Obesity in an ageing population is 'biggest issue for NHS'

He is among the top 1% most commonly cited clinical researchers in the world, but continues to co-lead the CVD prevention clinic at Glasgow Royal Infirmary where he sees first-hand the impact of excess weight on patients' health.

He said: "The penny is starting to drop - not for everybody, some people still think that it's the individual's fault - but actually, I would say that the vast majority of people living with high [body-mass index] do not want to be living with a high BMI.

"They've tried their best not to be that BMI, but most people haven't succeeded.

"And it's not just one group - weight gain has gone up across every strata of society. Willpower is not enough - we have to change the environment, and we cannot just tackle dietary-related disease without tackling excess weight.

"Otherwise, we're just going to lead to more and more people living longer with more and more obesity-related conditions. That's the biggest issue for the NHS."

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Prof Sattar has just been appointed by the UK Government as its Obesity Mission Chair.

It is one of five dedicated roles alongside expert posts for mental health, dementia, cancer, and addiction which are harnessing the Vaccine Taskforce-style approach taken to Covid but using it as a template to drive forward research and innovation into other key healthcare challenges.

Prof Sattar's role will include overseeing the evaluation of NHS England's Wegovy pilot, a £40 million trial designed to test whether the weight-loss drugs can be safely and effectively expanded to patients outwith hospital-based weight-management clinics.

Prof Sattar said he would like to see wider use of Wegovy piloted on the NHS in Scotland (Image: Gordon Terris/Herald&Times)

The drugs mimic the action of a human gut hormone called GLP-1 to slow digestion and make users feel full.

They have been shown to help patients shed 15-20% of their bodyweight, similar to the results achieved by bariatric surgery.

The UK Government wants to be able to use the slimming injections more widely on the NHS to help cut waiting lists linked to obesity-related complications among patients with a 30-plus BMI.

Prof Sattar said he would be keen to explore a similar pilot scheme on NHS Scotland.

He said: "I would love it if we could speak with the Scottish Government to see whether we could run our own pilot scheme that would be somewhat complimentary but not necessarily completely overlapping.

"For research in any areas, one study is not necessarily the final, definitive study - you would get more if you had two studies, and you would get more confidence if the results were broadly similar.

"So it's something that I hope we can speak to colleagues north of the border about to see if that's possible as well."

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Prof Sattar cautions that the current £200-a-month price tag for semaglutide-based medicines such as Wegovy and Ozempic (the version prescribed for diabetes) mean there is no prospect of them being rolled out on the NHS to tens of millions of people in the near future.

Supplies are also rationed due to the enormous global demand.

Its Danish manufacturer, Novo Nordisk, is building new factories to ramp up production and rival pharmaceutical giants are racing to get their own versions onto the market, which could ultimately drive down costs.

However, Prof Sattar says one of the most important developments to date has been the way that clinical trials into Wegovy have demonstrated the benefits of tackling obesity as a disease in its own right.

He said: "Heart failure symptoms improved quite meaningfully in a way that was perhaps quite unexpected by many cardiologists.

"That gave them an insight that excess weight was more of a player in heart failure than they imagined.

"I think that's probably the case in many diseases where it's been under-recognised that excess weight can either be part of the cause of a disease or can accelerate the disease or can synergise with the main cause of a disease to lead to greater symptoms, and suffering.

"I think we've underestimated that for a whole range of conditions and I suspect we'll see more of this over the next few years with these weight-loss drugs.

"They've already stopped a trial early in chronic kidney disease because the results were so good.

"There's evidence for blood pressure and for diabetes. We know they improve blood sugar levels markedly, well beyond any other tools we have."

Obesity has been rising steeply since the 1970s (Image: Our World in Data)

Back in 1970, around one in 10 adults in Britain would have been categorised as obese. It is now one in three.

Obesity rates have soared in tandem with an ageing population and the growing availability of medications to manage the so-called "downstream consequences" of excess weight.

In a paper last year, Prof Sattar and colleagues argued that "most chronic conditions are, to differing extents, caused or exacerbated by excess adiposity [body fat]" but that "weight management is rarely discussed or attempted for patients".

By investing much more in prevention as well as tackling obesity as a primary disease in its own right, there would be a corresponding reduction in everything from heart attacks, strokes, heart failure, high blood pressure, and Type 2 diabetes to fatty liver disease, chronic kidney disease, osteoarthritis, rheumatoid arthritis, psoriasis, gastrointestinal disorders, some cancers, and aggravated COPD symptoms.

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Prof Sattar said: "We've done really well in the UK in many respects. We've reduced cardiovascular disease and death substantially.

"Academics have been brilliant in developing trials for high blood pressure and rheumatology and heart failure so that we have far better drugs for treating rheumatoid arthritis, blood pressure and heart failure.

"So these individuals are no longer dying within three to four years - they're living many more years.

"We're doing an awful lot better in keeping people alive a lot longer, but at the same time we haven't tackled weight by any stretch of the imagination.

"So there are more people now living with excess weight for longer, which leads them to develop second and third and fourth diseases linked to excess weight.

"That's why we have more middle aged people with multiple conditions in our hospitals than elderly people.

"The thing that has been neglected is the excess weight."

While Prof Sattar welcomes the contribution GLP-1 drugs like Wegovy could make to reversing that, he stresses that prevention is better than cure.

"These drugs have benefits, but they do not restore people back to their normal health. Taking someone with heart failure and giving them something to relieve the symptoms doesn't mean they're the same as someone who never had heart failure."

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The proliferation of comparatively cheap, calorie-dense foods has been one of the toughest obstacles in tackling the obesity crisis (Image: Getty)

The bottom line, he adds, is that our current food environment exposes consumers to far too many opportunities to grab cheap, calorie-dense items designed to "make people eat more calories than they need to and drink more calories than they need to".

Changing that would require a combination of junk food taxes, legislation, and incentives designed to push consumers towards healthier products and shift the food industry away from highly profitable, calorie-packed treats.

Yet even comparatively modest interventions such as curbs on junk food deals by retailers have been kicked into the long grass by governments in both Westminster and Holyrood.

"It's a very tough ask," said Prof Sattar.

"I don't know that any government anywhere in the world has actually tried to do it. Maybe that's not a reality."