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Weight and Obesity   Download this section

Obesity and being overweight contribute to a range of diseases such as coronary heart disease, type 2 diabetes, osteoarthritis and some cancers (NICE, 2006).

Being overweight or obese is defined as having abnormal or excessive fat accumulations that present a risk to health (World Health Organisation, 2013).

Globally, obesity has reached epidemic proportions. In 2008, more than 1.4 billion adults were overweight and more than half a billion were obese leading to at least 2.8 million people dying each year as a result of being overweight or obese (World Health Organisation, 2013).

Treating the effects of obesity is estimated to cost the NHS £5billion per year. The wider cost to the economy is estimated at closer to £20billion per year once factors such as lost productivity and sick days are taken into account (Local Government Association, 2013) and the resulting NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050 (Foresight, 2007).

Excess weight gain is seen as the result of an energy imbalance – that is, the intake of more calories than are expended through exercise and activity. In order to maintain a healthy weight, an individual needs to achieve an energy balance between intake (food) and expended energy (exercise and activity).

The causes for this imbalance are a complicated mix of physiological, environmental and behavioural factors (Department of Health, 2011). Most weight gain is gradual and people may not notice it happening (NICE, 2006).

The chart below taken from a report into obesity and socio-economic groups shows some of the key determinants of obesity.

 

Some of the key determinants of obesity

Some of the key determinants of obesity

 

The link to obesity is one that begins in childhood, with breastfeeding being found to generally reduce the risk of obesity (Unicef). Exclusive breastfeeding is encouraged during the first 6 months of life (NICE, 2008), however, Britain has one of the lowest levels of breastfeeding in Europe (NICE).

Breastfeeding initiation at birth has increased since 2005 to the current England rate of 83%, however, only 34% of babies continued to be breastfed at 6 months old (Infant Feeding Survey, 2010).

 

How is Obesity Measured? 

Body Mass Index (BMI) is the most common and accessible way of measuring body fatness in adults. BMI is calculated by dividing weight in kilograms by height in metres squared and can be easily calculated using the NHS Choices BMI Healthy Weight Calculator.

Because BMI gives a proxy measure of body fatness, there are some limitations with the measure. It does not account for factors of fitness (muscle mass), puberty, ethnicity and the distribution of body fat which can all affect body fatness measures using the BMI method. However, its ease of use and readily available threshold figures make it the most practical tool to measure body fatness (National Obesity Observatory, 2009).

 

Adult BMI Threshold Measurements

 Adult BMI Threshold Measurements

SOURCE: National Institute for Healthcare & Excellence (NICE) (2013).  Public Health Draft Guidance: Managing Overweight and Obesity in Adults.

 

The method of assigning a BMI score is different for children and adults. Defining children as overweight or obese is a more complex process, given that their height and weight change at the same time. The National Child Measurement Programme monitors the weight of UK children and uses Growth Reference Charts to define whether children are overweight or obese.

 

Health Risks Linked To Obesity

Obesity and overweight contribute to a range of diseases such as coronary heart disease, type 2 diabetes, osteoarthritis and some cancers (NICE, 2006). BMI classification with a combined waist circumference measurement can identify level of health risk for an individual.

 

Health risk associated with BMI and waist circumference measurement

 Health risk associated with BMI and waist circumference measurement

 

Diabetes

A larger proportion of those who are obese develop diabetes and at a younger age. The difference in diabetes prevalence is such that obese people aged 25-64 have a higher prevalence of diabetes than their normal weight people who are 20 years older. 21% of obese men aged 55-64 had diabetes, compared with 15% of men aged 75 and over who were not overweight. Similarly 14% of obese women aged 55-64 had diabetes, compared with 9% of women aged 75 and over who were not overweight (Health Survey for England, 2011).

People of Asian, Black African and African-Caribbean origin are at higher risk of developing diabetes than White populations (Department of Health, 2001).

NICE (2013) Public Health Guidance 46 identifies that people from these ethnic groups are more likely to develop diabetes at a lower equivalent body mass index score than white populations and recommends that in addition to body mass index, waist band measurement should also be used to assess levels of body fat in people from these ethnic groups.

The guidance also identifies that health promotion information is not necessarily given to Asian, black African and African-Caribbean populations at lower body mass index levels even though the risk to poor health is greater. People from these ethnic groups are at greater risk of developing diabetes and other diseases at a lower body mass index than white populations but BMI and waist circumference cut-off points indicating a healthy range for these measures for ethnic groups are yet to be established.

 

Doctor diagnosed diabetes: by BMI status, age, and sex

 Doctor diagnosed diabetes: by BMI status, age, and sex

SOURCE: Health Survey for England 2011.  http://www.hscic.gov.uk/catalogue/PUB09300

England is one of the most obese countries in the world with one in four adults classed as obese and another one in three classed as overweight. Obesity is linked to a host of health risks such as diabetes, heart disease, stroke, some cancers, mental health problems and musculoskeletal issues (Local Government Association, 2013).

Obesity has continued to increase in the UK between 1993 and 2012. 13% of men were categorised as obese in 1993, compared with 24% in 2012. 16% of women were obese in 1993 compared with 26% in 2012. The rate of increase in obesity has been slowing in the second half of the period and there are indications that the trend may be flattening out over recent years. However, obesity in women in 2010, 2011 and 2012 was at its highest level since 1993 (Health Survey for England, 2012).

Changes in levels of obesity in the England adult population between 1993-2012 show that over this 19 year period, the number of people who are obese has almost doubled in men and women.

  • In 1993, 14% of women were classed as obese which carried a very high risk to their health because of their weight. In 2012, this had increased to 24% of women.
  • In 1993, 11% of men were classed as obese which carried a very high risk to their health because of their weight. In 2012, this had increased to 22% of men.

Source: Health and Social Care Information Centre (2012)

New data are now available from the Active People Survey from Sport England on the prevalence of excess weight (overweight including obesity, BMI equal to or greater than 25kg/m2) in adults (age 16 and over) at local authority level.

This is an indicator in the Public Health Outcomes Framework (PHOF) Health Improvement domain and the England rate is 63.8%. There is a set of supporting indicators for adult underweight, healthy weight, overweight, and obesity prevalence available from the PHE obesity webpage.

The 2012-2013 National Child Measurement Programme records bodyweight of children at reception and year 6 ages of children at school. In England, 76.9% of children at reception age were recorded as healthy weight compared to 65.4% at year 6. Of the remainder, 12.9% were classed as overweight with a further 9.5% obese at reception age. At year 6, this was recorded as 14.4% overweight with a further 19.0% obese.

 

Prevalence of underweight, healthy weight, overweight and obese children by school year and sex: England 2012/13

Source: The Health and Social Care Information Centre, Lifestyle Statistics / Department of Health Obesity Team NCMP Dataset

Copyright © 2013. The Health and Social Care Information Centre, Lifestyle Statistics. All Rights Reserved.

 

The Regional Picture

According to the Health Survey for England (HSE), obesity prevalence in Yorkshire & Humber during 2009 – 2011, for females is the highest in England.

For both males and females the prevalence of obesity has consistently risen since the 1980’s in line with the national trend.

Adult Males (aged 16+ years) regional level age standardised obesity prevalence (%)
Males                  
  North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East South West
2008-2010 25.4 23.9 24.5 23.2 25.7 22.9 22.2 23.9 25.5
2007-2009 26.6 23.5 24.6 22 24.5 21.6 21.1 22.3 24.6
2006-2008 26.7 23.1 25.7 23.3 25.4 21.7 20.6 24.1 23
2005-2007 27 23.4 24.8 24.9 25.9 22.4 18.1 23.1 21.1
2004-2006 24.8 22.4 23.9 24.8 26.2 22.8 17 22.8 20.9
2003-2005 22.4 22.3 23.5 23.6 23.6 23.8 17.1 20.2 21.3
2002-2004 23.6 22.3 24.8 23.7 22.9 22.5 17.4 20.5 20.3
2001-2003 23.8 21.5 23.6 23.2 22.6 20.7 17.9 19.5 18.9
2000-2002 24.5 20 22.2 23 22.3 19.2 17.9 19.8 18.4
1999-2001 23.6 19.9 19.7 20.5 21.2 18.9 18.1 18.2 18.4
1998-2000 18.1 17.9 18.5 17.4 20.7 17.3 16.4 17.4 16.7

 

Adult Females (aged 16+ years) regional level age standardised obesity prevalence (%)
Females                  
  North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East South West
2008-2010 27.4 23.5 27.4 27.2 26.1 23.1 22 22.7 24.5
2007-2009 28.5 22.8 26.5 25.5 25.9 23.4 21.7 22.4 23.9
2006-2008 28.3 22.5 25.5 24.3 26.4 23.6 22.2 23.4 22.6
2005-2007 27.4 23.4 24.3 24.3 26.1 24.3 18.9 24.5 22.7
2004-2006 26.4 22.1 24 25.9 26.3 22.8 19.1 22.1 23.1
2003-2005 25.5 23.8 23.7 24.5 26.9 22.9 19.2 20 21.2
2002-2004 22.6 23 24 25.3 26 22.4 21.6 19 18.6
2001-2003 23.6 21.9 24.1 24.4 26.5 22.7 21.3 19.5 20.3
2000-2002 22.6 21.3 23.3 25.2 25.4 21.4 21.7 19.7 19.5
1999-2001 21.5 20.7 21.8 23.4 26.4 20.9 20.2 18.9 21.4
1998-2000 19.8 21 20.5 24.3 23.5 19.6 20.2 17.7 18.8

The prevalence of excess weight in adults in Yorkshire and Humber is estimated to be 65.4%. This is based on the new data available from the Active People Survey

 

Excess weight in adults 2012

Source: Active People Survey: Sport England

 

Children

Regional National Child Measurement Programme (NCMP) data below show that in Yorkshire & Humber the percentage of overweight and obese children in Reception class is 21.9%, which is lower than the England average of 22.9%. In Year 6 the percentage overweight and obese is 33.2% in Yorkshire & Humber, similar to the national rate of 33.3% (National Child Measurement Programme, 2013).

 

Percentage of obese children in reception

Source: The Health and Social Care Information Centre, Lifestyle Statistics / Department of Health Obesity Team NCMP Dataset

Copyright © 2013. The Health and Social Care Information Centre, Lifestyle Statistics. All Rights Reserved

 

 Percentage of obese children in year 6

Source: The Health and Social Care Information Centre, Lifestyle Statistics / Department of Health Obesity Team NCMP Dataset

Copyright © 2013. The Health and Social Care Information Centre, Lifestyle Statistics. All Rights Reserved

 

Adults

Based on the new data available on the Public Health Outcomes Framework (PHOF) from the Active People Survey, the prevalence of excess weight in adults In York is estimated to be 58.4%. The chart breaks down the data collected for York and compared to Yorkshire and Humber.

 prevalence of weight among adults in york 2012

Source: Active People Survey: Sport England

Obesity data available for local GP practices show a lower prevalence of obesity than national figures from the Active People Survey suggest. Figures recorded at GP practice level are generally regarded as an underestimate of the true levels of obesity in the practice population (National Obesity Observatory, 2009).

The prevalence of obese adults (16+) known to all GP’s in the City of York Council boundary during 2011-12 was 9.4%, much lower than the Active People Survey 2012 data which shows a prevalence of 20.7%. This suggests that there may be obese or overweight individuals who are not receiving any interventions focussed around their bodyweight at their GP practice.

In comparison to the regional Yorkshire & Humber figure for obese adults of 25.0%, York fares slightly better. This should be taken in the context of a national rising trend of obesity as well as the fact that England has one of the most obese populations in the world.

Children

The National Child Measurement Programme charts below show the percentage of children classified as obese or overweight in Reception (aged 4-5) and Year 6 (aged 10-11 years) by local authority compared to statistical neighbours. Statistical neighbours are other areas that share similar characteristics to York and so allow comparisons to be made between areas. York's performance against its statistical neighbours is shown below. York has a similar percentage of children at Reception and a lower percentage in Year 6 classified as obese or overweight compared to the England average.

 Percentage of children classified as obese or overweight by children age

SOURCE: National Child Measurement Programme (NCMP), The Information Centre for Health and Social Care

 

However, local information shows that the rate of obesity almost doubles in the years between a child aged 4-5 years and aged 10-11 years.

 children in Reception who are overweight or obese

Source: The Health and Social Care Information Centre, Lifestyle Statistics / Department of Health Obesity Team NCMP Dataset

Copyright © 2013. The Health and Social Care Information Centre, Lifestyle Statistics. All Rights Reserved

 

children in Year 6 who are overweight or obese

Source: The Health and Social Care Information Centre, Lifestyle Statistics / Department of Health Obesity Team NCMP Dataset

Copyright © 2013. The Health and Social Care Information Centre, Lifestyle Statistics. All Rights Reserved

 

National and international data shows that obesity is linked to deprivation, with those living in more deprived areas more likely to be obese than people living in more affluent areas. This effect is known to be more pronounced for women and children who are living in deprivation (Robertson et al, 2007).

The correlation between deprivation and obesity is also shown to exist in York as the chart below shows.

 Percentage of Children at risk of obesity

SOURCE: National Child Measurement Programme (NCMP), The Information Centre for Health and Social Care

A full suite of information about obesity can be accessed from the Public Health England National Obesity Observatory at: http://www.noo.org.uk/visualisation

A range of public health interventions exist to support the promotion of healthy lifestlyle around obesity such as:

  • Breastfeeding Support Programmes
  • Targeted sport and active leisure programmes
  • Access to active sport and leisure options
  • Dietary advice and support

A systematic review into interventions to prevent obesity in children found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. A broad range of programme components were used and analysis suggests the following to be promising policies and strategies (Waters et al, 2011):

  • school curriculum that includes healthy eating, physical activity and body image
  • increased sessions for physical activity and the development of fundamental movement skills throughout the school week
  • improvements in nutritional quality of the food supply in schools
  • environments and cultural practices that support children eating healthier foods and being active throughout each day
  • support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)
  • parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

NICE Clinical Guidance CG43 identifies a range of strategies that could help people to achieve and maintain a healthy weight:

  • Base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.
  • Eat plenty of fibre-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread, and brown rice and pasta.
  • Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.
  • Eat a low-fat diet and avoid increasing your fat and/or calorie intake.
  • Eat as little as possible of:  fried foods, drinks and confectionery high in added sugars, other food and drinks high in fat and sugar, such as some take-away and fast foods.
  • Eat breakfast.
  • Watch the portion size of meals and snacks, and how often you are eating.
  • For adults, minimise the calories you take in from alcohol.
  • Make enjoyable activities – such as walking, cycling, swimming, aerobics and gardening – part of everyday life.
  • Minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games.
  • Build activity into the working day – for example, take the stairs instead of the lift, take a walk at lunchtime.

A range of practical information and advice is also available on the NHS Change 4 Life website.

 

Health Inequalities

Ethnicity

There is an increased risk of diabetes in certain ethnic groups. Other possible health outcomes of interest that are connected to ethnicity and body fatness may include cancer, stroke and myocardial infarction but there is a lack of evidence to identify these risks (NICE, 2013).

 

Deprivation

The prevalence of obesity is linked to poverty and deprivation. There is also evidence to show that breastfeeding is more prevalent in ‘middle class’ families and that the methods used to engage women from different socio-economic backgrounds should differ to ensure interventions are effective across the entire population.

It appears there are very few controlled interventions that have targeted lower socio-economic groups or have examined the effect of interventions on different socio-economic groups.

Where evidence is available, it shows that participants from lower income groups are likely to show less response to health promotion programmes and have higher drop-out rates. Interventions are often of short duration and fail to take sufficient account of ethnic and social diversity. The evidence suggests that educational information alone is relatively ineffective among lower income groups and may increase inequalities.

However, there is evidence that breastfeeding support programmes can be effective for women in less affluent groups. More focussed intervention could be offered through maternal and child health care and social support services since this may have a beneficial impact on reducing the social gradient in obesity.

However the design of services must be carefully considered as to how best to engage these women and evaluations of these interventions are needed (Robertson et al, 2007).

Further analysis of success rates for breastfeeding would identify how effective our local programmes are at ensuring that women least likely to start and continue breastfeeding are actively engaged and that all pregnant women and new mothers are offered support for breastfeeding and that they are successful at educating women about breastfeeding during the antenatal and postnatal periods in line with NICE public health guidance PH11 on maternal and child nutrition and NICE clinical guideline CG37 on postnatal care.




References

This page was last updated on 27 January 2015
This page will be reviewed by 27 January 2016