‘Who exactly becomes obese?’

Jack Nicholson once said, with my sunglasses on I am Jack Nicholson; without them I am fat and 60! With or without sunglasses, more than half of the UK adult population are now overweight or obese. ‘So what?’ cry the libertarians as they lick the icing off their lips from their Krispy Kreme donut. ‘It’s my free choice to eat what I like and when I like now my nanny (real or imagined) has her P45’.

Thus, cowed by taunts of ‘nanny state’, oblivious of the tsunami of obstacles shaping our ‘free’ choices which have turned our daily lives into an obesogenic environment survival race, and ignorant of the detailed analysis of evidence of who gets fat and why, piecemeal solutions have been trotted out over the years that have had precisely zero impact on our status as the ‘fat man of Europe’.

Last year McKinsey produced a report putting a figure of £47Bn cost to the economy on why obesity matters to the UK, more than the cost of war and terror threats. To say therefore that obesity represents an economic crisis is not an overstatement, and logically everyone of us who becomes obese adds to our nation’s burden.

2020health’s 2014 report ‘Careless eating costs lives’ highlighted that no individual obesitythumbnailsector or solution can solve the problem. There are so many actors around us shaping our choices that simply to talk about personal responsibility is naive, lthough of course our own behavior is a critical element. We highlighted actions for 13 different agencies, from the treasury to health, education to Ofcom, schools and industry to local government. Nothing less than a cross-departmental, coordinated, holistic national and local strategy will work. But we still don’t have the whole picture.

What is still lacking is an analysis of detailed, changing trends and factors. For instance which women, in what circumstances, why some and not others, and how have changes over the years come about?  Above all if policy is going to be effective, we need to know, apart from libertarians, who exactly gets fat? If it were simply those living in poverty, there would be a natural cap. But numbers of obese rise year on year – it has to be more nuanced than this.

With this challenge in mind 2020health is carrying out research which examines and compiles the wealth of current knowledge and statistics on obesity in England in order to address one crucial question: ‘Who exactly becomes obese?’ By looking at changing trends, the structural and choice architecture of people’s lives this research aims to inform the gaps in knowledge of obesity research that must be filled in order to begin to intelligently and meaningfully address the ways in which individuals, organisations and policy makers in both the public and private sectors can address UK obesity.

There are some interesting early findings. Men have caught up with women in the fat league tables, but while country-wide demographics show obesity as an epidemic that is equal among sexes, some research suggests that obesity, correlated with a range of other socio-demographics data, is highly gendered.  In other words, for a given socio-economic or demographic factor, gender becomes highly informative in understanding trends in obesity.  Whilst we’ve known that neighbourhood characteristics share correlation towards obesity rates, research that simply links obesity to deprivation has the potential to overlook complexity in neighbourhood poverty influences.  One of these characteristics is fast food density in a given area, and recent literature suggests that, for men especially, it is food options in the vicinity of their employment which have the highest correlations to body Mass index (BMI).

The evidence that links poverty, deprivation, and lower socioeconomic positions to obesity remains overwhelming, but what has emerged in recent research on obesity is that obesity rates are now rising fairly rapidly among other economic groups.  This, too, is gendered.  For middle and upper financial classes, men are becoming far more affected by obesity, but this trend is mitigated for women.  Additionally, both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or poor, with the downwardly mobile currently sharing the highest rates and rises of obesity. Again, these rates are gendered.  For the stable poor, obesity is much higher in women, for the stable wealthy, obesity is higher for men, and for the economically mobile, it rises for both men and women.

For children, the rates of obesity are more alarming.  Childhood obesity is still associated with poverty and parents’ education and habits.  However, in many cities and towns, researchers have found ‘hotspots’ of childhood obesity that are not associated with health.  These hotspots tend to overlap with both the poorest and wealthiest neighbourhoods.

Clinical depression and anxiety are also positively correlated with higher BMIs, but evidence suggests that, outside the clinic, more subtle ownership of depression and anxiety is deeply linked with obesity.  One very large study found that, especially for men, it is the ‘anxious’ middle class that is currently experiencing the largest rise in obesity rates.

The final report will explore and discuss these themes and others in more detail, with the aim of directly informing decisions on how we reverse UK obesity trends and our unenviable status as nutritional overachievers. If it was as easy as naming and shaming a particular food ingredient, we would have nailed this problem decades ago. Our hope is that this research will give a deeper understanding of this national crisis, and that we will have politicians and agencies bold and wise enough to understand that their duty to protect society from obesogenic harm actually increases, not decreases our freedoms.

Listen to the Spectator & 2020health podcast special: exploring obesity

Blog by Julia Manning, Chief Executive, 2020health, for Spectator Health

About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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