Tackling obesity

Citation

(1999), "Tackling obesity", Nutrition & Food Science, Vol. 99 No. 5. https://doi.org/10.1108/nfs.1999.01799eab.001

Tackling obesity

New figures published recently by the Department of Health show that levels of obesity have risen dramatically over the last five years. Seventeen per cent of men are now obese, compared with 13 per cent in 1993, and almost 20 per cent of women are obese compared with 16 per cent in 1993. In 1980 6 per cent of men and 8 per cent of women were clinically obese. Obesity is one of the largest and fastest growing public health problems across the world and half the population of the UK is overweight. If current trends continue more than a quarter of adults in the UK will be obese by the year 2010.

Bread for Life campaign shows that the majority of the British population, 79 per cent, think that obesity will continue to be a growing public health problem. The research has highlighted a great variety of public attitudes about obesity. For example, only 3 per cent of men and 6 per cent of women perceive themselves to be very overweight and more than half the adults surveyed did not believe they are at risk of being overweight in the future. Almost three quarters of young people (16 to 24 years) think they are unlikely to have a weight problem in the future. The rapid increase in obesity prevalence parallels that which is occurring in the USA. This indicates that the obesity epidemic will not be self-limiting.

The risk factors associated with obesity include raised blood pressure and raised cholesterol levels which lead to coronary heart disease and stroke. Obesity fosters inactivity and generally involves an unhealthy diet which together contribute to cancer, diabetes, gall bladder disease, arthritis and musculoskeletal problems. Obesity is therefore asssociated with increased risk of premature death and considerable ill health. This is estimated to account for 6 to 8 per cent of the nation’s direct health care costs, approximately £3.5 billion per annum. After smoking, obesity is the most preventable cause of ill health in Britain. There is no one healthy weight but instead a range of healthy body weights, corresponding to a body mass index of 18.5 to 25, within which the risk of ill health or premature mortality is minimised. A person is described as overweight when their BMI is greater than 26 and obese when the BMI is greater than 30.

Obesity is a multi-factorial condition but one indisputable fact is that energy intake must exceed energy expenditure for weight gain to occur. Epidemiological and experimental evidence have demonstrated that sedentary lifestyles and a diet containing a high proportion of fat and a low proportion of carbohydrate are specific behavioural risk factors for weight gain. The marked decrease in levels of habitual physical activity in the latter half of the twentieth century has been an important contributory factor to the rise in the number of overweight or obese people.

Recent advances in molecular biology have identified a number of specific genes which are associated with increased susceptibility to obesity. These genes, acting primarily through the regulation of appetite, can increase the probability of an individual becoming obese. This partly explains why obesity occurs more commonly in some families. However, genetic or metabolic influences on an individual’s susceptibility to obesity cannot explain the nationwide increase in obesity since the gene pool has remained essentially constant. Many aspects of people’s lifestyle are conditioned by their parents. Individuals who have overweight or obese parents and gain weight in adolescence or young adulthood are at particularly high risk of obesity in later life. One quarter of women incorrectly believe that slow metabolism is a reason for their weight gain and one in ten of all adults think it is due to genetic make-up. One quarter of all adults think that weight gain is just part of growing older.

Generally people know they should eat proportionally more fruit and vegetables and less fried foods, sweet foods and chocolate if trying to maintain or lose weight. People are confused about whether bread is part of a healthy diet. Almost half (47 per cent) of those surveyed incorrectly thought they should eat less bread when trying to lose weight. Complex carbohydrates generally have a lower energy density than simple sugars and may contain more fibre which increases their ability to satisfy hunger. In experimental studies, foods high in fat promote ‘‘passive over-consumption’’ in part due to their low bulk and poor ability to satisfy the innate desire for food. Foods high in complex carbohydrates have a lower energy density and higher satiety value. Intervention studies have shown evidence of modest weight loss when the proportion of fat in the diet is reduced and complex carbohydrate increased.

Changes in lifestyle are difficult since diet and physical exercise habits are long-standing and highly resistant to change. Media hype around different diet plans contributes to confusion and mixed messages about the right type of foods to eat and in what quantities. The one indisputable fact is that the maintenance of a healthy body weight requires a balance between energy intake and output. Crash diets are not the solution for people with a weight problem. Weight control is a long-term commitment and needs to be supported by a dietary plan which provides sufficient quantities of food to avoid hunger and ensures an adequate intake of essential micronutrients.

Tessa Jowell, Minister for Public Health, has outlined some broad ranging initiatives to tackle the problem of overweight and obesity such as more information about what constitutes a balanced diet, increasing access to fresh fruit and vegetables and promoting a more active lifestyle. The Healthy Schools Programme is re-establishing nutritional standards for school meals, so children have a balanced diet. The Cooking for Kids scheme is teaching children how to prepare and cook healthy foods. Easily accessible information on diet and nutrition is provided on the Wired for Health Website and this also provides guidelines for teachers on nutrition in schools.

Physical activity is being encouraged through the Safe and Sound Challenge which promotes opportunities to develop healthier ways of transport to schools, such as walking or safe cycle routes. A number of schemes have been set up to encourage children to take more exercise, for example, by promoting an hour’s exercise every day. Active children are likely to become active adults which will cut the risk of heart disease and stroke. For adults the Healthy Living Centres funded by £300 million lottery cash will encourage diet and nutrition classes. GPs are also prescribing exercise classes which are tailored to meet physical needs and abilities of those taking part. Through Healthy Living Centres this may be able to be extended.

In essence tackling the obesity problem means promoting greater awareness of its causes. The adverse health consequences should provide the foundation for preventive action. To be effective interventions to promote a healthy weight must begin in childhood and adolescence. Individuals can reduce their excess weight by a determined adoption of a low fat/high carbohydrate diet with plenty of fresh fruit and vegetables and by increasing habitual levels of activity.

The Weight of the Nation: Obesity in the UK was written by Dr Susan Jebb, Head of Nutrition and Health at the Medical Research Council Human Nutrition Research Centre in Cambridge. The research was carried out by The Gallup Organisation in March 1999. A total of 1,044 respondents of 16 years and older, representative of the population in the UK, were sampled. The Bread for Life campaign was launched by The Flour Advisory Bureau in 1992 to encourage people to eat more bread as part of a balanced healthy diet.