Obesity management needs medications on PBS: RACGP

Increased government funding for longer GP consultations, and subsidies to make weight loss tools such as medication and bariatric surgery more affordable, are among recommendations in the RACGP’s new position statement on obesity prevention management.
 
Within the position statement, the RACGP is calling for Pharmaceutical Benefits Scheme (PBS) subsidies for obesity-management medication.
 
‘The RACGP recommends increased government support for clinical services, effective obesity-management adjunct therapies including equitable access to public-funded bariatric metabolic surgery and PBS subsidised obesity-management medication,’ it says.
 
This recommendation comes at a time when demand for weight-loss medications is higher than ever before, with global shortages continuing to impact supplies.
 
Releasing the position statement to mark World Obesity Day, the RACGP says access to affordable care from a GP who is familiar with a patient’s history, and to evidence-based management services, could ‘change lives and save lives’ for people living with overweight or obesity.
 
RACGP Specific Interests Obesity Management Chair Dr Terri-Lynne South said obesity is ‘one of our most important health issues’, with 32% of Australian adults – almost one in three – living with obesity.
 
‘It’s a chronic complex condition, with multiple causes that need to be addressed,’ Dr South told newsGP.
 
‘And for any complex condition, we need more time, and multidisciplinary care, and we need to be able to not just manage people who already have the clinical condition called obesity, but be part of the management of prevention as well.’
 
The RACGP obesity position statement also states that general practice has a central role to play in the primary, secondary and tertiary prevention of obesity.
 
However, it says this role needs to be supported through improved funding of GP consultations to reflect the complexity of the disease process, as well as funding directed towards addressing inequities in access to effective obesity-management services and therapies.
 
The RACGP also said it recognises the need for more education of GPs in all levels of prevention to address stigmatisation and inequity.
 
Dr South said as primary care providers, GPs are well placed to offer generational support.
 
This comes as data from the Murdoch Children’s Research Institute, also released on Tuesday,  revealed half of all children in Australia are now expected to be overweight or obese by 2050.
 
‘Because most adults and children see a GP at least once a year, we are able to lead some generational change, both from a prevention point of view, as well as managing complications of people who actually do have clinical obesity,’ Dr South said.
 
She added that the number of people who were actually eligible for metabolic bariatric surgery, compared to the percentage of people who were accessing it is ‘extremely low’.
 
‘And then of all those who are accessing it, most of it is private sector,’ Dr South said.
 
‘This is where I think we need to have better health economic data to be able to put to the governments, to actually see where some interventions are ultimately saving Australian money.
 
‘If we take obesity in its complications and costs at its broadest level, these interventions may actually be cost effective.’
 
RACGP President Dr Michael Wright said a 40% increase to longer consultations, and a 25% increase to mental health consultations, would ‘halve out-of-pocket costs’ to patients who needed such support.
 
‘This will reduce the number of people who end up in hospital due to the many chronic illnesses that are linked to obesity,’ he said.   
 
‘This is why it is essential that everyone in Australia has access to affordable general practice care.’
 
In its position statement, the RACGP noted that despite 32% of Australian adults living with obesity, a retrospective analysis of a large Melbourne general practice database found only 22.2% and 4.3% of patients had a body mass index and waist circumference, respectively, recorded in their electronic medical record, which is not consistent with current recommendations.
 
Yet research has shown that if a formal diagnosis of obesity is made and documented, there is a greater chance that an obesity management plan will be developed.
 
What is needed, said Dr South, is more time with patients.
 
‘To understand the drivers of obesity, particularly for the individual, it does take time and takes a good assessment,’ Dr South said.
 
‘A lot of primary health care providers see the complications [from obesity]. So, they see the obstructive sleep, they see the pre-diabetes, the type 2 diabetes, the worsening osteoarthritis, but they don’t necessarily see that obesity is driving a lot of these health conditions.
 
‘It’s easier to see those other conditions, to treat the high blood pressure, but not necessarily also focus on what’s behind it.’
 
Dr South said with interventions such as weight loss medication and surgery, there is the risk of losing the ‘opportunity of broader health gains’ without additional measures.
 
‘We would definitely have the messaging that this is just a tool, an adjuvant, to the baseline of lifestyle intervention,’ she said.
 
‘What I’m finding is that these interventions help the motivated, educated patient to do those health interventions.’

The RACGP’s Healthy Habits free digital health program is now available and aims to support GPs working with patients wanting to make positive lifestyle changes.

For interested GPs, the RACGP also offers Recognition of Extended Skills in Obesity Management, alongside other areas. For more information, visit the RACGP website. 

bariatric obesity obesity management overweight weight loss