Obesity, deprivation and Covid-19: why rowing back on the obesity strategy could prove to be a costly error

In June 2020, the government began its ‘war on obesity’ with the publication of its obesity strategy, spurred into action by data linking obesity with increased risk of severe disease from Covid-19.  However, despite the strategy, our analysis of new data showed that in 2020 (the first year of the Covid-19 pandemic) obesity rates climbed across England and inequalities in obesity prevalence between the least- and most-deprived areas widened.

What is more, the government has rowed back on a range of measures announced in the obesity strategy. This included cancelling the local authority adult weight management services grant, despite the fact that, at £30 million, the grant was equivalent to less than 1 per cent of the total health budget and was delivering effective interventions, including advice and practical support to help people lose weight, across England.

Obesity rates and the first year of Covid-19

2020/21 saw not only rising rates of across England but there was also, for the first time on available record, an uptick in obesity rates in every deprivation decile. At the same time the gap in rates of obesity between least and most deprived widened substantially, from 16 points in 2019/20 to nearly 18 points in 2020/21.

This means more people are now obese, which will likely lead to poorer health and contribute to inequalities in health.

The causes of rising obesity rates and the health inequalities between different groups are complex and multi-faceted. There are social, economic and environmental factors that make it much harder to for people who live in more-deprived areas to maintain a healthy diet. For example, following the government’s Eatwell guideline would cost nearly three times the current average spend per person per week on food. There is also a very strong relationship between deprivation and number of fast-food outlets in a neighbourhood.

In addition, in 2020/21 the measures put in place to limit the spread of Covid-19 are likely to have had an impact on people’s health behaviours – including diet and physical activity – in a variety of ways. It is too early to tell if these measures will have a long-term impact on our health or on obesity rates, but they are likely to have contributed to the patterns we are seeing from the first year of the pandemic.

The obesity strategy and weight management services

Since the obesity strategy was published, the government has rowed back on, paused or cancelled various policies that made up the strategy. This includes the £30 million local authority ‘adult weight management services’ grant despite evidence-based guidance from NICE highlighting how these services can provide effective support to help people change behaviours, improve their diet and gain a better understanding of nutrition.

The effectiveness of the grant is borne out in the data. First, the grant, which was only in place for one year, was very effective in driving referrals to weight management services in all parts of England, but more so in the most-deprived areas, where obesity prevalence is greatest and health outcomes are worst.

The services that the grant was funding have been effective in helping people lose weight. One in five people who were referred to local authority weight management services via the new grant funding route achieved a significant weight loss in 2021/22. If people sustained this weight loss, it would translate to better health and better health outcomes.

These types of weight management services are not a ‘silver bullet’, but they should form an important part of wider strategy for tackling obesity.

Conclusion

The evidence on the policy and practical interventions that can help tackle obesity and reduce the associated health inequalities is well known. All that is missing is the political will to implement them.

Re-instating the adult weight management grant would be one highly cost-effective way of driving health improvement and tackling health inequalities. If the next prime minister wants to continue the ‘war on obesity’ and make up some lost ground, then there’s at least one ready-made policy waiting for them.