Obesity: The Epidemic
Obesity has reached epidemic proportions globally,
with 1 billion overweight adults, at least 300 million
of them clinically obese in 2003. (WHO, 2003). This
trend continues to rise today with the World Health Organisation predicting that 2.3 billion adults will
be overweight and 700 million obese by 2015. (WHO, 2008).Obesity is a major cause of chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke and certain forms of cancer.
The health consequences range from a reduction in
the quality of life to premature death.
This rising epidemic reflects the changes in our society and behavioural patterns of communities over recent decades. While genes are important in determining a person’s susceptibility to weight gain, energy balance is determined by calorie intake and energy expenditure through physical activity. The fundamental cause of overweight and obesity is ‘energy imbalance’. The causes of this remain unclear although many believe that numerous behavioural, psychological, social and environmental factors determine the increase of obesity.
Economic growth, modernization, urbanisation and globalization of food markets are just some of the societal forces at work that are leading to an increased consumption of more energy-dense, nutrient poor foods with high levels of sugar and saturated fats, combined with a reduction in physical activity patterns. Such reductions in physical activity are partly down to a shift in less physically demanding work, the increasing use of automated transport, technology in the home and more passive leisure pursuits such as computer gaming.
Very small changes in lifestyle can result in significant weight gain. For example just 50-60 calories a day excess from increased food intake or decreased physical activity can result in over 2.4kg increase in weight annually. However it may be far harder for one to lose weight. For adults to lose 1kg of fat requires an energy deficit of around 7000 calories. Therefore to lose 0.5-1kg per week would require an energy deficit of between 500-1000 calories per day (NICE, 2006).
What is classified as overweight and obese?
The prevalence of overweight and obesity is commonly assessed by using body mass index (BMI), defined as the weight in kilograms divided by the square of the height in metres (Kg/m2). A BMI over 25kg/m2 is defined as overweight and a BMI of over 30kg/m2 as obese.
England
England officially has the highest prevalence rates of obesity amongst all of the EU-15 countries with a staggering 23.2% of the total population of adults in England classified Obese in 2008, an overall increase from 15% in 1993. Although this is lower than the USA whose levels are very high at 32.2%, England’s are still much worse than Italy (9.9%), France (9.4%), Switzerland (7.7%) and South Korea (3.5%) to name a few. (Department of Health, 2009).
- Obesity in both children and adults has increased substantially over the last decade in England, affecting 15% of children aged 2-10 years old and around ¼ of men and women in 2007.
- 37% of adults in England had a raised waist circumference in 2007 compared to 23% in 1993.
- Using both BMI and waist circumference to assess risk of health problems, for men in England, 19% were estimated to be at risk, 13% at high risk and 21% at very high risk. Equivalent figures for women in England were 15% at increased risk, 16% at high risk and 23% at very high risk.
- In 2007, only 27% of men in England and 31 % of women in England consumed five or more portions of fruit and vegetables a day.
- Diabetes as measured by the Health Survey for England continues to rise among adult male and females.
- The cost of Obesity in England is between £3.3 and £3.7 billion per year. The cost of obesity plus overweight is estimated between £6.6 and £7.4 billion per year. (Health Select Committee, 33)
- According to the West Midlands Regional Assembly (2008) the cost of inactivity could be as high as £8.2 billion annually.
According to The National Audit Office (NAO), the prevalence of obesity:
- Increases with age
- Is more prevalent among lower socioeconomic and lower-income groups, with a particularly strong social class gradient among women
- Is more prevalent among certain ethnic groups, particularly among African Caribbean and Pakistani women
- Is a problem across all regions in England but shows some important regional variations.
(NICE, 2006).
Other people who are at greater risk of becoming obese include: people who have given up smoking, people who have changed from an active to an inactive lifestyle and people who were previously overweight and have lost weight. Epidemiological studies also suggest that there are critical periods in life when weight gain is greatest and may be associated with excess weight gain. These include:
- Prenatal period (Fetal nutrition has permanent effects).
- Rapid growth in infancy.
- Adiposity rebound (rapid increase in BMI between ages of 5-7 years which may lead to obesity later in life)
- Adolescence- associated with increase autonomy (changed food habits, leisure)
- Young adulthood- reduced physical activity (women- 15-19 years: Men can be as late as early thirties).
- Pregnancy. Excessive weight gain can result in retention of weight after baby born.
- Menopause- Hormonal changes, changes in metabolism & reduced physical activity levels.
Existing NHS Service Provision and The Academy 4 Wellbeing’s role
There is considerable variability in the management of overweight and obese people in the NHS. Although there appears to be a willingness to address the problem of obesity, the provision of services remains limited and inconsistent. The Primary Care Organisations have developed a number of innovative approaches to the management of obesity, including partnerships with local authority and commercial weight loss organisations, but there is considerable regional variation in service provision. The NAO in 2001 has highlighted the need for joint working with different agencies to facilitate cross-government initiatives to prevent obesity at both national and local level. (NICE, 2006).
The Academy 4 Wellbeing aims to work in partnership with the NHS and other organisations to provide holistic weight management and health and wellbeing solutions to tackle the epidemic of obesity and improve the quality of life of people.
References
Department of Health (2009). Health Profile of England, 2008. London
NICE: National Institute for Clinical Excellence (2006). Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children.
The Information Centre for Health and Social Care (2009). Statistics on Obesity, Physical Activity and Diet: England,
World Health Organisation (2004). Global Strategy on Diet, Physical Activity and Health