Obesity

Context

Excess calorie consumption is the fundamental cause of weight gain. Evidence shows that the majority of adults are consuming around 200 to 300 extra calories per day, and children who are already overweight or living with obesity are consuming up to 500 calories extra per day. Typically diets in the UK are not in line with the Eatwell Guide principles and contain too much sugar, saturated fat and salt and not enough fibre, fruit and vegetables. The types of food and drink consumed and patterns of eating, have also changed markedly over the last 50 years. Adults and children are constantly encouraged to buy and consume excess food through food advertising, promotions, and the high density of food outlets on high streets. The eating out of home sector provides 20-25% of an adult’s energy intake.

Prevalence

In England 63.8% of adults (18+ years) are classified as overweight or obese, equating to approximately 2 in 3 adults. 21.3% of Reception children (aged 4- 5 years) in England are living with overweight or obesity, rising to 36.6% of children by Year 6 (aged 10-11 years). Obesity is associated with reduced life expectancy. It is a risk factor for a range of chronic diseases, including cardiovascular disease (CVD), type 2 diabetes, at least 12 kinds of cancer, liver and respiratory disease. More recently, evidence has shown an established link between people living with obesity and an increased risk of severe illness and mortality from COVID-19.

Obesity in both adults and children is associated with poor psychological and emotional health and poor sleep. People living with obesity are likely to suffer from weight stigma, negatively impacting on their self-esteem18. Furthermore, children who are overweight or obese have a higher likelihood of being obese as an adult, increasing their risk of developing chronic diseases19

Overweight and obesity are terms that refer to an excess of body fat and they usually relate to increased weight-for-height. The most common method of measuring obesity is the Body Mass Index (BMI). BMI = Person’s weight (kg) / Person’s height (in metres²). Table 1 and Table 2 show the different weight classifications and their associated BMI range.

*Thresholds above are those conventionally used for population monitoring and are not the same as those used in a clinical setting, where overweight is defined as a BMI ≥ 91st but below the 98th centile, and obese is defined as a BMI ≥ 98th centile.

Deprivation

• Obesity prevalence is highest amongst the most deprived groups in society. Children in the most deprived parts of the country are more than twice as likely to be obese as their peers living in the least deprived areas.
• Differences in obesity rates translate to worse health outcomes for people in more deprived areas and contribute to health inequalities. Admissions directly attributable to obesity are over three times more likely in the most deprived areas compared to the least deprived areas.

Ethnicity

• Data published in 2021 assessing overweight and obesity prevalence across different ethnic groups, reported that Black adults had the highest rates at 70%. Adults from Asian (57.6%), Other White (59.1%), and Mixed ethnic groups (60.1%) had lower rates of overweight and obesity than those who were White British (65.2%). Although rates vary between ethnic groups overall, the data shows that a substantial proportion of all ethnic groups are either overweight or obese.
• Guidance published by the National Institute of Excellence (NICE) advises that people of Black, Asian, and other ethnic minority backgrounds are at an equivalent risk of diabetes and other health conditions or mortality due to excess weight at a lower BMI than the White European population.
• Children from certain UK minority ethnic groups, particularly Black African origin and Bangladeshi ethnicities are more likely to develop obesity. The 2020-2021 NCMP report shows that obesity prevalence in children between ethnic groups has increased, with the ethnic groups that previously had the highest obesity prevalence, in the most part, experiencing the largest increases.

Learning Disabilities

• Data on the prevalence of excess weight in people with Learning Disabilities (LD) in England (aged 18+ years) showed that approximately 27% of people with LD were classified as overweight, compared to 31.8% of people without LD. However, approximately 37% of people with LD were classified as obese, compared to 30.1% of people without LD. The more severe the classification of obesity, the greater the risk to an individual’s health.
• For people with LD the diet and exercise requirements of losing weight are similar to the actions required of those without LD. However, there are additional complexities to achieving these actions including, a lack of support or knowledge from carers, mainstream messaging around healthy eating and physical activity not being adapted to be accessible, communication difficulties and reduced health literacy, transport and financial issues accessing support services, and mobility and illness that can prevent successful engagement. In addition, some people with LD have problems with weight control as a result of conditions such as Prader-Willi Syndrome or because of specific medications.
• There is evidence demonstrating a higher prevalence of obesity in children with physical and/or intellectual disabilities.