Obesity is when a person is carrying too much body fat for their height and sex. The most widely used way to measure this is the body mass index (BMI) – weight in kilograms divided by height in metres squared.
A BMI of:
25 – 29.9 is classed as overweight30 – 39.9 is classed as obeseOver 40 is very (morbidly) obese.
What are the impacts?
Obesity is a major public health concern. Obesity affects the ability of an individual to participate in everyday activities as well as having both short term and long term impacts on health.
It can cause breathlessness, difficulty sleeping, feeling tired, back and joint pain. Some people may also experience psychological problems such as low self-esteem, poor self-image, low confidence levels, which may lead to depression. As a result obesity can impair a person’s wellbeing and quality of life.
Longer term health problems include coronary heart disease and stroke which are more common in obesity as a result of high blood pressure and a greater risk of high cholesterol which leads to narrowing of the arteries. People who are obese are also more likely to develop type two diabetes and some types of cancer, such as that of the breast and colon.
The health care costs associated with treating obesity are high and increasing and show that maintaining a healthy weight and preventing obesity has benefits for both the individual and the health service.
What is the scale of the problem?
Obesity is a result of an energy imbalance; this occurs when the energy consumed from food does not equal the energy expended to keep the body working properly and through taking part in physical activity. A poor diet and a sedentary lifestyle are the main causes of overweight and obesity.
The 2009 Welsh Health Survey showed that 57 per cent of adults were classified as overweight or obese, including 21 per cent obese. Less data are available about the prevalence of obesity in children; however data from the survey of Health Behaviour in School age Children (HBSC) in Wales, suggests that in the 13 year old age group, 18 per cent of boys and 17 per cent of girls are overweight or obese.
Obesity is steadily increasing, and has been described as a worldwide epidemic. The UK Government’s Foresight programme produced a report in October 2007 considering how society might deliver a sustainable response to obesity in the UK over the next 40 years. The report shows that nearly 60 per cent of the UK population could be obese by 2050 with the socially and economically disadvantaged and some ethnic minorities being more vulnerable.
What can you do?
The best way to prevent becoming overweight, or obese, is by eating healthily and exercising regularly. More detailed information is available from the NHS Choices website.
Evidence based guidelines for the management of obesity were published by NICE (National Institute for Health and Clinical Excellence) in 2006.
What is being done to manage the impact?
Although obesity is caused by a simple energy imbalance the reason behind food choices and uptake of physical activity are complex and is linked to biological predisposition, the supply and availability of food, advertising, changing work and living conditions including increased use of machinery and government policies.
Obesity is a public health priority for Governments at all levels in order to provide a co-ordinated approached. At a European level a Strategy on Nutrition, Overweight and Obesity related Health Issues (European Commission, 2007) and the European Obesity Charter (World Health Organisation, 2006) has been developed. Reducing unhealthy eating, increasing participation rates in physical activity and reducing obesity are priorities for public health policies, strategies and action plans in Wales. Locally, the development of Health, Social Care and Well-being Strategies and Children and Young People Plans are an opportunity for Health Boards and Local Authorities to work closely together to create a comprehensive and community-wide approach to managing these issues, covering both prevention approaches and access to treatment for those who need it.
The Welsh Assembly Government has produced an obesity pathway which is a tool for Health Boards, working jointly with Local Authorities and other key stakeholders, to map local policies, services and activity for both children and adults against four tiers of intervention and to identify any gaps. The Obesity Pathway has four tiers and describes minimum service requirements and best practice.
The four tiers are:
Level 1: Community based prevention and early intervention (self care)
Level 2: Community and primary care weight management services
Level 3: Specialist multi disciplinary team weight management services
Level 4: Specialist medical and surgical services.
Community based prevention activities include all initiatives to promote healthy eating, physical activity and the maintenance of a healthy body weight throughout the lifecycle such as in schools or for the workforce. Examples include:
- Change4Life the social marketing programme designed to help families make changes to their lifestyles, so that they can eat well, move more and live longer
- Planning policy to support physical activity and healthy eating - including active travel planning, consideration of green spaces and availability of land for growing food and number and location of fast food outlets
- Community based cookery clubs in disadvantaged communities
- Schools adopting Appetite for Life recommendation and developing and implementing a food and fitness policy
- School nurses measuring and monitoring the weight and height of school children.
Community and primary care weight management services include the availability of a range of services for children, young people and adults who wish to lose weight.
- Mind, Exercise, Nutrition, Do it! A weight management programme for children aged 7 -13 and their families which is available in all local authorities in Wales.
- The National Exercise Referral Scheme which is a 16 week programme that enables sedentary people with a medical condition to become engaged in structured physical activity opportunities supervised by a qualified exercise professional.
- Identification of overweight and obesity as part of health checks in primary care.
Specialist multi-disciplinary team weight management services are those that provide more specialist interventions including dietary, physical activity and behavioural components and are delivered both through primary and secondary care, and they can be combined with drug therapy.
Specialist medical and surgical services include access to bariatric surgery for those that have failed to achieve weight loss.
Public Health Wales:
- provides specialist public health advice about obesity to the Welsh Assembly Government in their development of programmes and policies;
- gathers information and evidence to monitor trends in obesity and obesity related health in Wales, such as the national Child Measurement Programme for Wales for primary school children;
- reviews and disseminates evidence of effective action to prevent and treat obesity;
- manages the Physical Activity and Nutrition Networks Wales. The Network recognises that many different professionals and sectors have a role to play in improving the nutrition and physical activity levels of the people of Wales. It supports members by providing and improving access to information and by providing a forum for sharing knowledge and good practice, enabling members to learn from each other. As part of this Network a website PlanET Health Cymru (Planning for the Environment, Transport and Health in Wales) has been set up aimed at improving joint working between health professionals and planners;
- through specialist local public health teams, support is provided to local authorities and health boards to develop assess local needs, develop evidence based local strategies and plans to address obesity and stimulate local action in the form of local projects and programmes;
- supports the Welsh Network of Healthy Schools Schemes which promotes the development of a health promoting school;
- supports workplace health issues through promoting and assisting organisations interested in the Corporate Health Standard and the Small Workplace Award.