Obesity in the UK: Before Covid Obesity Was The Original Pandemic
Represented as the public health time-bomb of the 21st century, before Covid obesity was regarded as the true modern pandemic. There is a multitude of facts to support this assertion, and the figures only point toward an even grimmer future. According to the Royal College of Physicians/Faculty of Public Health, in the UK an estimated 70% of men and 63% of women in the UK are overweight or obese, and 31.1% of children are overweight. Cases of obesity in the UK have tripled over the last 20 years. If the current trends remain unchecked more than a billion people around the world will be obese by 2030 — double the number there was in 2010.
The original health crisis
The adverse health effects that come with being overweight include diabetes, strokes, heart attacks, and cancer. A study by the National Audit Office estimates that obesity costs the NHS at least £500m a year — and the wider economy more than £2bn a year in lost productivity. If the current rate of obesity grows as predicted, three-quarters of the population could suffer the ill effects of excess weight within 10 to 15 years, and the strain on the NHS and economy would be fundamentally unsustainable.
Health officials have long known of this time bomb. Dr Trisha Macnair, a specialist in nutrition and obesity, explained the severity of the situation.
“It is one of the greatest health challenges we face as a society especially as it affects every age group but particularly the young who will carry this burden and all its complications through their life. We are seeing it in every aspect of society from healthcare to the simple mechanics of how we live. It’s getting worse and we need to take action to reverse the trend. It’s costing us billions in medical care and likely to swamp the budget of the NHS because of problems such as diabetes, arthritis, heart disease, and all the consequences of reduced mobility, pressure ulcers and poor healing”.
This has caused considerable concern among government officials who realise the danger that obesity could potentially cause if current trends are not reversed or at least halted. However, their response has been perceived to be panicked and clumsy, their intelligence flawed and wrong. The obesity epidemic surges onward with an appetite unsuppressed.
The most peculiar aspect of this epidemic however is that we are saturated with an abundance of information that wasn’t available in generations past, our knowledge of exercise and nutrition has never been greater. However, studies have found that we consume fewer calories now than we did 30 years ago. But perplexingly since 1980, the UK’s obesity rates have almost tripled. This has thrown up several questions such as whether is it modern lifestyles that are to blame for these figures or the government policymakers who try to shape them. Perhaps more importantly, why have these policymakers been unable to find a solution to stop Britain from bursting at the seams?
Policy failures
The government has drafted in a variety of initiatives in an attempt to curb obesity. One of these was the “Call to Action” initiative. This initiative aimed to cut 5 billion calories, or 100 less each day, from the nation’s diet through the reformulation of products to make them less energy-dense, portion control, and actions to encourage consumers to choose these products through a responsible balance of promotional activity. The Department of Health (DoH) however was criticised by some such as Charlie Powell, campaigns director of the Children’s Food Campaign for a “woolly ‘call to action’ with no detail about how the calorie reduction ‘ambition’ will be achieved”. Many felt the government’s ambiguous advice simply amounted to telling people to eat less.
The DoH was also derided for its statistics and figures aimed at attempting to convey what five billion calories represented. “Five billion calories represent 16.9 million cheeseburgers, which would cover around 20 premiership football pitches. It also equates to 28,409,091 caffè lattes, which would fill four Olympic swimming pools.” However, figures such as this simply translate as incomprehensible numbers to the average person and do not convey the actual deficit of five billion calories.
More importantly, the use of averages in an attempt to combat obesity is always fundamentally flawed. Averages work with the best efficiency on issues that affect everyone, which is why anti-smoking campaigns generally work and have resulted in new laws coming into force. It is infinitely harder however to recommend broad sweeps of cuts of 100 calories which do not take into account a myriad of factors ranging from weight, height, and lifestyle.
Fat and BMI
Even the way of measuring obesity has come under scrutiny. All forecasts and measurements are taken under the Body Mass Index (BMI), calculated using age, height, and weight. It has come under criticism for being too simplistic and portraying inaccurate results. Dr. Matthew Capehorn is the Clinical Director of the National Obesity Forum and an advocate of BMI.
“BMI is an excellent and easy tool that we can use to know whether a patient’s weight is appropriate for their height.
In the huge majority of situations, it is extremely effective and a quick and easy way to identify those patients at risk of co-morbidities (i.e., the 50 or so medical conditions that are either caused by or worsened by, obesity).”
He conceded however the system is far from infallible, “because it is a ratio of weight to height then particularly lean and muscular people can give a false high result, and therefore reflection of risk (as muscle weighs more than fat).”
Admitting that BMI is far from perfect, he continued, “In many circumstances, waist circumference is a better indicator of risk, where a large waist has a high correlation with visceral fat (the more metabolically active dangerous type of fat).”
The visceral fat that Dr. Capehorn references is gaining more credence as the real cause of ill health. Visceral fat lies deeper in the body than subcutaneous fat (fat stored beneath the skin), surrounding vital organs like the heart and liver. Far from being stored passively, visceral fat produces chemicals and hormones that can interfere with the way our organs function. According to the Harvard Medical Guide visceral fat has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes. Given the uncertainty and unreliability around BMI, there have been calls for levels of visceral fat to be regarded as the new measurement of obesity.
The obvious way to combat visceral fat would be to lose it. This is harder than it seems however due to passive obesity, caused by an inherently sedentary society filled with jobs that involve a state of relative immobility, ease of commuting to these jobs, and easy access to a wide range of usually convenient and unhealthy foods.
Government approach
The current government’s approach to combating obesity has been viewed as trying to use libertarian paternalism, the idea that individuals should be persuaded into making beneficial choices for themselves without the need for implementation of laws or regulations. Considering the ever-tightening grip that obesity is holding over Britain, one of the success stories from this mentality was the implementation of the “traffic light signals” placed on packages of food, highlighting easily the good and bad ingredients.
The government has not escaped criticism, however. Dr Simon Griffin is the assistant director at MRC Epidemiology Unit of the Institute of Metabolic Science. He slated the governments’ effectiveness in tackling obesity;
“The new responsibility deal puts the purveyors of energy dense food in charge of the strategy to reduce consumption of energy dense food, this is unlikely to be effective as these companies have to appease shareholders and hence maintain profit margins.”
What Dr. Griffin references is how the government courted controversy when in 2010 the then Secretary of State for Health Andrew Lansley was criticised for a conflict of interest by pledging to work with the food industry and in effect putting companies such as McDonald’s, KFC and Mars at the epicentre of government policy-making by reaching an agreement where the companies would cut its usage of ingredients such as salt and trans fats in exchange for not legislating against them.
With government policies and initiatives still not making a dent in the obesity epidemic in Britain however, it remains to be seen how long the government will persevere with the nudging and persuading approach adopted, and how long it will take for it to be replaced by a two-handed shove.
Food tax: overbearing meddling or key to better health?
A radical approach would be to introduce a food tax, which targets products such as butter, milk, pizza, and meat with high levels of saturated fat, as Denmark has done.
However, not everyone agrees that a food tax is the way to go. Dr Capehorn explained;
“A food tax will not help or work in my personal opinion, for several reasons. No specific food group is to blame for obesity; it is more about the portion size/calorie content. Adding a tax to fatty foods does not prevent someone from having too many calories from sugary foods and vice-versa, or even too many calories from what is perceived as healthy foods.”
He elaborated further, “Vending machines add a levy onto the price of foods sold, and yet this does not show that a higher price will necessarily influence our spending/eating habits. If you are desperate for your chocolate bar “fix” then you pay the extra.”
Describing why he opposes a surcharge he said, “A tax will just penalise those on a low income, and discriminate against those of normal healthy weight, who like to have the occasional treat as part of a nutritionally balanced calorie controlled diet, who should not have to pay extra for this. Also, fundamentally, will it educate anyone?”
Dr Trisha Macnair fundamentally disagrees with this view and champions the idea of a food tax.
“People need to be “guided” by government out of their bad habits. I know this sounds paternalistic, but I think this has to be part of the state remit. In the USA people harp on about their human rights to eat badly and be obese but they pay their health bills — here in the UK where we have a national health service that funds people’s health care the public has a responsibility (never talked about) to look after their health and not place too many demands on the NHS through poor lifestyle choices.”
With no hesitation, she said, “The government should be taxing unhealthy food, radically changing school meals, teaching children to cook, and hugely changing school approach to exercise and support which is generally dismal”.
Dr Griffin however offered a different approach altogether.
He elaborated,” Taxing fat is problematic as it may be refined sugar rather than fat that is more to blame. This would be a particular problem if people cut down their fat due to higher prices consequent on taxation but replace it with sugar. Obvious places to start would be a sensible minimum unit price for alcohol and a tax on sugar-sweetened beverages which have no nutritional value and for which the substitutions are unlikely to be harmful. The evidence for both of these strategies is fairly good and, importantly, the likelihood of significant harms arising from these policies is low.”
The Danish implemented this surcharge on the basis that saturated fat is the main contributor to obesity. On this level, it can be seen why the government would think a food tax would make sense in two ways, in the sense that the added cost could deter consumers from unhealthy eating, or they would continue buying it regardless and the government could ring-fence the money raised and distribute it toward the cost of healthcare.
However, many medical professionals are becoming increasingly sceptical of the purported link between saturated fat and obesity. Dr. Capehorn staunchly believes this and bluntly says, “Saturated fat does not in itself cause obesity. “
“There is a great deal of evidence to suggest that saturated fat increases the risks of cardiovascular disease, but if you consume a diet high in saturated fat, but have fewer calories than your body needs, you will lose weight, even though that diet is bad for the risk to your cardiovascular health” he explained.
“Conversely, consuming too many calories of a very balanced diet will cause weight gain despite being considered “healthy”.
There are myths and mistakes made when talking about eating for weight loss (where as a general rule calories are more important) and eating “healthily” (which should take into account the macro- and micro-nutrient makeup of the food we eat).”
It appears the government is just as confused about how to tackle obesity as ever and their current methods of assessing obesity are bloated with myth, misconception, and gross oversimplification.
Dr Capehorn voiced his concerns, “Regrettably, despite the evidence (e.g., Foresight Report) and the acceptance of the problem by the government, they have not been doing enough to curb the problem. Although the Change4Life campaign is a fantastic public health campaign it is not enough. There is little, or no, evidence to suggest that preventative measures will help, and increasing evidence that more attention should focus on the treatment of those with a weight problem, as here we will improve the quality of life of patients and reduce the long-term costs and burden on the NHS and society.”
Dr Capehorn concluded with an ominous statistic, “The Government’s own Foresight Report (2007) showed that if current trends continue then by 2050, over 50% of the adult population will be obese and the direct and indirect costs of obesity will be as much as £50bn per year which will bankrupt the NHS.”
http://www.featuresexec.com/bulletin/interview_article.php?id=8155
http://www.streamingwell.com/matthew-capehorn-obesity-specialist-national-obesity-forum.html
http://www.mrc-epid.cam.ac.uk/People/simon.griffin.html
http://www.thelancet.com/series/obesity
http://www.dh.gov.uk/health/2012/04/obesityfacts/
http://www.bbc.co.uk/health/physical_health/conditions/obesity.shtml
http://news.bbc.co.uk/1/hi/programmes/if/3493238.stm
http://www.dh.gov.uk/health/category/policy-areas/public-health/obesity-healthy-living/
http://www.guardian.co.uk/politics/2011/oct/04/uk-obesity-tax-david-cameron
http://www.guardian.co.uk/society/2011/nov/16/obesity-advisory-group-disbanded
http://www.obesitymyths.com/myth1.4.htm
http://www.health.harvard.edu/fhg/updates/Abdominal-fat-and-what-to-do-about-it.shtml
http://www.keepufits.com/the-concept-of-passive-obesity.html
