The management of obesity necessitates a comprehensive approach involving lifestyle interventions, potential pharmacotherapy, and/or bariatric surgery for certain individuals.
Optimal care involves a multi-disciplinary team addressing physical and mental health comorbidities. Primary care in conjunction with allied health is ideally suited for most obesity cases. More severe conditions and associated comorbidities may require treatment in secondary or tertiary care settings.
Australian healthcare services fall short in meeting the requirements of individuals seeking treatment for obesity. There is a notable lack of diagnosis and treatment for obesity in both children and adults, with adults taking an average of nearly nine years to seek professional healthcare assistance to manage obesity.
Most weight management interventions are not initiated within a healthcare framework until the condition reaches a more severe stage, leading to various complications (metabolic, mechanical or psychosocial).
The Australian National Obesity Strategy 2022–23 underscores the significance of healthcare in addressing obesity rates and the pressing need for change. However, there is a need for more clarity on how this strategy will translate into practical changes at policy and budgetary levels, specifically addressing the impact on funding and delivery of services and treatments.
Gender disparities in obesity treatment are influenced by complex factors. A notable majority of patients seeking clinical attention and undergoing bariatric surgery are women, despite comparable obesity rates in men and women. The pervasive nature of obesity stigma within healthcare systems further compounds the situation adversely, affecting patients’ well-being and hindering engagement with the system.
There is also a lack of national obesity treatment guidelines. The absence of coordinated services and referral pathways across primary, secondary, and tertiary care is exacerbated by budgetary tensions between state-funded hospitals and federally-funded primary care.
A shortage of services is evident. Public hospital waiting lists for specialised obesity services range from months to years, with services disproportionately concentrated in major cities. Multidisciplinary specialist obesity services are limited, often imposing stringent eligibility criteria, typically reserved for individuals with escalating complexity, further straining the system due to rising demand.
Public and private health systems lack the capacity to adequately address the needs of adults who may qualify for bariatric surgery.
The tangible consequence of this service inadequacy is the substantial gap in the provision of care for individuals with severe obesity without current significant physical comorbidities. This is a missed opportunity to deliver care and potentially intervene early.
The rising prevalence of obesity, coupled with lengthy waiting lists for bariatric surgery in the public health system, has driven individuals to consider early access to their superannuation to self-fund the surgery. Certain obesity medications, such as liraglutide (Saxenda), approved for weight management are not subsidised by the Pharmaceutical Benefits Scheme (PBS), resulting in patients bearing a monthly cost of approximately $387.
To address these challenges, establishing clear referral pathways and collaborative partnerships is crucial. Primary care should be empowered to manage individuals seeking obesity treatment, working in tandem with well-resourced secondary and tertiary care.
Accessible referral options at both community and higher healthcare levels, along with funding for necessary bariatric surgery, are imperative. Building links between primary, secondary, and tertiary healthcare to ensure continuity of care and support for patients with severe obesity can be achieved through formal partnerships, such as collaborations between local GPs specialising in obesity management and hospital-based endocrinologists in obesity clinics.
Scaling up services to meet the increasing demand requires innovative solutions. Self-directed weight loss and maintenance interventions through smartphone apps, for example, offer a scalable and empowering approach.
We are currently conducting a trial involving a multifaceted approach encompassing lifestyle modifications and pharmacotherapy. The primary objective is to educate patients about their energy metabolism, recognising the considerable heterogeneity in responses to various treatments.
While recent attention has focused on GLP-1 analogues in obesity management, it is essential to clarify that these do not offer a cure. The key is individualisation of treatment through specialised services, with pharmacotherapy constituting only a fraction of the comprehensive approach. The pivotal focus should be on comprehending one’s metabolism and discerning the specific substrates necessary for maintaining a healthy body mass.
With the widespread availability of these medications, there is a concern that we may inadvertently exacerbate the issue by procrastinating in addressing the underlying problems. These drugs cannot be administered indefinitely, and upon cessation, there is a substantial weight regain due to the metabolic adaptations of the body.
The core mission of a specialised service is to scrutinise individuals, their phenotypes, and their metabolic responses within the innovative framework developed by our clinic. The commitment extends to conducting sponsored Phase 3 randomised controlled trials adding a research-based dimension and enabling first-hand experience with novel agents that may shape future advancements in obesity management.
Key messages
- Obesity remains poorly managed in Australia
- There are multiple barriers to treatment
- A new approach is being trialled.
Author competing interests – the author is involved with the trial mentioned