Obesity - a major Pubic Health Issue

Marlyn Glen

13 January 2012

Think back to your old primary school photographs and recall how many of your classmates were obese.

Yet the most recent survey of Primary 1 pupils in Dundee puts the number at almost 1 in 10.

Former Labour Health Minister in England Alan Johnston has described obesity, as a "potential crisis on the scale of climate change, and would probably hit us much earlier than that"

The Scottish Government describes it as an " epidemic" and that " only the USA and Mexico" have higher levels than Scotland in the 34 countries of the OECD.

The cost of drugs used in the treatment of obesity in NHS Tayside has risen dramatically in the past decade.

In 1999/2000 it cost over £31,000. Ten years later it had soared to over £230,000.

And with obesity comes a host of other diseases , such as diabetes.

In 2002 the number of people diagnosed with diabetes in NHS Tayside was 11,100.

Last October that number increased to over 19,000. (Type 1 – 1,800; Type 2 – 17,200) The estimated number of undiagnosed cases of Type 2 diabetes was put at over 3,500.

In the previous 12 months almost 1,000 had been added to the diabetes register diagnosed with Type 2 diabetes. One of the risk factors for Type 2 is obesity.

However, while obesity levels have to be turned round and driven down as quickly as possible, the reality is that significant reductions in bad health habits can occur at frustratingly slow rates.

Cigarette smoking is heavily implicated in the cause of many diseases, yet 25 per cent of Scots adults still smoke.

That’s down by just 6 per cent since 1999, after millions of pounds spent on anti-smoking measures and the introduction of a ban on smoking in public places.

The percentage of pregnant women who smoke at first booking in NHS Tayside rose after the smoking ban was introduced in 2006, up from 20 per cent to 23 per cent in 2010.

Why has the obesity problem arisen?

Levels of physical activity have certainly decreased since the 1950s, and 60s in the workplace and in the home.

The BBC recently reported the results of an interesting slimming survey carried out in the mid 1960s when just 1-2 per cent of adults in Britain were obese and which was repeated last year, when 25 per cent of adults were obese.

In 1967, 90 per cent of those had tried to lose weight over the year compared with just over 50 per cent in the 2010 survey.

In 1967, just 7 per cent of those who regarded themselves as overweight had done nothing about it , compared with over 40 per cent in 2010.

In the 50s and 60s there was virtually no school run, children walked to school or even cycled there.

Domestic cleaning, leisure and manual work required much more physical effort.

Children’s played outside in the street.

Nowadays for many the bedroom is their playground where the computer is the major form of communication , all carried out from a chair.

Activities such as these need far less energy than before, yet foods enriched with carbohydrates will layer on the weight unless it is lost through exercise.

In the 1950s and 60s there was relatively little convenience food.

Today food is everywhere and available from supermarkets 24/7

The Commons 2004 report on Obesity contained striking examples of the demands needed to burn off high-energy foods through activity, and the big money behind the push to eat on the move, free from the needs of domestic preparation and cooking :

*A 125g Big Mac required almost one and a half hours of walking "moderately quickly" , a Mars Bar one hour walking at the same pace.

" ….. if a person were to consume a can of Coca-Cola with two meals per day, over a week that would result in an energy surplus of nearly 2,000 calories—more than a whole day’s recommended calorie intake for the average woman, and about three quarters of the recommended daily calorie intake for a man. "

*The top ten advertised food brands - fast-food giants that include names such as McDonalds Coca-Cola, Kentucky Fried Chicken, Burger King, Pizza Hut , etc, had a combined UK advertising annual budget of £450 million.

Against that the Government campaign to encourage healthy eating habits - at least five portions of fruit and vegetables a day – could pit only £5 million.

Obesity is very much a disease of those on low-income whereas once it was regarded as a consequence of the lifestyle of the idle rich.

Amongst today’s less-well off , less money is spent on food as incomes reduce or become more insecure.

Calorie-crammed refined foods have become cheaper options than healthier lean meats, fish, fresh vegetables, and fruit on the grounds of lower cost.

Cheaper sugar and fats can taste good , provide that "full up" experience , and children’s preferences determine many families' eating habits and purchases.

So the "lifestyle choice" for them is an economic one rather than a pleasure one - more affordable, more satiating food, but carrying with it the risk of deposits of fat forming if the high energy intake is not burned off .

And with that comes the increased risk of disease.

There is no simple nor quick solution to the problem of obesity.

Creating sustainable positive changes in personal behaviour can frequently be a long-term objective .

It is public health problem because of its co-morbidities , its cost to the NHS and to society as a whole.

However, this is one health campaign that individuals and society in general must win.

If we do not, then we would run the very grave risk of consigning our future citizens to a legacy of lower life expectancies than our own.

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