Obesity: a complex problem
Julia Manning, 2020health
Nadiya Hussain was recently crowned queen of a relatively new British institution: the Great British Bake-off – and a few weeks later was a star guest at the Women of the Year lunch on Park Lane. Yet in the same week on the other side of Green Park, a key ingredient of her success was being demonised as successive ‘witnesses’ at Parliament’s Health Select Committee inquiry into Childhood Obesity told of the evils of sugar and repeated the long-established statistic that people with lower incomes were most at risk of becoming obese . Forty years ago, warnings on the rise in prevalence of obesity began to emerge from the National Institutes for Health in the USA. By 1985 they had raised the stakes and were referring to obesity as a ‘killer disease’ (Gomez, 2014). In 1991 the UK government acknowledged that obesity represented a national threat to public health but there was no accompanying strong policy. Early in 2001 the UK’s National Audit Office produced a report warning government that if nothing changed, a quarter of the population would be obese by 2010; their prediction was almost exact, and today over 26% of the UK population are clinically obese.
But can the solution to the ‘obesity crisis’ be as simple as one ingredient (essential to our beloved bake-off cakes), and is it still true to say that it is the poor and deprived who are most at risk of obesity?
2020health have looked afresh at the evidence from the past 10 years in our report: Fat Chance? Exploring the evidence on who becomes obese. The answers are not simple, but complex. We found it wasn’t simply about those who are poor; it was younger, socially deprived women most at risk of obesity. Living in an environment that has a high density of fast food outlets, insufficient green space and a perceived fear of crime all correlated with an increase in obesity in girls. For men, they are more likely to be obese if their place of work has a high density of surrounding fast food outlets. Economic instability is now associated with some of the most rapidly rising rates of obesity in the UK , which constitutes a massive challenge as we anticipate greater automation of workplace and fewer middle class jobs. Again this is gendered, as for the stable poor, obesity is much higher in women. For the stable wealthy, obesity is higher for men, and for the economically mobile, obesity rises for both men and women. Obesity has been associated with certain ethnicities too, but you are at greater risk if your parents are obese, especially if it’s your mother.
Obesity is a problem with multiple drivers, many of them outside of the health sector. It has grown over the past decades to be a problem that, it is estimated by Management Consultants McKinsey, to now cost our economy £47bn per year (in direct costs to NHS including associated disease, loss of productivity in the workplace, welfare support for those of working age and through the burden of early retirement). It is therefore hard to understand the reticence of successive policy makers to respond to the economic and social crisis that obesity represents.
We are hoping that this study will serve as a valuable contribution to the evidence base on obesity to inform intelligent health interventions and workable solutions. A new children’s obesity strategy has been promised after Christmas and the government has the chance to this time do something significant. What our report emphasises is that we cannot take the same approach as before and expect outcomes to improve. Nor is there a silver bullet such as increasing the cost of donuts which will change our ever-fattening trajectory.
We now know that we have to understand exactly who we are targeting. We have to understand the complexity of the problem and that this requires a cross-departmental, Cabinet-level high-status commitment to a strategy. We have to insist on some environmental changes if people are ever to stand a chance of making healthy choices.