In the United Kingdom, the National Health Service (NHS) manages four independent health care systems, publicly funded through central taxation. The NHS provides a range of health services that are free for legal residents including emergency and urgent care, general practitioners, dental services, mental health services, eye care services, pharmacy, health promotion, and dietary guidelines.

Obesity rates increasing

Nevertheless, in spite of their services, results from a study conducted this year by The Global Burden of Disease, found that the “UK has higher levels of obesity and overweight people than anywhere in Western Europe, 67% of men and 57% of women are either overweight or obese, and more than a quarter of children are also overweight or obese – 26% of boys and 29% of girls” (NHS. 2014).


The NHS defines obesity using the BMI or body mass index weight to height ratio.

– A BMI of 25 to 29.9 means you are considered overweight
– A BMI of 30 to 39.9 means you are considered obese
– A BMI of 40 or above means you are considered severely obese

Direct and indirect costs of obesity

Direct annual costs to the NHS from due overweight and obese people are more than £5 billion. However, the condition causes 16 million absent days every year, costs the economy almost £20 billion, which could rise to £50 billion per year by 2050 if things do not change.

Therefore, other indirect costs that are difficult to measure are the myriad of diseases and risks attributed to obesity including issues with the musculoskeletal, circulatory, and endocrine systems, cancer and auto immune disorders, reproductive, respiratory, and urological problems, non-alcoholic fatty liver disease, gastrointestinal disease, and the impact on psychological and social tolerance and acceptance.

Geared up

Over the past few years, numerous government initiatives and programmes have been introduced to encourage individuals and businesses to take action to improve their diet, reduce obesity, and decrease other comorbidities such as heart disease and stroke.

The Change4Life programme and the Public Health Responsibility Deal hope to increase personal and organisational awareness. Their goal is to ‘shrink’ the obesity trends in both adults and children.

Pound for a pound: Perhaps the carrot approach works better than the stick.

Emulating a study done in the United States, the NHS is considering a different approach to encourage weight loss – paying people cold hard cash.

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Last year, researchers at the Perelman School of Medicine at the University of Pennsylvania, the University of Michigan, and Carnegie Mellon University in the US, found that “tying financial incentives to group weight loss led to significantly greater weight loss than cash awards based on an individual’s success in losing weight on his or her own” (Penn Medicine. 2013).

Using two strategies, one that paid individual employees $100/month for each month their goal was met and another that offered $500/month to groups of five who met their goals. Their results demonstrated greater effectiveness in the group strategy due to greater reward and the competitive component.

Will it work for the UK? why not?

This month, Sophie Warnes with the Mirror, reported that in the short run, a pound for pound program would cost the NHS money, £41billion for one year in fact.

However, Ms. Warnes stated, “if getting them (obese and overweight people) to lose weight in one year eradicated all obesity problems and worked for the rest of their lives, it would save the NHS money. And the scheme would pay for itself in less than two years” (Warnes, 2014).

Most diet programs drop off in terms of efficacy after a time because the only tangible reward is weight loss. They cost money, there is no competition, and they offer little incentive to continue making better lifestyle choices once initial weight loss goals have been reached. Perhaps, people cannot see or choose to ignore the less tangible benefits of improved health, reduced risk of other diseases, and the reduction in costs.

Yes some of the participants in the US study did gain back the weight, so maybe they should have to pay back the money.


Boseley, S. (2014). UK among worst in Western Europe for level of overweight and obese people. Retrieved from:

National Health Service (NHS). (2014). Obesity. UK Gov. Retrieved from:

Penn Medicine. (2013). Rewarding Groups for Losing Weight More Effective than Rewarding Individuals, Penn Medicine Study Finds. Press Release. University of Pennsylvania. Retrieved from:

Warnes, S. (2014). Why the NHS should pay you £1,357 a year not to eat chocolate. Mirror. Retrieved from:

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