Chapter 3: Background

According to Brown and Psarou (2008), the guidance provided by the World Health Organization (WHO) gives the definition of obesity as a condition in which an individual has excess body fat. This definition is by body mass index (BMI). A BMI of more than 30 kg/m² according to WHO is indicative of obesity (Brown and Psarou, 2008).

According to Mittal, Srivastava and Srivastava (2016), the origin of obesity is multi-factorial and there is a possible interaction between lifestyle and environmental factors with numerous genetic variants to bring about obesity.  Globally, the prevalence of obesity has been attributed to numerous reasons. The major reason is the change in peoples’ physical activity and the nutritional habits (Mitchell, Cowburn and Foster, 2011).

Parlińska and Rembielak (2014) particularly state that the diet today has an increased proportion of protein and fat and a reduction in fibre, and the drinks chosen by people tending to be sweetened ones, leading to high caloric intake with a failure to reduce sensations of hunger. Using cross sectional data from UK national data and nutrition survey (NDNS), Adams and White (2015) found that a higher intake of processed ingredients showed an inverse and consistent relationship with body weight. These provide evidence for the correlation between nutrition habits and the risk of obesity. However, Adams and White (2015) acknowledge to have had problems with the classification of foods due to a lack of standardization and therefore this may affect the reliability of the results.

While there has been increased prevalence of obesity, physical activity has greatly reduced with motorization and technology (Parlińska and Rembielak, 2014).  This is supported by Papadopoulou and Stanner (2014) in their statement that obesity is linked to behavioural, cultural, and lifestyle factors that lead to the encouragement of a positive move in the balance of energy through an increase in energy intake and a reduction of energy use. People have the tendency to choose what is more convenient for instance watching TV and social networking as ways of entertainment rather than games that involve physical activity; and the use of motor vehicles as opposed to walking.

According to Hamer, Weiler and Stamatakis (2014), excessive level of sedentary behaviour for instance watching television has a relationship with numerous health risks associated with metabolism. Following these arguments, the authors conducted a study aimed at examining the relationship between watching sports on television, the level of physical activity and the risk of being obese among older UK adults. The study was longitudinal in nature, with data from the English Longitudinal Study of Aging (ELSA) which was deemed to be representative. Moreover, covariates included health and demographic related variables previously associated with obesity. The results revealed that there is a link between television viewing and the risk of obesity particularly in men. The rise in obesity as a result of decreased physical activity is further supported by the study of Sundin, Fear, Wessely and Rona (2011) which found that the prevalence obesity in the military was lower (13 percent) than that of the general population (16 to 26 percent) of the age range (16 to 54 years).

Obesity has been viewed in many aspects, including its relationship with socioeconomic backgrounds (Zala, 2013). Such studies suggest a positive link between increased prevalence of obesity and economically disadvantaged households as well as social minorities. The explanation provided is that processed foods are cheaper and that low income persons are more likely to spend their time in pursuit of money, taking multiple jobs and as such do not have time to prepare wholesome meals. This argument is however under debate since studies have no proven statistical correlation which exempts richer families from the risk of obesity (Zala, 2013).

There has been a rise in the rates of obesity in many countries over the recent years. According to WHO, about 1.5 billion persons aged above 20 globally were either overweight or obese in 2008. Among these, 300 million were women and 200 million were men (Tyczynski, Oleske, Klingman, Ferrufino and Won, 2012).  Papadopoulou, and Stanner (2014) posit that based on the guideline provided by WHO, obesity among men has increased to 24 percent from 13 percent and in women, to 25 percent from 16 percent between 1993 and 2012. Approximations from the UK show that one in every four men and women is obese (Reeves, Balkwill, Cairns, Green and Beral, 2014).

3.1       Prevention and management of adult obesity in the UK

Although obesity was formally recognized in England as a threat to national health in the 1990’s and recommendations drawn with the aim of reducing the prevalence of obesity among adults by 7 percent by 2005, the policies suggested were not implemented (Jebb, Aveyard and Hawkes, 2013). It is until after 2001 and following a parliamentary inquiry that the UK government reacted to the issue of obesity, specifically focusing on children and introducing new initiatives (Jebb, Aveyard and Hawkes, 2013). Since then, there has been an evolution in the various recommendations provided for the prevention and management of diabetes in the UK (Poobalan, et al., 2010).

These recommendations focus on nutrition, obesogenic environments, physical activities and various actors in the promotion of healthy lifestyles and treatment of obesity. For instance, reports indicate the need to have healthier alternatives to energy rich snacks in fast food outlets and vending machines in schools. Moreover, the recommendations push for the need for food standard agency (FSA) and the UK government to work together towards the simplification of food labeling so that the general population can more easily interpret and to initiate a ban on unhealthy foods that are targeted towards children and the provision of advice to breastfeeding or pregnant women with regard to physical activity and a healthy diet.

Additionally, recommendations targeting physical exercise include the increase in the allocation of the number of hours of physical activity in schools, making pedestrian routes safer, increased consumer education concerning the use of pedometers, and increased physical education exercises which are single sex to increase the involvement of girls. Further, recommendations targeting obesity management include the maintenance of records of persons with risk of developing obesity and those in treatment, increased funds towards the management of obesity, the expansion of obesity services, ease of access to treatment for obese children and increased funds allocation towards training on the management of obesity.

Actions that have been taken with regard to these recommendations among the adult population include a shift from regulatory controls to the development of more voluntary actions towards the restriction of food marketing, social marketing campaigns and change4life program whose objective is to provide support in decision making with regard to healthier choice of food (Jebb, Aveyard and Hawkes, 2013). Also, another program, start4life has focused on supporting mothers in their pregnancy and early years as it pertains to breastfeeding and practices of healthy weaning as a way of reducing maternal obesity (Jebb, Aveyard and Hawkes, 2013). With regard to the management of obesity, information has been provided in the NHS websites with increasing number of local areas offering either subsidized or free referral schemes for community weight management (Jebb, Aveyard and Hawkes, 2013).

3.2       Problem statement

Obesity is described by the World Health Organisation (WHO) as a global epidemic (Ramasubramanian, Lane and Rahman, 2013). Illnesses in the UK that are correlated with obesity costs the NHS approximately ₤5. 1 billion annually (Griffiths, Frearson, Taylor, Radley and Cooke, 2014). Such illnesses include hypertension, cardiovascular disease, angina pectoris, certain cancers, osteoarthritis, respiratory disease, gallbladder disease and type 2 diabetes (El-Sayed, Scarborough and Galea, 2011; Tabassum and Batty, 2013; Parkin and Boyd, 2011; Reeves, Balkwill, Cairns, Green and Beral, 2014).  More specifically, cardiovascular diseases account for 37 percent of UK annual deaths and cancers 27 percent of annual deaths (Allender and Rayner, 2007). Also, more than 65,000 annual deaths in the UK are associated with obesity and overweight (Mitchell, Cowburn and Foster, 2011).

Apart from the economic burden, obesity has been found to be negatively related to academic outcomes in adolescents and young adults (Booth, et al., 2014). The epidemic is worsened by the forecasts which indicate that 50 percent of women and 60 percent of men in the general population in the UK will be obese by 2050 (El-Sayed, Scarborough and Galea, 2011). This suggests the urgency to find a workable intervention.

3.3       Research aim and objectives

The aim of the study is to examine the prevention and management of obesity among adults aged 18 and above, focusing on the role of public health campaigns and environmental factors associated with obesity. The main objectives include:

1. To examine the public health measures and environmental factors that have an influence in the prevention and management of obesity
2. To examine the impact that the measures have created so far in different study contexts
3. To investigate the applicability of such measures and the possibility of replicating their positive results to the UK adult population
4. Based on the findings, to recommend practical measures that will enable sustainable prevention and management of obesity among the UK adult population

3.4       Rationale

There is a need for the development of strategies that are effective in the prevention and management of obesity and overweight in the UK (Leslie, Watson and Hankey, 2010). Recent studies suggest that obesity recommendations in the UK have a clear definition of the population targeted and have been well prioritised in terms of prevention and treatment (Poobalan, Aucott, Ahmed, Smith and Cairns, 2010). However, the forecasted statistics as aforementioned still indicate an expected increase in the rate of obesity among the general population. This means that the present interventions already established and outlined need to be re-examined in order to re-determined their fitness in the reduction of obesity and mainly through prevention which is cheaper and more sustainable in the long run.

The current research reviews the studies conducted that focus on the prevention and management and obesity among adults (18 years and above) with greater focus on public health campaigns and environmental factors. Given that the study focuses on a review of literature, it reconciles research conducted in this area, examining the quality and applicability of the results. It therefore more accurately informs policy.

Chapter 4: Obesity and public health measures

 

Chapter 5: Obesity and related environmental factors

 

Chapter 6: Conclusions

 

Chapter 7: Recommendations for future practice

 

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Appendix