OBESITY IN SCOTLAND - Obesity Action Scotland

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OBESITY  in SCOTLAND
           OBESITY IN  SCOTLAND

                                                                                                   July 2016
Briefing
           Facts
           }} Obesity is defined as Body Mass Index over 30 kg/m2, which records weight
              adjusted for height
           }} Obesity is a serious public health threat in Scotland: affecting one in every four
              adults and almost one in five children
           }} Two in every three adults in Scotland (65%) are overweight; people of normal
              weight in Scotland are now in the minority
           }} Obesity rates in Scotland are amongst the highest in the world, even higher than in
              England
           }} The current obesity crisis results from living in obesogenic environments: where
              relative inactivity and overconsumption of energy dense foods is too available,
              affordable and accepted
           }} Although personal choices are important, obesogenic environments create
              dangerously high levels of obesity in the population
           }} Obesity harms many aspects of health; it interferes with sexual function, breathing,
              mood and social interactions
           }} Obesity also shortens life, increasing deaths from type 2 diabetes, heart disease
              and common cancers
           }} In Scotland, obesity reduces productivity and physical activity; it increases
              sickness absence, and demand for health and social care services
           }} The cost of obesity to the NHS in Scotland is huge, estimated between £360
              million and £600 million annually

           Definition
           On a population level, overweight and obesity are usually defined using Body Mass Index
           (BMI). BMI is a measure of whether a person is a healthy weight for their height. For most
           adults a BMI of 25 – 29.9 kg/m2 is overweight and BMI over 30 kg/m2 is obese.

           BMI, calculated from a person’s height and weight, is the most effective population measure
           available as it is relatively accurate, simple and cheap for large population groups. However,
           there will always be exceptions to the rule; for example, people who are very muscular and
           pregnant women will be quite heavy for their height with a high BMI, but will not have the
           health risks of carrying extra fat mass. In such individual circumstances other measures can be
           used to provide a more accurate assessment of healthy weight.

                 Calculate your BMI             (    your weight in kg
                                                   your height in metres  )   Divide your answer
                                                                              again by your
                                                                              height in metres

                                                           232 - 242 St Vincent Street    0141 221 6072
                                                           Glasgow G2 5RJ                 @obesityactionsc
                         www.obesityactionscotland.org     info@obesityactionscotland.org
Monitoring Obesity in Scotland                                 Rates are higher in areas of greater
                                                               deprivation, particularly among women1,
                           Carried out annually,               children2, older age groups, black and minority
                           the Scottish Health                 ethnic groups, and people with disabilities4.
                           Survey1 provides a
                           detailed picture of the
                           health of the Scottish           Childhood Obesity in Scotland
                           population. Each year
                           the survey provides              }} In 2014, 31% of children in Scotland (aged 2
                           BMI data for adults and             to 15) were at risk of overweight or obesity; of
                           children.                           which 17% were at risk of obesity and 14% at
                                                               risk of overweight1
                           Routine Child Health
                           Reviews2 which include           }} In 2014/15, almost 22% of Primary 1 children
                           height and weight are               (aged 4 to 6) were at risk of overweight or
                           undertaken in Primary               obesity; of which 10% were at risk of obesity
1 (age 4 to 6) covering 92%                                    and 12% were at risk of overweight; this was
of that population group.                                      slightly less than in 2005/6 (10.5% and 12.8%
The resulting statistics                                       respectively), however these high rates have
report BMI annually.                                           persisted relatively unchanged over the last
                                                               decade2
In England the National
Child Measurement                                           }} The proportion of healthy weight Primary 1
Programme3 measures height and weight at                       children has not improved in the last 10 years
reception (age 4 to 6) and year 6 (age 10 to 11).              (in 2007/8 and 2014/15 it was 77%)2

                                                            }} Children in Scotland living in two most
Overweight and Obesity in Scotland                             deprived quintiles, are least likely to have
                                                               healthy weight1
}} Two in three (65%)
   adults aged 16-64            Overweight                  }} In 2014/15 in the least deprived areas 17% of
   are overweight or                                           Primary 1 children were classified as at risk of
   obese (had BMI                                              overweight and obesity compared to 25% in
                                              Obese
   over 25)1                   Normal                          the most deprived areas2
                               Weight

}} More than one in
   4 adults are obese
   (28% had BMI over                         Underweight    Obesity in Pregnant Women
   30)1
                                                            Provisional 2015 data indicates that 21% of
}} Between 1995 and 2014, the proportion                    pregnant women in Scotland are obese at
   of adults categorised as obese (BMI 30+),                their first antenatal booking, with a further 28%
   increased by half, from 17.2% to 28%1                    classified as overweight7.

}} Since 1995, the proportion of the population
   which was overweight or obese (BMI 25+)
   increased from 52.4% to 65%1

}} Women have higher obesity rates than men
   (29% compared with 26%)1

}} Obesity increases with age, with almost 35%
   of men and 37% of women in the 65-74 age
   group being obese1

}} Obesity does not affect everyone equally.

                            www.obesityactionscotland.org
Impact of Obesity

Obesity can have a negative impact on health as well as other aspects of life for adults and children
reducing their overall quality of life. Obesity increases the risk of:

          Type 2 Diabetes: Fat cells in the body,                   Complications during pregnancy and
          especially from fat tissue around waist,                  birth: miscarriage, gestational diabetes,
          produce hormones and proteins that                        high blood pressure and pre-eclampsia,
          interfere with body’s cardiovascular                      blood clots, baby’s shoulders becoming
          and metabolic systems, increasing risk                    “stuck” during labour, heavier than
          of type 2 diabetes. Obese women are                       normal bleeding after birth4,20
          13 times more likely to develop type 2
          diabetes than normal-weight women14.                      Musculoskeletal problems: gout,
          47% of type 2 diabetes is attributable to                 osteoarthritis, and lower back pain
          obesity15                                                 are caused by the mechanical and/
                                                                    or metabolic strain of excess fat mass
          11 Common Cancers: breast, womb                           on the bones. 47% of gout and 12% of
          (endometrial), bowel, pancreas,                           osteoarthritis are attributable to obesity
          oesophageal, kidney, ovarian, prostate,
          gallbladder, liver and stomach. Hormones                  Mental health problems: depression,
          and proteins produced by                                  bipolar disorder and anxiety are
          fat cells are released into the                           associated with obesity21. Mechanisms
          bloodstream and carried around the body                   are still being investigated and could
          to many organs increasing the cancer                      include higher inflammation levels, insulin
          risk16. 29% of colon cancers, 14% of                      resistance, hormonal changes and social
          endometrial, 13% ovarian, 3%                              and cultural factors22
          prostate and 1% rectal cancers are
          attributable to obesity15                                 Respiratory disorders: asthma,
                                                                    chronic obstructive pulmonary disease,
          Cardiovascular disease: hypertension,                     obstructive sleep apnoea are caused
          atherosclerosis, heart failure, ischaemic                 by mechanical factors and metabolic
          heart disease, ischaemic stroke. Obesity                  pathways related to obesity
          increases the risk of cardiovascular
          disease through causing high blood
          pressure and type 2 diabetes. 36% of                      Kidney disease23
          hypertension, 18% myocardial infarction,
          15% angina pectoris, and 6% of strokes
          are attributable to obesity15                             Premature death: obesity reduces life
                                                                    expectancy by an average of 3 years;
                                                                    severe obesity (BMI > 40) reduces it by
          Alzheimer’s disease26 and dementia                        8-10 years24

          Gastrointestinal disorders: gallstones,                   Unemployment4
          pancreatitis, liver disease, gastro-
          oesophageal reflux disease, irritable
          bowel syndrome. Gastrointestinal
          disorders are 2 to 3                                      Discrimination and stigmatisation4
          times more common in obese individuals
          than in people of normal weight17. 15%
          of gallstone cases are attributable to                    Increased risk of hospitalisation
          obesity15                                                 Severely obese people (BMI > 40) have
                                                                    been found to be 3 times more likely than
          Infertility in women and impotency in                     those of healthy weight to need social
          men18. Losing weight improves women’s                     care4
          chance of getting pregnant and in men
          improves hormone imbalance and
          erectile dysfunction19
}} Food Production – drivers of the food
   Additional Risks for Obese Children                    industry e.g. the pressure for profitability,
                                                          the price of food, effort to increase efficiency
   Emotional and behavioural impacts:                     of production; variables reflecting the wider
   stigmatisation, bullying, low self-esteem,             social and economic situation in the UK e.g.
   and school absence4                                    purchasing power and societal pressure to
                                                          consume
   Breathing difficulties, increased risk of
   fractures, hypertension, early markers of           }} Individual Psychology – psychological
   cardiovascular disease, insulin resistance             attributes e.g. self-esteem, stress, ‘demand
   and psychological effects27                            for indulgence’, level of food ‘literacy’;
                                                          variables related to the level of parental
   Risk becoming obese adults4                            control and level of children’s control of diet

   Higher risk of morbidity, disability and            }} Social Psychology – factors that have
   premature mortality in adulthood21.                    influence at the societal level e.g. education,
                                                          media availability and consumption, TV
                                                          watching; variables related to social norms
                                                          around weight and body image
Causes of Obesity
                                                       }} Physiology – biological variables e.g. genetic
Obesity, understood as the accumulation of                predisposition to obesity, level of satiety and
excess body fat, occurs when energy intake from           resting metabolic rate
food and drink is greater than the body’s energy
requirements over a prolonged period.                  }} Individual Activity – individual’s or group’s
                                                          level of recreational, domestic, occupational
An obesogenic environment promotes weight                 and transport activity, parental modelling of
gain, acts on individual biology and psychology           activity and learned activity patterns
influencing individual lifestyles. Although personal
responsibility plays an important role in weight       }} Physical Activity Environment – factors that
gain, in obesogenic environments inactivity and           may facilitate or obstruct physical activity e.g.
overconsumption of energy dense foods are                 cost of physical exercise, perceived danger
easy, affordable and widely accepted, making an           in the environment and the ‘walkability’ of
unhealthy lifestyle the default option.                   the living environment; variables that reflect
                                                          cultural values associated with activity
The Foresight Report13 for the UK Government              patterns
identified 7 clusters of factors / behaviours that
are contributing to obesity
(termed a systems map):                                These clusters are interconnected. For example,
                                                       some individuals may exhibit compensatory
}} Food Consumption                                    behaviour such as allowing themselves an
   – characteristics of the                            energy-dense snack as a ‘reward’ after
   food market in which                                exercising.
   consumers operate
   e.g. the level of food                              This connectivity is important when designing/
   abundance and variety,                              delivering interventions, as it may help to explain
   the nutritional quality                             unexpected impacts or losses of impact due to
   of food and drink, the                              mitigating effects of different factors/behaviours.
   energy density of food,
   and portion size

                                                                              www.obesityactionscotland.org
Scotland vs the World                                          Cost of Obesity in Scotland

}} Obesity rates in                                            The annual cost to the NHS in Scotland of
   Scotland are higher                                         overweight and obesity is estimated to be
   than in England: 65% vs 60% are overweight                  between £360 million and £600 million28.
   and obese, and 28% vs 24% are obese9
                                                               Average NHS costs for people with a body mass
}} Obesity rates in Scotland are the highest in the            index of 40 (severe obesity) are estimated to be
   United Kingdom9                                             twice those for people with a BMI of 20 (within
                                                               normal weight range). The costs to the health
}} Obesity rates in Scotland are among the                     service of obesity and its comorbidities may be
   highest in the developed world10, with current              comparable to those attributable to smoking.
   projections suggesting that by 2030 rates
   could exceed 40%11                                          Treating smoking-related illness costs NHS
                                                               Scotland around £400 million per year29. ASH
}} A global analysis indicated that prevalence                 Scotland estimated that societal costs of tobacco
   of obesity and overweight in children and                   use in Scotland were nearly £1.1 billion30.
   adolescents in developed countries was 23%5.
   The rate in Scotland is 31%                                 Healthcare expenditure is only part of the issue;
                                                               there are also the indirect economic costs of
}} Scotland had the highest prevalence of obesity              overweight and obesity. The McKinsey Institute
   in pregnant women when compared to 11                       estimates that the cost to the UK is equivalent to
   other European countries (where BMI data is
                                                               3% of gross domestic product ($73billion).
   available)8. In 2010, a European comparison8
   indicated that 21% of pregnant women in
                                                               This analysis takes into account of the loss
   Scotland were obese. The next closest rate
                                                               of productivity attributable to loss of life or
   was Germany at 14% which has a similar age
                                                               impaired life quality, direct health care costs and
   distribution for pregnant women as Scotland8
                                                               investment to mitigate the impact of obesity.
}} If worldwide obesity trends continue, the
   probability of meeting the World Health
   Organisation’s global obesity target which
   aims for no rise in obesity above 2010 levels
   by 2025 will be close to zero12

     REFERENCES

1. Brown L, Christie S, Gill V, et al. The Scottish health   6. World Health Organisation. Report of the
   survey. 2014 edition. Volume 1. Main report. 2015.            commission on ending childhood obesity. 2016.
2. Information Services Division Scotland. Primary 1         7. Information Services Division Scotland. Births in
   body mass index (BMI) statistics Scotland - school            Scottish hospitals - year ending 31st March 2015.
   year 2014/15. 2016.                                           SMR02 data. Updated 2015. Accessed 10/06,
3. Health & Social Care Information Centre. National             2016.
   child measurement programme: England 2014/15              8. EURO-PERISTAT Project. European perinatal
   school year. 2015.                                            health report. Health and care of pregnant women
4. Public Health England. Making the case for tackling           and babies in Europe in 2010. www.europeristat.
   obesity. Why invest? Updated 2015. Accessed                   com. Accessed 10/06, 2016.
   09/05, 2016.                                              9. Baker C, Bate A. Obesity statistics. Briefing paper.
5. European Association for the Study of Obesity.                2016; 3336.
   Facts & statistics. Updated 2016. Accessed 08/06,         10. OECD. Obesity update 2014. 2014.
   2016.
REFERENCES

11. RR Donnelley B62286 02/10. Preventing                  21. Simon GE, Von Korff M, Saunders K, et al.
    overweight and obesity in Scotland. A route map            Obesity and psychiatric disorders in the US adult
    towards healthy weight. 2010.                              population. Arch Gen Psychiatry. 2016; 63(7):824-
12. NCD Risk Factor Collaboration (NCD-RisC).                  830.
    Trends in adult body-mass index in 200 countries       22. Harvard TH Chan School of Public Health.
    from 1975 to 2014: A pooled analysis of 1698               Weight problem take a heft toll on body and mind.
    population-based measurement studies with 19.2             Accessed 13/05, 2016.
    million participants. The Lancet. 2016; 387:1377-      23. Kopple JD. Obesity and chronic kidney disease.
    1396.                                                      Journal of Renal Nutrition. 2010; 20:S2930.
13. Butland B, Jebb S, Kopelman P, et al. Foresight.       24. Dent M, Swanston D. Briefing note: Obesity and
    Tackling obesities: Future choices - project report.       life expectancy. 2010.
    2nd edition. 2007.                                     25. Scarborough P, Cowburn G, Cobiac L, et
14. NHS Information Centre Lifestyle Statistics.               al. Translating the world health organisation
    Statistics on obesity, physical activity and diet,         25x25 goals into a united kingdom context: The
    England 2012. 2012.                                        PROMISE study. 2016.
15. McGuire A, Morris S, Raikou M. Appendix 6              26. Christensen A, Pike CJ. Menopause, obesity
    estimating the cost of obesity in England in the           and inflammation: Interactive risk factors
    national audit office tackling obesity in England.         for Alzheimer’s disease. Frontiers in Aging
    2001.                                                      Neuroscience. 2015; 7(7):130.
16. Cancer Research UK. How being overweight               27. World Health Organisation. Obesity and
    causes cancer. Updated 2015. Accessed 12/05,               overweight. Factsheet no 311. Updated 2015.
    2016.                                                      Accessed 05/13, 2016.
17. American College of Gastroenterology. Obesity.         28. Castle A. SPICe briefing: Obesity in Scotland.
    Updated 2016. Accessed 13/05, 2016.                        2015; 15/01.
18. Public Health England. Health risks of adult           29. Scottish Government. Publication of Scottish
    obesity. Accessed 10/05, 2016.                             government tobacco control strategy. Updated
19. Pasquali R, Patton L, Gambineri A. Obesity                 2013. Accessed 10/06, 2016.
    and infertility. Current Opinion in Endocrinology,     30. Action on Smoking and Health Scotland. Up in
    Diabetes and Obesity. 2007; 14(6):482-487.                 smoke. The economic cost of tobacco in Scotland.
20. NHS Choices. Risk of being overweight in                   2010.
    pregnancy. Updated 2015. Accessed 13/05, 2016.

Obesity Action Scotland
Obesity Action Scotland was established mid-2015 to provide clinical
leadership and independent advocacy on preventing and reducing overweight
and obesity in Scotland.

Our main aims:
• To raise awareness and understanding of what drives obesity and the
   health problems associated with obesity and overweight with health                     Royal College of
   practitioners, policy makers and the public                                            Physicians and Surgeons
• To evaluate current research and identify strategies to prevent obesity and             232 - 242 St Vincent Street
   overweight based on the best available evidence                                        Glasgow G2 5RJ
• To work with key organisations in Scotland, the rest of the UK and                      0141 221 6072
   worldwide, to promote healthy weight and wellbeing                                     info@obesityactionscotland.org
                                                                                          @obesityactionsc
Overseeing our work is the Steering Group whose membership spans various                  www.obesityactionscotland.org
disciplines involved in preventing and tackling obesity and its consequences:
clinicians, public health experts, epidemiologists, nutritionists and dieticians,         Further copies can be
GPs and weight management experts.                                                        downloaded from our
There are four members of staff.                                                          website
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