Health behaviours: obesity
- In 2019/20, 1 in 5 children aged 4-5 years old and nearly 1 in 3 children aged 10-11 years old were overweight or obese in Suffolk. Early evidence appears to show that this proportion has increased even further following the COVID-19 pandemic. (Prevalence of overweight/obesity among children)
- In 2019/20, more than 6 in 10 adults were overweight or obese in Suffolk. The highest prevalence of GP recorded obesity was found in Mildenhall, Bury St Edmunds, areas of Ipswich, Felixstowe, and areas of Lowestoft. (Prevalence of overweight/obesity among adults)
- The health complications associated with obesity are wide ranging. Obese people are five times more likely to develop type 2 diabetes and 2.5 times more likely to develop high blood pressure, which is a risk factor for stroke and heart disease. Obese people are also at increased risk of certain cancers and are three times more likely to develop colon cancer. (Why is obesity important?)
- Across England, overweight and obesity levels increase with age and are highest among people aged 45+, among whom the prevalence of overweight and obesity is around 3 in every 4 people. Given Suffolk’s ageing population and high proportion of older people, overweight and obesity are likely to be an increasingly common problem in future years. (Why is obesity important?)
- The number of people admitted to hospital for reasons linked to obesity has nearly trebled over the last seven years, from 738 to 2,075 per 100,000 Suffolk residents. In 2019/20, this equated to nearly 16,000 Suffolk residents. (Hospital admissions associated with obesity)
It is estimated that obesity is responsible for more than 30,000 deaths each year in England. On average, obesity deprives an individual of an extra 9 years of life, preventing many individuals from reaching retirement age. In the future, obesity could overtake tobacco smoking as the biggest cause of preventable death.
Being overweight or obese is defined as having abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI between 25 - 30 is considered overweight, and a BMI above 30 indicates obesity.
Obesity is most commonly caused by eating too much food high in fat and sugar and moving too little. When people consume high amounts of energy, particularly fat and sugars, but don't burn off the energy through exercise and physical activity, much of the surplus energy is stored by the body as fat. Some underlying medical conditions and medication can also contribute to weight gain, as can some rare genetic conditions. But in most cases obesity has more to do with environmental or societal factors, such as unhealthy eating habits.
The health complications associated with obesity are wide ranging (Figure 1). Obese people are five times more likely to develop type 2 diabetes and 2.5 times more likely to develop high blood pressure, which is a risk factor for stroke and heart disease. Obese people are also at increased risk of certain cancers and are three times more likely to develop colon cancer. Obese children are more likely to suffer from bullying and may be affected by weight stigma, which can lead to low self-esteem, body image issues, anxiety and depression.
Despite the compelling evidence base for eating a healthy diet, many people still find it difficult to eat healthily. This is primarily because we live in environments where less healthy choices are the default, thereby encouraging excess weight gain and obesity. As a society, we are not burning off enough of the calories that we consume. People in the UK are around 20% less active now than in the 1960s. If current trends continue, we will be 35% less active by 2030.
Societal changes have designed physical activity out of our lives. Fewer people work in manual jobs and technology dominates at home and at work, the two places where we spend most of our time. It is estimated that adults spend around six hours a day in sedentary pursuits (watching TV, other screen time, reading and other low energy activities).
Diet and physical activity are both closely linked to maintaining a healthy weight and, while the long term impact of the COVID 19 is not yet clear, we do know that life under lockdown has changed behaviours for many people. Working and studying at home inevitably leads to a more sedentary life for many people. For some people it will have been more difficult to access healthy foods, either due to shortage of supply or difficulty getting to shops. For others, food insecurity may have driven people to purchase cheaper packaged and processed foods. All of these factors increase the risk of gaining excess weight. Between 2019/20 and 2020/21 there was a significant increase in the proportion of overweight/obese children in England – it was the largest single-year increase since children started being annually measured 15 years ago. Data for adults covering the COVID-19 pandemic is yet to be published.
In July 2020 the Department of Health and Social Care published ‘Tackling Obesity: Empowering Adults and Children to Live Healthier Lives’. This contained the following options:
- Introducing a new campaign for those who are overweight to take steps to move towards a healthier weight
- Working to expand weight management services through the NHS
- Publishing a consultation to gather viewings on the traffic light labelling system
- Requiring large out of home food businesses to add calorie labels to the food they sell and consulting on calorie labelling on alcohol
- Ending promotions of high fat, sugar and salt food and banning their advertisement on TV and online before 9pm
It is estimated that the NHS spent £6.1 billion on overweight and obesity-related ill-health each year. In addition to direct health costs, a person who is severely obese is three times more likely to need social care than someone who is a healthy weight. More broadly, obesity has a serious impact on economic development. The overall cost of obesity to wider society is estimated at £27 billion. The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.
Across England, overweight and obesity levels increase with age and are highest among people aged 45 and over, among whom the prevalence of overweight and obesity ranges between 72-77%. Given Suffolk’s ageing population and high proportion of older people, overweight and obesity are likely to be an increasingly common problem in future years.
Years Lived with Disability (YLDs) are a measurement of the burden of disease, which can also be described as years lived in less than ideal health. This includes conditions such as influenza, which may last for only a few days, or epilepsy, which can last a lifetime. It is measured by taking the prevalence of the condition multiplied by the disability weight for that condition. Disability weights reflect the severity of different conditions and are developed through surveys of the general public.
In 2019, having a high BMI was the number one risk factor for YLDs in Suffolk, accounting for more than 8,890 years lived by Suffolk residents in less than ideal health.
Having a high BMI was the fourth highest risk factor for death, contributing to nearly 770 deaths among Suffolk residents in 2019. Two other metabolic risks closely associated with obesity, high blood pressure and high fasting plasma glucose, contributed to even more deaths in 2019 than having a high BMI.
In 2019/20, more than 6 in 10 adults (62.7%) were overweight or obese in Suffolk, which is comparable to the England average (62.8%). Being comparable to England may seem comforting but it shouldn’t be - England has one of the highest rates of obesity in Western Europe.
The prevalence of overweight and obesity was statistically comparable to England and Suffolk in all districts/boroughs except Babergh, where it was significantly higher (69.1%).
Figure 3: Prevalence of overweight and obesity among adults, 2019/20, districts/boroughs, Suffolk, England
Prevalence of obesity is recorded by GP surgeries as part of the Quality and Outcomes Framework (QOF). This data can be used to identify small areas where prevalence is higher than average. The map below shows GP recorded obesity prevalence for each middle-layer super output area (MSOAs, which are geographic boundaries that contain an average of 7,500 residents). Additionally, the obesity prevalence for all Suffolk GP practices has been overlaid to provide a comparator between GP practices in Suffolk. The map shows that there is higher prevalence of clinically obese adults in Mildenhall, Bury St Edmunds, areas of Ipswich, Felixstowe, and areas of Lowestoft.
Figure 4: Proportion of registered GP patients who are clinically obese, by Middle Layer Super Output Area (MSOA) and GP practice location, 2019/20
The National Childhood Measurement Programme (NCMP) measures the height and weight of children aged 4-5 (reception year) and 10-11 (Year 6) each year in primary schools across England.
Results from the NCMP conducted in academic year 2019/20 indicate that prevalence of overweight and obesity in reception age children is lower in Suffolk (21.6%) than England (23.0%) and similar to the East of England (21.8%). Similarly, the prevalence of overweight and obesity in Year 6 children is lower in Suffolk (31.8%) than England (35.2%) and similar to the East of England (32.7%). Whilst it is positive to see that the proportion of overweight children in Suffolk is lower than across England, this should not mask the fact that all areas in England are experiencing a serious problem with childhood obesity.
Due to the impact of the Covid-19 pandemic, the 2020/21 NCMP collection was carried out as a sample and statistical weighting was applied to the data to produce an estimate of obesity prevalence at national level. NHS Digital ensure that all published NCMP data meet stringent rules. Suffolk met these criteria for reception year age children but not for year 6 age children. Given this discrepancy and the general disruption to the NCMP programme throughout 2020-21, this section focuses on published national level data.
The results suggest that across England there was a significant increase in the proportion of overweight/obese children between 2019/20 and 2020/21 – the largest single-year increase since the programme began 15 years ago. Among reception age children, this rose from 23.0% to 27.7% and among year 6 age children this rose from 35.2% to 40.9%. Possible reasons for this rise include the impact of lockdown measures resulting in children living more sedentary lives and food insecurity driving some families to purchase cheaper packaged and processed foods.
Results from the NCMP conducted in academic year 2019/20 indicate that prevalence of overweight and obesity among children varied between districts and boroughs. The highest proportions were found in Ipswich, which is the only area in Suffolk with prevalence higher than the England level (although the difference is not statistically significant).
Figure 5: Prevalence of overweight/obese among reception age children, Suffolk, districts/boroughs, England, 2019/20
Figure 6: Prevalence of overweight/obese among Year 6 age children, Suffolk, districts/boroughs, England, 2019/20
Nationally, there is a strong association between deprivation and obesity in children. In 2019/20, the prevalence of obesity among reception year children (aged 4 to 5) was almost twice as high in the most deprived areas (16.2%) compared to the least deprived areas (8.7%). Similarly, the prevalence of obesity among Year 6 children (aged 10 to 11) was more than twice as high in the most deprived areas (35.3%) compared to the least deprived areas (17.3%).
Figure 7: Prevalence of overweight/obese among Year 6 age children, Suffolk, districts/boroughs, England, 2019/20
Only a handful of people are admitted to hospital for reasons directly related to being obese; the vast majority are admitted for conditions that are caused by or exacerbated by being overweight. In 2019/20, 15,975 people in Suffolk were admitted to hospital for reasons linked to their obesity. This corresponds to a rate of 2,075 per 100,000 Suffolk residents, which is higher than the England average (1,869 per 100,000 population).
The number of hospital admissions where obesity is a factor has nearly trebled over the last seven years, from 738 to 2,075 per 100,000 Suffolk residents, and there has been a similar trend across the whole of England. This is a worrying trend when considered in terms of both the detrimental impact on population health outcomes and high treatment costs.
You can explore data about obesity related hospital admissions in the NHS Digital obesity related hospital admissions tool.
The NHS Long Term Plan contained the following actions on obesity:
- Provision of access to weight management services in primary care for people with a diagnosis of type 2 diabetes
- Funding of a doubling of the NHS Diabetes Prevention Programme over the next five years
- Testing an NHS programme supporting very low-calorie diets for obese people with type 2 diabetes
- Action on healthy NHS premises for example on hospital food standards
NICE produce a range of products relating to obesity, including pathways, guidance and quality standards.
The Public Health England guidance document Adult obesity: applying All Our Health gives further reading, resources and good practice.
OneLife Suffolk is a local resource, which offers support and advice on a wide variety of different health improvement programmes. OneLife Suffolk provides free weight management programmes for adults and children, including Slimming World on referral. The weight management services are designed to create long lasting shifts in behaviour and give support and tools throughout the programme.