And this is the fifth and final edition of my ‘Obesity in the UK‘ series: Conclusions on Causes and Consequences of Rising Obesity Levels in the United Kingdom. Throughout this series, we have explored causes and consequences; physiological, behavioral, economic and social. All references are available upon request.
So, here’s my sum up:
A response to the question of the causes of rising obesity incidence in the United Kingdom principally focuses on the drivers this incidence.
Whilst sometimes framed as a debate on genetics versus environment, the causes are most broadly attributed to these: behavioral and environmental factors, and psychosocial factors.
A growing body of evidence shows that behavioral factors outweigh genetic factors. This is an important finding for intervention studies and policy. This series has argued that rising incidence in the UK has been fuelled by multiple, interconnecting causes. Early intervention by government, the World Health Organization and citizens can begin to alter these trends.
However, many studies suggesting that individuals can halt or reverse progression to obesity by food and diet control follow the cognitive model of eating behavior. This model assumes that intentions are a weaker predictor of behavior than attitudes, social norms and even perceived behavioral control.
At an individual level, studies have shown that obesity is associated with low self-esteem and body dissatisfaction in children and adults, affecting work and performance; and in some cases leading to depression, anxiety and other negative psychological consequences. The bias and discrimination reported by overweight and obese individuals has also been explored.
A very important limitation to discuss is the use of BMI. Most of the literature reviewed in this series, and indeed around this subject area, uses BMI to classify overweight or obese status. However, BMI as a classification is occasionally met with criticism. It is not always an accurate measure of risk. It does not account for muscle density, fat distribution or ethnic variations in risk thresholds. The National Institute for Health and Care Excellence (NICE) recommends that in obesity management, BMI is used in combination with waist circumference as centripetal adiposity is often considered a risk factor for a number of cardiovascular diseases.
Furthermore, in many instances, self-reported data was used. It is not uncommon for these to be inaccurate: overestimated height in men and underestimated weight in women.
Individual-level factors can no doubt contribute to consequences on a larger societal level as a greater proportion of the population falls into obesity. The economic costs to individuals can be high; and may be related to prevention, treatment and social adjustments
However, the cost at a national level, in the United Kingdom, may be even greater as obesity and its associated comorbidities incur greater costs to NHS health, support and emergency services.
Although the rising incidence of obesity in the UK and globally is alarming, the phenomenon has precipitated a greater awareness of obesity as a public health problem in the principal global policy formulating body, the World Health Organization and also by the UK government. The UK has introduced important policy options and strategies.
The rise in obesity has been shown to be multifaceted. The significant contribution of behavioral factors to the rising incidence of obesity suggests an important role for well-defined interventions to manage and reduce obesity levels.
Further research may be needed to better understand the most effective interventions that should be applied. Despite the concern of rising obesity, UK data is promising as it has already been shown that increasing obesity levels in children in particular are responding to the intervention measures.
Let’s see what the future holds!