Islanders not as fat as all that


THE REPORT which placed Shetland at the top of the UK’s “obesity map” came in for more criticism this week after it became clear that it was sponsored by a pharmaceutical company which manufactures the anti-obesity drug Xenical (Orlistat).

The report, created by Dr Foster Research, shows that more than one in 10 patients registered with GPs in some parts of the country are obese. Shetland is said to have the highest proportion, with 15.5 per cent of patients desribed as obese, closely followed by parts of Wales.

The accepted prevalence for obesity is in the UK is 23 per cent for men and 25 per cent for women, which means the 15.9 per cent figure is significantly less than the UK average.

The data was gathered from medical practices but it would appear that the figures for Shetland were based on only one of the eight practices in the isles.

The report was sponsored by Roche Products Ltd, who manafacture the anti-obesity drug Xenical. The active ingredient in Xenical is a drug called Orlistat. Orlistat works by preventing gastric and pancreatic lipases from working. Taken at mealtimes, Orlistat prevents fat from being broken down and absorbed by the body. This means that the body cannot use this fat as a source of energy, or convert it into tissue. Instead, the fat is excreted in faeces. This is supposed to help aid weight loss.

However, the drug can have side effects, including headaches, abdominal pain and discomfort, flatulence, diarrhea, infections in the airways, hypoglycaemia, faecal incontinence, fatigue, urinary tract infections, anxiety, tooth and gum disorders, gall stones, raised liver enzymes and hepatitis.

NHS health improvement manager Elizabeth Robinson dis­missed any notion that Shetland was the most obese area in the UK. She said that although the figures were accurate, it appeared that they were based on a single practice of 1,000 people – which she said was particularly vigilant at ensuring that doctors see the vast majority of its registered patients.

She said: “We have a healthy weight strategy for Shetland and we would always focus on getting people to lose weight by changing their lifestyle – by taking on more physical activity and through adjusting their diet. While there are some cases where anti-obesity drugs might be needed, they would always be a last resort.”

Alex Young, senior project manager at Dr Foster Research, said Roche were trying to highlight that Xenical can provide a 5-10 per cent weight loss which can be incredibly beneficial to an obese individual – lowering blood pres­sure and reducing the risk of developing diabetes by as much as 50 per cent.

Mr Young said Dr Foster Research was commissioned to research an independent report which was not biased in any way, so the fact that the report was bought by Roche did not affect how the research was carried out.

However, Dr Fosters’ recom­mendation on tackling the problem of obesity was “a combination of diet and exercise . . . followed by drug treatments if the former is unsuccessful”.

The findings of the report have been further criticised for being based on the Quality and Outcomes Framework (QOF), a programme which financially rewards general practices for keeping a register of patients over 16 with a BMI (or body mass index – a statistical measurement which compares a person’s weight and height) of over 30. A individual with a BMI of over 30 is considered clinically obese.

NHS Shetland director of public health Sarah Taylor said: “We know that small rural practices are good at identifying health problems and have good coverage of patients, so this probably represents under-reporting in other areas. It may be that in Shetland GP practices are doing work on obesity and encourages people to come forward for help, so our practices identify more people with obesity than other areas.”

Ms Robinson said that in fairness to the authors of the report, the research did include discalimers pointing out that research based on the QOF was dependent on diagnosis and recording within practices, using practices’ clinical information systems, and there may be variations in the accuracy and completeness of practice records.

The use of the QOF can also be problematic because the data do not include information on the age of individual patients. Differences in the average age of different populations are likely to affect comparisons of the prevalence of diseases. As Shetland has an ageing population and obesity is more prevalent in older patients this would be likely affect results.

To read the report go to:


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