House of Commons - Health - Written Evidence

Select Committee on Health Written Evidence

APPENDIX 52

Memorandum by International Obesity TaskForce (OB 115)

SEEKING BOLD SOLUTIONS FOR BRITAIN'S RUNAWAY OB ESITY EPIDEMIC

Britain is approaching a critical turning point in the runaway epidemic of obesity. The whole of society faces an unprecedented dilemma as the majority of the population and an increasing proportion of young people are exposed to the multiple health disadvantages that accompany sustained overweight and obesity.

Concern about those chronic diseases induced by poor diet and inactivity, including obesity, can no longer be confined to health ministries; all sectors of government, industry and civil society must face the challenge to work together in devising and implementing the bold solutions required if Britain's obesity epidemic—and its consequential burden of diseases—are to be addressed.

The pressures of sedentary living, often imposed on both adults and children by the dominance of motor cars with unsafe environments or simply by the lure of leisurely inactivities, can only be managed if the importance of a healthy "food ecology" is fully recognised and novel approaches devised to combine better nutritional standards with greater activity as a routine essential of everyday living.

Architectural design and town planning policies, public transport networks, traffic management and road safety, community policing and safer streets, municipal provision of green spaces and recreational areas, all need to be re-thought and improved if a lasting solution is to be found. One of the greatest challenges is to transform the daily diet of millions of people by ensuring the provision of healthier food—whether in schools, workplaces, restaurants, supermarkets and shopping centres as well as in the home. Improving the nutritional quality of foods and beverages is an imperative worldwide: the solution to the excess consumption of high fat, high sugar and high salt products rests largely with those who make and sell them. Global manufacturing and marketing strategies to promote increased sales and consumption currently overwhelm the efforts of most individuals to improve their health and should be refocused on genuinely contributing to better dietary health.

The oversupply, intensive marketing and low price policies for foods high in fat, sugar or salt, stimulated by inappropriate agricultural subsidies over decades, can lead to both immediate and latent health problems for which both individuals and society already pay a high price. The tax burden due to diet-induced ill health is now estimated to amount to more than £15 billion each year[161]

Therefore the search for strategies that work must include a significant change of heart from food manufacturers and retailers to respond to the growing demand for better food options. Consumers should no longer be obliged to pay a "health premium" to avoid products that contribute to diet-related diseases; instead the food and drinks sector should target a mass-market for healthier choices to ensure that these are made affordable and available to everyone.

The scale of the epidemic

The prevalence of obesity in adults has risen so rapidly that it affects three times more people than it did 20 years ago. Overweight and obesity together affects two thirds of the adult male and more than half the adult female population.[162]

Childhood obesity is rising twice as fast. According to recent government figures nearly 16% of children between the age of 6 to 15 can be defined as obese—three times as many as 10 years earlier.[163] As a consequence, obesity rates among younger adults have also risen dramatically in the past decade. Obesity among young women under 25 increased and even more among young men during the 1990s. By 2001 more than one in 12 women and one in 10 men under 25 were obese.[164] The more socially disadvantaged in Britain are at greater risk with a stark differential between the so-called unskilled and professional groups. Unskilled women are twice as likely to be obese as their professional counterparts and the differential is almost as great between men.[165]

In the Asian communities escalating diabetes and heart disease occur at ever younger ages because of their sensitivity to even modest increases in weight.[166] There is evidence to suggest death rates from heart disease and cancer for Asian immigrants increase progressively for each year they live in England.[167]

The National Audit Office's forecast of one in four adults becoming obese by 2010 underestimated the pace of change.[168] By 2001 roughly a quarter of men age 35-75 were already obese while the obesity rate in women varied from 22% of those age 35-5 to 27-0% in the higher age categories up to age 75. Among ethnic subgroups, 26% of Pakistani women and 32% of Black Caribbean women over the age of 16 were found to be obese in 1999.[169] By 2001 the level of morbid obesity—the very severe form above BMI 40 that is a threshold for surgical intervention—almost doubled during the preceding decade so that one in 10 obese women are now candidates for surgery.[170]

2020 vision

Looking ahead, the IOTF's universal standard for assessing overweight and obesity in children and adolescents shows a firmly embedded upward trend over several decades in Britain.[171] New data extend Chinn and Rona's original analysis and show that 17% of boys and 23.6% of girls in the 7-11 age group were overweight or obese in 1998[172][173] On the basis of conservative estimates we can predict that 23.5% of boys and 32% of girls are likely to be overweight or obese using IOTF definitions by 2020 if current government policies remain unchanged[174] Recent evidence suggests the acceleraing upward trend is accelerating so that obesity rates could well be even higher. A further major increase adult obesity is foreshadowed on a similar basis. Current UK obesity trends imply that 34% of men and 38% of women will be obese by 2020. This range is seen already seen in North American sub-populations, where 40% of Mexican American women and 50% of Black American women have a BMI of 30 or more.

Wider definitions

The significance of obesity as a disease and causal factor for other diseases is now recognised globally following the 1997 WHO expert consultation on obesity[175] However the higher risk of abdominal obesity linked to the cluster of risk factors including elevated triglycerides, low density cholesterol, blood pressure and fasting glucose levels, now defined as the metabolic syndrome, reveals a far wider section of the population is at risk. A recent analysis by the US Centers for Disease Control estimated that one million youngsters age 12-19, or 4.2% of all teenagers, are already affected by the metabolic syndrome. The syndrome was found among 28.7% of obese adolescents and 6.8% of those classified as overweight but not obese. It was almost non-existent among those deemed to be of normal weight.[176] If these proportions were applicable to the UK teenage population, it would imply that almost one in 20 adolescents in Britain may have undiagnosed metabolic syndrome and therefore be on a fast track towards developing type 2 diabetes or early heart disease.

TOWARDS STRATEGIES THAT WORK

There is a need for urgent action which cannot simply be based on the idea of small changes in current policies because of the seemingly irreversible nature of obesity. The alternative is of a world of increasing obesity, with an exponential growth in type 2 diabetes, heart disease and some forms of cancer. A new generation is inheriting a legacy of high fat, sugar and salt diets, and is therefore set on a path with a reduced life expectancy: some may even be outlived by their parents. One of the immediate and fundamental actions that can be adopted in Britain is to demonstrate to other governments their commitment to a coherent action plan as well as supporting the recommendations of the World Health Organization `916' expert report on diet, nutrition and the prevention of chronic diseases[177] and WHO in its development of a global strategy for action[178]

Bold solutions are needed to avert this public health disaster, while at the same time addressing the needs of the majority of people, who have already become overweight. Delivering successful strategies means reshaping the world of food for everyone—not just for the obese, and putting people, not motor cars, first in the transformation of our towns and cities. We are already late in taking up the biggest public health challenge of the 21st century.