Rates of obesity in England are high and rising, with a strong systemic relationship between obesity and deprivation. Rates are also higher in women than in men, and in some ethnic minority groups compared to the white British group.
Recent governments have taken a fragmented approach to tackling obesity, and while some individual policies have been successful, this approach has fallen short of the cross-cutting population health approach that is needed. This briefing explores the role of the NHS in tackling obesity, focusing on how the NHS can work with local partners and engage with communities to deliver targeted interventions to treat and prevent obesity.
Key messages
In 2019, 64 per cent of adults in England were overweight, with 28 per cent being obese and 3 per cent morbidly obese. Obesity is a significant health risk and is associated with increased risk of diseases including diabetes, heart disease and some cancers.
Childhood obesity has followed a similar pattern. For children in year six there was a 13-percentage-point gap in obesity rates between the most and least deprived children in 2019, up by 5 percentage points since 2006.
There is more that the NHS can and should be doing to tackle obesity. This includes using local insights to target services at communities with the greatest need, training its workforce to offer advice about diet and nutrition, and incentivising referrals to specialist diet programmes and more intensive clinical interventions like weight-loss surgery.
These levers, while effective, are best used as part of a whole-system approach to tackling obesity. There is an important, yet under-developed, role for integrated care systems and local place-based partnerships in co-ordinating action and helping partners to take a coherent approach.
Embracing a whole systems ‘weight neutral’ approach over a weight stigma based ‘personal willpower failure’ model. Recognising the impact of the latter in eating disorders, depression and anxiety and crucially increasing health inequalities. Nutriri is a volunteer/expert by experience led VCFSE struggling to fund a wider test case to prove at scale what we see working locally.
Given the rising rates of obesity, it seems clear that healthcare interventions to encourage weight loss are not working. In this context, the NHS needs to focus on how to improve health outcomes and quality of life measures for the significant proportion of the UK population who are and will remain overweight or obese. Some of the measures recommended in this report, such as tackling wider determinants of health, will do this, but it is disappointing to see the role of weight stigma and anti-fat bias ignored. There is evidence that weight stigma in healthcare results in worse health outcomes for people with higher BMIs, for example through missed diagnoses and perpetuation of shame around weight contributing to mental health problems. (See for example Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5)
You are correct in stating that obesity is a complex condition ( it is not a disease in the UK) and that the aetioligy of each individual’s situation needs to be considered. One of the principal problems is that health care practitioners receive very little, if any trading in obesity. The average time devoted to understanding obesity in medical school is about 6 hours and in other disciplines less than that or nothing at all. Do these reports that come out regularly will collect dust like all the others and the incidence of obesity will continue to increase.
Mental health is key to why we overeat and how we can beat it. Identifying the reasons why we overeat is crucial. From childhood up, it's a form of self-harming. Also, chemicals added to food that entice the brain, in fact, any chemicals, should be minimal. I suspect they cause more than obesity and may be why UK health is so poor.
I find that the children born in the 60s are not obese. I was a supervisor in school meals and the food cooked was fresh and balanced. What they are getting now is packaged and frozen rubbish. I worked for a while in the kitchen of today and found that chicken planes were more breadcrumb than meat. the Chocolate flans were packed with sugar. Chocolate doughnuts says it all. I made dough from scratch, fried and dusted with cinnamon and small amount of sugar,a small amount of jam was added. The money spent on the NHS would be better spent to school meals. children dont eat before dinner or after unless they bring something with them. The only way they would get rubbish is by supplying them with chips and cheap ways to feed children at school. Excrsise is up to the head of he school. thisis shoiuld b compulsory s when in my day.
Agree, there is a relationship between obesity and deprivation. However, it is not just the deprived people eat unhealthily, even the over indulgence of food by the rich also makes them obese.
Obesity is a complex disease and to tackle this , each persons physiological as well as mental health need to be considered to provide relevant treatment. Each patient is different and relevant treatment and advice should be provided. Public Health should convey proper evidence based messages to the community.
Comments
Embracing a whole systems ‘weight neutral’ approach over a weight stigma based ‘personal willpower failure’ model. Recognising the impact of the latter in eating disorders, depression and anxiety and crucially increasing health inequalities. Nutriri is a volunteer/expert by experience led VCFSE struggling to fund a wider test case to prove at scale what we see working locally.
Given the rising rates of obesity, it seems clear that healthcare interventions to encourage weight loss are not working. In this context, the NHS needs to focus on how to improve health outcomes and quality of life measures for the significant proportion of the UK population who are and will remain overweight or obese. Some of the measures recommended in this report, such as tackling wider determinants of health, will do this, but it is disappointing to see the role of weight stigma and anti-fat bias ignored. There is evidence that weight stigma in healthcare results in worse health outcomes for people with higher BMIs, for example through missed diagnoses and perpetuation of shame around weight contributing to mental health problems. (See for example Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5)
You are correct in stating that obesity is a complex condition ( it is not a disease in the UK) and that the aetioligy of each individual’s situation needs to be considered. One of the principal problems is that health care practitioners receive very little, if any trading in obesity. The average time devoted to understanding obesity in medical school is about 6 hours and in other disciplines less than that or nothing at all. Do these reports that come out regularly will collect dust like all the others and the incidence of obesity will continue to increase.
Mental health is key to why we overeat and how we can beat it. Identifying the reasons why we overeat is crucial. From childhood up, it's a form of self-harming. Also, chemicals added to food that entice the brain, in fact, any chemicals, should be minimal. I suspect they cause more than obesity and may be why UK health is so poor.
I find that the children born in the 60s are not obese. I was a supervisor in school meals and the food cooked was fresh and balanced. What they are getting now is packaged and frozen rubbish. I worked for a while in the kitchen of today and found that chicken planes were more breadcrumb than meat. the Chocolate flans were packed with sugar. Chocolate doughnuts says it all. I made dough from scratch, fried and dusted with cinnamon and small amount of sugar,a small amount of jam was added. The money spent on the NHS would be better spent to school meals. children dont eat before dinner or after unless they bring something with them. The only way they would get rubbish is by supplying them with chips and cheap ways to feed children at school. Excrsise is up to the head of he school. thisis shoiuld b compulsory s when in my day.
Agree, there is a relationship between obesity and deprivation. However, it is not just the deprived people eat unhealthily, even the over indulgence of food by the rich also makes them obese.
Obesity is a complex disease and to tackle this , each persons physiological as well as mental health need to be considered to provide relevant treatment. Each patient is different and relevant treatment and advice should be provided. Public Health should convey proper evidence based messages to the community.
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