In the 1980s fewer than one in ten British adults were obese (people with a BMI of 30 or more). By 2016, this had risen to over a quarter, thereby leaving the UK as the “heaviest” country in Europe. For children aged between 2-15 years, three in ten are overweight or obese. As we know overweight children are more likely to become overweight adults, this means a whole new generation is growing up facing a lifetime of problems with their weight.
Does it matter? Well, the evidence suggests it does. Obesity raises the risk of type 2 diabetes, cancer and heart disease and some of these risks are substantial: an obese woman is about 13 times more likely to develop type 2 diabetes than a woman of healthy weight and an obese man is three times more likely to develop cancer of the colon.
How has this happened? Firstly, though we may have risen up the European obesity league, increasing numbers of people across high-income countries are becoming obese. To some extent we can blame our genes: humans evolved in a world where food was not plentiful and one where a lot of effort had to be expended to get what food there was. The odd feast on sweet, high-fat food was no bad thing and for many of us, our bodies are programmed to eat when we can and store the fat we create, getting us ready for the shortage (or famine) that was waiting around the corner.
However, clearly this does not explain why obesity has risen so much since the 1980s given most people in England have had access to enough food for generations and that much of the traditional British grub of fish and chips or a fry-up would scarcely qualify as low-cal. Nor does it explain why financial deprivation seems to worsen obesity, especially amongst children.
Other factors are clearly playing a part. Firstly, we have become an increasingly sedentary population and for many both their job and lifestyles no longer burn many calories, whether this is because they spend time in front of a PC, the TV or a tablet. This is combined with the abundance of highly processed food, often both cheap and convenient that provides the kick of sugars and fat we are pre-programmed to enjoy. Out of this comes the rise in obesity and as the same factors apply across much of the rich world (and increasingly, middle-income world too), it’s a problem not limited to the UK.
The government and NHS can list a long series of initiatives to help tackle the UK’s obesity problem, however it is clear from the statistics that, taken together, these have failed to deliver. Where else might we look? At national level, the arsenal to combat smoking has included taxation and regulation. Former Chancellor George Osborne took a leaf out of this book by announcing a tax on sugary drinks but with a key innovation: he warned industry it was coming, allowing them time to reformulate their drinks to avoid the tax and many have done so. Those that have not will now have to pay the tax.
Public Health England is also working with industry to reformulate a wider range of products but so far the government has shied away from wider action on advertising, tax or regulation and has not given councils powers to act locally. The government needs to learn the lessons of the sugary drinks experiment alongside what we already know from the taxation and regulation of tobacco and alcohol and be ready to set out a broader anti-obesity strategy that uses these powerful levers.
As an international problem, we can also look to the experience of other countries and cities that have successfully reduced obesity. One of the few to achieve real reductions in the proportions of children that are obese (and even greater falls in obesity in the most deprived) is Amsterdam with its “Healthy Weight Programme.” Rather than target the individual, this programme targets the wider environment that has led to more children becoming obese. It includes urban re-design alongside regulation, looking to make it easier for people to make healthy choices. This can include more and better open spaces for children (and adults) to play safely, or more pedestrian and bicycle friendly roads.
This calls for a boldness and ambition in government at all levels alongside wider society. However, this does need to be done with care. Cancer Research UK’s recent campaign on the link between obesity and cancer provoked accusations of “fat-shaming.” However, when someone is told by their GP that they have arthritis, it is not (in general) seen as an attack on their self-worth. More generally the question, “have you put on weight?” is rarely interpreted as a supportive comment. Understanding—and changing—society’s sometimes toxic attitudes to weight more broadly might help everyone, whether they are under-weight, overweight or just in-between.
