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Topic on a Page - Obesity (All Ages)

Data
Sources:

Adult and Child Obesity Supplementary Data Published: Dec 2016

Public Health England: Public Health Profiles

Department of Health (DofH)

National Audit Office (NAO): Tackling Obesity in England Published: February 2001

Public Health England (PHE):

Data Profiles: Liver Disease

Child obesity and excess weight: small area level data Updated: April 2018

Fast food outlets: density by local authority in England

NCMP and Child Obesity Profile

Sport England:

Local Sport Data

Association for Young People's Health:

Key data on Young People 2017

House of Commons Library Briefing Papers:

Obesity Statistics

Further data sources:

Scroll to the bottom of the page to view and compare further datasets

Supporting Information:

Lincolnshire Infant Feeding Strategy Published: 2013

Public Health England (PHE):

Obesity and the environment briefing: increasing physical activity and active travel

Obesity and the environment briefing: regulating the growth of fast food outlets

Adult Obesity and Type 2 Diabetes Published: July 2014

Strategic high impact changes: Childhood obesity Published: April 2011

Adult weight management guidance for commissioners and providers Published: June 2017

Child weight management: commission and provide services

National Child Measurement Programme: Operational Guidance

National Child Measurement Programme (NCMP): trends in child BMI

Weight management: guidance for commissioners and providers

A Guide to Delivering and Commissioning Tier 2 Adult Weight Management Services

Key performance indicators: tier 2 weight management services for adults

Standard evaluation framework for weight management interventions Revised: February 2018

Local Government Association (LGA):

Tackling the Causes and Effects of Obesity

Healthy weight, healthy futures: local government action to tackle childhood obesity

National Institute for Care and Health Excellence (NICE):

Obesity prevention [CG43] (2015)

Obesity: identification, assessment and management [CG189] (2014)

Obesity: working with local communities [PH42] (updated June 2017)

Obesity Quality Standard: clinical assessment and management [QS127] (2016)

Obesity in Adults: prevention and lifestyle weight management programmes [QS111] (2016)

Obesity in children and young people: prevention and lifestyle weight management programmes [QS94] (2015)

Department of Health (DofH):

Policy: Obesity and healthy eating

Childhood obesity: a plan for action: Chapter 2

NHS England (NHSE):

Report of the working group into joined up clinical pathways for obesity Published: March 2014

NHS Evidence:

Obesity

Healthy Eating

Cancer Research UK:

Tipping the scales: Why preventing obesity makes economic sense

Linked Topics:

Topic last reviewed: Oct-18

JSNA Topic: Obesity (All Ages)

Background

Excess weight i.e. being overweight or obese is a major public health crisis due to its association with serious chronic diseases such as type 2 diabetes, heart disease, stroke, liver disease and some cancers. Being overweight or obese is therefore associated with increased disability, reduced quality of life and premature death. Obesity is estimated to be the third largest risk factor contributing to premature deaths (World Health Organisation, 2018).This rising burden of ill-health driven by unhealthy lifestyles is influenced by deprivation, social, environmental and economic factors.

A basic definition of obesity is the excess accumulation of body fat. Weight gain can occur gradually over time when energy intake from food and drink is slightly greater than energy used through the body’s metabolism and physical activity. NHS England defines the term obese as describing 'a person who's overweight, with a lot of body fat.'

The recommended measure of overweight and obesity is body mass index (BMI). BMI is calculated by dividing body weight (kilograms) by height (metres) squared. For individuals classified as overweight or obese, the risk of poor health and wellbeing outcomes increases sharply with increasing BMI.

For children this is adjusted for the child’s age and gender (see NHS Healthy weight for BMI percentile classification for children). The National Child Measurement Programme (NCMP) uses BMI reference charts to classify children and takes into account children’s weight and height for their age and sex. Children above the 85th centile are considered overweight and those above the 95th centile, obese. Childhood obesity presents immediate and long-term negative effects on a child’s physical, social, educational and mental health and well-being. Overweight and obese children are more likely to become overweight or obese adults (Source: Public Health England).

The NHS costs attributable to being overweight and obese are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year (Source: Foresight 2007).

The significant health and financial burden of excess weight means preventing and treating those who are overweight or obese is a substantial public health challenge.

Context

National Strategies, Policies & Guidance

NICE provides guidance and advice around obesity, covering; prevention, identification and management which can be found at NICE: Obesity Overview.

In 2016, the Government published the new childhood obesity strategy Childhood Obesity: A Plan for Action. In June 2018, the Government published part 2 of the plan.

Excess weight and obesity are common among all social groups, and prevalence tends to increase with social disadvantage (The Marmot Review 2010).

In 2016 the Local Government Association (LGA) published a briefing on childhood obesity Healthy weight, healthy futures: Local government action to tackle childhood obesity.

In 2011 the Coalition Government set out its approach to tackling obesity through concerted action across all sectors of society in Healthy Lives, Healthy People: A Call to Action on Obesity in England.

The Foresight Report (2007) Tackling Obesities: Future choices proposed a complex range of over 100 interconnecting factors that cause overweight and obesity in adults and children. These factors, related to seven key domains (biology, individual activity, individual psychology, food environment, societal influences, food production and activity environment) were presented in a visual map to understand what influences an individual's energy intake (i.e. from food and drink), energy expenditure (i.e. from physical activity) and resultant weight status. The report established the phrase – `The Obesogenic Environment`. The simple definition of obesity does not adequately explain and define the complex societal and environmental factors which have contributed to the rapid increase in the prevalence of obesity in the last 20-30 years. Factors which have contributed to this increase include physiological factors, eating habits, activity levels and psychological influences which occur at an individual and societal level (Source: Foresight, 2007). Eating habits in turn have been affected by the rapid increase in food availability over the last decades, especially food with high energy density, and physical activity by access to environments that are conducive to physical activity. The mid-term review of Tackling Obesities: Future choices was published in 2012.

Local Strategies & Plans

Obesity has been identified as a key priority in the Joint Health and Wellbeing Strategy for Lincolnshire approved by the Health and Wellbeing Board in June 2018.

The Director of Public Health Annual Report 2015 focussed on the increasing burden of liver disease and the respective causes, one of which is the impact of obesity on liver function and liver health.

What is the picture in Lincolnshire?

What the data is telling us

Children

The National Child Measurement Programme (NCMP) weighs and measures children in reception year and year six in maintained schools in England annually. The programme began in 2005. It was formerly known as the National Childhood Obesity Dataset and now provides the most robust source of childhood obesity data in England. Data from the NCMP is summarised in an interactive tool in the Public Health England NCMP profiles (NCMP Local Authority Profile).

In 2016/17 24.6% of 4-5 year olds and 34% of 10-11 year olds in Lincolnshire were reported to be overweight or obese (Source: NCMP). Lincolnshire has similar levels of children who are overweight or obese to the England average at both 4-5 and 10-11 years. However, when rates are compared across Districts within the County marked variation is seen.

In 2016/17, Boston (27.8%) had the highest proportion of 4-5 year olds who were overweight or obese, followed by East Lindsey (26%) and Lincoln (25.3%), although there was no significant difference between them. North Kesteven (21.7%), South Holland (23.7%) and West Lindsey (23.7%) had the lowest proportions of 4-5 year olds measured as overweight or obese, the rate for South Kesteven was 24.6%.

There was a similar pattern in 10-11 year olds in Lincolnshire 2016/17, with the highest proportions measured in Boston (40.6%), Lincoln (37.4%) and South Holland (35.4%), and the lowest in North Kesteven (31.6%) and West Lindsey (31.4%) The rate for East Lindsey was 33.2% and South Kesteven 32%.

In addition to measuring overweight and obese children, 2016/17 saw the introduction of the severe obesity indicator to NCMP, which measures children whose BMI is in the 99.6th centile of the UK90 growth reference.

In 2016/17, 2.5% of all reception year children were measured as severely obese, compared to 2.3% regionally and nationally. For year 6 pupils in Lincolnshire, severe obesity is higher at 3.8%; however this is lower than the national rate of 4.1% and comparable to the regional rate of 3.8%.

At district level, 4.1% of 4-5 year olds in Boston and 3% in South Holland were severely obese, while North Kesteven and South Kesteven had the lowest proportions at 1.7% and 1.8% respectively. The other rates for this indicator were Lincoln 2.76%, East Lindsey 2.69% and West Lindsey 1.95%. In year 6, Lincoln and Boston have the highest proportions of severely obese pupils, at 5% and 4.7% respectively, while South Kesteven and West Lindsey have the lowest proportion of severe obesity at 2.9% and 3.3%. The other rates for this indicator are South Holland 4.10%, North Kesteven 3.68% and East Lindsey 3.73%.

Pupil NCMP participation rates in Lincolnshire have improved since 2010/11, when 92.7% of eligible pupils were measured. In 2016/17, Lincolnshire had a participation rate of 98.2%, which is better than the regional and national rates of 94.5% and 95% respectively.

Adults

Previously the main source of the data on excess weight prevalence in adults had been the Health Survey for England (HSE) which stated that 58% of women and 65% of men were overweight or obese (2014). The Public Health Outcomes Framework (PHOF) contains a new indicator on the percentage of adults aged 18 and over who are overweight or obese. This is taken from the Active Lives Survey (formerly Active People Survey) and measures those adults whose BMI is greater than 25kg/m2.

In 2016/17, 63.7% of adults in Lincolnshire were overweight or obese, which is significantly worse than the national average of 61.3%. At district level, East Lindsey has the highest percentage of overweight or obese adults, at 67.8%, and is the only district in Lincolnshire to be significantly worse than the England average. By comparison, Lincoln and West Lindsey have the lowest proportions of adults with excess weight, at 60.7% and 62% respectively. (Source: PHE)

National statistics on obesity show that during 2016/17 the rate of hospital episodes with a primary or secondary diagnosis of obesity in Lincolnshire was 1,131 (per 100,000 residents). Figures show that more women are admitted for obesity related issues than men, with admission rates of 1,470 per 100,000 women and 788 per 100,000 men. This is comparable to the rates observed regionally and nationally. (Source: NHS Digital)

Looking at admissions with a primary diagnosis of obesity, who also received a main or secondary procedure of bariatric surgery, the rates reduce significantly to 9 admissions per 100,000 residents in Lincolnshire.

In 2017, there were 6,756 items prescribed for the treatment of obesity by Primary Care providers across Lincolnshire, based on data for the four Lincolnshire CCGs.

National estimates for the levels of morbid obesity when applied to Lincolnshire suggest that there may be 11,500 adults with a BMI over 40 and nearly 800 with a BMI over 50. Over 3,200 adults may be eligible and may wish to take up bariatric surgery. (Source: Clinical Commissioning Policy: Complex and Specialised Obesity Surgery, NHS Commissioning Board, 2013)

Trend

Children

Since 2007/08, the proportion of overweight or obese children in Lincolnshire has fluctuated. The proportion of reception year pupils (aged 4-5) has risen from 23.5% in 2007/08 to 24.6% in 2016/17, with the latest rates being higher than the regional and national equivalents. Over the same period, the proportion of year 6 pupils (aged 10-11) has risen from 33% in 2007/08 to 34 % in 2016/17, with the latest rate being significantly comparable to the East Midlands and England rates.

At District level, the prevalence of overweight or obese children (both Reception and Year 6) has fluctuated across the county, with Boston seeing a noticeable increase in reception year excess weight from 2010/11 onwards. Current rates of excess weight of reception year children in Boston show an increase from 23.1% in 2015/16 to 27.8% in 2016/17. Excess weight in year 6 pupils is also highest in Boston, with rates steadily rising since 2006/07. Since 2015/16, excess weight has increased by 5.3% from 35.3% in 2015/16 to 40.6% in 2016/17.

Adults

Excess weight in adults has reduced slightly in Lincolnshire from 66.5% in 2015/16 to 63.7% in 2016/17; however rates are still significantly higher than the national average of 61.3%. At district level, there has been some change seen in the last year. Excess weight in Boston has fallen from 70.5% in 2015/16 to 62.9% in 2016/17, with Boston now being similar to East Midlands and England. East Lindsey has seen an increase of 58% from 62% in 2015/16 to 67.8% in 2016/17, and is now significantly worse than the regional and national averages.

Long term trends from HSE published data shows that as of 2016, 26% of men in England were classified as obese, which has doubled since 1993. Similarly, 27% of women were measured as obese, up from 16% in 1993 (Source: NHS Digital, Health Survey for England 2016).

The HSE also includes data on waist circumference. Since 1993, the proportion of adults with a very high waist circumference (102cm in men and 88cm in women) has increased from 20% for men to 34% in 2016 and from 26% of women to 46% in 2016. For men and women, the proportion of adults at very high risk increases with age, with more men aged 65-74 (50%) and more women aged 75 (66%) having a very high waist circumference.

Key Inequalities

No one is immune to obesity, but some people are more likely to become overweight or obese than others. The Marmot Review highlighted that; low income, social deprivation and ethnicity have an important impact on the likelihood of becoming obese.

There is a strong relationship between deprivation and childhood obesity. Analysis of data from the National Child Measurement Programme (NCMP) shows that obesity prevalence among children in both Reception and Year 6 rises with increased socioeconomic deprivation. In England, obesity prevalence in the most deprived 10% of children is approximately twice that of the least deprived 10%.

People from some BAME groups, such as those with south Asian heritage, are more likely to be overweight and obese, and have a higher susceptibility to particular diseases linked to excess weight, such as type 2 diabetes.

(Source: Public Health England, Health matters: obesity and the food environment 2017)

The Government's Eatwell Guide outlines a diet that meets population nutrient needs. However, research undertaken by the Food Foundation, Affordability of the UK's Eatwell Guide (2018), finds that low income households in the UK may be struggling to follow the Eatwell Guide. Most adults and children in the UK do not currently meet requirements for a nutritious diet, eating too much sugar, saturated fat and salt, and failing to meet recommendations for eating the daily amount of fruit and vegetables (Food Foundation, 2016). This is particularly true for lower income households, who consume a less healthy diet than those with higher incomes. (See JSNA Food and Nutrition)

Current Activity & Services

Children

Change4Life is a national campaign mainly aimed at families, to improve activity, diet and assist weight management. The information is mainly aimed at families.

Many primary schools utilise their school sports premium to engage pupils in greater activity and healthier lifestyles. For example, 55 primary schools have subscribed to the Legacy Challenge and the Change4Life Clubs co-ordinated by Inspire +, a school sports charity, in collaboration with school games organisers across Lincolnshire.

Lincolnshire Children's Services have secured national funding to support 15 schools to adopt the Food for Life Partnership catering standard. The catering mark aims to improve the quality and nutritional content of school meals as well as increasing pupils' and parents' understanding of issues around healthy eating and food sustainability.

The Food in Schools service, through which schools are given advice and training around diet and nutrition, was funded by Lincolnshire County Council and delivered free of charge until September 2016. During this time 235 schools engaged in the programme. The standard of the scheme was demonstrated when a local secondary school, Kesteven and Grantham Girls School, received national recognition for their excellence in school food and catering. Since September 2016 the Food in Schools service has adopted a commercial model where schools must pay for the service.

Adults

Public Health England and Leeds Beckett University have established a national programme with a view to designing local whole systems approaches to assist in preventing and tackling obesity.
Designing a ‘whole systems approach’ to prevent and tackle obesity

Launched by Public Health England in March 2016, ‘One You’ is a campaign to help adults avoid future diseases caused by modern day life and includes advice on healthy eating and exercise.

The prevention and treatment of overweight and obesity for adults is usually presented through a four-tiered model or pathway:

  • Tier 4 – Morbid Obesity Services
  • Tier 3 – Specialist multi-disciplinary Obesity Services
  • Tier 2 – First Line/community Weight Management Services
  • Tier 1 – Early Intervention and Prevention (including environmental settings for walking, cycling and healthy food opportunities)

Treatment Services

Dedicated services for morbidly obese adults (Tier 4 services) are limited to bariatric surgery and clinical support, which is currently based in numerous sites outside of the county. Currently no Tier 3 service exists in Lincolnshire.

There is a Dietetic Service and a specialist Midwife role for Obesity/Diabetes provided by United Lincolnshire Hospitals NHS Trust.

Prevention

Lincolnshire is part of the National Diabetes Prevention Programme national roll out as part of a Greater Lincolnshire network. Approximately 1,200 adults will have the opportunity to engage with this programme.

The Walking for Health Programme that is operated across the county engages with mid-life and older adults to walk regularly for health gain. Regular walking has been shown to be of benefit for nearly a quarter of walkers for weight loss.

To describe the Tier 1 approach; there are numerous and diverse local activities ranging from clubs and associations to gyms and leisure providers for sport, recreation and leisure. Some of these utilise community grants for greater and targeted participation, e.g. Lincoln City and Boston United Football in the Community Trusts. A range of grant based initiatives have sought to change the physical environment and/or supports adults to be active, e.g. Walking for Health groups, Macmillan Project, Access Lincoln (formerly the LN6 Project). Within urban and rural environments there is access to open spaces: parks, playing fields, trails and byways, allotments, park runs, canals, rivers and a coastline. (See JSNA: Physical Activity)

Currently, no large scale health improvement interventions support this area of work. However, commercial weight management schemes, e.g. Weight Watchers and Slimming World, are available locally throughout the county. Similarly, commercial exercise and well-being services are available throughout the county, by local leisure providers:
Boston Borough Council
East Lindsey District Council
South Holland District Council
South Kesteven District Council
North Kesteven District Council
West Lindsey District Council
Lincoln City Council

Lincolnshire has a considerable food agricultural industry and heritage. Numerous healthy eating schemes exist at a district or lower level; however, coverage is patchy and their reliance on piecemeal sources of funding raise questions about their sustainability. (See JSNA: Food and Nutrition).

Unmet Needs & Gaps

No Tier 3 weight management services are commissioned locally.

Clinical Commissioning Groups (CCGs) have considered the commissioning of Tier 3 specialist services. Any future plans will be dependent on the CCGs Sustainability and Transformation Plans.

The stakeholders within the JSNA topic expert panel drew out a number of unresolved gaps and issues:

  • A strategic focus on childhood and adult obesity is currently missing with partnerships
  • Little local data has historically been available to determine the scale of need
  • limited clinical and community based provision to prevent adults from becoming overweight/obese or to manage/treat people who are obese/ morbidly obese within the county
  • it is viewed that the work to date has not had the scale nor substance to significantly impact upon this problem

Local Views & Insights

Healthwatch Lincolnshire undertook a survey of children and parents; Children and Parents – Our Opinion: Food and Fitness, 2016. A range of findings indicated that children are not sufficiently active; little cooking takes place at mealtimes; fizzy drinks are popular; cooking and eating is becoming less of a social experience; portion size is misunderstood and `5-a-day` is not happening.

Service providers seek the views of clients in addition to monitoring service provision, for example, the Boston Walking for Health scheme regularly surveys clients (100 plus clients each time). In a recent sample 24% of walkers had lost weight as result of their regular walking, 81% were walking more and using their car less and 29% had lowered their blood pressure. Such findings and feedback reinforce the value of physical activity to service users.

Risks of not doing something

Public Health England estimates the overall cost of obesity to the wider society is approximately £27 billion. This burden is shared across health & care settings and upon the economy including:

  • Obesity medication - £13.3bn
  • Cost to the NHS - £6.1bn (based on 2014/15 figures)
  • Cost to Social Care - £352m
  • Obesity attributed days of sickness - £16m.

The UK wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.

NICE Guidance: Weight Management: lifestyle services for overweight or obese adults [PH53] further estimates that these figures could rise to £50bn by 2050.

In 2001, a report by the National Audit Office (NAO) ‘Tackling obesity in England' estimated that approximately 6% of all deaths in England in 1998 were caused by obesity – a total of 30,000 excess deaths in that year. This compared to approximately 10% of deaths that were attributable to smoking, and 1% caused by road traffic incidents at that time. The NAO analysis also showed that many of the deaths caused by obesity were premature – 9,000 of these deaths took place before state retirement age, and on average, each person whose death could be attributed to obesity lost nine years of life. Such premature deaths contribute to the burden of health inequalities.

Lincolnshire population trends suggest an increasing mid-life and older population, with excess weight. This trend will place an increasing burden upon the NHS locally.

What is coming on the horizon?

Given that the causes of childhood obesity are complex including; eating behaviour, parental obesity, the environment we live in, social norms and changing nutritional patterns, designing effective interventions is also complex. Combination lifestyle interventions have demonstrated some effectiveness in preventing and treating obesity in children, although there is uncertainty about how long the effects may last. There is also some evidence that healthy eating, including exclusive breastfeeding for the first six months of life and physical activity is more likely to lead to healthy weight children at two years. A recent in-depth review by Public Health into the evidence to inform the best approach in Lincolnshire has shown that there is no single intervention that is likely to have a lasting positive effect.

Evidence supports action centred on the following to promote healthy weight in children:

  • Physical activity (recommended amount of time each day for child's age)
  • Promoting active transport to school and in general
  • Reducing screen time
  • Laying down early foundations for healthy eating: offering portion sizes appropriate to the child's needs and reducing the amount of excess calories consumed in sugary foods and drinks
  • Building a whole school approach to tackling childhood obesity
  • Parental support.

A local strategic action plan to promote healthy weight in childhood is in development, based upon the life course approach to tackling obesity in the following settings:

  • Ante-natal and post-natal
  • Pre-school
  • Primary school
  • Secondary Schools.

As part of the delivery mechanism for the JHWS, a multi-agency Strategic Obesity Group is being established as a sub group of the Health and Wellbeing Board. The group will be tasked with tackling the issue of obesity in Lincolnshire by building on best practice from elsewhere, such as the Whole System Obesity Programme led by the Leeds Becket University. North Kesteven District Council was one of four areas involved with this national pilot seeking to implement a whole systems approach to tackling obesity.

What should we be doing next?

People need the information and support to make substantial changes. Adults who are overweight or obese can gain health benefits from meeting the guidelines for physical activity even in the absence of any changes to their weight status. To reach a healthy weight, additional physical activity and a reduction in calorie intake may be required.

Develop a self-care approach to help adults make small lifestyle changes for health gain, e.g. the promotion of the PHE campaign One You.

The evidence-base is growing and supports the use of short-term and medium-term interventions for individual health gain. Interventions typically employ 12 -20 weeks of support for behaviour change. The example of the National Diabetes Prevention Programme provides insight for future interventions.

Develop Making Every Contact Count (MECC) to help professionals to recognise the obesity agenda in their work practice and have the confidence to talk about the options to remain healthy with their service users.

Review PHE's Whole Systems Approach to the Obesity programme and establish a Lincolnshire approach to tackling obesity.

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk

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