Table Of ContentPublic Health Mini-Guide
Obesity
About the authors
Nick Townsend is a Senior Researcher at Oxford University, UK. He leads
on a programme of research into the epidemiology of cardiovascular disease
(CVD) with a special interest in obesity and its associated risk factors. Nick has
published widely on obesity as well as presenting findings at a number of UK and
international conferences. He teaches on a range of graduate and postgraduate
courses within the university and has also acted as a guest lecturer on the courses
of other institutions. His research focuses on the complex determination of
obesity, with a focus on policy interventions and the promotion of healthy
behaviour in schools.
Angela Scriven is a Reader in Health Promotion at Brunel University in
London, UK. She has been teaching and researching in the field of health
promotion for over 30 year and has published widely including authoring,
editing or co-editing the following books Health Promotion Alliances: Theory
and Practice (1998); Health Promotion: Professional Perspectives (1996; 2001 2nd
edn); Promoting Health: Global Perspectives (2005); Health Promoting Practice:
The Contribution of Nurses and Allied Health Professionals (2005); Public Health:
Social Context and Action (2007); Promoting Health: A Practical Guide (2010);
Health Promotion for Health Practitioners (2010); Health Promotion Settings:
Principles and Practice (2012). Her research is centred on the relationship
between health promotion policy and practice within specific contexts. She
is a member of the International Union of Health Promotion and Education
(IUHPE), is President Elect for the Institute of Health Promotion and Education
(IHPE) and is a Fellow of the Royal Society for Public Health (RSPH).
For Elsevier
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Public Health Mini-Guide
Obesity
Nick Townsend
Senior Researcher, University of Oxford, Oxford, UK
Angela Scriven
Reader in Health Promotion, Brunel University, London, UK
Series editor:
Angela Scriven
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2014
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
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Titles in the Public Health Mini-Guide series:
Obesity
Nick Townsend, Angela Scriven
ISBN 9780702046346
Alcohol Misuse (forthcoming)
Ken Barrie, Angela Scriven
ISBN 9780702046384
Diabetes (forthcoming)
Josie Evans, Angela Scriven
ISBN 9780702046377
Series preface
The UK Government highlighted in the Foreword to its strategy for public
health in England, the Healthy Lives, Healthy People White Paper1 some of the
public health challenges that are facing those working to improve public health:
‘Britain is now the most obese nation in Europe. We have among the worst
rates of sexually transmitted infections recorded, a relatively large population of
problem drug users and rising levels of harm from alcohol. Smoking alone claims
over 80,000 lives in every year. Experts estimate that tackling poor mental health
could reduce our overall disease burden by nearly a quarter. Health inequalities
between rich and poor have been getting progressively worse’.
The public health targets are clear both in the White Paper and in Our Health
and Wellbeing Today,2 published to accompany the White Paper, with the targets
being supplemented by further policy drivers for mental health, tobacco control,
obesity, sexual health and the wider determinants. The proposals and identified
priorities in the White Paper apply to England, but they are of equal concern
in the Devolved Administrations and globally, as evidenced in World Health
Organization reports (www.who.int/whr/en/index.html). The Public Health
Mini-Guides series covers some of the key health targets identified by the UK
Government and WHO. The Mini-Guides highlight, in a concise, easily accessible
manner, what the problems are and the range of potential solutions available to
those professionals with a responsibility to promote health.
What the Public Health Mini-Guides provide
The Mini-Guides are written to provide up-to-date, evidence-based information in a
convenient pocket-sized format, on a range of current key public health topics. They
will support the work of health and social care practitioners and students on courses
related to public health and health promotion.
Each volume provides an objective and balanced introduction to an overview
of the epidemiological, scientific, and other factors relating to public health. The
Mini-Guides are structured to provide easy access to information. The first chapters
cover background information needed to quickly understand the issue, including
the epidemiology, demography and physiology. The later chapters examine
examples of public health action to address the issue, covering health promotion
Series preface
intervention, legislative and other measures. The Mini-Guides are designed to
be essential reference texts for students, practitioners and researchers with a
professional interest in public health and health promotion.
Uxbridge, 2012 Angela Scriven
References
1. The Stationery Office. Healthy Lives, Healthy People. White Paper. 2010.
2. Department of Health. Our Health and Wellbeing Today. London: Department of Health; 2010.
viii
Preface
Obesity and its linked morbidity and mortality place a burden not only on the
individual but also on society as a whole. It is a significant public health challenge
on a global scale. This Mini Guide presents key themes relating to this challenge,
including the means of measuring obesity, the most recent prevalence and trends,
and the health consequences and causes of obesity, along with approaches to
counter obesity both at an individual and a population level.
Chapter 1 starts with defining obesity, and then critiques the various measures by
assessing their strengths and weaknesses. Obesity in children and the use of growth charts
is considered alongside the range of thresholds available (UK90, CDC, IOTF, WHO)
and an explanation of the difficulties in using them. The chapter finishes with a short
piece on the adiposity rebound and evidence of predicting future obesity. Chapter 2
covers prevalence and trends with regional, ethnic and social differences in prevalence
in the UK compared to international data and estimated future trends. Chapter 3
examines the health consequences of obesity, highlighting any extra complications from
obesity in childhood. Relative risks, where available, of some of these morbidities are
presented. Causal pathways are discussed and the difficulty in separating obesity as a risk
factor is explained alongside the evidence of obesity related mortality. Chapter 4 covers
the causes of obesity and their interrelations and demonstrates the complex nature of
the determination of obesity. Chapter 5 deals with ways of combating obesity at the
individual level with description of how to treat obese individuals, from diet and exercise
to medical intervention including NICE recommendations. Chapter 6 assesses how
to intervene at a population rather than individual level, introducing a public health
approach to preventing obesity, including policy impacts.
Each chapter covers important content on these themes with suggestions on
where readers can find more information through links to webpages, resources and
further reading. Understanding is facilitated through Case Studies, examples in
Boxes, Thinking Points and an end-of-chapter set of Summary Points.
1 Defining the obesity
problem
a General Practice (GP) surgery is
What is obesity?
routinely measuring patients visiting
Obesity is a medical condition their practice in order to identify
characterised by an excess of adipose those who are overweight or obese,
tissue (fat) in the body that may have it is important that when individuals
adverse effect on the health of an are classified within high-risk weight
individual1–4 (see Chapter 3 for detailed status thresholds, they receive suitable
coverage of the health risks of obesity). treatment to enable them to reduce
The World Health Organization their weight in a healthy manner.
(WHO) similarly defines overweight Surveillance programmes The aim
and obesity as abnormal or excessive here is to monitor the levels of obesity
fat accumulation that presents a risk to in a population rather than to identify
health.5 This is an important definition, those who require treatment.9–11
as it indicates what to measure when Within surveillance programmes, data
investigating obesity. are usually anonymised, meaning that
no routine feedback of individualised
Measuring obesity results is provided, nor is any formal
link to treatment maintained. Data
Screening programmes These collected from these programmes
are large-scale programmes that enable the identification and
identify those who are at risk from monitoring of trends over time and
obesity-related ill health. They assist in the targeting of interventions.
should be accompanied by an Additionally, information from
explicit intention to prevent and also surveillance programmes may be
reduce the prevalence of obesity in used to analyse different causal and
the population.6–9 For example, if contributory factors for overweight
Public Health Mini-Guides: Obesity
and obesity, supporting the On occasions programmes may
development of effective interventions straddle the line between screening and
and public health approaches to surveillance, such as the National Child
tackle obesity12,13 (see Chapter 6 for Measurement Programme (NCMP) in
an overview of public health obesity England (see the NCMP Case Study in
interventions). Box 1.1).
Thinking points
1. Some people object to the collection of measurements related to obesity, although
screening for other health conditions is welcomed; why is there this disparity?
2. What unintended harms can arise from running obesity measuring
programmes?
3. Is it ethically sound to run a surveillance programme in which those identified
as at risk of ill health are not informed?
4. With changes to the NHS in England, the running of the NCMP may have to
change; should it be retained, and what should be saved in order to link future
obesity measurement findings to earlier data?
Box 1.1 Case study: National Child Measurement Programme
The National Child Measurement Programme (NCMP) for England was established in
2005/06. The NCMP collects population-level surveillance data for children through
taking annual measurements of height and weight for Reception year (typically
aged 4–5 years) and Year 6 (typically aged 10–11 years) primary school pupils.14
The measurement exercise was coordinated locally by Primary Care Trusts (PCTs)
with the support and cooperation of schools.15 PCTs were freestanding statutory
bodies of the National Health Service (NHS) that had the responsibility for securing
the provision of a full range of primary care services for the local populations. There
were 152 PCTs covering all of England within which the collection of NCMP data was
coordinated. However, changes to the structure of the NHS under the Health and
Social Care Bill 2011 announced the abolishment of PCTs by 2013, with the public
health aspects of the PCTs taken on by local councils.16 With the abolition of the
PCTs, responsibility for NCMP measurement was taken on by Local Authorities with
central collation of the data conducted by the Health and Social Care Information
Centre (HSCIC) which was formally known as the NHS Information Centre. With
the abolition of the PCTs in 2013 this measurement became the responsibility of
Local Authorities. Authorities can undertake measurements at any time during the
school year.17 Height and weight measurements are taken by health professionals,
Continued
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