Obesity

Last updated: 2018-05-09 14:15:57
[+] Expand all

1. Summary

Last updated: 09/05/18

2. Introduction

Obesity is a significant public health concern both in Stockton-on-Tees and nationally, which results in long term negative social, psychological and physical consequences. Obesity increases the risk of developing irreversible, chronic conditions at younger ages such as Type 2 Diabetes, cardiovascular disease (CVD), liver disease, musculoskeletal disorders, obstructive sleep apnoea, asthma, certain cancers, poor mental health and quality of life, and a reduced life expectancy of around 9 years compared to those of a healthy weight (1).

Currently, one in four adults are obese and almost 7 out of 10 men & 6 out of 10 women are either overweight or obese.

Higher levels of deprivation are associated with an increased likelihood of obesity in both adults and children (2). Obesity is a notoriously difficult condition to reverse once established; four out of five children who are obese go on to become obese adults (3) and many adults struggle to lose excess weight, often regaining any weight loss through dieting (4). Reducing levels of obesity is a complex and multifaceted problem with over a hundred contributing factors as identified in the Foresight Tackling Obesities systems map. Prevention therefore seems the best approach.

A report from Public Health England on attitudes to obesity has highlighted that people tend not to recognise obesity when it does exist – and especially so in men. Obesity is frequently regarded as a problem for individuals and health care professionals rather than society more generally, and those who are obese are often stigmatised (5). Obesity is not just detrimental at the individual level; it affects overall society and can have economic impacts, by for example, affecting a person's ability to work. Overall, it has been projected that the indirect costs of obesity to the UK economy could be as much as £27 billion by 2015 (6) and it has been suggested that obesity has the potential to reverse recent gains in life expectancy (7) and reduce healthy life expectancy by up to a third over the next 20 years.

Reducing the prevalence of overweight and obesity would reduce the amount spent on health and social care services. Work undertaken by Public Health England initially suggests that severely obese people are over 3 times more likely to need formal social care than those who are a healthy weight. The annual national cost to the wider economy is 27 billion.

 

Other JSNA topics this topic closely linked to:

Diet and nutrition

Environment

Physical inactivity

Poverty

Cancer

Transport

 

Last updated: 09/05/18

3. Data and Intelligence

The prevalence of excess weight (overweight including obesity) rose substantially between 1993 and 2002. Prevalence of excess weight is higher among men than women.

Obesity prevalence continues to rise, with prevalence for both men and women at its highest recorded level in the Health Survey for England.

The gap between men and women has narrowed over time.

The national prevalence of severe obesity (BMI ≥40kg/m2) has increased since 1993 for both men and women. Overall, a very small proportion of the population are severely obese but the rise in prevalence has been substantial since 1993; a 6.2 fold increase for men (increasing from 0.3% to 1.9%) and a 2.5 fold increase for women (increasing from 1.5% to 3.7%). Severe obesity prevalence is much higher for women than men.

In 2015/16, the proportion of Stockton-on-Tees residents with excess weight was higher than the national average (although this rate is statistically similar to the national average). Unfortunately, due to a change in the method of recording this data, no trend is available.

The Department of Health’s National Child Measurement Programme shows that by the start of school as many as 13% children are already overweight and 10% obese, rising to 14% and 17% by the end of primary school.

In 2016/17, the proportion of reception year children in Stockton-on-Tees who were overweight or obese was statistically significantly higher than the national average.

In 2016/17, the proportion of year 6 children in Stockton-on-Tees who were overweight or obese was statistically significantly higher than the national average and has risen each year since 2014-15.

In 2012-15, there was a correlation (r2 = 0.3831) between deprivation and overweight/obesity in reception age children. The more deprived wards in Stockton-on-Tees had higher levels or overweight/obesity compare to the least deprived wards.

In 2012-15, there was a correlation (r2 = 0.5848) between deprivation and overweight/obesity in year 6 children. The more deprived wards in Stockton-on-Tees had higher levels or overweight/obesity compare to the least deprived wards.

Last updated: 09/05/18

4. Which population groups are at risk and why?

Age

The prevalence of obesity and overweight among adults changes with age. Prevalence of overweight and obesity combined is lowest in the 16 to 24 age group, increases with age until the 55 to 64 age group and declines in the older age groups

In children, prevalence also increases with age. The National Child Measurement Programme (NCMP) shows obesity prevalence is significantly higher in 11-year-olds than 5-year olds.
Gender The NCMP shows that boys are more likely to be obese than girls and The Health Survey for England shows that there is a much higher prevalence of overweight men than women.
Socioeconomic status

The distribution of overweight and obesity has a significant social gradient, with prevalence among people who are socially and economically deprived.                                                      The gap between the two is significant, and has widened since 1997 in both sexes (National Obesity Observatory, 2011).

Familial factors There is evidence that childhood obesity is higher in households where parents are classed as overweight or obese (NHS Information Centre for Health and Social Care, 2012).
Mental health The relationship between obesity and common mental health disorders is complex. Evidence suggests there are links between obesity and depression, although it is not clear which ways the influence flows.  A recent study found that among those who are morbidly obese, one in six have been diagnosed with depression or anxiety and more than half report having low self-esteem and recognise that their weight has an impact on many daily activities and on their relationships (Department of Health, 2011).
Ethnicity

Obesity prevalence varies substantially between ethnic groups for both adults and children (Health Survey for England, 2004). 

For men, when using BMI, findings suggest that compared to the general population, obesity prevalence is lower in Bangladeshi and Chinese communities.  However, if using a different measurement such as raised waist-to-hip ratio, obesity prevalence is higher in Bangladeshi men.

For women, when using BMI, obesity prevalence appears to be higher in Black African, Black Caribbean and Pakistani women and lower in women from Chinese communities. When using raised waist-to-hip ratio, obesity prevalence is higher in Bangladeshi women.                      Children from most minority ethnic groups have a higher prevalence of obesity than White British children, although the patterns are different for boys and girls and for different age groups. Among Reception age children, Black African boys and girls have the highest prevalence of obesity. In Year 6, Bangladeshi boys have the highest prevalence, whereas among girls, those from African and Other Black groups have the highest prevalence (National Obesity Observatory, 2010).
Disability

There are associations between limiting longstanding illness and a high BMI. 

Obesity disproportionately affects adults and children with a learning disability.  Approximately one adult in three with a learning disability is obese compared to one in five in the general population (Disability Rights Commission, 2005).

Compared to a child who has neither a limiting illness or a disability, a child with:

  • a limiting illness and a learning disability is over one-and-a-half times as likely to be obese or overweight;
  • a limiting illness is one-and-a-half times as likely to be obese; and
  • a learning disability is twice as likely to be obese (ChiMat, 2011).

 

Last updated: 09/05/18

5. Consultation and engagement

Last updated: 09/05/18

6. Strategic issues

Last updated: 09/05/18

7. Evidence base

 

Issue number

1 = highest priority

 

1

Source

Government Office for Science (GOV)

National Institute for Health and Care Excellence (NICE)

Public Health England (PHE)

Title incl. web link

GOV: Foresight Report: Tackling Obesity, Future Choices. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/287937/07-1184x-tackling-obesities-future-choices-report.pdf

NICE: Obesity Prevention CG43 (2015)

https://www.nice.org.uk/guidance/cg43

PHE: Strategies for Encouraging Healthier ‘Out of Home’ Food Provision. A toolkit for local councils working with small food businesses

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/604912/Encouraging_healthier_out_of_home_food_provision_toolkit_for_local_councils.pdf

Summary

GOV: The complex relations between the social, economic and physical environments and individual factors that underlie the development of obesity.

NICE: The guideline covers preventing children, young people and adults becoming overweight or obese. It outlines how the NHS, local authorities, early years’ settings, schools and workplaces can increase physical activity levels and make dietary improvements among their target populations.

PHE: The toolkit summarises the evidence base, types of interventions, and emerging local practice, to help those responsible within local councils (councillors, health and wellbeing boards, planners, public health and environmental health), to think about how working in a systems approach, they might bring together a coalition of partners to improve the food environment for children and families.

2

Source

University of Leeds

Title incl. web link

University of Leeds: Tackling Child Obesity through the Healthy Child Programme: a Framework for Action

https://www.henry.org.uk/sites/www.henry.org.uk/files/2017-11/Framework-for-Action-tackling-child-obesity-through-the-Healthy-Child-Programme.pdf

Summary

The Framework for Action was developed through exploration and critical review of the evidence relating to the early indicators of lifestyle development. This led to the identification of strategic themes in the areas of parenting, eating behaviour, nutrition, play, screen time and sleep, with additional consideration of health and community professionals’ roles in promoting healthy lifestyle.

Source

NICE Eyes on Evidence, February 2016

Title incl. web link

 

Summary

Previous studies have shown that parents are likely to misperceive the weight status of their child (Lundahl et al. 2014) and suggest that parents may be reluctant to ‘label’ their child as overweight. This is concerning, because healthcare professionals often rely on parents to seek help for their overweight children

New evidence shows that parents were more likely to underestimate their child’s weight status if they came from more deprived regions, were black or of South Asian family origin, and if the child was older or male. This is concerning, because healthcare professionals and treatment services often rely on parents to seek help for their overweight children.

3

Source

Public Health England

Title incl. web link

A guide to community-centred approaches for health and wellbeing

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417515/A_guide_to_community-centred_approaches_for_health_and_wellbeing__full_report_.pdf

Summary

Community-centred approaches are not just community-based, they are about mobilising assets within communities, promoting equity and increasing people’s control over their health and lives. A new family of community-centred approaches represents some of the available options that can be used to improve health and wellbeing, grouped around four different strands:

  • strengthening communities
  • volunteer and peer roles
  • collaborations and partnerships
  • access to community resources

Source

Improvement and Development Agency

Title incl. web link

A glass half-full: how an asset approach can improve community health and well-being

http://www.scdc.org.uk/media/resources/assets-alliance/A%20Glass%20Half%20Full.pdf

Summary

A growing body of evidence shows that when practitioners begin with a focus on what communities have (their assets) as opposed to what they don’t have (their needs) a community’s efficacy in addressing its own needs increases, as does its capacity to lever in external support.

The second part of this publication offers practitioners and politicians, who want to apply the principles of community driven development as a means to challenge health inequalities, a set of coherent and structured techniques for putting asset principles and values into practice.

Source

BMC Public Health

Title incl. web link

Hillier- Brown FC, Bambra CL, Cairns JM, et al. A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children. BMC Public Health 2014

https://www.ncbi.nlm.nih.gov/pubmed/25113624

Summary

The review found only limited evidence although some individual and community based interventions may be effective in reducing socio-economic inequalities in obesity-related outcomes amongst children but further research is required, particularly of more complex, societal level interventions and amongst adolescents.

 

 

Last updated: 09/05/18

8. What is being done and why?

Weight management programmes

There are a number of weight management programmes across the borough for children and young people within the context of the family and for adults who are overweight. Stockton-on-Tees Borough Council Public Health Directorate fund the adult weight management service Lite4life, delivered by Tees Active Limited, and a Family Weight Management Service for 0-19 year olds, delivered by Harrogate District Foundation Trust. There are also many commercial weight management programmes available for adults.

Specialist Weight Management Service

Some adults require a more specialist service, if their Body Mass Index (BMI) is very high and they have other medical conditions. The Specialist Weight Management Service for adults is funded by Hartlepool and Stockton-on-Tees Clinical Commissioning Group. It is delivered by a multi-disciplinary team by South Tees Foundation Trust.

Bariatric surgery

Bariatric surgery for adults is provided by North Tees and Hartlepool Foundation Trust. Bariatric surgery is a medical term used for the various surgical procedures used to promote weight loss. Bariatric surgery can be an option for people who have a BMI above 40.

Obesity prevention

There are a vast range of organisations contributing towards making Stockton-on-Tees a healthier place to live, which will help to prevent people from becoming overweight and will support those people who are trying to reduce their weight. Many of these organisations and interventions are included in the below JSNA topics:

Physical inactivity: http://www.teesjsna.org.uk/stockton-physical-inactivity/

Transport: http://www.teesjsna.org.uk/stockton-transport/

Diet & nutrition: http://www.teesjsna.org.uk/stockton-diet-and-nutrition/

 

Last updated: 09/05/18

9. What needs are unmet?

Last updated: 09/05/18

10. What needs to be done and why?

Last updated: 09/05/18

11. What additional needs assessment is required?

Further local consultation and engagement with stakeholders, partners and the public is needed to identify approaches to system changes to reduce obesity levels

Local consultation and engagement with children, young people and families is required to support future improvements to weight management service provision. 

Last updated: 09/05/18

12. References

1 NAO Tackling Obesity in Britain. London: National Audit Office, 2001

2 PHE, National Obesity Observatory, Health inequalities

3 Nader P et al (2006) Identifying Risk for Obesity in Early Childhood. Paediatrics, 2006 Sep: 118(3): e594-601

4 Fildes A, et al. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records (2015). American Journal of Public Health, 2015 Sep;105(9):e54-9

5 Public Health England (2015) Attitudes to obesity. Findings from the 2015 British Social Attitudes survey

6 PHE, National Obesity Observatory Economics of obesity

7 NOO, Briefing Note: Obesity and life expectancy, National Obesity Observatory, August 2010

8 UK Health Forum and Cancer Research UK, Tipping the Scales: Why preventing obesity makes economic sense, January 2016

9 Public Health England (2015) A guide to community-centred approaches for health and wellbeing

Last updated: 09/05/18

13. Key contact

Name: Claire Spence

Job title: Health Improvement Specialist

Organisation: Stockton Borough Council

Phone number: 01642 528475

Contributor/s:

Mandy MacKinnon – SBC Early Intervention Manager (Adults), Public Health

Jane Smith – SBC Early Intervention Manager (Children), Public Health

James O'Donnell - Publc Health Intelligence Specialist

 

Last updated: 09/05/18

e-mail: claire.spence@stockton.gov.uk