PUBLIC HEALTH
OBESITY UPDATE: WHERE ARE WE NOW? Emma Berry Associate Nutritionist, Freelance
Emma is working in NHS Research and Development and is a freelance nutrition writer.
REFERENCES For full article references please CLICK HERE . . .
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The obesity epidemic has been well documented for many years. The World Health Organisation’s (WHO) report documenting the substantial rise in obesity and setting in place a strategy for prevention, was published almost two decades ago.1 This article looks to review the differences in the levels of obesity found within the UK since the report and discusses the most recent policies in place to tackle obesity. The WHO report1 outlined that the level of obesity was rising at a staggering rate. This rise in level of overweight and obese individuals has also seen an increase in related health issues, such as cardiovascular diseases and various forms of cancer. The WHO report put forward a strategy for preventing a further rise in obesity levels and managing the current high levels found globally. Obesity has been defined as a high level of adipose tissue which has a negative impact on an individual’s health. There are many ways to determine obesity of an individual or population, these include body mass index (BMI kg/m2), skinfold measurements, waist circumference and waist:hip ratio, many of which are further broken down into various obesity classifications.1 Whilst the definition of obesity has not changed drastically over time, the ways in which adipose tissue can be measured have become more advanced. Determining body composition is now possible through the use of methods such as Air-Displacement-Plethysmography, Dual-Energy X-ray Absorptiometry, Bioelectrical impedance analysis and more.2,3 Whilst these methods are not used for population measures of obesity but are generally used for academic
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studies, it is important to note how advanced technology has become and how these can increase the precision of body composition measures. The most common way of determining obesity at a population level, is through using BMI (kg/m2). Being defined as clinically obese is when an adult individual’s BMI is over 30kg/m2.4 When the WHO report was released in 2000, 21.5% of adult men and 21.8% of adult women were classified as obese in England.5 In Scotland, 22% of adult men and 26% of adult women were found to be obese in 2003.6 The most recent figures have demonstrated that obesity rates have increased, with 27% of men and women now classified as obese.4 In Scotland, obesity is also rising steadily with 29% of men and women now classified as obese, based on findings of the 2016 Scottish Health Survey.7 Although the adult level of obesity looks to still be increasing, childhood obesity seems to be holding steady. In England, 9% of children in Reception year were classified as at risk of being obese in 2015/2016, compared to 10% in 2006/2007. 20% of children in Year 6 were at risk of being obese in 2015/16, which is slightly higher than the 17% who were identified as being ‘at risk’ in 2006/07. However, it is believed that
this figures from 2006/2007 were underestimated due to a poor level of participation.8 In Scotland, childhood obesity has remained around the same level for the last decade. In 2015/16, 10% of children in Scotland's Primary 1 school year were at risk of obesity, with the same figure having been recorded in 2006/07.9 Unfortunately, there are no recent statistics for older children in Scotland alone that would allow us to determine if this age group is also remaining steady for obesity figures. However, overall for ages 2-15 in Scotland, the percentage of children at risk of obesity is 14%, which is the lowest recorded figure since 1998.7 FUTURE PLANS TO TACKLE OBESITY
In 2016, the UK government published guidance on how they plan to table and reduce childhood obesity.10 This guidance outlines their plans over the coming years to make a long-term sustainable change through engaging individuals, food and drink industries and communities to become healthier. Their action plan includes encouraging industry reformulation to reduce the sugar content in all foods and drinks by 20%, by means of the sugar sweetened beverage tax. They will also be recommitting to the Healthy Start Scheme to ensure that all families with low income have access to nutritious food. Food and drink industries are also being encouraged to develop new, healthier products for consumption and to work with the UK Government to make nutrient labels easier to understand for individuals. They are also aiming to help healthcare professionals in encouraging healthy lifestyles with family and children. The Department of Health will also be working with Public Health England to ensure that healthy options will be made easily available in all public sector locations. Furthermore, the UK Government will be looking to repeat the success of the Change4life Sugar Smart app by encouraging the development of new technology which could encourage healthier decisions in individuals. In so doing, they hope that the development of this new technology will produce innovative solutions for tackling childhood obesity. They have outlined a number of aims which specifically target primary schools. These include
encouraging all children to do 60 minutes of physical activity every day, whilst aiming to improve sport and activity programmes in schools. They will also be looking to create a healthy rating scheme for primary schools and to make school food healthier. As well targeting children in primary schools, they are looking to support children in early years’ settings in receiving healthy food through developing revised menus and encouraging these children to meet the physical activity guidelines through an update of the Early Years Foundation Stage Framework. On the 26th of October 2017, the Scottish Government opened a consultation on the proposed actions laid out in the consultation document A Healthier Future - Action and Ambitions on Diet, Activity and Healthy Weight.11 The document outlined a range of proposed actions which could be taken to improve the level of obesity in Scotland. These proposals include limiting the marketing and advertisement of unhealthy foods, supporting preventative measures for families, encouraging the reformulation of food and drinks and working with various groups to encourage local support and create more opportunities for healthy lifestyles. The consultation allowed individuals to comment on the proposed plans and suggest new ideas to help encourage an innovative plan to tackle the obesity problem. This consultation closed at the end of January and results will be published in a report. CLINICAL TREATMENT FOR OBESITY
Although many of the new UK policies outlined look to encourage families and children to pursue healthier lifestyles. The UK adult level of obesity is still seen to be increasing. One method of helping individuals to reduce their body weight is through bariatric surgery.4 The UK currently has a four-tier system in place to treat clinical obesity (shown in Figure 1 overleaf). Bariatric surgery is the final tier, taken when all other options have not been successful.12 There are various different types of bariatric surgery performed within the UK, the most commonly of which being gastric band, gastric bypass and sleeve gastrectomy.13 www.NHDmag.com February 2018 - Issue 131
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PUBLIC HEALTH Figure 1: Tiers of weight management for clinical management and treatment12
The number of individuals who have undergone this procedure has steadily increased in recent years. In 2006-2007, 1,951 bariatric procedures took place in England, which rose to 6,384 procedures in 2013/14. However, the figure in 2014/15 appeared to drop slightly to 6,032.4 Although this drop suggests that there is a reduced number of individuals undergoing bariatric procedures, there may be various factors for this; the most recent figures have not been released to determine if there has been a continuation in this trend. Although these treatments have grown in popularity over the last decade, there are often long-term side effects due to the patient’s reduced ability to consume a normal diet. Often these individuals can suffer from various nutritional deficiencies and complications, such as Dumping Syndrome.14 Nutritional deficiencies often include iron, thiamine, vitamin E and copper, but many others can also appear. Nutritional deficiencies which present in postoperative care often depend on the type of surgery performed.14 As the number of people within the UK classified as morbidly obese (BMI of 40 and above) increases, there is a chance that requirement for these procedures could increase 10
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further.4 Therefore, it is important to ensure that these individuals can remain healthy after undergoing bariatric procedures, to reduce the risks of complications and to avoid adding additional costs to the already cash-strapped NHS. Further research is required to ensure that the post-operative care is optimal. CONCLUSION
Obesity is still a serious problem within the UK. Although the obesity epidemic has been documented for many years, the level of adult obesity is still growing within both Scotland and England. However, improvement is starting to be seen in the level of childhood obesity. Future policies look set to attempt to further reduce the obesity levels, targeting mainly children and families, whilst further encouraging a healthy environment for everyone. However, whilst the encouragement of healthier lifestyles may help to reduce the level of obesity seen within the population, the use of bariatric surgery may become more popular as a treatment for individuals. Although this could help many individuals, the long-term effects and bariatric diet requires further research to ensure these individuals remain healthy after surgery.
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