss jabs to help a person lose weight doesn’t address the core reasons for why they may have been absent from work or unemployed in the first place. Nor does it help to address the mental health struggles they may still harbour as a result of discrimination they might have experienced.
5. Barriers to employment
Weight loss alone does not begin to address the complex physical and mental health reasons for why a person might be unemployed. A person may also be unemployed due to factors such as caring responsibilities or disability.
Current prescribing restrictions also limit some injections to a maximum of 24 months (although further trials are ongoing). This means that even if a person has successfully lost weight, they may regain that weight again when they stop using the drug. This could mean any health problems they experienced prior to losing weight (and which may have prevented them from being in employment) could reemerge.
There are better ways of getting people back into work than prescribing weight-loss jabs. Flexible working approaches, for instance, may make it easier for someone who is unemployed due to caring responsibilities or health problems to transition back into employment. Supportive policies and workplace wellbeing programmes may be a more cost-effective way of helping people to overcome barriers, improve their health and transition back into work.
Lucie Nield has received funding from The National Institute for Health Research (NIHR) for evaluation of children’s weight management services.
Lucie Nield sits on the Board of Trustees for Darnall Wellbeing (a local community service organisation).
