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Tackling obesity the need for concerted action
Obesity must be tackled if it is not to become the foremost threat to health in this country. So said Edward Leigh MP, chairman of the Public Accounts Committee, at a conference in London this week. Speaking a few days after the committee had published its report on ways of improving the prevention and management of overweight and obesity, Mr Leigh said that the condition was increasing more rapidly in England than in any other European country.
The statistics are certainly staggering. Four million men and three million women in England are now obese (body mass index >30) and the numbers have tripled during the past two decades. No country in the world is free of this problem and none has found the perfect solution, although within Europe there is a much lower prevalence of obesity in the Netherlands, Switzerland and Scandinavian countries. Professor Philip James (chairman, International Obesity Task Force) highlighted the case of Finland, where a national programme started more than a decade ago to increase fruit and vegetable intake and cut fat intake has made a significant contribution to containing the rise in obesity. In Finland, just one in 10 women is obese compared with one in five in England.
In the Netherlands where rates of obesity are lower still just one in 12 people is obese 45 per cent of urban journeys are made by car; the equivalent for England is 62 per cent. According to figures presented by Dr William Dietz (National Centre for Chronic Disease Prevention and Health Promotion, United States), the Dutch even appear to walk more than the English, at least in urban areas. And, then of course there is the bicycle, used for 30 per cent of urban journeys in the Netherlands and for less than 10 per cent in England.
Cars are used more extensively in Britain than elsewhere in Europe, despite lower car ownership. Dr Adrian Davis (independent transport and health adviser) pointed out that health was not intrinsically a policy objective of transport planning. Although various government departments were working together to promote walking and cycling as sustainable transport, more action was needed on issues of traffic speed and road space allocation so that cyclists and pedestrians felt they had a right to be there. There was a role here for public health and health professionals to use their influence to argue the case for environmentally led transport planning conducive to good health.
Mr Leigh emphasised the need for a more proactive approach from general practitioners. In a recent survey by TOAST (The Obesity Awareness and Solutions Trust), 90 per cent thought that GPs did not provide enough support. However, responsibility lay not with GPs alone, but with the whole primary care team. Moreover, the attitude of blaming people for their obesity had to disappear, he said. "Obesity is actually a normal response to an abnormal environment, not an abnormal response to a normal environment."
Will Hutton (chairman, Industrial Society) concurred with this view, pointing out that "obesity is a response to the social, economic and global influences of the modern world. Maybe eating too much is a rational way out of the multiple pressures of modern life. In short, it's a political/societal problem, and we have to think hard about how we resolve this issue. But putting up notices in surgeries about the dangers of certain kinds of food will have no impact not until obesity is understood to be as dangerous as smoking."
Professor David Hall (president, Royal College of Paediatrics and Child Health) also explored the comparison between smoking and obesity. There was now growing awareness of the damage obesity could do to health, the stage that had been reached with smoking in the 1970s. However, given the need to change a whole range of habits and behaviours, obesity would be more difficult to tackle than smoking, which required that individuals take one action alone.
According to the Public Accounts Committee report, obesity is linked to 30,000 deaths a year, shortening life by nine years on average. On a conservative basis it costs the National Health Service at least £0.5bn a year and the wider economy £2bn a year, for example, in sickness absence. Yet, the NHS is currently spending less that £10m a year on tackling obesity, Mr Leigh said. With more than eight million people in the UK who could potentially benefit, that represents just £1 a head.
The implications for the health care costs of obesity were enormous, according to Dr Dietz. The obesity epidemic would be followed by a massive rise in diabetes and cardiovascular disease. In the US, where the incidence of obesity is higher than in Britain, the plateauing out of cardiovascular disease had now stopped, he emphasised, and was increasing again.
Speaking about the role of diet, Dr Susan Jebb (head of nutrition and health research, Medical Research Council) said that the strategy for obesity had to be one that was capable of reducing co-morbidities, such as coronary heart disease, diabetes and cancer. There was a need to reduce the proportion of fat, increase the proportion of carbohydrates, especially those from wholegrain sources, increase fruit and vegetable intake, ensuring snacks did not contribute to excess energy intake and consider portion size, especially where weight needed to be lost. "This strategy is well established and consistent with dietary advice for prevention of cardiovascular disease, cancer and diabetes," she said.
However, knowledge was not enough and telling people what to eat had been proven not to work. In any case, many people knew what was good for them. What was needed was support, from health professionals and family, as well as practical skills in cooking, shopping and eating out. "Obesity requires concerted action by government, industry, health professionals, schools, employers and individuals to implement both dietary change and to encourage more physical activity," Dr Jebb concluded.
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Citation: The Pharmaceutical Journal URI: 20005926