Factors and Strategies for Treating Adult Obesity in England

The factors that cause adult obesity in England and the strategies of treating the condition
Name
University

Factors that cause obesity 2
Abstract
In recent decades obesity has assumed mammoth proportions. A high proportion of the world
population is now either obese or overweight. The problem is further exacerbated due to the
co-morbidities associated with increasing BMIs. Causes of high BMIs and high waist to hip
ratio are sedentary lifestyles coupled with an energy dense diet. Food choices that are high in
fats, sugar with bigger portion sizes has turned the blessing of food abundance into a curse
due to overindulgence. Psychological problems such as depression, stress and distress have
led to a change in our relationship with food. Whether obesity causes depression or whether
depression causes obesity is a subject often discussed. But eating disorders and binge eating
are common disorders. A better understanding of health behaviour is necessary to deal with
the problem. Seeking medical intervention is a choice that many obese people have to opt for
because of complex health problems that obesity can trigger. Pharmaceuticals and surgery are
often the last resort that people take to lose weight. But policy recommendations on changing
the food scene, with respect to smaller portion sizes, levying taxes on sweetened beverages,
use of healthier ingredients and an emphasis on home cooking and eating are important when
trying to change the obesogenic environment that we live in. Public health campaigns that
promote healthy lifestyles and are easy to dissipate through mass and social media can prove
to be effective at prevention of obesity. Treatment is often long drawn and bereft with the risk
of weight gain over time.

Factors that cause obesity 3
Introduction.......................................................................................................................................4
Chapter 1...........................................................................................................................................7
Chapter 2.........................................................................................................................................16
Chapter-3.........................................................................................................................................24
Conclusion.......................................................................................................................................33
References.......................................................................................................................................35

Factors that cause obesity 4
Introduction
Obesity is a serious public health problem. And obesity, that afflicts more than 25% of the
population in the United Kingdom is a natural outcome of our food culture, the culture of
sedentary lifestyle and the affluence that our economy bestows us with. Food rich in
carbohydrates and fats and the inability to burn fewer calories than we consume has resulted
in a malady that, like the rest of the world, is making us burst at our seams. According to the
WHO 'overweight and obesity are defines as abnormal or excessive fat accumulation that
may impair health' (WHO, n.d.). An urgent call by the World Health Organisation to halt the
rate of spread of non-communicable diseases is also a call for us to check our weight
(Jackson, et al., 2014). The body mass index is an index that relates height to the weight of a
person. Therefore a person's BMI
= Weight (in kg) / Height in meters squared
A BMI of 27.3, for women and a BMI of 27.8, for men means that a person is overweight. A
BMI of 30 or more than 30 for men and women is enough for a person to be classified as
obese (Medicinenet, n.d.).
According to the World health organisation (WHO), the worldwide statistics of obesity are
alarming. Since 1975 the number of obese in the world has tripled. 1.9 billion adults were
overweight in 2016, of these 650 million were obese. 39% of adults in the world were
overweight in 2016 of which obesity was found in 13%. In most countries overweight and
obesity is responsible for more mortality than people who are underweight (WHO, n.d.)
Among the two genders there is greater deposition of subcutaneous fat among women. If the
BMI of a man and a woman is same, the woman will carry more fat. The android deposition
of fat (adipose deposition occurs in the abdominal area) is a risk factor for cardiovascular
disease and diabetes. The gynoid pattern of fat deposition occurs to a greater degree around

Factors that cause obesity 5
the hips and is a protective factor for diabetes and cardiovascular disease (Wiklund, et al.,
2008). Waist to hip ratio is also used to account for distribution of fat and in conjunction with
BMI, it is used s a measure of obesity.
It is estimated that in England, by 2025, 47% males and 36% females will be obese and the
projections for 2050 are 60% of the male population and 50% of females could become
obese. Only 10% males will have a healthy BMI in 2050 (a drop of 30% from now) and just
15% females will have a healthy BMI ( a drop of 25%) (Butland, et al., n.d.). These are
alarming figures and public health policy will have to be designed to arrest the rate of spread
of obesity in the population through prevention rather than treatment since the latter course
impacts the economy in a negative manner.
Though the problem of the rise in obesity is a public health issue, stakeholders in the areas of
healthcare, health insurance, policy making, food and beverage industry and economists are
worried because of the associated complexities of weight gain. Obese people are at a higher
risk of hypertension, diabetes and cardiovascular disease. (Banning, 2005). The risk of
cancer among the obese is 20% higher than among the healthy weight individuals (De
Pergola & Silvestris, 2013). In case cancer occurs, outcomes for obese individuals are usually
poorer (Wolin, et al., 2010). A meta analysis and systematic review found that a 5kg/m2
increase in the BMI among men raised the risk of oesophageal adenocarcinoma, thyroid,
renal and colon cancers. In women, a similar increase in BMI could cause gallbladder,
endometrial, and renal cancers. (Renehan, et al., 2008).
Health promoting lifestyle recommendations had the most public support at 71%, while food
labelling had the support of 66% respondents. At 32% there was minimum public support for
increased taxes on unhealthy foods. Greater effort at increasing awareness about the causes of
obesity could lead to higher support for public health policy (Beeken & Wardle, 2013).

Factors that cause obesity 6
In England, the 1996 figures for overweight men and women were 56% and 46% respectively
(Banning, 2005). Obesity poses different risks based on the location fat deposition for
different people. Fat distributed around the abdomen is termed central adiposity and makes
individuals more prone to hypertension and heart disease as compared to peripheral adiposity.
According to McKeigue et al waist circumference of ˃102cm in men and ˃88cm in women
is an indicator of obesity (McKeigue, et al., 1991).
Impact of obesity
Obesity and overweight related expenditure on treatment by NHS in 2014-2015 was £6.1
billion. (Gov.uk, n.d.). Every year Britain spends more on obesity and diabetes treatment
than the expenditure on services such as, police, fire services and the judicial system taken
together. Economic development is severely impacted by the expenses on obesity treatment
and related costs. The costs actually add up to a whopping £27 billion. And since the problem
of obesity is expected to grow the cost to NHS is projected to increase to £9.7 billion and
overall cost to £49.9 billion annually by the year 2050 (Gov.uk, n.d.). Impact of obesity on
the economy is enormous (Tremmel, et al., 2017).
This dissertation discusses the factors that cause adult obesity in England and the strategies of
treating the condition. The high prevalence of obesity in England as in other parts of the
world is a serious threat to public health. This thesis attempts to discuss the psychological
effects of obesity in adults and the interventions that can help to solve the problem of obesity.

Factors that cause obesity 7
Chapter 1
Factors of adult obesity in Britain
The aim of this chapter is to investigate through a literature search, the factors that are
responsible for obesity in England. Several factors appear to have increased the incidence of
obesity among adults in Britain. Lifestyle and sedentary behaviours account for most of the
cases. Energy dense food availability has increased. People prefer to eat outside rather than
cooking healthy homemade meals. Food rich in fats and sugar has become part of the food
landscape and this has caused waistlines to grow. Weight perception differs on the basis of
race and ethnicity. Some cultures may believe that being overweight or obese is a sign of
good health. There are ethnicities that do not perceive being overweight with the need to
make efforts to lose weight. Several cases of obesity can be explained on the basis of genes.
Many genes predispose people to obesity and cause hyperphagia or overeating leading to
obesity and diabetes. Individual behaviour that leads to faulty diet, sedentary lifestyle and
compromised sleep duration adds to the problem of obesity. Even though knowledge about
healthy diet, need to exercise and proper sleep is not scarce, people find it difficult to change
behaviours. An obesogenic environment where there are fewer green spaces, cycling is
difficult and energy dense food is easier to find the obese have a difficult time changing
lifestyles.
1.1 Food culture
The main factors like elsewhere in the world exist in England in a similar manner and include
behaviour, environment, genetics and culture. The food culture of most places including
England is such that if one chooses to eat outside the home it is difficult to find food that is
healthy. More and more people seek convenience and pleasure and seek to eat outside while
home cooked food has fewer takers. Most food available at take-aways, bakeries, sandwich
outlets, corner shops and fast food restaurants is laden with sugar, carbohydrates and fats.

Factors that cause obesity 8
Eating outside the home from once to several times a week has increasingly become a part of
food culture of Britain. 18% of the total meals were consumed outside the home in 2015 as
compared to 5% in 2014 (Gov.uk, n.d.). Every meal that is consumed away from home at a
restaurant is more likely to be richer in terms of calories and such consumption adds to the
cases of obesity.
Readily available and cheap meals outside the home have also increased their popularity and
such foods are also convenience foods and so a choice for people from all age-groups. The
number of take-away outlets, fast food outlets and fish and chips restaurants in England in
2014 was 50,000. The food served at all such outlets is rich in sugar, fats, saturated fats, salts
and low in micronutrients. 27% of the adult population eats at one such outlet at least once a
week (Gov.uk, n.d.).
Another factor that has caused the numbers of obese to grow is that people in Britain are not
burning the calories that are consumed. The impact of technology on homes and work places
is such that people are able to remain sedentary. Physical activity has fallen by 20% and is
expected to fall by 30% by the year 2030. Making the choice to include 150 minutes of
activity per week is now a necessary part of lifestyles.
The problem of availability of unhealthy food in outlets is prevalent to a greater extent in low
income areas. Reasons that affect the profitability of small food businesses include limited
variety in their menus so that healthy food is not available. Space and equipment resources
are lacking for cooking of healthier food. Fresh fruit and vegetables have a shorter shelf life,
so it is not seen as an economical option. Meals with lower salt may not go down well with
customers. Whereas, in reality, using less oil, serving smaller portions and using healthy
products might be more profitable for small food businesses.