Obesity

Your opinion at the start - stage 1/6

More and more people are overweight and obese. This is said to be a major and growing cause of ill-health. How should we best respond?

Read background

Research: Paul Eustice; editing: Perry Walker; expert advice: Amy Godfrey, Research Assistant in Food and Public Health, University of Hertfordshire and Dr Laura McGowan, Chartered Psychologist, Queen's University Belfast.

Drag these using the hand symbol () so that they are in order, most preferred at the top

  • Using education to encourage healthier choices
  • Offering psychological support for those labelled obese
  • Providing surgery
  • Tackling inequality
  • Raising the price of unhealthy foods (junk food tax) and/or controlling advertising for them
What is obesity?

Obesity is defined by the World Health Organisation (WHO) as “abnormal or excessive fat accumulation that may impair health” (1). It is measured using Body Mass Index (BMI), which is a ratio of weight to height. The formula is weight divided by the square of the height (w/h2). A male of 5 foot 8 inches would officially be overweight at 12 stone 4 lbs (BMI 26.1). At 14 stone 8 lbs he would be obese (BMI 31).

underweight

Up to 18.49
WHO preferred range 18.5-24.9
overweight 25
almost obese 25-29
obese class 1 30-34.9
obese class 2 35-39.9
obese class 3 over 40

The British NHS use the same scale (9) but in fact it is only a very rough guide. It does not distinguish fat from muscle so athletes are often misclassified as obese (13;43). It is particularly misleading during the rapid changes of puberty.

Body Mass Index (BMI) as a measure of obesity is increasingly challenged as crude and misleading (13;2.5-6). Nick Trefethen, Professor of Numerical Analysis at Oxford University, recently proposed a new formulae to correct this problem: 1.3 x weight, divided by height to the power 2.5 (6).

Obesity is not a simple matter of overall weight. Another measurement focuses on where the fat accumulates. It is said to be more harmful if gathered round the waist, so ‘safety levels’ are waist measurements below 31.5 inches for women or 37 inches for men.

Obesity is normally caused by taking in more calories than we use. However, individually, it can result from a range of medical conditions or reaction to medications. It can also result from eating the same amount of food of a less healthy kind, with more fat and sugar. But it is not just a simple matter of individual ‘choice’; changes in social habits are affecting whole populations.

Why is it a problem and who says so?

It matters because, globally, WHO claim 2.8 million people die each year “as a result of being overweight or obese.”(1). Obesity is associated with heart disease and stroke, diabetes, osteoarthritis and ‘some cancers’ (endometrial, breast, and colon). The UK Department of Health announced in 2013 that “In England, most people are overweight or obese. This includes 61.9% of adults and 28% of children aged between 2 and 15." They include in the consequences of obesity harm to “self-esteem and mental health” (4) but they are also concerned that “health problems associated with being overweight or obese cost the NHS more than £5 billion every year.” Unhealthy populations are expensive and the NHS has financial problems (31#3)

It could be argued that a lot of self-esteem issues arise from the way overweight people are stigmatised. An approach to obesity that always links calories and weight with illness and ‘being a problem’ will increase pressure on them to diet to conform to an ideal size and shape. This leads to repeated cycles of weight loss and regain which can in themselves be harmful.

It can also be argued that focusing the problem on an individual’s responsibility to lose weight ignores wider problems of poverty, education and food prices, moving the focus away from our responsibility to create a fairer society where everybody can afford healthy choices and is properly supported in making them (7,8). So we may be using ‘obesity’ as a simple shorthand for a complex problem, making simplistic assumptions that misrepresent the problem we need to solve.

Regional differences in obesity figures suggest that a national campaign, saying the same thing to everybody, is fighting against stronger influences that vary by region (41p25;43). The effectiveness of ‘healthy living’ messages sponsored by public agencies has been questioned.

What could we do about it?

We may need to think more widely about nutritional choices and life styles. WHO point out that our personal choices and habits are influenced by a wide range of social factors and by “policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.” To make healthy choices we need “supportive environments and communities” so that the healthy choices are “accessible, available and affordable”. Those with lower incomes might focus more on calories per £ rather than good nutrition. Advertising encourages unhealthy choices, promoting processed foods with too much fat, sugar and salt content and encouraging children to make poor choices early on (1).

What solutions do we prioritise?

Medical; fiscal; social and economic; psychological; educational; physical activity? A study in 2007 found a consensus that we needed “mutually reinforcing measures related to education, information, healthier food and physical activity”. So the policy options we offer you are not mutually exclusive and may well work best when they work together. However, they all require time, attention and money, which are finite resources, so we have to prioritise. If resources are limited, what kind of approach would you put at the front of the queue?

References and sources

1 http://www.who.int/mediacentre/factsheets/fs311/en/
2 http://www.who.int/features/factfiles/obesity/en/
3 http://www.who.int/features/factfiles/obesity/facts/en/
4 https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet
5 https://www.gov.uk/government/publications/healthy-lives-healthy-people-a-call-to-action-on-obesity-in-england
6 http://people.maths.ox.ac.uk/trefethen/bmi.html
7 http://www.healthateverysize.org.uk/haes.html
8 http://www.nutritionj.com/content/10/1/9
9 www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx
10 http://www.ncbi.nlm.nih.gov/pubmed/17371314
11 http://www.ncbi.nlm.nih.gov/pubmed/17371314
12 http://www.telegraph.co.uk/women/mother-tongue/9821382/Tax-junk-food-and-subsidise-vegetables-to-fight-poor-obesity-crisis.html
13 http://www.bps.org.uk/sites/default/files/images/pat_rep95_obesity_web.pdf
14 http://www.noo.org.uk/NOO_about_obesity/morbid_obesity
15 http://onlinelibrary.wiley.com/doi/10.1111/obr.12002/full
16 http://business-reporter.co.uk/2013/03/obesity-epidemic-being-fed-by-rising-cost-of-food-in-uk/
17 http://www.ox.ac.uk/media/news_stories/2012/120516_1.html
18 http://www.theguardian.com/lifeandstyle/2008/nov/06/oliver-health
19 http://www.gserve.nice.org.uk/nicemedia/documents/cooking_skills_health.pdf
20 http://www.local.gov.uk/media-releases/-/journal_content/56/10180/6356479/NEWS
21 http://onlinelibrary.wiley.com/doi/10.1111/obr.12093/full
22 http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_079713
23 http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.59.103006.093551
24 http://www.parliament.uk/briefing-papers/SN03724/obesity
25 http://www.cdc.gov/physicalactivity/everyone/getactive/barriers.html
26 http://content.time.com/time/health/article/0,8599,1897920,00.html
27 http://obesity-conference.govtoday.co.uk/event-home
28 http://www.nhs.uk/Change4Life/Pages/change-for-life.aspx
29 The EarlyBird diabetes study of 300 children in Devon
30 http://coi.gov.uk/documents/commongood/commongood-behaviourchange.pdf
31 http://www.theguardian.com/lifeandstyle/2014/jun/23/truth-about-obesity-10-shocking-things-need-to-know
32 http://www.esrc.ac.uk/_images/briefing-unhealthy-ads_tcm8-24202.pdf
33 http://www.birminghammail.co.uk/news/local-news/zero-tolerance-policy-help-tackle-4028212
34 http://www.nhs.uk/change4life/Pages/why-change-for-life.aspx
35 https://responsibilitydeal.dh.gov.uk/)
36 http://www.dartmouth.edu/~bil/pubs/demos_2012_JNeuro.pdf
37a http://www.jlgh.org/Past-Issues/Volume-4---Issue-4/Behavioral-and-Psychological-Factors-in-Obesity.aspx
38a http://www.theguardian.com/society/2013/feb/19/patient-stomach-psychology-obesity
37b http://www.bbc.co.uk/news/health-18628811
38b http://www.anzmac.org/conference_archive/2008/_Proceedings/PDF/S07_/Stuart_S5%20See%20P4%20.pdf
39 http://curia.europa.eu/juris/document/document.jsf?text=&docid=155125&pageIndex=0&doclang=EN
40 http://www.theguardian.com/law/2014/jul/17/obesity-disability-european-court-discrimination-claim
41 http://www.hscic.gov.uk/catalogue/PUB05131/obes-phys-acti-diet-eng-2012-rep.pdf
42 http://www.sthc.co.uk/Documents/CMO_Report_2009.pdf
43 http://www.prospectmagazine.co.uk/regulars/8160-numbersgame
44 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/
45 http://www.bariatricnews.net/?q=news/11727/outcomes-first-uk-bariatric-surgery-report
46 https://www.rcplondon.ac.uk/sites/default/files/action-on-obesity.pdf
47 http://www.noo.org.uk/uploads/doc/vid_10266_Obesity%20and%20mental%20health_FINAL_070311_MG.pdf
48 highered.mheducation.com/sites/dl/free/.../363504/Ch04_Myers3Ce.pdf
49 Influence of obesity, physical inactivity, and weight cycling on chronic inflammation

K Strohacker , Brian K. McFarlin; Frontiers in Bioscience E2, 98-104, January 1, 2010]

50 http://www.bbc.co.uk/news/health-26442420
51 http://wamc.org/post/ny-sugar-tax-revisitedsugat tax
56 http://www.nice.org.uk/news/press-and-media/adults-who-are-obese-can-improve-their-health-by-losing-even-a-small-amount-of-weight
57 http://poverty.org.uk/63/index.shtml
58 http://www.parliament.the-stationery-office.co.uk/pa/cm200304/cmselect/cmhealth/uc23-v/uc2302.htm
59 http://www.noo.org.uk/uploads/doc/vid_7929_Adult%20Socioeco%20Data%20Briefing%20October%202010.pdf
60 http://www.aso.org.uk/wp-content/uploads/downloads/2012/02/Statistics_on_Obesity_Physical_Activity_and_Diet_England_2010.pdf
61 http://www.bhfactive.org.uk/userfiles/Documents/obes-phys-acti-diet-eng-2013-rep.pdf
62 http://www.jamieoliver.com/us/foundation/jamies-food-revolution/about_jamie_oliver
63 http://www.theatlantic.com/magazine/archive/2014/04/why-rich-women-dont-get-fat/358643/
64 http://www.bbc.co.uk/news/health-28246641