APPENDIX 35
Memorandum by the Royal College of Nursing
of the United Kingdom (OB 62)
TERMS OF
REFERENCE OF
THE INQUIRY
The Committee will consider:
— The health implications of obesity.
— What are the causes of the rise in
obesity in recent decades.
— What can be done about it?
— Are the institutional structures
in place to deliver an improvement?
— Recommendations for national and
local strategy.
INTRODUCTION
The Royal College of Nursing (RCN) is the UK's
largest professional association and trade union for nurses, with
over 355,000 members. Most RCN members work in the NHS, with around
a quarter in the independent sector. The RCN works locally, nationally
and internationally to promote standards of care and the interests
of patients and nurses, and of nursing as a profession. The RCN
is a major contributor to the development of nursing practice,
standards of care and health policy.
The RCN has over 100 professional nursing forums,
including a health visitors and public health forum, practice
nurses association, district nurses forum, adolescent health forum,
community children's nurses forum, school nurses forum and diabetes
nursing forum.
THE HEALTH
IMPLICATIONS OF
OBESITY
Obesity is a factor contributing to the development
of over 30 diseases or conditions including musculoskeletal problems,
diabetes, cardiovascular and pulmonary complications and cancer.
Obesity is linked to an increased risk of cancer at certain sites
including colon, breast (in post menopausal women), endometrium,
oesophagus and kidney[156]
Obesity in adolescence is associated with increased morbidity
and mortality, independent of adult weight. In 2000 the first
children in the UK were diagnosed with type 2 diabetes. All were
overweight girls, aged nine to 16[157]
TRENDS IN
OBESITY
The prevalence of overweight and obesity is
increasing world-wide and is now a major problem in both developing
and developed countries. In many developing countries, obesity
coexists with under-nutrition whilst in developed countries, the
over consumption of foods which are high in fat and calories combined
with lack of physical activity are considered to be major causal
factors. The rise in the prevalence of clinical obesity in the
UK has been widely publicised with a doubling of the number of
people with body mass index (BMI) of greater than 30kg per square
metre over a 10 year period. Figures from the Health Survey for
England demonstrate that clinical obesity is 13% for men and 17%
for women. Almost half of Scottish adults have been identified
as being overweight with 16% clinical obesity in men and 17% in
women. In Wales 52% of the population were assessed as either
overweight or obese. In Northern Ireland the Health and Social
Wellbeing Survey 1997 estimated that 63% of men and 50% of women
were overweight or obese[158].
Evidence has shown that higher levels of obesity occur among the
most deprived groups. There is growing evidence that increasing
numbers of children are suffering from obesity. A recent study
suggested a quarter of six year olds are overweight and 10% obese;
and that a third of 15 year olds are overweight, with 17% obese[159]
http://www.wales.gov.uk/keypubstatisticsforwales;
Health Education Board for Scotland (Hebs) 2001 Community Development
Approaches in Primary Care: Options for Obesity Management http://www.hebs.scot.nhs.uk/services/pubs
WHAT ARE
THE CAUSES
OF THE
RISE IN
OBESITY IN
RECENT DECADES?
Research has provided a greater understanding
of obesity as a chronic complex of interactions between genetic,
metabolic, behavioural, psychological and environmental factors.
The tendency towards obesity is fostered by lack of physical activity
and high calorie, often low-cost foods. Easily accessible and
relatively cheap fast foods are also considered to contribute
to obesity. Unhealthy diet and lifestyle is often linked to poverty
and many studies have drawn links between poverty and obesity[160]
WHAT CAN
BE DONE
ABOUT IT?
Nurses, midwives and health visitors are well
placed to offer advice and information to individuals on how to
adopt a healthy lifestyle. They also play an important role in
public health initiatives which aim to confront all health issues
including obesity and other eating disorders. The prevention of
obesity is crucial and working with children is key to achieving
long term success. School nurses are an important resource in
terms of working with the school population so that attention
can be paid to healthy eating and increased activity. Helping
families and communities to live a healthier lifestyle requires
a community development approach and success can be difficult
and slow.
The public health teams within primary care
trusts must integrate with primary health care so that the complex
causes of obesity can be addressed through a co-ordinated and
comprehensive approach. The current smoking cessation campaign
is proving to be effective, showing that people can be helped
to change some fundamental aspects of their lives. A campaign
aimed at confronting obesity is essential to the nation's future
health status and the RCN would be keen to work with the government
on this.
In order to tackle obesity the Government needs
to pay attention to:
— Access to healthy low-cost food,
perhaps looking at expanding schemes similar to the school fruit
scheme.
— Increasing levels of physical activity—particularly
within schools.
— Increasing knowledge of nutrition
and cooking within schools.
ARE THE
INSTITUTIONAL STRUCTURES
IN PLACE
TO DELIVER
AN IMPROVEMENT?
A campaign aimed at reducing obesity needs to
have a national focus, but people will need the freedom to implement
strategies locally which are sensitive to their community. An
example of good practice is the Surestart programme in Bradford
which includes a dietician who specialises in traditional Asian
diets. Increasing the number of nurses, health visitors and midwives
would help to achieve success.
April 2003
156 Bianchini, F et al (2002) Overweight, Obesity
and Cancer Risk Lancet Oncology. 3; 565-574. Back
157
Drake et al (2002) Type 2 diabetes in obese white children
Archives of disease in childhood 86,3, 2007-2008. Back
158
Department of Health (England) Health Survey for England
http://www.doh.gov.uk/publications; Northern Ireland DHSS Health
and Social Care in Northern Ireland: A Statistical Profile
http://www.dhsspsni.gov.uk/publications/2002; Scottish Intercollegiate
Guidelines Network (SIGN) Obesity in Scotland; Wales Government
Health Statistics. Back
159
Reilly J, Dorosty A (1999) Epidemic of obesity in UK children
Lancet 354, 9193, 1874-1875. Back
160
For example, Dr R Stanwell-Smith (2003) Poverty and Health Health
and Hygiene. Back
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