Fat chance: The British ‘obesity epidemic’

Obesity has become a major problem across the Western world including Great Britain. Some academic scholars claim that obesity is a natural consequence of ‘food addiction’. While I can share this viewpoint, there are many examples of obese people whose eating behaviour would not be classed as addicted using the addiction components model. However, that does not mean obesity is not a problem. Academically, I only became interested in obesity when I was appointed a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity chaired by Professor Stuart Biddle and led to a major report that we published on obesity and sedentary behaviour in 2010 (see ‘Further reading).

Obesity is measured using a calculation based on a person’s Body Mass Index (BMI). BMI is calculated by dividing a person’s weight measurement [in kilograms] by the square of their height [in metres]. In adults, a BMI of 25kg/m² to 29.9kg/m² means that person is considered to be overweight, and a BMI of 30kg/m² or above means that person is considered to be obese. A recent 2013 report by the Health and Social Care Information Centre presented a range of information on obesity in England drawn together from a variety of sources. The report noted that:

“NICE [National Institute for Health and Care Excellence] guidelines on prevention, identification, assessment and management of overweight and obesity highlight their impact on risk factors for developing long-term health problems. It states that the risk of these health problems should be identified using both BMI and waist circumference for those with a BMI less than 35kg/m². For adults with a BMI of 35kg/m² or more, risks are assumed to be very high with any waist circumference”.

The main source of the report’s data on the prevalence of overweight and obesity is taken from the annual Health Survey for England (HSE) that is written by NatCen Social Research, and published by the Health and Social Care Information Centre (HSCIC). Most of the information presented in the 2013 report is taken from the HSE 2011.The main findings were that:

• The proportion of adults with a normal Body Mass Index (BMI) decreased from 41% to 34% among men and from 50% to 39% among women between 1993 and 2011.
• The proportion that were overweight including obese increased from 58% to 65% in men and from 49% to 58% in women between 1993 and 2011.

• There was a marked increase in the proportion of adults that were obese from 13% in 1993 to 24% in 2011 for men and from 16% to 26% for women.
• The proportion of adults with a raised waist circumference increased from 20% to 34% among men and from 26% to 47% among women between 1993 and 2011.
• In 2011, around three in ten boys and girls (aged 2 to 15) were classed as either overweight or obese (31% and 28% respectively), which is very similar to the 2010 findings (31% for boys and 29% for girls).
• In 2011/12, around one in ten pupils in Reception class (aged 4-5 years) were classified as obese (9.5%) which compares to around a fifth of pupils in Year 6 (aged 10-11 years) (19.2%).
• In 2011, obese adults (aged 16 and over) were more likely to have high blood pressure than those in the normal weight group. High blood pressure was recorded in 53% of men and 44% of women in the obese group and in 16% of men and 14% of women in the normal weight group.
• Over the period 2001/02 to 2011/12 in almost every year more than twice as many females than males were admitted to hospital with a primary diagnosis of obesity.
• In 2011, there were 0.9 million prescription items dispensed for the treatment of obesity, a 19% decrease on the previous year.

Using regression analysis, the HSE also examined the risk factors associated with being overweight and obese. For both men and women, being ‘most at risk’ was positively associated with: age; being an ex-cigarette smoker; self-perceptions of not eating healthily; not being physically active; and hypertension. Income was also associated with being ‘most at risk’, with a positive association for men and a negative association for women. It was also reported that among women only, moderate alcohol consumption was negatively associated with being ‘most at risk’.

Another summary report on adult weight published earlier this year by the National Obesity Observatory briefly reviewed the scientific data and concluded that in the UK: (i) an estimated 62% of adults (aged 16 and over) are overweight or obese, and that 2.5% have severe obesity; (ii) men and women have a similar prevalence of obesity, but men (41%) are more likely to be overweight than women (33%); (iii) the prevalence of obesity and overweight changes with age, and prevalence of overweight and obesity is lowest in the 16-24 years age group, and generally higher in the older age groups among both men and women; and (iv) women living in more deprived areas have the highest prevalence of obesity and those living in less deprived areas have the lowest, but there is no clear pattern for men.

The 2013 Health and Social Care Information Centre report also contextualized the obesity problem in the UK by comparing obesity rates with other European countries and worldwide using data published by the Organisation for Economic Co-operation and Development (OECD). In 2012, the OECD has published a number of ‘Health at a Glance’ reports including one on European health comparisons, and one on worldwide health comparisons (published in 2011). The data from these reports was summarised as follows:

“More than half (52%) of the adult population in the European Union reported that they were overweight or obese. The obesity rate has doubled over the last twenty years in many European countries and stands at between 7.9% in Romania and 10.3% in Italy to 26.1% in the UK and 28.5% in Hungary. The prevalence of overweight and obesity among adults exceeds 50% in 18 of 27 EU member states…[Worldwide] more than half (50.3%) of the adult population in the OECD reported that they were overweight or obese. The least obese countries were India (2.1%), Indonesia (2.4%) and China (2.9%) and the most obese countries were the US (33.8%), Mexico (30.0%) and New Zealand (26.5%). Obesity prevalence has more than doubled over the past 20 years in Australia and New Zealand. Some 20-24% of adults in Australia, Canada, the United Kingdom (UK) and Ireland are obese, about the same rate as in the United States in the early 1990s. Obesity rates in many western European countries have also increased substantially over the past decade. The rapid rise occurred regardless of where levels stood two decades ago. Obesity almost doubled in both the Netherlands and the UK, even though the current rate in the Netherlands is around half that of the UK”.

From an addiction perspective, there’s also some interesting data examining the co-relationship between obesity and drinking alcohol. For instance, a 2012 report by Gatineau and Mathrani examining the relationship between obesity and alcohol consumption reviewed the literature and made a number of conclusions. These were that (i) there is no clear causal relationship between alcohol consumption and obesity, although there are associations between alcohol and obesity and these are heavily influenced by lifestyle, genetic and social factors; (ii) many people are not aware of the calories contained in alcoholic drinks; (iii) the effects of alcohol on body weight may be more pronounced in overweight and obese people; (iv) alcohol consumption can lead to an increase in food intake; (v) heavy, but less frequent drinkers seem to be at higher risk of obesity than moderate, frequent drinkers; (vi) the relationships between obesity and alcohol consumption differ between men and women; (vii) excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis; and (viii) there is emerging evidence of a link between familial risk of alcohol dependency and obesity in women.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families.

Gatineau, M & Mathrani, S. (2012). Obesity and alcohol: An overview. Oxford: National Obesity Observatory.

Health and Social Care Information Centre (2013). Statistics on Obesity, Physical Activity and Diet: England, 2013. London: Health and Social Care Information Centre.

Organisation for Economic Co-operation and Development (2011). Health at a Glance 2011. Available at: http://www.oecd.org/dataoecd/6/28/491 05858.pdf

Organisation for Economic Co-operation and Development (2012). Health at a Glance: Europe 2012. Available at: http://www.oecd.org/health/healthatagla nceeurope.htm

National Obesity Observatory (2013). Adult weight. Oxford: National Obesity Observatory.