On the principle that even a broken clock is right twice a day I accept that Johnson is at least getting it right about the dangers to the nation’s health and wealth caused by obesity. His damascene conversion has been caused by the fact that as a seriously obese and unhealthy person he nearly died from the coronavirus when a healthier slimmer man than he might just have been mildly ill. Just 7 months ago he declared war on so-called sin taxes now it looks as if he will be promoting them!
The results of the Health Survey for England 2018 indicate that:
- Almost three out of 10 people are obese
- Obesity prevalence continues to rise, particularly among women.
- Women and men living in the most deprived areas are more likely to be obese than those living in the least deprived areas.
Adults are classed as obese if their body mass index (BMI) is 30kg/m² or more. A BMI of 25 or more is classed as overweight.
High waist circumference is an independent predictor of future obesity-related conditions, including type 2 diabetes, hypertension, and heart disease.
The prevalence of very high waist circumference is much higher among women than men. Both sexes have seen a large increase since 1993.
Being overweight or obese is linked to a wide range of diseases including type 2 diabetes, hypertension, some cancers, heart disease, stroke, liver disease and musculoskeletal conditions
Obesity can also be associated with poor psychological and emotional health, and poor sleep.
Since 2007, there has been an upward trend in adult obesity and it has been rising faster than previously forecasted. If this rise continues, then between 26.6 per cent and 33.9 per cent of adults could be obese by 2024, although rates could rise further as childhood obesity has not declined in recent years.
The prevalence of severe obesity, defined as a body mass index (BMI) of 40kg/m² or more, has increased over the last three decades for both men and women. Overall, a very small proportion of the population are severely obese but the rise in prevalence has been substantial since 1993-1995; a seven-fold increase for men and a 2.9-fold increase for women. Severe obesity prevalence is much higher for women than men.
The really sad thing is that those figures change little from the age of 11 upwards. At that age 3% of children are already morbidly obese and 30% are obese.
Most people really know these things and want to do something about the obesity of themselves and their children. Look at all the adverts for slimming schemes, pills, supplements and diets. Celebrities endorse all these products and they would not clog up our airways if they didn’t have a receptive market.
However, dealing with these problems is not easy. The easy approach would be to condemn those who are overweight or obese and give them a good lecture. We can wag our finger at them and ask if they know that they or their children are almost certain to die younger than their peers; or if they know how many illnesses flow from being overweight. Perhaps sometimes a finger waving is needed but only as part of a positive programme which not only understands why the problem occurs but offers a range of support mechanisms to deal with them.
- Some people are overweight or obese because they have a mental illness and sometimes they have a mental illness because of their weight.
- Some people live in poverty without the facilities to create decent meals and the spices and sauces to make good food from scratch
- Some people have no one to take exercise with so don’t take exercise.
- Some people live hectic lives and cannot plan ahead effectively if they are on unreliable zero hours contracts and have people to feed.
- Some people just love food full of sugar or salt because it gives them great comfort!
At times most of these things apply to most of us. During the lockdown Erica and I have had a takeaway every week partly as a little treat and partly to help keep local businesses going. Any politician who eats healthily at elections is not working hard enough! The chips and the biscuits come out and the fruit is too often neglected. But occasional treats don’t really matter – Erica’s doughnuts are to die for! It is regularly eating foods that are high in salt, sugar and saturated fats that is the problem.
There are those who say that people should be able to make their own choices in life. That’s true providing they do know the consequences of those actions and if they want to change their life styles can be helped to do so. Very few people deliberately choose to follow a lifestyle that will kill them early. We used to say exactly the same, as a society, about smoking. Look how few people now die from lung cancer and associated illnesses.
Some people said the same 30 years ago when seat belts became compulsory in cars. Now we all automatically put our seat belt on and a huge and quantifiable amount of misery has been saved.
As a Liberal Democrat I believe that we need to develop a whole systems approach to obesity which recognises it is a complex and dynamic problem with long-term implications. To support action on reducing obesity, local authorities and their departments, such as social care, should utilise systems thinking. A collaborative whole systems approach is more likely to succeed than single, separate interventions.
A local whole systems approach responds to complexity through an ongoing, dynamic and flexible way of working. It enables local stakeholders, including communities, to come together, share an understanding of the reality of the challenge, consider how the local system is operating and where there are the greatest opportunities for change. Integrating a WSA into the council has many benefits. It:
- Supports the council’s key priorities – tackling obesity can improve workforce health, contribute to a stronger local economy, and reduce social care costs.
- Develops a coordinated set of approaches – recognises that tackling a single cause of obesity in isolation is less effective than a coordinated range of activities over the short, medium and long term.
- Ensures partners across the system work together – moving from silo working in departments to an approach engaging a wider range of stakeholders, focused around agreed goals.
- Maximises all the assets in the local system, including community resources – bringing in valuable insights and creating additional resource.
- Reflects the local leadership role of local authorities – working with and through an extensive range of stakeholders, including communities.
- Develops transferable workforce skills and capacity, relating to system thinking – relevant to many different complex issues.
Together we can fight the scourge of obesity. We can help people have healthier and longer lives. We can save cash in the NHS by moving to the prevention of conditions that otherwise have to be treated. We can encourage local food chains which help local retailers and producers.
It should not have taken the apparent near death of our Prime Minister to bring about a wider understanding of this problem. But it did so let’s cease the moment and create that joint working to support people away from obesity and into good health.