Millions of people could be denied access to treatments such as weight-loss jabs because of flawed NHS guidance, a major think tank has warned.
King’s Fund senior analyst Danielle Jefferies said Body Mass Index (BMI) measures, which are used to determine obesity levels, are primarily based on research for white European or American people.
That means they do not account for the inherited ethnic differences of people from Black, Asian, brown, dual heritage or indigenous ethnicities – differences that can mean some groups are more likely to develop some health conditions.
The 2021 census for England and Wales showed 1.3 million people listed themselves as “other” for their ethnic group, while 1.7 million people listed themselves in “mixed or multiple” categories.
Ms Jefferies said that meant the current BMI thresholds “potentially do not fully work for up to 3 million people in the UK”, meaning they could miss out on treatments because they have a lower BMI than is required for some treatments.
The warning comes as the NHS prepares to roll out access to weight-loss jab Mounjaro, to 250,000 patients a year over the next 12 years.
Access to Mounjaro is based on strict measures, including the stipulation that a person has a BMI of over 40. Other NHS treatments, such as IVF, bariatric surgery, and joint replacement surgery, are also managed based on a person’s BMI.
Currently, BMI guidelines for people from black, Asian and Middle Eastern backgrounds are lowered to account for health risks that occur at a lower BMI than for white people. But the same is not done for those in these mixed heritage groups.
Ms Jeffries said: “The current NICE guidelines take a broad-brush approach by recommending lower BMI thresholds for anyone of Black, Asian or Middle Eastern background, which effectively includes almost everyone who is not white.
“This creates some knotty issues. First, because it leaves some people wondering if they are ‘white enough’ to use the old thresholds, which is a subjective and problematic way to categorise people from global majority ethnic backgrounds.”
“For example, does this include people who identify as Latino, white Middle Eastern, or Hispanic? Or does this include someone who is mixed and has one grandparent who is Black or Asian and the rest white?”
Ms Jefferies said the NHS BMI calculator automatically gives patients who identify as ‘other white ethnic group’ – for example, someone who could identify as Latino – a higher threshold as if they were white.
She said this can have “real-world consequences” and including or excluding an ethnic group from the threshold adjustment could “significantly impact national obesity figures and change how we measure health inequalities between different ethnicities”.
“For individuals, lower BMI thresholds could be life-changing. For the average-height adult, the cut-off point for being obese for people from a white ethnicity is more than a stone heavier than for people from a Black, Asian or Middle Eastern background. That could be significant if that person was sat in a GP appointment asking whether they qualify for bariatric surgery or weight-loss drugs, or if they are healthy enough to receive NHS-funded IVF,” she added.
On Thursday, it was revealed that the price of Mounjaro will nearly triple for private patients in the UK, after the US-owned company equalised costs in markets across the globe.
A month’s supply of the highest doses of the “King Kong” of weight-loss medicine will rise from £122 to £330 – an increase of 170 per cent. However, drug manufacturer Lilly said it would not raise the price paid by the NHS, and it was working with private healthcare providers to maintain access to the jab.
NICE and the Department for Health and Social Care have been approached for comment.
