Obesity: The House of Commons Health Committee, Obesity, 3rd report of session 2003-2004:

This report highlighted the growing concerns regarding national obesity levels. Obesity is now a major public health issue worldwide, affecting both developed and developing countries, adults and children alike. Obesity levels have dramatically increased by over 400% in the UK over the last 25 years, with these rates increasing faster than in most European countries.

Currently a worrying two thirds of the adult population is overweight and if this trend continues, one in three adults will be obese by 2020. An increasing amount of children are also overweight (one fifth of boys and a quarter of girls), which will reduce their life expectancy in years to come if this situation is not changed – it is believed that being overweight reduces life expectancy by 9 years. Nearly 10% of all deaths are related to excess weight and the estimated medical cost of this is thought to be between £6.6-7.4 billion a year – this is very high and could be reduced by simple changes to diet and activity, and could in turn prevent an enormous number of health problems.

Childhood obesity has almost doubled since the mid 1980’s and is a trend that shows no signs of stopping. Obesity experts suspect that overweight or obese children become obese adults and this is a great concern both clinically and to public health. Due to the rising rate of childhood obesity it is expected that half of all children will be overweight in 2020.

Physical inactivity, along with an increase in the availability of high calorie foods has played a major role in the increase in obesity levels. These factors have been helped to develop by the various environmental factors and technology improvements that have provided us with labour saving devices.

Health problems related to obesity are diverse, and increase with the level of obesity: type II diabetes, heart disease and some cancer – breast, endometrial, oesophageal and colonic. Excess weight puts a lot of stress on your heart, resulting in blood flowing around your body at a much higher rate, which contributes to the higher risk of heart disease and hypertension.

Complications to the bones are also another common problem due to excess weight putting pressure on bones and wearing away at the protective bone cartilage. This causes pain to the lower back, hips and knees. During childhood bones are growing, with exercise helping to provide a child with bones of maximum strength that will minimise fractures and bone pains in adulthood. However obesity in childhood will prevent children’s bones reaching maximum strength and may cause problems (fractures and osteoporosis) in later life.

Psychological damage is also a common occurrence in overweight people – adults and children, causing depression and anxiety, which is in part due to low self esteem, and perhaps social exclusion.

These problems must be combated by a wide variety of approaches, at school, at work and within the community, allowing the public to be aware of the dangers of being overweight, the importance of physical activity and how this can be achieved.

• Increase practical skills and information on how to reduce obesity.
• Increase awareness of obesity and the importance of healthy eating.
• Simplify food labels to allow healthy choice to be made easily.
• Control advertising/marketing of ‘unhealthy’ foods.
• Improve standards of school meals.
• Promote the reduction of energy dense foods in industry.
• Healthy pricing schemes, where healthy foods are offered at lower prices so that every one can afford them.
• Organised recreation in schools and communities, less than 50% of schools meet targets of 2 hours of physical activity each week.
• Imaginative ways are needed to increase physical activity e.g. dance and aerobics.
• Schools must control bullying, and encourage those who are not very good at sport to participate.
• Physical and academic achievements should be included in Ofsted school inspections.
• Walking strategies are required to improve the safety and ease of walking to the shops, work and schools and around local parks.
• Increase the awareness of obesity in the business community and consider incentives to make the work place more active.
• Establish a framework to prevent and treat obesity via the NHS – behavioural, lifestyles changes, counselling, drug therapy and (last resort) surgery.
• Screen children annually in school to monitor weight and identify those who are obese or overweight.

To view the whole report – The House of Commons Health Committee, Obesity, 3rd report of session 2003-2004, which can be downloaded free of charge from:
http://www.parliament.the-stationery-office.co.uk/pa/cm200304/cmselect/cmhealth/23/23.pdf

Issues and action in childhood obesity. The Association for the Study of Obesity, 2002: A summary of the 2002 conference from the Association for the Study of Obesity (ASO) is available from http://www.healthedtrust.com/jan/pg5.htm Topics included: Consequences of childhood obesity. Physical inactivity and energy imbalance. Global problem. Active travel suggestions. Pre-school and school nutrition programmes.

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The National Diet and Nutrition Survey: young people aged 4-18 (NDNS):

The NDNS provides extensive information on the dietary habits and nutrient status of various age groups. The 2000 report focused on young people.

It is evident that a vast proportion of children are physically inactive, only participate in exercise during school, and this participation reduces with age. Only 60% of boys and 40% of girls are carrying out the recommendations made by the government for 1 hour of moderate exercise daily.

Average nutrient intakes were usually adequate, with the older age groups having low intakes of zinc, potassium and calcium, and older girls having low intakes of iron, copper and iodine. However children’s intake of saturated fat, non-milk intrinsic sugars (mainly from ‘fizzy’ drinks) and salt were very high, and worryingly fibre, fruit and vegetable intakes were very low.

The concern of low calcium intakes is increased by low blood levels of vitamin D, which aids calcium absorption. This will have maximum impact on bones, reducing a child’s ability to gain peak bone mass, which is achieved during adolescence. These factors can increase the risk of fractures and osteoporosis in later life.

It is clear from viewing children’s intake that food preference plays a major role in a child’s food and drink intake - they will not consume something if they do not like it! This is a very good reason for varying a child’s diet at an early age so that they have been exposed to a variety of foods and can continue to consume a varied diet throughout adulthood.

Gregory J et al. (2000) National Diet and Nutrition Survey: young people aged 4 to 18 years. Findings: Volume 1. London: The Stationery Office.

For a brief summary written by the British Nutrition Foundation visit:
http://www.nutrition.org.uk/conferences/keyfacts/schoolkids.htm

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Choosing health? Choosing a better diet:

A Department of Health consultation outlined priorities for a food and nutrition plan, and included what needs to be, and what is being done to improve the nation’s health. Priorities included promoting a healthy diet, maintaining the energy balance, so energy intake equals energy output, reducing the population’s fat intake, and increasing public awareness of the calorie content of alcohol, which is higher than carbohydrate and protein (see table below). Responses to this consultation are currently being compiled and a white paper will be produced outlining the findings.

It is clear from the report that the public are aware, to a small extent, of what constitutes a healthy diet, but are unaware of how to achieve diet recommendations, or the quantity that is necessary.

Current dietary patterns are not meeting recommendations required to maximise health (see table below). Fruit and vegetable intakes are very low, as are national intakes of dietary fibre, and intakes of fat, sugar and salt are above recommendations. Policies that are developed from this consultation must address these problems effectively.

This report can be accessed free of charge and includes sections on pregnancy and the early years, and schools.
http://www.dh.gov.uk/assetRoot/04/08/14/56/04081456.pdf

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