Obesity is not inevitable: a personal view
Obesity is not inevitable for individuals or for countries, but neither is it easy to avoid or reverse it. The environment we all live in can often make it hard for all of us to consistently make healthy choices these days.
And that is why many of us today are carrying excess weight. Almost 7 out of 10 men, and 6 out of 10 women in England are overweight or living with obesity. Too many children are now obese before they reach school age and more become obese while they are at school – this is a tragedy – and the impact of obesity is even worse in disadvantaged groups and some ethnic minorities.
Living with obesity increases the risk of type 2 diabetes, many cancers, cardiovascular diseases, liver disease and respiratory diseases, and has other effects for example on joint and back pain and on mental health. Losing weight if you are living with obesity improves health – for example for people with pre-diabetes, losing one kilo reduces risk of diabetes by 16%. Weight loss of 5-10% lowers blood pressure and so reduces risk of heart disease.
Thirty years ago, it was different – something has changed – how has this happened?
Why do people become overweight and obese?
To put it simply, people become overweight because they eat and drink more calories than they need. Inactivity is important, but it is not the main problem. We mainly eat and drink what is made easily available and promoted to us in supermarkets, restaurants, pubs and takeaways.
Attractive high calorie food and drink has become much more widely available in the last three decades – over the years it has become cheaper in real terms and much more intensively advertised and promoted. That is very likely to be one of the main causes of the rise in obesity.
It has been a shock to the country that so many people have died in the UK from coronavirus – more than in other countries. We can all be affected by this new disease but, people living in deprived communities and those from ethnic minorities have suffered especially badly from coronavirus.
Overweight and obesity is one factor that explains why some people suffer more than others and is something that we can change.
Risk of a positive test and outcome of COVID-19 is worse according to weight. With a BMI of 35-40 risk of death from COVID-19 is up by 40% – with a BMI over 40 it almost doubles. In intensive care units, 8% of critically ill patients with COVID-19 were morbidly obese compared with 3% of the general population.
We can do better on obesity
We need to show that the UK can do better, and we can do better than this on obesity.
We especially want to do better for our children and for people living in deprived communities in our country – this is not just about caring for our own health.
Many of us have been motivated to do something about our health by coronavirus. Downloads of PHE’s physical activity app almost doubled during lockdown, but most people cannot control their weight on their own – help is needed.
Government has a central role to act to make the healthier choice the easier choice. That means substantially changing the way food and drink are advertised, promoted and sold across the board. Many of the policies that matter and will make an impact lie outside the health sector, so promoting a healthy weight is a whole of government issue.
We have a good track record in other areas of public health. Other countries envy what the UK has achieved on tobacco control and on salt reduction – it has required sustained policy effort in those areas over many years and we can do the same on obesity. It will not be easy, but it will be well worth it.
There is synergy with other policy drivers – safeguarding the environment and net zero carbon for example. Increasing physical activity also has other benefits.
The NHS can help significantly as a brand leader and by providing services, local government commissions health checks, and employers and civil society also need to play their part.
Weight management services and other individual level interventions are needed and do help those who receive them, but we need to do this together with other measures to change the underlying causes of the trend in overweight and obesity and to support people in maintaining a healthier weight.
That is why now is the right time to focus the nation’s mind on how they can reach and maintain a healthy weight with the Government supporting them in their weight loss, alongside introducing policies to make the healthier choice the easier choice. The public are likely to respond well now to a publicity campaign to raise the profile of obesity both in relation to COVID-19 and to general health.