The prevalence of obesity in England is increasing at all ages; almost two-thirds of adults and one-third of children are either overweight or obese.  If present trends continue, 60% of men, 50% of women and 25% of children will be obese by 2050.

Overweight and obesity are major risk factors for disease and mortality including cardiovascular disease, cancer and disability during older age.   It contributes to a decrease in life expectancy.  Furthermore, obesity is associated with serious chronic conditions such as type 2 diabetes, hypertension, and hyperlipidaemia, which are major risk factors for cardiovascular disease (Health Survey for England, 2009).   Risk factors for some of these conditions start at a relatively low body mass index (BMI), and this will cause future health service costs to rise significantly.  In Stockton -on-Tees alone, NHS costs of principal diseases related to obesity are estimated to be £71.8 million (Department of Health, 2010).

The rising trend in obesity is one of the biggest threats to the health of the population of Stockton-on-Tees. The prevalence of obesity in Stockton-on-Tees is significantly higher than the national average for both adults and children.  The trend of weight problems in children and young people is of particular concern because of evidence suggesting a ‘conveyor belt’ effect in which excess weight in childhood continues into adulthood (Department of Health, 2008). In addition to the increased health risks in later life, children and young people face immediate health and psychological consequences of obesity including increased risks for elevated blood pressure and type 2 diabetes, low self-esteem, anxiety and depression.

The causes of obesity are complex and relate to a wide variety of societal and behavioural factors which cannot be tackled in isolation. Social determinants have an important impact on the likelihood of becoming obese and they need to be addressed.

The inequalities, health risks and costs associated with obesity combine to make the prevention of obesity a major public health challenge.

This topic is linked with the following JSNA topics:


Last updated: 2015-06-04 16:10:15
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1. What are the key issues?

  • There is no single commissioner for the obesity pathway in Stockton-on-Tees.  Commissioners of different parts of the obesity pathway for both children and adults will need to work in partnership to ensure support can be stepped up or down dependent upon the level of support needed and to reduce risk of gaps in services.
  • There are increasing obesity rates in both adults and children with subsequent projected increased demand on services.
  • Both child and adult obesity rates in Stockton-on-Tees are significantly higher than the national average but not regional average.
  • The prevalence of obesity is related to deprivation, with more deprived populations tending to have higher rates of obesity.
  • Obesity prevalence rises with age; child obesity in Stockton-on-Tees more than doubles from the age of 4-5 years to 10-11 years.
  • Nationally, individuals of Asian origin; people with learning and physical disabilities; and pregnant women have the greatest health risks due to obesity. These population groups need targeted weight management services.
  • Nationally, the proportion of pregnant women who are obese has doubled over the last 19 years. Maternal obesity poses significantly increased morbidity and mortality to the mother and infant, and places a significant burden on NHS resources. Obesity is a risk associated with many conditions, including type 2 diabetes; cardiovascular disease; some cancers; hypertension; liver disease; osteoarthritis and stroke.  Risk factors for some of these diseases, notably type 2 diabetes and hypertension, start to increase at a relatively low BMI, particularly for those people from some ethnic groups, including South Asian people.
  • Children face immediate health and psychological consequences of obesity including increased risks for elevated blood pressure and type 2 diabetes, low self-esteem, anxiety and depression.


Last updated: 04/06/15

2. What commissioning priorities are recommended?

Review care pathways and the obesity service model. Achieved – review carried out.

Adopt a life course approach
to ensure health inequalities are addressed at all stages of the life course using evidence-based approaches. Replaced by 2015/01.

Balance investment between prevention and treatment services
, ensuring targeted support for those people identified most at risk of overweight and obesity. Replaced by 2015/02.

Increase capacity
across the different sectors to ensure every contact becomes a health improvement opportunity and to ensure increased capacity and capability in the workforce to support children, young people and adults to achieve and maintain a healthy weight. Replaced by 2015/03.

Ensure children identified as ‘at risk’ through the  National Child Measurement Programme (NCMP) are appropriately supported
, along with their families. Replaced by 2015/04.

Improve joint working between key sectors
, such as planning and transport departments, to ensure the potential for physical activity and healthy eating is maximised, including the use of health impact assessments in order to address the obesogenic environment. Abandoned.

Improve the availability of local obesity data
for certain sub-groups of the population, such as pregnant women and people with learning disabilities. Abandoned.

Commission family and adult weight management services that offer a range of different approaches
, using a life course approach to ensure health inequalities are addressed at all ages. Services should be targeted to where need is greatest, particularly areas with high deprivation, using evidence-based approaches.

Fund evidence-based initiatives to prevent obesity and reduce further weight gain
, using examples of good practice and local intelligence to target funding towards areas with higher risk and higher rates of overweight and obesity.

Include, where appropriate, brief advice and interventions about weight
that are in contracts not specifically commissioned to provide weight management services.

Commission National Child Measurement Programme pro-active parent feedback
to increase referrals into services and support families with lifestyle changes.

Improve residents' perceptions of unhealthy weight
and their knowledge of both the short- and long-term consequences it has on health.


Last updated: 04/06/15

3. Who is at risk and why?

The prevalence of overweight and obesity rises with age, in both men and women, from a relatively low level in the 16-24 age group to a peak at 65-74 (although obesity peaks slightly earlier in men).  Older adults (aged 75+) have a lower prevalence of obesity (National Obesity Observatory, 2011).

In children, prevalence also increases with age. The National Child Measurement Programme (NCMP) shows obesity prevalence is significantly higher in Year 6 than in Reception classes.  The Health Survey for England (HSE, 2009) shows that boys aged 11-15 were more likely to be obese than those aged 2-10 years (20% and 14% respectively); however, there was no equivalent difference between the age groups among girls (15% were obese in each age group).

There is no current evidence suggesting gender plays a significant role in determining the prevalence of obesity in adults.  However, the NCMP shows that boys are significantly more likely to be obese than girls.

Obesity prevalence varies substantially between ethnic groups for both adults and children (Health Survey for England, 2004).  However, estimates of adult obesity prevalence by ethnic group seem to differ according to the measurement used (for example, BMI, waist-to-hip ratio and waist circumference).

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).

There is continuing debate about the applicability of definitions of obesity between ethnic groups for adults and children. Since different ethnic groups have different physiological responses to fat storage, revised BMI thresholds and waist circumference measures have been recommended, particularly for South Asian populations who are at risk of chronic diseases and mortality at lower levels than European populations (National Obesity Observatory, 2009).

Socioeconomic status
The distribution of overweight and obesity has a significant social gradient, with prevalence among people who are socially and economically deprived.  Adults and children in social class V (unskilled manual) have a higher prevalence of obesity than those in social class I (professional). 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. The prevalence of obese children in households with overweight/obese adults was 24% for boys and 21% for girls. By comparison, rates of obesity for children in normal/underweight households were 11% for boys and 10% for girls (NHS Information Centre for Health and Social Care, 2012).

Maternal obesity
The proportion of pregnant women who are obese has doubled from 7.6% in 1989 to 15.6% in 2007 (Heselhurst et al, 2010). Maternal obesity presents a series of significant health risks to both mother and child during pregnancy and childbirth.  It is associated with an increased risk of serious adverse outcomes including miscarriage, foetal congenital abnormality, thromboembolism, gestational diabetes, pre-eclampsia, post-partum haemorrhage, stillbirth and neonatal death. There is also a higher caesarean section rate and lower breastfeeding rate in this group of women compared with women with a healthy BMI (Department of Health, 2008).

There is a significant relationship between maternal obesity and deprivation. Women who are obese are significantly more likely to be older in pregnancy and to live in areas of high deprivation, compared with women who are not obese (CMACE, 2010).

There are also significant links with ethnicity.  The CMACE report (2010) found that women with BMI ≥35 from BME groups were three-and-a-half times more likely to have type 2 diabetes and 1.6 times more likely to have gestational diabetes than white women with BMI ≥35.  

There are associations between limiting longstanding illness and BMI.  For men, 16% of those with a healthy weight have a limiting, longstanding illness compared with 29% of obese men.  In women, the rates are 17% for healthy weight and 36% for obese women (Department of Health, 2008). 

Obesity disproportionately affects people 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).

Children who have a limiting illness are more likely to be obese or overweight, particularly if they also have a learning disability. 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
  • a learning disability is twice as likely to be obese (ChiMat, 2011)

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).

Risks associated with obesity
Compared with a man of healthy weight, an obese man is:

  • five times more likely to develop type 2 diabetes;
  • three times more likely to develop cancer of the colon; and
  • over two-and-a-half times more likely to develop high blood pressure – a major risk factor for stroke and heart disease.

Compared with a woman of healthy weight, an obese woman is:

  • almost thirteen times more likely to develop type 2 diabetes;
  • four times more likely to develop high blood pressure; and
  • three or more times more likely to have a heart attack.

Increased risk for other diseases includes angina, gallbladder disease, liver disease, ovarian cancer, osteoarthritis and stroke. Risk factors for some of these diseases, notably type 2 diabetes and hypertension, start to increase at relatively low BMIs, particularly for those people from some ethnic groups, including South Asian people (Government Office for Science, 2007).

In addition to the increased risk for health problems in later life, children face immediate health and psychological consequences of obesity including increased risks for elevated blood pressure and type 2 diabetes, low self-esteem, anxiety and depression (Health Survey for England, 2009).


Last updated: 25/01/13

4. What is the level of need in the population?

Estimates using the Active People Survey for England 2012 indicate that over one quarter (26.1%) of adults in Stockton-on-Tees are obese. Although from a different methodology, this is broadly similar to the 2006-08 estimate (27.7%), comparable with other similar areas and is not significantly different from the England average of 23.0%.

Adjusted adult obesity 2012, Stockton and comparators

Learning disability
Current estimates show that 3,600 people in Stockton-on-Tees have a learning disability (Poppi, 2015; Pansi, 2015).  Further estimates indicate that approximately 49% of this population group is overweight or obese, which amounts to around 1,700 people, with about 75% projected to be physically inactive.

Maternal obesity
Data from James Cook University Hospital (JCUH) shows that the incidence of maternal obesity is higher than both the national and North East average (15.6% and 17.3% compared with 18.8%). Figure 5 shows that the percentage of women who are classified as obese at the booking appointment stage is increasing each year.

Maternal obesity trend at booking, JCUH 2007-2011

There has been a steady increase in the prevalence of obesity in children aged 2-15 years between 1995 and 2004 (Health Survey for England). The rate of increase has slowed since 2005, suggesting a flattening out of the previous upward trend.  The NCMP shows small annual changes in obesity prevalence nationally (Public Health England, 2015).

Although locally there has been a small reduction in obesity in Reception class and a degree of stability in Year 6, Stockton-on-Tees child obesity prevalence is still higher than the England average at age 11. In line with England, obesity prevalence rises with age and is significantly higher in 10-11 year olds (Y6) than in 4-5 year olds (Reception year, Y-R).  In Stockton-on-Tees, the prevalence of child obesity significantly increases between these ages.

Stockton NCMP obesity trend

Stockton reception obesity benchmarks 2013/14

Stockton Y6 NCMP obesity benchmark 2013/14


Obesity and deprivation
The following two maps show rates of obesity in each ward in Stockton-on-Tees. These can be compared with maps showing deprivation scores.  Obesity prevalence tends to be higher in the more deprived wards of Stockton-on-Tees.  In Y-R it is: Fairfield; Hardwick; Norton North and Mandale & Victoria.  In Y6, it is: Newtown; Billingham East; Roseworth and Billingham West.
NCMP obesity ward map Stockton Reception 10/11 to 12/13

NCMP obesity wards Stockton Year 6 10/11 to 12/13

Evidence shows that the prevalence of child obesity is closely related to deprivation. The graphs below show the association between obesity and deprivation in Tees wards for children aged 5 and 11 years.  The strength of the relationship between obesity and deprivation appears stronger at age 11 than age 5. Obesity and deprivation, Tees wards, Reception 2010/11 to 2012/13

Obesity and deprivation, Tees wards, Year 6 2010/11 to 2012/13


Additional sources of data

Public Health England – National obesity observatory

Public Health England – NCMP local authority profile


Last updated: 16/06/15

5. What services are currently provided?

Stockton-on-Tees tackles adult obesity using a four-tiered model.

Tier 1 - Prevention
There are population-wide basic interventions and prevention for healthy weight adults.  Key interventions which contribute to the prevention of overweight and obesity are discussed in more detail in the Diet and Nutrition and Physical Inactivity topics.

Tier 2 – Targeted interventions
Community Weight Management Service (Lite4life) – This service provides weight management support for adults with a BMI ≥ 25. The service is delivered through groups and offers a maintenance programme and support with access to other services.

Tier 3 – Specialist interventions
Specialist Weight Management Service – A multi-disciplinary team provides this service for people with either a BMI ≥ 40 or a BMI ≥ 35 with significant co-morbidities. 

Tier 4 – Bariatric surgery
This service is for patients with a BMI ≥ 40, those with BMI 35 to 40 and other significant disease (e.g. type 2 diabetes, high blood pressure) or to be considered as a first-line option for adults with a BMI ≥ 50.   Bariatric surgery is provided at James Cook University Hospital, Middlesbrough for the Tees population.

Children and young people
Stockton-on-Tees tackles obesity in children using the three-tiered model:

  • Tier 1 - universal/prevention services for children and young people with BMI ≤ 91st centile;
  • Tier 2 - community weight management services for children and young people with BMI 91st–98th centile;
  • Tier 3 – specialist intervention for children and young people with BMI ≥ 98th centile currently carried out on an individual basis through existing secondary care contracts.

Tier 1 – Prevention
Universal prevention services for children and young people of healthy weight. There are key interventions which contribute to the prevention of overweight and obesity, which are discussed in more detail in the Diet and Nutrition and Physical Inactivity topics.

Tier 2 –Weight management service
A community service specifically for children and young people and families.

Tier 3 – Specialist intervention
There is currently no weight management service at tier 3.  Any specialist intervention is carried out on an individual basis through existing secondary care contracts.


Last updated: 04/06/15

6. What is the projected level of need?

Obesity prevalence is forecast to rise for both adults and children.  The trend has been upward for decades, and suggests that by 2030 41-48% of men and 35-43% of women could be obese. The most recent data suggests that the rise in obesity is levelling off.  However, more than one-quarter of adults are already obese and there is a serious and growing burden of obesity-related ill-health.

The Foresight report suggests an increase in the prevalence of obesity among people aged under 20 to around 15% by 2025.  The proportion of boys having a healthy BMI will be 45% while for girls only 30% will be in the healthy weight category (Government Office for Science , 2007).

Percentage of children predicted to be obese by age and sex, England, 2004 and 2025












All under 20










All under 20



Source: Foresight report


For children, there is evidence from the last three to four years of HSE data that the increase in child obesity is slowing. This is also evident from the local NCMP data. Forecasts to 2020 show encouraging signs that the rising trend may be levelling out, suggesting that there will be considerably lower proportions of overweight and obese children and young people than previously estimated McPherson et al, 2011). While it is encouraging that the trend in child obesity is levelling off, and may reduce in the future, the forecast prevalence of obesity and overweight remains high.

Forecasts for overweight and obesity in children and young people in 2020, England





‘Foresight’ forecast 2007

McPherson forecast 2011

‘Foresight’ forecast 2007

McPherson forecast 2011
























Social class
There is no evidence that social class differences in the prevalence of obesity in the future will increase beyond those that exist. However, obesity prevalence among social class I women (aged 20-60) is forecast to be only 15% by 2050, in contrast to 62% forecast for women in social class V.

HSE samples are relatively small for some ethnic groups and so extrapolations should be treated with particular caution.  The projections suggest only very slight increases in the prevalence of obesity among Indian men and women.  However, obesity trends among black African women and Pakistani men and women are similar to that of the white population, with levels forecast to rise markedly.


Last updated: 25/01/13

7. What needs might be unmet?

  • There is inadequate capacity building within the workforce to ensure frontline staff are trained to raise the issue of weight consistently and sensitively and offer appropriate interventions and support.
  • There is a lack of uptake of preventive services particularly by those at most risk of obesity-related diseases.
  • Targeted weight management service provision is required for those identified at risk in adult and child populations (i.e. BME communities; learning disabilities; maternal obesity; men; areas of high deprivation; and for people with mental health needs).
  • If current prevalence trends continue, demand for weight management services will outstrip capacity.


Last updated: 04/06/15

8. What evidence is there for effective intervention?

9. What do people say?

The Public Health team at Stockton Borough Council led a Healthy Weight Services Review in 2014.  This included consultation with residents to better understand resident’s perception of their weight and opinions on weight management services. In total, 204 responses were received. All data was statistically weighted by age, gender and location of residence.  The main findings were:

  • Most respondents reported excess weight: 33% were obese, and 31% were overweight
  • In contrast, 60% of obese respondents said they felt their weight was currently ‘quite healthy’.
  • Half of respondents were either very or quite happy with their weight, with about 8 in 10 of those feeling “quite happy” in this respect. Among obese respondents, 62% were "quite happy" with their weight. Half of all respondents who were "quite happy" were obese.
  • Most (96%) respondents said that they would like to lose weight at the moment.
  • The key reason why people want to lose weight at the moment was because of “how they feel about themselves”.
  • The key reason given for not being able to change bodyweight at the moment was “not having enough motivation at the moment”.
  • The vast majority of those who tried to lose weight in the past said that they were able to do so.
  • A degree of ‘yo-yo’ dieting was detected. One-third of respondents had lost weight in the past and put some weight back on.
  • The most preferred way to lose weight in future was to ‘look for somewhere to join in with physical activities’
  • The key thing respondents identified they would value from a weight loss service was affordability.



Last updated: 04/06/15

10. What additional needs assessment is required?

A comprehensive review of Healthy Weight Services was completed in 2014. Future reviews of services and other factors that impact on weight will be ongoing.


Last updated: 04/06/15

Key Contact

Name: Claire Spence

Job title: Health Improvement Specialist

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

Phone number: 01642 528475



Local strategies and plans

NHS  Tees Integrated Strategic and Operational Plan 2011-2014

NHS Tees Weight Management Services Strategic Review and Development Plan 2010


National strategies and plans

Department of Health (Childhood Obesity National Support Team,  2011). Strategic high impact changes: childhood obesity.

Department of Health (2011).  Healthy Lives, Healthy People: A call to action on obesity in England.


Other references

Centre for Maternal and Child Enquiries (CMACE, 2010). Maternal Obesity in the UK: Findings from a National Project.

Child and Maternal Health Observatory (2011). Disability and Obesity:  The Prevalence of Obesity in Disabled Children.

Department of Health (2005). Health Survey for England 2004.

Department of Health (2008). Healthy Weight, Healthy Lives: A cross-government strategy for England.

Department of Health (2010). Supporting of Commissioning of Adult Weight Management Services Tool – Prioritising Investment

Disability Rights Commission (2005). Equal Treatment: Closing the Gap Interim Report.

Government Office for Science (2007). Tackling Obesities: Future Choices – Project Report (2nd Edition).

Health Survey for England (2009) Health Survey for England - 2009: Health and lifestyles

Heslehurst, N., Rankin, J., Wilkinson, J. & Summerbell, C.D. (2010). A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619,323 births, 1989-2007. International Journal of Obesity, 34 (3), 420 – 428 

McPherson, K., Marsh, T. and Brown, M. (2011). Is the rise in obesity prevalence in England and Wales flattening?

National Obesity Observatory (2010). Epidemiology of childhood obesity

National Obesity Observatory (2011).  NCMP: Changes in children’s BMI between 2006/07 and 2009/10.

National Obesity Observatory (2012) Factsheets

National Obesity Observatory (2009). Body mass index as a measure of obesity.

National Obesity Observatory (2011b). Obesity and Ethnicity.

National Obesity Observatory (2010). NOO Data Briefing: Adult Weight.

NHS Information Centre, National Child Measurement Programme

NHS Information Centre (2012) Statistics on obesity, physical activity and diet: England 2012.

Projecting Adult Needs and Service Information (PANSI). www.pansi.org.uk

Projecting Older People Population Information (POPPI). www.poppi.org.uk

Public Health England (2015). NCMP Local Authority Profile.

World Health Organisation (2012). BMI Classification.