Weight-loss programmes often fail and forcing claimants to undergo surgery is unethical – better to work on health of whole population, says journal’s editorial

David Cameron’s proposal to make weight-loss programmes compulsory for anybody who is obese and claiming benefits is “financially and ethically questionable”, according to medical experts.

The prime minister said last month that people who cannot work because they are overweight or suffering addiction problems could be compelled to go for treatment if they wanted to receive benefits. But an editorial in the leading medical journal in the field, the Lancet Diabetes & Endocrinology says weight-loss programmes rarely work in the long term.

“It is therefore important to ask whether requiring people to participate in weight-loss programmes despite a high likelihood of failure is acceptable from the point of view of an individual, provider or society,” it says.



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Weight-loss programmes have a poor track record. Our biology is against us – after a few weeks of weight loss, the body adapts to resist any further change. “Although many people who claim sickness benefits for obesity might welcome the opportunity to take part in an intervention that helps them to lose weight, any mandated programme should have a strong evidence base for success,” says the editorial.



But although drugs have had some success, the only treatment that offers long-term sustainable weight-loss and improved quality of life in a high proportion of people is bariatric surgery, in which the size of the stomach is reduced in the operating theatre using a variety of methods including the gastric band and gastric sleeve.

“Requiring people to undergo a major surgical procedure as a condition of receiving benefits seems far from ethical,” says the journal.

What if the person seeking benefits had tried to lose weight but failed, it asks. “If people do not lose weight with one scheme, will they be enrolled into another more aggressive programme? Is there potential for escalation of treatment to bariatric surgery in people who have not lost weight with other interventions?” It was possible some people might end up enrolling on programmes that they had not intention of engaging with.

Far from saving money, the journal argues that compelling people to be treated would cost more. In May last year it was revealed there were 1,780 people claiming benefits as a result of obesity, but this number is very small in relation to the 2.5 million total, says the editorial. More money would be needed to recruit and train staff to run weight-loss programmes, it claims, which would be wasted if they do not work. And bariatric surgery has high costs.

The editorial says the money would be far better spent on the population as a whole – two thirds of adults are currently obese or overweight. Weight-loss programmes could be offered to those who want to engage in them, but money could also be spent on universal free access to leisure facilities, healthy outdoor spaces and public health education on diet and exercise.

“Instead of investment in a scheme that, at best, provides a short-term election soundbite, the government would be better placed to invest in schemes with the potential to improve the long-term health of the whole UK population,” it says.