A Call for Effective Policies and Prevention Strategies in the UK

Issue

The irrefutable association between obesity and reduced life quality and expectancy has been and continues to be widely illustrated in the country, and worldwide. Obesity is a risk factor for multiple chronic diseases, which include type 2 diabetes, cardiovascular disease, respiratory and liver disease, various types of cancers (including cancer of the breast, colon, kidney, esophagus, among others) (Guh et al., 2009). Obesity could also potentially impact on the mental health of individuals (Romain, Marleau and Baillot, 2018). The increasing proportion of UK’s population that suffers from obesity not only brings about present and future problems for the individuals and the National Healthcare System (NHS), but also results in obesity being among the greatest long-term health problems that face UK. As a consequence, obesity is now an immediate and major concern for the overweight and the obese, and the country’s NHS. Additionally, many of the obese or overweight people wanting to lose the extra weight have found this so hard to do.

The country’s increasing obesity rates, along with the difficulty that obese and overweight individuals encounter in their attempt to lose weight, pose significant barriers to UK’s and its population’s achievement and maintenance of a healthy weight, and therefore good health. Thus, the government, through the NHS, should develop policies that aim to effectively change the current obesity situation by empowering the populace to make healthier life choices and to fully support the overweight and obese individuals who desire to lose weight. Additionally, the government should shift its focus from treatment, and pay increased attention to public health and obesity prevention. Doing this will considerably enable the populace to attain and maintain a healthy weight, which is among the most vital things the country could do to improve its health.

Background

The development and subsequent increase in obesity in the UK, as throughout the world, has been demonstrated to be related to multiple environmental factors which promote a positive energy balance (Hill, Wyatt and Peters, 2012). The most common cause of obesity is food intake behavior. Most people become overweight or develop obesity as a result of consuming more food than they require for a certain degree of physical activity, such that their energy intake becomes more than their general energy expenditure (Davey, 2004). Therefore, Drummen et al. (2018) assert that the consumption of too much food, or any other factor that contributes to increased energy intake and/or reduced energy expenditure even to a minimal degree daily would, in the long term, bring about weight gain and potentially obesity. According to Davey (2004), this excess food consumption that results in obesity has been contributed to by increased availability of food and greater food affordability.

Obesity has also developed and increased following the various policies relating to the production of food, its advertising and promotion, pricing, and availability of fast foods that are high in fat or sugar (Greenhalgh, 2019). The intensive farming techniques aimed at providing affordable food in abundance have also resulted in obesity by contributing to excess consumption of energy. These intensified farming methods caused the availability of a variety of foods that are relatively cheap and highly palatable, nearly everywhere (Dallacker et al., 2019). The increase in food portion sizes, and ready availability of pre-packed, ready-to-eat snacks and fast foods in supersize packages promote larger food portion consumptions, which lead to obesity. This is because consumers believe that purchasing king size/supersize food products reduces their product cost (Pornpitakpan, 2010; Wansink and Cheney, 2005). Food advertising has increasingly exposed people to messages that hearten them to consume certain (energy dense) foods. The promotion and advertisement of ready-made, pre-packed energy, fat or sugar dense convenience foods on television and other media notably influence the food choices of people, especially children (Thai et al., 2017). A study by Borzekowski and Robinson (2001) found that 3 to 5 year old children who were exposed to 30 second advertisements that promoted a certain sugar dense beverage or fast food were more likely to select the advertised product when presented with similar options. Ponce-Blandon et al. (2020) also found that advertising influenced children’s food consumption preferences. The abundance of food and the impact of advertising and promotion have resulted in eating patterns that result in weight gain, thereby contributing to increased obesity over time. Thus, the food industry’s aggressive advertisement and promotion of energy dense and micronutrient poor foods has been strongly criticized, and recommendations made for the restriction of such marketing.

Obesity has also developed and increased owing to the decreased physical activity levels. Reduced physical activity leads to obesity, which in turn is attributed to a notable proportion of the deaths resulting from chronic diseases (Chin, Kahathuduwa and Binks, 2016; Peeters, 2018; Sallis et al., 2020. Besides reduced consumption of sugary drinks and energy dense foods, increased levels of physical activity are recommended in order to prevent obesity. Automation and use of labour saving devices have replaced manual tasks and caused most occupations to be sedentary, resulting in an insidious decrease in physical activity related to physical activity (Campbell et al., 2017). Additionally, motor vehicles have replaced walking as the main means of transport, while urbanization has made most roads and city areas unsafe, resulting in a decline in walking and cycling (Ding and Gebel, 2012). These factors have significantly contributed to the reduction of physical activity levels across all sections of the population, thereby resulting in the development of obesity.

The sedentary lifestyle led by most British citizens has and continues to contribute to lower physical activity levels that significantly result in obesity. This is because, although reduced physical activity leads to a reduction in the daily energy requirements, most people fail to adjust their food (energy) consumption appropriately- this is likely to result in them becoming overweight or obese (Biddle et al., 2017). It is therefore not surprising that, as a country, UK is getting fatter, considering that a majority of the British citizens do not even walk 1 mile in a day. The sedentary life of the UK population that is associated with obesity has further been exacerbated by factors such as televisions, computers, electronic games and other technological developments.

What Has Been Done So Far

The development and rise of obesity in children and adults, as well as the implications of its persistence into adulthood, have become of particular concern to the government due to the high costs that the NHS incurs annually as a result of overweight and obesity and related diseases, as well as the indirect costs, such as loss of productivity and income, to the society.

Policy makers and the NHS have, over the years, faced notable difficulties in addressing the increasing prevalence of obesity in the country. This is due to the socioeconomic, geographical and cultural factors that contribute to obesity and increase its intricacy (Jaacks et al., 2019). In the recent years, the UK Government has undertaken work and various measures aimed at the prevention and reduction of obesity, an impressive amount of which has largely focused on reducing the prevalence of obesity among children. This has involved the development of a childhood obesity plan, which has been produced in a series of chapters. The first chapter, “Childhood Obesity, A Plan for Action”, was released in 2016, while the second (“Childhood obesity: a plan for action, chapter 2) in 2018, and the third chapter- “Advancing our health; prevention in the 2020s”- which formed part of the green paper, in 2019. The second chapter outlined the nation’s ambitious plan of halving childhood obesity and reducing the gap between the children in the most and least deprived sectors by the year 2030 (Obesity, 2021).

In 2007/2007 period, the government introduced the National Child Measurement Programme, which was charged with collecting the weight and height measurements for children in Reception (those aged 4 to 5 years) and Year 6 (10-11 years of age) in mainstream schools in the country. As a result, the programme, which now measures more than one million children each year, with participation having increased to over 95% as of 2018/19 from 80% when it commenced, currently possesses 15 years of data (Obesity, 2021).

Additionally, the UK has, from the year 2006, drawn on the framework provided by the “Healthy Weight, Healthy Lives: A cross governmental strategy for England” report to tackle obesity countrywide through five main themes and goals/targets (‘Healthy weight, healthy lives: a cross governmental strategy for England’ document ǀ Policy Navigator, 2021). The “Healthy Lives, Healthy People: A call to action on obesity in England” report by the DoH in 2011, however, stresses the need for local governments, communities and leaders to take charge and make their own decisions with regard to obesity, as opposed to the national and overall top down strategies that have various limitations (Healthy Lives, Healthy People: A Call to Action on Obesity in England, 2021). As a consequence, various localities have undertaken different strategies targeted at the promotion of healthy weight and tackling of obesity. This localized approach to obesity has been done in accordance with the most recent guidance (“Obesity: Working with local communities”) by the National Institute for Health and Care Excellence (NICE), which suggests the coordination of leadership and action at both the local community and strategic level (Overview ǀ Obesity: working with local communities ǀ Guidance ǀ NICE, 2021).

The country has also developed the Public Health Outcomes Framework, through which it measures various dimensions associated with obesity, including progress on excess weight, levels of physical activity, diet and eating habits, and premature mortality (Public Health Outcomes Framework, 2021). More recently (in 2020), the government, in cognizance of the threat that the coronavirus (Covid-19) posed especially among the obese, started a campaign that encouraged adults to lose weight. It also published the “Tackling obesity: empowering adults and children to live healthier lives” report, in which it outlined policies targeted at supporting healthy living and expanding the weight management services offered by the NHS (Obesity, 2021). However, despite these various approaches and strategies, UK has not yet been able to reverse the upward trajectory in obesity in the country.

Current Status

Currently, it is estimated that 28% of adults in the UK are obese (with a body mass index (BMI) of 30 or more), with a further 36.2% being overweight- with a BMI of 25-30 (Health Survey for England 2019 [NS] - NHS Digital, 2021). Of this proportion, males accounted for 27%, while females accounted for 28% of the obese adults. According to the findings of the survey, men demonstrated a high likelihood of being obese or overweight (at 68.2%), compared to women (60.4%), while those aged between 45 and 74% were most likely obese or overweight. The prevalence of obesity or overweight is also 9% higher among the most deprived sections of the country’s population compared to the least deprived sections (Health Survey for England 2019 [NS] - NHS Digital, 2021).

With regard to children, the survey found that 18% of boys and 13% of girls in the UK were obese, with children whose parents were obese demonstrating a higher likelihood of being obese (Health Survey for England 2019 [NS] - NHS Digital, 2021). Data by the National Child Measurement Programme (NCMP) shows that 14.4% and 13.1% of children in Reception (between 4 and 5 years of age) were obese and overweight respectively, while those in Year 6 (between 10 and 11 years of age) that were obese and overweight accounted for 25.5% and 14.1% respectively between 2020 and 2021 (National Child Measurement Programme, England 2021/21 School Year – NHS Digital, 2021). These findings show that, while the prevalence of obesity has not changed significantly for children in reception since the year 2006/2007, the prevalence has notably increased from 17.5% in 2006/2007 to the current 25.5% for Year 6 children.

Regarding gender, boys demonstrate a higher obesity prevalence rate compared to girls in both Reception and Year 6 groups- while 14.8% of boys are obese compared to 14.1% of girls in Reception age, 29.2% of boys compared to 21.7% of girls in Year 6 are obese (National Child Measurement Programme, England 2021/21 School Year – NHS Digital, 2021). Additionally, the programme’s findings show that children in the most deprived sections of the country’s population were more than twice as likely to be obese compared to those in the least deprived sections. Of the children in Reception, 20.3% of those in the most deprived areas relative to 7.8% of those in the least deprived areas were obese, while, among Year 6 children, 33.8% of those in the most deprived areas compared to 14.3% in the least deprived sections were obese. The present statistics demonstrate an increase in the gap between the most deprived and the least deprived areas since 2006/2007 (Baker, 2021). These statistics demonstrate that obesity, in its increasing rates, is storing up potential problems for the NHS and individuals.

Key Considerations

Many individuals in England are increasingly having difficulties achieving and maintaining a healthy weight, which is critical to being fit and leading a healthy life. Compared to other European countries, UK records some of the worst trends and figures with regard to obesity. For example, according to Janssen, Bardoutsos and Vidra (2020), whereas a majority of European nations have recorded a 10-40% increase in the obesity trends over the last decade, the UK has witnessed its obesity prevalence increase more than twofold, and still continues to rise.

Obesity, which is an atypical accumulation of body fat that exceeds the recommended body weight by 20%, and which the World Health Organization describes as a body mass index of 30kg/m2 (Obesity and overweight, 2021), has become of key public health concern in the UK given its prevalence, health effects and associated costs. Despite the significant increase in obesity prevalence in the UK since the 1980s, with the 2019 Health Survey for England report indicating a 28% prevalence rate among adults, it is projected that this prevalence will still continue to rise moving forward. Whereas current statistics, as highlighted in the previous section, demonstrate a 65% and 25% increase in obesity prevalence among men and women respectively compared to since 1991, Savona, Rutter and Cummins (2018) predict that, going by the current trends, the proportion of obese males will account for 60% and that of females 50% of all adults by the year 2050. Additionally, going by current trends illustrates that about 8% of children in Reception and 80% of those in Year 6 will become obese adults, with the proportion of obese boys and girls also increasing (Whitaker et al., 2017), although evidence by NHS (2020) suggests that obesity prevalence among boys in Year 6- estimated to be 50%- will be higher than that of girls. Similar obesity prevalence increases have been predicted among adults engaged in unskilled manual labor, and females in social class V and males in social classes I and V (Adult obesity prevalence by National Statistics Socio-economic Classification, 2021). Obesity prevalence is also higher among children whose both parents are obese or overweight, with more boys compared to girls being more likely to be affected by their parents’ weight (Reducing obesity: modeling future trends, 2021). Young children aged 1-2 years with 1 obese parent demonstrate a 30% more likelihood of becoming an obese adult than a non-obese adult, a ratio which 17 times for those aged 15-17 years. The survey (Reducing obesity: modeling future trends, 2021) also shows that the rising childhood obesity prevalence presents the likelihood of persisting into adulthood, thereby increasing their susceptibility to illness.

With close to two-thirds (63%) of adults being overweight, with 50% of these being obese (Statistics on Obesity, Physical Activity and Diet, England, 2020 – NHS Digital, 2021); 1 in every 3 children leaving primary school already overweight or obese; and 1 in every 5 children living with obesity (National Child Measurement Programme, England 2021/21 School Year – NHS Digital, 2021), obesity has become and remains one of the most serious long-term health challenges that UK faces (Tackling obesity: empowering adults and children to live healthier lives, 2021). This is due to the multiplicity of the problems or impacts associated directly or indirectly with obesity. Obesity also presents the NHS with increased annual costs, given that obesity directly accounted for 11,117 hospital admissions between 2019 and 2020, while 876,000 of the hospital admissions it had involved obesity as a factor (Statistics on Obesity, Physical Activity and Diet, England, 2020 – NHS Digital, 2021).

Just as in adults, obesity among children presents a high likelihood of leading to various noteworthy long-term health impacts, such as cardiovascular disease, diabetes, osteoarthritis, certain types of cancers and endothelial dysfunction, as well as influencing their outcomes (Hill, Solt and Foster, 2018; Manco et al., 2017). According to Public Health England (PHE), obesity increases individuals’ likelihood of developing colon cancer by up to 3 times, blood pressure- which is a key factor for cardiovascular disease- by up to 2.5 times, and type 2 diabetes by up to 5 times (Health matters: obesity and the food environment, 2021). PHE also estimates besides depriving, on average, an individual of 9 years of life thereby preventing a majority from attaining the retirement age, obesity also results in over 30,000 deaths annually in the UK.

Obesity also leads to the NHS and the broader economy incurring substantial costs, which place a greater burden on the NHS and economy’s resources. Owing to the high hospital admissions directly linked to obesity, and those in which obesity is a factor, the NHS spends approximately £6.1 billion on obesity and overweight-related patient care (Health matters: obesity and the food environment, 2021). This amount spent exceeds the amount spent, in combination, on the judiciary, the fire service and the police. Obesity also more broadly impacts on the wider economy and economic development of the country, as it brings about an estimated £27billion in costs to the wider society. PHE further estimates that the obesity and overweight-attributable NHS will rise to £9.7 billion by the year 2050, while those to the wider society are estimated to rise to £49.9 billion annually (Health matters: obesity and the food environment, 2021).

The impacts of obesity are also evident in people’s individual lives with regard to the harm it causes to their life’s prospects and self-esteem, as well as an exacerbation of their existing mental conditions. Jackson, Beeken and Wardle (2015), in their study of the association between obesity and psychological well-being ad perceived weight discrimination among UK’s older adults, found that overweight or obese individuals felt that they were discriminated against due to their weight, and this in turn resulted in a reduction in the likelihood of them exercising publicly.

Being more of a lifestyle issue, obesity is difficult to tackle given that the DoH is limited with regard to the amount of direct impact it can have on the problem. This also makes it very difficult to treat, and almost impossible to maintain in the long term the ‘recommended’ weight after the loss of excess weight.

Following the impacts and costs associated with the increasing prevalence of obesity in the UK, the government has endeavored to seek and implement effective strategies for the prevention of obesity. These are aimed at promoting healthy food consumption and other lifestyle habits, which is a key component in the attainment and maintenance of a healthy weight, and therefore reduction of obesity prevalence and related health consequences. With the reduction of obesity prevalence in the country a priority, the promotion of healthy food consumption habits is core to the strategies implemented by the government. However, there still exists a paucity of strategies that ensure UK citizens enjoy and can easily access healthy choices. As such, the various dietary interventions targeted at promoting healthy eating habits and preventing obesity, will continue to be out of reach for those at an increased risk of developing obesity.

Options

The key considerations identified in the above section paint a grim picture of the obesity situation in the UK. They also imply that obesity is a serious health problem that not only affects individuals at a personal level, but also places an increasingly greater burden on the NHS and the wider society due to the high costs they incur annually. In this regard, it is therefore essential that the government takes various measures with the aim of mitigating the situation and promoting the nation’s health.

For instance, the UK DoH should increasingly use the results of these various surveys and reports on obesity to develop policies and strategies that are necessary to promote and support the attainment of healthy weight in the nation. The reports and surveys are vital for policy development as they produce detailed and reliable data relating to obesity trends in the country and obesity factors such as food consumption and energy intake habits, physical activity levels, diet, hospital admissions, weight perception and weight management, among others. For example, the government could make use of statistics on the physical activity levels among adults, young people and children and compare them to the current physical activity guidelines to develop approaches that would encourage more people to meet the recommended physical activity levels as a way of tackling obesity.

However, the strategy of reversing the deep-rooted sedentary lifestyle that a majority of UK citizens presently lead through encouraging them to increase their physical activity levels is faced with a very little likelihood of success- this is due to the prevalence of television, computers, electronic games and other technological developments, which act as barriers to people’s engagement in physical activity (Shibata et al., 2016). While the government has also tried various eating pattern behavior change interventions, these strategies are also less likely to succeed given that the current abundance and affordability of food have resulted in the weakening of the human psychological and physiological mechanisms that are aimed at protecting people against body weight gain (Brunstrom and Cheon, 2018).

Therefore, apart from these aforementioned intervention options, perhaps it is high time the government considered radical policy changes if the goal of preventing obesity is to be achieved. This is because radical policy changes will contribute to social and environmental changes/strategies and empower and enforce the populace to adopt healthy eating habits that in turn tackle the main positive energy balance problem that is responsible for the development and rise of obesity.

Just as with the control strategies enforced in the tobacco industry and which have changed people’s perceptions of smoking over the years, there have been suggestions to similarly challenge the present social norms regarding motor vehicle usage as the main mode of transport in order to encourage walking and cycling which contribute to increased physical activity levels (Mindell, 2001). Similar principles can be used with regard to food consumption- for example, taxing snack foods and unhealthy, energy dense fast foods, though a low-cost approach, would potentially lower their consumption among lower socioeconomic group members that are most affected by obesity (Umer et al., 2017). Healthier food choices could then be subsidized using the collected taxes.

Just like some countries have banned the advertisement of tobacco, whether partially or totally, as well as smoking in public places, similar strategies can be applied in relation to the advertisement and promotion of junk foods and sugar sweetened drinks.

Conclusion

The increasing prevalence of obesity, as well as the numerous health problems and costs associated with it, has made obesity to become a key concern to the government, the NHS, individuals and the wider society. As a result of the near impossibility of treating obesity using conventional means, effort has been shifted towards its prevention, and the government has, alongside the DoH taken measures and implemented various interventions targeted at tackling obesity. However, the ineffectiveness and little likelihood of success demonstrated by these interventions could be an indication of the need to undertake radical policy changes that would more effectively challenge social norms and change people’s social perceptions, as well as establish a regulated and controlled food production, advertising and consumption environment. This way, the challenge of positive energy will be tackled and people enabled to attain and maintain a healthy weight, thereby preventing obesity.

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