Adult obesity

England is one of the most obese countries in the world with one in four adults obese, another one in three are classed as overweight. Treating the effects of obesity is estimated to cost the NHS £5bn a year. The wider cost to the economy is estimated at closer to £20bn a year once factors such as lost productivity and sick days are taken into account.

The World Health Organisation defines obesity as a body mass index (BMI) of 30 or higher and overweight as a BMI of 25-30. BMI takes into account both body weight and height and so is a better measure of excess weight than measuring weight alone.

The numbers of people who are classified as obese are predicted to more than double over the next 40 years. The Foresight Report (2007) predicted that with no action 60% of men, 50% of women, and 25% of children will be obese by 2050 across the UK. Healthy Lives, Healthy People: A call to action on obesity in England, which was published in October 2011, set a new target for a downward trend in excess weight for children and adults by 2020.

What do we know?

Obesity is the consequence of a complex set of factors acting across many areas of our lives, from the influence of our genetics to the influence of our families and community that we live in, our physical environment and how we get our food.

The consequences of obesity are wide ranging and include diseases such as diabetes, heart disease, some cancers as well as mental health conditions and musculoskeletal conditions including back pain and knee pain.
An obese woman is 13 times more likely to develop type 2 diabetes than a woman of healthy weight. Overall 29 per cent of men and 36 per cent of women classed as obese have a life limiting illness – double the rates in the healthy-weight population.

In the UK, physical inactivity is responsible for 1 in 6 deaths annually. The associated national economic burden is estimated to be in the region of £7.4 billion per annum. UK active have suggested that a 1% reduction in inactivity each year for five years would save the UK around £1.2 billion. (Moving more, living more, HMG, 2014)

Actions to reduce the burden of obesity can have multiple benefits beyond directly improving weight-related health conditions, for example increasing walking and cycling may reduce car travel thus reducing pollution and congestion and providing safer and more welcoming streets which in turn may boost local business.

Facts, Figures, Trends

It is estimated that almost two thirds (63.3%) of adults in Slough are overweight, and of those who are overweight 40% are classified as obese. This means that one in four adults in Slough are clinically obese. These figures are high, though are similar to the national average.

Although it is estimated that a quarter of adults in Slough are obese, only 9.5% of adults are recorded as being obese by their GP. This suggests that the majority of those who are obese are either not visiting their GP or are not being measured.

Physical inactivity is a key risk factor for overweight and obesity. Almost a third (31.4%) of adults in Slough are physically inactive. Though this is concerning, it represents a significant improvement since 2012 when rates of inactivity in adults were 38%. Being physically inactive is defined as doing less than thirty minutes of moderate intensity physical activity in a week.

Similarly, there has been a heartening increase in the proportion of physically active adults (defined as those achieveing 150 minutes or more of at least moderate intensity physical activity per week)  in Slough, from 49.1% in 2012 to 52.7% in 2013.

Dietary risks are much more difficult to measure in a population. A key indicator as part of the Public Health Outcomes Framework (PHOF), however, is the proportion of the population eating the recommended 5-a-day of fruit and vegetables. The proportion of people in Slough achieveing the recommended 5-a-day in 2014 was 50.1%, similar to the England average of 53.5%.

(Source : Public Health England Fingertips 2012-14)

The future burden of adult obesity in Slough is, of course, closely linked to current childhood obesity rates. Though, given the high turnover of population in the borough, this effect is weakened compared to that seen nationally. The rate of child obesty in school children aged 10 and 11 in Slough increased from 21.7% in 2013/14 to 24.2% in 2014/15 (based on postcode of child, rather than postcode of school).

(Source: HSCIC NCMP)

National & Local Strategies (Current best practices)

National

Healthy Lives, Healthy People: A call to action on obesity in England (2011). This set out a new approach for public heath action on obesity based on:

  • Moving beyond the focus on children toward a life course approach
  • Enabling preventive action and ensuring support for those who need it
  • Calling for a new level of ambition

2010-2015 Government policy on obesity and health eating

  • giving people advice on a healthy diet and physical activity through the Change4Life programme
  • improving labelling on food and drink and encouraging businesses to promote healthy choices through the Public Health Responsibility Deal
  • giving people guidance on how much physical activity they should be doing

 NICE Guildeine NG7: Preventing excess weight gain

  • Encourage people to make changes (in physical activity, eating and alcohol) in line with existing advice
  • Provide further advice for parents and carers of children and young people
  • Encourage self-monitoring
  • Clearly communicate the benefits of maintaining a healthy weight and of gradual improvements to physical activity and dietary habits
  • Tailor messages for specific groups
  • Ensure activities are integrated with the local strategic approach to obesity

As well as prevention of overweight and obesity, the importance of management of obesity and facilitation of weightloss is recognised nationally in the NICE Guildelines CG189: Obesity identification, assessment and management and PH53: Weight management lifestyle services for overweight or obese adults.

Weight management services are usually described using a “tier” system, with different tiers of weight management services cover different activities. Definitions vary locally but usually tier 1 covers universal services (such as health promotion or primary care); tier 2 covers lifestyle interventions; tier 3 covers specialist weight management services; and tier 4 covers bariatric surgery.

Local

'Get Active Slough - a leisure strategy for Slough' aims to:

  • Ensure that sporting and physical activity opportunities available meet needs of the entire community
  • Target those groups with greater health risks
  • Enable people to build physical activity and sport into their daily lives
  • Develop a mixture of indoor and outdoor facilities to meet local needs
  • Enable key partners involved in sport and physical activity to work together effectively
  • Ensure sport and physical activity features as a key part of other local strategies and service plans

Current local activity

  • Slimming world vouchers are provided by GPs to patients who are struggling to manage their weight without support.
  • The new National Diabetes Prevention Programme (NDPP) as well as a new cardiovascular prevention and community rehabilitation service for Slough that are in development in 2016 will provide healthy eating and physical activity training to those at high risk or those who have already developed cardiovascular disease.

What is this telling us?

Obesity is a national priority, and poses a poses a particular concern for Slough because of existing burden of risk factors for chronic disease.

Extensive and wide ranging joint interventions and investments are necessary within the local environment to reduce obesity levels that can be sustained and families supported in the right and appropriate manner without stigma.

Furthermore, embedding programmes and behavioural changes in individuals and communities as a whole, will take time, even decades to achieve.
This is the challenge nationally and locally, that requires an integrated, effective, sustainable and inclusive approach allowing all the key stakeholders, particularly parents and families, to take ownership of this agenda and their physical and emotional well being.

What are the key inequalities?

  • Deprivation: The association between deprivation and obesity is stronger in children than in adults. In adults there appears to be a gender difference between various measures of deprivation and risk of obesity. for women, obesity prevalence increases with greater levels of deprivation, regardless of the measure used. For men, only occupation-based and qualification-based measures show differences in obesity rates by levels of deprivation.
  • Ethnicity: There is no straightforward relationship between obesity and ethnicity, with a complex interplay of factors affecting health in minority ethnic communities in the UK. Additionally, there is little nationally representative data on obesity prevalence in adults from minority ethnic groups in the UK.
    There is continuing debate about the validity of using current definitions of obesity for non-white ethnic groups. Different ethnic groups are associated with a range of different body shapes and different physiological responses to fat storage. Revised body mass index (BMI) thresholds and waist circumference measures have been recommended for South Asian populations who are at risk of chronic diseases and mortality at lower levels than European populations.
  • Disability: There is limited data on disability and obesity. It is known that people with disabilities are more likely to be obese and have lower rates of physical activity than the general population. Both underweight and obesity are an issue for people with learning disabilities. This relationship varies according to age and gender.

(Source: National Obesity Observatory Health Inequalities).

What are the unmet needs/ service gaps?

  • Much progress has been made in terms of creating a local environment that supports and encourages physical activity in Slough through the work of the Physical Activity Strategy. Less success, however, has been seen in terms of making changes to the food environment for adults in Slough, for example the implementation of fast-food exclusion zones were explored but have not been possible.
  • Obesity registers in some GP surgeries are not up to date and not dynamic there is a significant under reporting since Quality Outcome Framework (QOF) obesity data is only reported for patients who are registered and who have a long term condition.
  • There are gaps in service provision at tier 3 /tier 4 weight managemet services. Public Health Berkshire obesity matrix team is working to streamline the obesity care pathway and improve the service equity, access and referrals.

Recommendations for consideration by other key organisations

Action on six policy objectives focusing on early years, income, the built environment and local people as well as health prevention to tackle the basis of inequality through a whole system approach, involving a range of local and national bodies from both the statutory, independent and private sector.

Every contact counts: All staff in direct patient contact roles, as well as the other professionals in regular contact with people should be trained to use the nutrition tool and training should be repeated at regular intervals so knowledge remains up to date.

There is a need to create more opportunities for healthy eating, including enhancing cooking skills, shopping skills and budget management for families, especially those living in the more deprived parts of the borough as well as for those with disabilities including learning disability.

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