Full to the Brim: Scottish Borders 'facing an obesity crisis'
Last updated 28th Apr 2025
Severely-obese patients may have to attend weight-loss programmes before being referred for joint replacements.
That's one of the proposals contained in NHS Borders new organisational strategy, which will help shape the future of local health services over the next five years.
It comes as a new report reveals the region is facing an obesity crisis, which could cost as much as £165 million to treat.
Full to the Brim estimates 32,000 adults in the region are thought to have a Body Mass Index (BMI) of over 30, which means they are at a higher risk of developing various health problems associated with excessive weight, such as heart disease, type 2 diabetes, and certain cancers.
Author Dr Sohail Bhatti, the region's Director of Public Health, says: "One of the most common operations we carry out is hip and knee replacement, often causing pain and discomfort, and... (a survey) showed that between nine to 13 per cent of the procedures were carried on individuals who fall into the morbidly obese category with a BMI of 40 and over.
"There is a strong case for delaying these operations as there are likely to be complications during recovery and healing.
"It could be also argued that anyone with a BMI of 35 or above should be given intensive support for reducing their weight, before operation, in order to optimise their recovery and reduce complications and hence length of stay.
"There is a cost of each operation; prolonged care for complications adds to that cost."
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Weight loss drugs are likely to play a bigger role in the future of the health service, the report states. Despite the cost, it reveals it could result in "considerable" savings in the longer-term.
Social prescribing, it recommends, also needs to be expanded.
The report makes detailed recommendations for the health service, including developing a register of people living with obesity and focusing on children through work with parents, schools and health professionals.
Recommendations for joint work with the council are also made; for example regarding advertising and planning consent for fast food outlets.
Dr Bhatti says: "Many of us struggle with weight due to various factors. We are often encouraged to consume excessive calories and discouraged from engaging in physical activity.
"In many areas of the Scottish Borders, access to fresh fruits and vegetables is restricted while fast food outlets are plentiful.
"Our schools follow Setting the Table guidance so don’t offer sugary snacks; however, many workplaces offer few healthy options.
"For those living in towns and cities, it is often more convenient to drive than walking or cycling. Additionally, in the Scottish Borders, covering large distances using public transport is challenging.
"Work carried out in 2023 showed that in 2016 and 2019, 65% of the adult population in Scottish Borders who took part in the Scottish Health Survey were overweight or experiencing obesity, compared to 67% of the same population across Scotland. This is shocking; and shows how 'normalised' it has become."
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NHS Borders has recently introduced a salary sacrifice scheme to enable employees to obtain e-bikes to get to and from work - and generally be more active.
Full to the Brim also recommends that this is extended to include gym equipment or even electric cars.
Dr Bhatti added: "The goal is to establish a system that helps people manage at home using community resources, rather than relying on overburdened statutory services, which spreads scarce resources even thinner."
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