Rotherham Institute for Obesity (RIO), Rotherham, S65 1DA, UK.
Luton and Dunstable Hospital, Luton, LU4 0DZ, UK.
Curr Obes Rep. 2016 Sep;5(3):320-6. doi: 10.1007/s13679-016-0221-z.
In the UK, as in most other countries in the world, levels of obesity are increasing. According to the Kinsey report, obesity has the second largest public health impact after smoking, and it is inextricably linked to physical inactivity. Since the UK Health and Social Care Act reforms of 2012, there has been a significant restructuring of the National Health Service (NHS). As a consequence, NHS England and the Department of Health have issued new policy guidelines regarding the commissioning of obesity treatment. A 4-tier model of care is now widely accepted and ranges from primary activity, through community weight management and specialist weight management for severe and complex obesity, to bariatric surgery. However, although there are clear care pathways and clinical guidelines for evidence-based practice, there remains no single stakeholder willing to take overall responsibility for obesity care. There is a lack of provision of adequate services characterised by a noticeable 'postcode lottery', and little political will to change the obesogenic environment.
在英国，和世界上大多数其他国家一样，肥胖率正在上升。根据金赛报告，肥胖对公众健康的影响仅次于吸烟，而且它与身体活动不足密切相关。自 2012 年英国《健康和社会关怀法案》改革以来，国民保健制度（NHS）进行了重大重组。因此，英格兰国民保健制度和卫生部发布了关于肥胖治疗委托的新政策指南。现在广泛接受的是四级护理模式，从初级活动，到社区体重管理和严重和复杂肥胖的专业体重管理，再到减肥手术。然而，尽管有明确的循证实践护理途径和临床指南，但仍然没有一个利益相关者愿意承担肥胖护理的全部责任。服务提供不足，明显存在“邮政编码彩票”现象，而且几乎没有改变肥胖环境的政治意愿。
