The Epidemic of Obesity
189. Obesity is most commonly defined as a body mass
index (BMI) above 30 where the BMI is calculated by dividing an
individual's weight in kilogrammes by their height in metres.
Adopting the same calculation, an individual with a BMI in the
range 25 to 30 is generally classified as "overweight".[238]
According to a recent detailed analysis produced by the National
Audit Office (NAO) and agreed with the relevant Government departments,
Britain is experiencing a rapid and worrying increase in the extent
of obesity.
"In 1998, the year for which the most recent
figures are available, 19 per cent of adults were obese, with
a BMI over 30. More women than men were obese - 21 per cent of
women compared to 17 per cent of men. But more men than women
were in the overweight category (BMI between 25 and 30) - 46 per
cent compared to 32 per cent. Combining the overweight and obese
groups, in 1998 nearly two thirds of men and just over half of
women were either obese or overweight."[239]
This in itself we find most disturbing but what makes
the figures particularly stark is the extraordinary rate of increase
over the last two decades. In the words of the same NAO report,
"The prevalence of obesity in England has almost tripled
since 1980 and will increase further on present trends",
and obesity is increasing more rapidly in England than in other
parts of Europe.[240]
190. More worrying still is the huge increase in
obesity amongst children. Data from a recent representative sample
of 2630 English children showed that the frequency of overweight
children ranged from 22% at age 6 years to 31% at age 15 years.[241]
Another study by the same authors has suggested that the number
of obese six year olds has doubled in the last ten years and the
number of obese 15 year olds has more than trebled.[242]
Fewer than 20% of 2-15 year olds eat fruit and vegetables more
than once per day and the typical diet of children and adolescents
is rich in fat, sugar and salt. Again there is a link between
social class and diet: "Among boys and girls aged 2-15 there
is a decrease from social classes I/II to IV/V and from higher
to lower income households in the proportion consuming fruit and
vegetables with a related increase in the proportion consuming
sweet foods, soft drinks crisps and chips".[243]
191. Diet is one key determinant in the rise of obesity
in youngsters: another is a decline in the amount of physical
exercise. In May 2000 the British Heart Foundation published an
analysis of physical activity in children. This found that schools
in England allocated less time to PE than anywhere else in the
EU according to the last survey which was conducted in 1994.[244]
Since then things have deteriorated: the percentage of children
spending two or more hours per week on PE has fallen from 46%
to 33%. In many EU countries, such as Austria, Norway, Portugal,
Spain and Switzerland the average time spent is 3.5 hours and
in France and Germany it is three hours. This is part of a general
trend towards sedentary rather than active behaviour amongst the
population aged five to 18. Between 1986 and 1996 the proportion
of 17 year olds walking to school fell from 59% to 49%. Only 1%
of children now cycle to school, whilst the number of children
travelling by car has doubled in the last 20 years. Active play
amongst children is being superseded by time spent watching television
or playing computer games. Nearly three quarters of 11-16 year
olds watch television for two hours a day and 10% of children
spend the same amount of time on the computer. The Yorkshire
Post recently ran a campaign "A Sporting Chance"
to draw attention to the decline of sport in schools. Amongst
the evidence they recorded was that:
- a third of primary schools have reduced the time
for PE during the last school year
- some 95% of primary schools have no full-time
PE specialist
- children spend twice as much time watching television
and playing computer games as they do in playing sport or otherwise
taking exercise.
They contacted 400 teachers in Yorkshire to ascertain
their views on the state of sport in school and found that 55%
of respondents were either "pessimistic" or "very
pessimistic". Moreover 88% said that pressure on the curriculum
time arising from the emphasis on maths and English was "a
major factor" in the decline of school sports.[245]
192. The situation amongst adults is also bleak.
A 1990 survey jointly conducted by the GB Sports Council and Health
Education Authority found that the activity levels at that time
recommended by the then HEA were not being met by seven out of
10 men and eight out of 10 women.
193. Health inequalities are mirrored in inequalities
in access to, and take up of, active leisure. In a recent article,
Professor Sally McIntyre has suggested that facilities encouraging
healthy lives are poorer in places where people are poorer, a
process she describes as "deprivation amplification".[246]
In addition, fewer residents have access to cars and public transport
in less affluent areas, so accessing sporting activities becomes
a less attractive option. In analysing the demographic distribution
of obesity the NAO found that obesity was higher in lower socio-economic
groups: 14% of women in Social Class I were classified as obese
against 28% in Social Class V.[247]
Obesity was also more prevalent in certain ethnic groups such
as Black Caribbean and Pakistani women.[248]
194. The consequences of the decline in physical
activity and increase in obesity are alarming. The NAO notes:
"Obesity is an important risk factor for a number
of chronic diseases that constitute the principal causes of death
in England, including heart disease, stroke and some cancers.
It also contributes to other serious life shortening conditions
such as Type 2 diabetes. As well as physical symptoms, the psychological
and social burdens of obesity can be significant: social stigma,
low self esteem, reduced mobility and a generally poorer quality
of life are common experiences for many obese people."[249]
The NAO estimates that over 30,000 deaths were attributable
to obesity in 1998, that the treatment of obesity cost the NHS
at least £500 million in that year, and that the indirect
costs of obesity in terms of lost output in the economy due to
sickness or death of workers is around £2 billion a year
at present and likely to rise to £3 billion by 2010.[250]
195. The White Paper Saving Lives describes
physical activity as "one of the key determinants of good
health".[251]
Summing up the available research the Acheson Report on Health
Inequalities concluded that:
"Increased physical activity is associated with
lower overall mortality rates and decreased risks of mortality
from cardiovascular disease, colon cancer and non-insulin dependent
diabetes mellitus. Regular physical activity prevents or delays
the development of hypertension ... Physical activity also relieves
the symptoms of depression and anxiety and is important in the
prevention of osteoporosis."[252]
The Sports Minister cited evidence to suggest that
"an active child is ten times more likely to be an active
adult"[253]
thus radically reducing the risk of chronic diseases of adulthood.[254]
Research has amply demonstrated that physical fitness in children
has benefits beyond the purely physiological: it reduces stress
and anxiety, promotes optimal development and enhances self-esteem.[255]
Mr Bob Laventure of the British Heart Foundation suggested that
the benefits of physical activity were not confined to children
and young adults. Whilst the ageing process inevitably involved
a decline in functional capacity he told us there was "a
vast amount of evidence ... that physical activity can play a
major part in either slowing that decline, or even, with types
of programmes, reversing the decline".[256]
As well as the physiological benefits, such as decrease in the
risk of falls, there were the psycho-social benefits arising from
greater independence to elderly people as a consequence of higher
levels of mobility.
196. The memorandum from Sport England argued that
sport could yield even wider benefits: they reported an OFSTED
finding that schools "which take sport seriously generate
faster-than-average improvements in academic results". They
also noted that employers have found that employees taking regular
exercise have less time off in sickness leave. A US study suggested
that inactive members of the community incurred medical costs
30% higher than for those leading active lives.[257]
197. Saving Lives described the "marked
growth in the number of people taking part in sport as a significant
feature of life for many people now".[258]
Perhaps the vagueness in this sentence is significant, because
it appears to be contradicted by other evidence. Sport England
pointed to a "number of different surveys, conducted over
the last ten years" which suggest that British people lead
"increasingly sedentary lives".[259]
198. We wanted to establish what the Government was
doing about the major threat to public health posted by obesity
and sedentary lifestyles amongst children and adults. In particular
we wanted to establish the extent to which Government was co-ordinating
its efforts in seeing sport and exercise as part of the health
agenda. We asked if DCMS had had an involvement in drawing up
the Mental Health White Paper or the moves towards Primary Care
Trusts. Mr Harry Reeves, Head of the Sport and Recreation Division,
DCMS, conceded that on these specific issues DCMS's involvement
was "very small".[260]
He felt that his Department had in the past been good at identifying
areas where their work directly cut across that of another Department
(for example, anti-doping in sport) but less good in areas where
the connection was more indirect. He did, however, suggest that
work was in progress to improve the connection. The Sports Minister
herself conceded that co-ordination between Health and Sport had
not always been optimised. She noted that her Department had a
shared adviser with the DfEE which had greatly improved inter-departmental
co-ordination. She felt that there might be merit in a similar
appointment to co-ordinate DCMS and DoH. We agree with this principle
and would indeed go further. We note how in countries such
as Cuba and Australia the sporting agenda is seen as part of a
much wider health and regeneration agenda. We believe that better
liaison is essential between all Government departments-notably
DCMS, DfEE, DETR and DoH-if this is to be achieved. Accordingly
we recommend that the Government appoints advisers specifically
to co-ordinate the work of all Government departments to deliver
the sport and health agenda as a matter of urgency.
199. We also wanted to establish whether DCMS itself
was an appropriate location for the sport function in central
Government. Throughout the EU sport finds itself in an extremely
wide range of different departments, as the following table indicates:
