The RACGP has come out with an updated position statement on obesity, formally acknowledging inequity in access to evidence-based services and therapies for the first time.
The Royal College of GPs has unveiled a new position statement on obesity, featuring a stronger call for funding to address patient complexity and barriers to access.
Comparing the RACGP’s new position statement to the previous version, which was last updated in May 2021, the main addition is a paragraph acknowledging that “general practice has a central role to play in the primary, secondary and tertiary prevention of obesity, the latter focusing on the management of individuals currently living with obesity”.
“This role needs to be continually supported through improved funding of GP consultations to reflect the complexity of the disease process, but also increased funding to be directed towards addressing the current inequity in access to effective evidence-based obesity-management services and therapies,” the statement said.
The previous version simply stated that GPs had a central role in obesity prevention and management which needed to be supported through improved funding of evidence-based medicine.
“The RACGP is continuing to call for a 40% increase to longer consults, and 25% increase to mental health consults – this will halve out-of-pocket costs for those who need it,” RACGP president Dr Michael Wright said.
“While the initiatives to boost the GP workforce in the Albanese Government’s $8.5 billion Medicare package are laudable, the universal bulk billing proposal won’t help people who need longer consults or mental healthcare from their GP.
“So, we’re continuing our calls for all political parties to support increased funding for longer consults and mental health consults, because we know it will improve health and wellbeing – and this will reduce the number of people who end up in hospital due to the many chronic illnesses that are linked to obesity.”
Other additions include a recommendation to support GP education on obesity management, particularly in regard to “stigmatisation and inequity”.
These areas, which it termed “therapeutic inertia”, included fighting misconceptions like the idea that people with obesity are not motivated or that raising the topic of obesity may offend patients.
While the new position statement does not mention any drugs by name, the RACGP noted that there were no obesity-management medicines currently listed on the PBS and recommended that this change.
“A retrospective analysis of a large US electronic medical record database revealed that only ~1% of adults meeting Food and Drug Administration criteria for obesity management medications were prescribed them, with even fewer continuing [on the drugs] 12 months later,” the new position statement said.
“The low uptake of these effective evidence-based adjunct therapies is even more pronounced in those from socio-economic disadvantaged groups, exacerbating the divide between those who can and cannot afford private health insurance.”
RACGP obesity management spokesman Dr Terri-Lynn South told The Medical Republic that the update also sought to highlight that lifestyle and surgical interventions for obesity are also out-of-reach to people on low income.
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“The takeaway is just how complex obesity is, both for the individual’s physiology – their microenvironment of their own family or interpersonal circumstances – but also that wider community and … population health point of view,” she said.
“We are living in what we call an obesogenic environment.
“We shouldn’t be blaming individuals who have a genetic predisposition which makes this a chronic health condition.”
The updated statement comes just over a month after the publication of a landmark paper in The Lancet, in which 56 leading obesity experts recommended moving away from using the BMI alone for diagnosis and to split obesity into pre-clinical and clinical categories.
The pre-clinical label would apply to people who have excess adiposity but preserved organ and tissue function, while the clinical category would require evidence of reduced organ function or significant, age-adjusted limitations of day-to-day activities.
According to Dr South, the final draft of the RACGP’s updated statement had been completed before the article in The Lancet had been published.
“[That article contains] one single body’s recommendation, although it may be adopted more widely in the future,” she said.
“I do think one area of overlap between The Lancet commission and the position statement is [that we are] talking about not just weight loss, but health gains.
“We’re looking at that broader picture and being less focused on the number on the scales, including that number represented as a BMI alone.”
