Adult obesity

Introduction

Being overweight and obesity are caused by eating and drinking more calories than are used up by physical activity, resulting in an accumulation of body fat that may impair health.

The Department of Health strategy Healthy Lives, Healthy People set out evidence that more and more people are becoming overweight or obese. The 2007 Foresight report – Tackling obesities: Future Choices – suggests that by 2050 60% of men and 50% of women will be obese.

This is a problem for individuals and society as a whole and people must be encouraged and, where necessary, supported to take greater responsibility for maintaining a healthy calorie balance from pregnancy through infancy, early years, childhood, adolescence and teenage years, and on through adulthood and preparing for older age.

Excess weight is a major risk factor for diseases such as type 2 diabetes, cancer and heart disease. Alongside the serious ill-health it provokes, it can reduce people’s prospects in life, affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health. Excess weight costs the NHS more than £5bn each year.

Watch and distribute bitesize video resources on the benefits of a well balanced diet from the council’s YouTube channel:

YouTube video link

The JSNA has a separate chapter on obesity in children and young people.

Key inequalities and risk factors

In terms of inequalities, the Healthy Lives, Healthy People Equality Analysis cites evidence that:

• learning disability – health checks have shown that people with learning disabilities had a higher rate of obesity (35%) than the general population (23%)
• mental health – there is strong evidence to suggest an association between obesity and poor mental health in teenagers and adults. Mental health of women is more closely affected by overweight and obesity than that of men
• gender – obesity and overweight prevalence is similar in males and females although the rate of increase in prevalence is greater in males than in females
• ethnicity – males from minority ethnic groups appear to have markedly lower obesity prevalence rates than those in the general population. Black African and Bangladeshi females appear to have higher obesity prevalence rates than the general population With the exception of black African and Pakistani populations, other ethnic groups appear to be becoming less obese or becoming more obese at a slower rate than the general population
• pregnancy and maternity – about half of women of childbearing age are either overweight or obese. At the start of pregnancy, 15.6% of women in England are obese. During pregnancy and childbirth, obesity presents a series of health risks to the foetus, the infant and to the mother
• deprivation – maternal obesity and weight retention after birth are related to socioeconomic deprivation
• educational attainment – obesity is also associated with educational attainment and prevalence is higher in both men and women who have fewer qualifications
• occupation – the prevalence of obesity for women in unskilled occupations is almost twice that of those in professional occupations. The overall pattern is similar for men: those in professional occupations have lower obesity prevalence than any other group

Facts, figures and trends

Obesity is estimated to be the fourth largest risk factor contributing to deaths in England (after hypertension, smoking, and high cholesterol) according to the NHS Atlas of Risk. For individuals classified as obese, the risk of poor health increases sharply with increasing BMI.

‘Overweight’ and ‘obese’ are clinical terms defined as abnormal or excessive fat accumulation that may impair health.  The most common measure is the Body Mass Index (BMI). BMI is a measure of weight in kilograms against height height in metres squared (kg/m2). A BMI of 25 kg/m2 or more is overweight, of 30 kg/m2 or more is obese and a BMI of 40 kg/m2 is morbidly obese.

The 2015 Health Survey for England set out trends in overweight, obesity and high waist circumference since 1993:

• the increase in overweight and obesity during the 1990s, was a cause for concern, because of the associated risks of ill-health and premature mortality
• between 1993 and 2001, the prevalence of overweight including obesity increased from 53% to 62% of adults in England
• since around 2001, the proportion of adults who are overweight or obese has changed little, and the trajectory has plateaued at 63%

However, levels of both general and abdominal obesity remain high and unequally distributed in the adult population in England, with important consequences for health and health inequalities:

The 2015 Survey reported 27% of both sexes were obese and prevalence of obesity for men and women increased with age, peaking around 55 to 64. Being overweight (without being obese) was more common among men (41%) than women (31%) and overall, 68% of men and 58% of women were above a normal weight for their height.

For women (but not men) obesity varied with socio-economic indicators, with those in the lowest income households or the most deprived areas most likely to be obese at 39% compared to 17% of women in the highest income households.

Waist circumference

Because body composition can vary significantly (tall and thin, small and muscular), in addition to BMI, a measure of waist circumference is used in people with a BMI less than 35kg/m2’ because a more ‘central’ fat distribution as identified by a high or very high waist circumference was found to be a better predictor of disease risk. Central obesity is defined as a very high waist circumference which is greater than 102cm for men and 88cm for women.

Prevalance of high and very high waist circumference by age is set out below. The pattern follows the same trend by age group, but those with very high waist measurements form a greater proportion than those who are rated obese by the BMI index:

Overall, central obesity has also risen markedly, from 20% of men and 26% of women in 1993, 34% and 44% respectively in 2013 and 35% and 47% respectively in 2015. A desirable waist circumference is less than 94cm in men and less than 80cm in women.

In Bracknell Forest, the percentage of adults of excess weight is measured by the Public Health Outcomes Framework and most easily accessible from the borough’s online Health Profile.

Figures for 2012 to 14 show 20.4% of the adult population in Bracknell Forest are obese (nationally 24.0%). A further 41% overweight (nationally 40.6%). In total 61.4% of the adult population are overweight or obese, this is in line with the national average and this is inline with the national average.

Lifestyle and environment

Of interest to commissioners of support services and health interventions, the Foresight report (2007) mapped 7 cross-cutting themes that influence the development of excess weight and obesity in the population:

Beyond biological factors such as genetics and health conditions, the inner ring represents those things that an individual can influence, manage or control:

• ‘individual psychology’ represents drives, motivation, perceived benefits and risks, experiences and perceptions that shape and influence decisions and choices about:
  • ‘food consumption’ – the quality, quantity and frequency of food consumed, and
  • ‘physical activity’ – the type, frequency and intensity of physical activity undertaken

The outer ring represents the broader economic and societal factors over which an individual has little or no control but which nevertheless influence, direct and impact on a person’s behaviour and the choices they can make:

• ‘societal influences’ represent the contexts in which a person lives such as the influence of media, education, cultures, communities, families, peers
• ‘activity environment’ represents the opportunities available for physical activity and enabling factors such as good transport links, well maintained paths and cycle paths, public open spaces, air quality
• ‘food environment’ represents such things as broad and varied choices in terms of the supply and proximity of healthy food

The conceptual model of physical activity promoting policy and the environment is also discussed in a NICE expert paper on physical activity.

Five a day

The costs of diet related chronic diseases to the NHS and more broadly to society are considerable. Poor diet is estimated to account for about one third of all deaths from cancer and CVD.

The 2013 Health Survey England (NHS Digital) measured fruit and vegetable consumption.  It found the mean daily fruit and vegetable consumption was higher in women than in men. Women consumed, on average, 3.7 portions per day compared with 3.5 for men and 28% of women ate five or more portions per day compared with 25% of men.

Mean daily fruit and vegetable consumption varied with age, with intake lowest among those aged 16 to 24 for both men and women. Adults in the 16 to 24 age group were also among those least likely to eat the recommended 5 or more portions:

To address the issue of obesity, a number of government policies and initiatives are in place, aimed at individuals, the NHS, local authorities and food manufacturers and retailers. The Change4Life public information campaign aims to improve diet and activity levels of parents and children. The Public Health Responsibility Deal involves voluntary participation from food manufacturers and retailers in a number of areas including calorie reduction and improving food labelling systems.14 The Living Well for Longer policy document aims to encourage and support local authorities and clinical commissioning groups (CCGs).

The average number of portions of fruit and vegetables eaten daily is reported in the Public Health Outcomes Framework:

Figures for Bracknell Forest show an increase in fruit and vegetable consumption between 2014 and 2015 compared to a decline at regional and England level.  Consumption of fruit was more popular than vegetables (accessed July 2017).

Physical activity

Physical inactivity is the 4th leading risk factor for global mortality accounting for 6% of deaths globally. People who have a physically active lifestyle have a 20 to 35% lower risk of cardiovascular disease, coronary heart disease and stroke compared to those who have a sedentary lifestyle. However, physical activity has been designed out of the modern lifestyle as Professor Kevin Fenton from Public Health England explains in this short video from the Public Health England YouTube channel:

The estimated direct cost of physical inactivity to the NHS across the UK is over £0.9 billion per year.

Figures from Public Health Outcomes Framework show that in 2015 the proportion of Bracknell Forest adults participating in at least 150 minutes of physical activity a week was 63.8%. This is a decrease on the 2013 figure (62.5%) but remains better than the national and regional averages.

In 2015, there was a higher percentage of men (62.1%) than women (52.2%) doing at least 150 minutes of physical activity a week compared to 62.9% (men) and 56.5% (women) in 2014.

In 2015, only 20.3% of the Bracknell Forest population was considered physically inactive, significantly better than the England average and representing a positive change over time:

Fewer men (25%) were inactive than women (32.2%) in Bracknell Forest in 2015, compared to 23.7% men and 24.6% women in 2014.

The environment and obesity

Obesity is a complex problem that requires action from individuals and society across multiple sectors. One important action is to modify the environment and design attractive environments (e.g. green infrastructure) so that it does not promote sedentary behaviour or provide easy access to energy-dense food. The aim is to help make the healthy choice the easy choice via environmental change and action at population and individual levels. This provides the opportunity to build the partnerships that are important for creating healthier places, and around which local leaders and communities can engage. Planning authorities can influence the built environment to improve health and reduce the extent to which it promotes obesity, the details of which should be set out in the area’s Local Plan.

Sense of place

In the widest sense, a “sense of place” is a desirable planning outcome because it sets out those things that people recognise as being distinctive to that place. The implication is that this ‘specialness’ is also desirable. (LGIU, 2017)

Therefore creating a sense of place can facilitate a range of planning-related outcomes:  Researchers have found that the risk of developing depression for city residents can be reduced by designing green space, active space and social space into cities. There are opportunities to create a sense of place through planning environments that address these three elements.  A partnership of agencies in Scotland has published the Place Standard (also see the LGiU Scotland briefing on the standard), which is a simple question and answer tool to help evaluate the quality of a place. This includes a question on identity and belonging; housing organisations need to demonstrate that they are using the standard to engage local people as a criteria for receiving government funding.

Costs

Hospital admissions with a primary diagnosis of obesity increased from just over 1,000 in 2000/2001 to a peak of nearly 12,000 in 2011/12. The rate has reduced in the last two years to 9,462 hospital admissions in 2013/14, female admissions accounted for more than double the number of male admissions.

Admissions with a primary or secondary diagnosis of obesity (i.e. attending hospital for another problem, for which obesity was relevant) have also risen more than ten-fold in the same period, from 29,000 in 2000/2001 to over 360,000 in 2013/2014. These admissions have increased year-on-year, with no apparent slowing of the rise.

In 2014 there were 485,600 items gastro-intestinal anti-obesity drugs prescribed at a cost of £13,915,500. (NHS Digital, accessed 01/06/2016)

Want to know more?

Active People Interactive (Sport England) – an interactive tool giving access to data from the Active People Survey which tracks the number of people taking part in sport and wider physical activity in England with the ability to disaggregate by time series, demography, sport / activity and geography.

Building the foundations – tackling obesity through planning and development (Local Government Association & Public Health England, 2016) – A report which identifies a series of themes and more specific elements that help to create healthy-weight environments.

Change4Life (Department of Health) – an online based tool, with lots of resources for lifestyle change to help parents and young people to improve diet and activity levels.

Health Survey for England 2015 (NHS Digital, 2016) – monitor trends in the nation’s health; estimating the proportion of people in England who have specified health conditions, and the prevalence of risk factors and behaviours associated with these conditions. The surveys provide regular information that cannot be obtained from other sources.

Healthy Lives, Healthy People: A call to action on obesity in England (Department of Health, 2011) – the government strategy for sustained downward trend in the level of excess weight in the population by 2020.

Living Well for Longer (Department of Health, 2014) – sets out what that the national health & care system at national and local level will do towards reducing premature mortality and improving national health and wellbeing.

Local Action on Health Inequalities: Improving access to green spaces (Public Health England, 2014) – a summary of evidence about the positive impact of access to green spaces on self-rated health, wellbeing, obesity and overweight levels, reduced social isolation and independence.

Making sense of a ‘sense of place’: a planning perspective (LGiU, 2017) – A briefing on calls for change within the planning system to focus more on a sense of place, with the aim of achieving development that is more accepted by local communities going beyond economic vitality to wider wellbeing outcomes.

Obesity and the Environment: Increasing physical activity and active travel (Public Helath England, 2013) – A ‘healthy people, healthy places’ briefing, this briefing summarises the importance of action on obesity and a specific focus on active travel, and outlines the regulatory and policy approaches that can be taken.

Obesity – working with local communities (NICE, 2012) – guidance aims to support effective, sustainable and community-wide action to prevent obesity. It sets out how local communities, with support from local organisations and networks, can achieve this.

Physical activity: walking and cycling (NICE, 2012) – guidance is for commissioners, managers and practitioners involved in physical activity promotion or who work in the environment, parks and leisure or transport planning sectors. It sets out how people can be encouraged to increase the amount they walk or cycle for travel or recreation purposes. This will help meet public health and other goals (for instance, to reduce traffic congestion, air pollution and greenhouse gas emissions).

Physical activity and the environment (NICE, 2008) – evidence base and guidance on how to improve the physical environment to encourage physical activity.  Useful for professionals with responsibility for the built or natural environment. This includes local transport authorities, transport planners, those working in local authorities and the education, community, voluntary and private sectors.

Physical activity: brief advice for adults in primary care (NICE, 2013) – guideline is for commissioners of health services and anyone working in primary care whose remit includes offering lifestyle advice. Examples include: exercise professionals, GPs, health trainers, health visitors, mental health professionals, midwives, pharmacists, practice nurses, physiotherapists.

Public Health Responsibility Deal (Public Health England, 2011) – an multi-sector and agency integrated and holistic approach at societal and individual levels to bring about and support sustained behavioural change, looking at a wide range of factors and opportunities for change in people’s environments, lifestyles, families, workplace, peer groups, and behaviours.

Start Active, Stay Active, A report on physical activity for health from the four home countries’ Chief Medical Officers (Department of Health, 2011) – UK-wide report with guidelines on the volume, duration, frequency and type of physical activity required to achieve general health benefits.

Weight management before, during and after pregnancy (NICE, 2010) – guidance for commissioners, managers and professionals with a direct or indirect role in, and responsibility for pregnant women or women planning pregnancy and new mothers such as GPs, obstetricians, midwives, health visitors, dietitians, community pharmacists and all those working in antenatal and postnatal services and children’s centres.

This page was created on 27 February 2014 and updated on 21 July 2017. Next review date June 2018.

Cite this page:

Bracknell Forest Council. (2017). JSNA – Adult Obesity. Available at: jsna.bracknell-forest.gov.uk/living-working-well/healthy-lifestyles/adult-obesity (Accessed: dd Mmmm yyyy)

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