By Professor Greg Whyte OBE, Chair of the ukactive Scientific Advisory Board and Professor of Applied Sport and Exercise Science at Liverpool John Moore’s University
Today (8 April) the World Obesity Federation will be hosting an international debate on the state of the world’s health against the backdrop of our global pandemic, and I’m pleased to have been invited to speak as a guest on this important issue.
While obesity is an important focus, it should be highlighted that our overall health, behaviour and lifestyle has rarely been more pertinent than it is today. The pandemic has simply shone a spotlight on our underlying health and habits which must be addressed – from nutrition, to exercise, work life to social life.
It is important we identify obesity as a symptom of a complex bio-psycho-socio-cultural problem, linked in part to poor nutrition and physical inactivity – one of many preventable conditions rooted in health inequalities on a national and international scale.
Obesity itself is a complex bio-psycho-socio-cultural disease that requires a multifaceted approach to its prevention and treatment. There is no one single or simple solution to addressing the pandemic of obesity (CDC, 2020). The belief that changing one possible cause of obesity in isolation is misguided and doomed to failure.
Recent history is strewn with examples of these ‘one-stop-shop’ failed policies ranging from food taxes to increased bariatric surgery. Furthermore, the use of flippant, headline grabbing slogans that are pitched in competition with other, important, lifestyle factors such as ‘You can’t outrun a bad diet’ are entirely misleading and counterproductive in the prevention and treatment of obesity.
We must take a comprehensive, multi-sector approach, addressing the range of bio-psycho-socio-cultural factors, if we are to be successful in addressing one of the most pressing public health problems facing society.
In England, in 2018, 63% of the adult population suffered from being overweight (25–29.9 kg/m2) or obese (>30 kg/m2) – up from 53% in 1993*. A gender difference exists, with 67% of men compared with 60% of women suffering from being overweight or obese. This gender difference varies when partitioning the disease into overweight (41% of men versus 30% of women) and obese (including morbid obesity; 26% of men versus 29% of women).
In 2018/19 there were 876,000 hospital admissions where obesity was recorded as the primary or a secondary diagnosis. Around two in every three patients admitted were female (65%) (NHS, 2020). Gender inequality exists in lifestyle factors that are linked to obesity, ie physical activity.
In England, in 2020, one in three (32%) adults failed to meet the Chief Medical Officer’s guidelines for physical activity for health, with 21% failing to attain 30 minutes of activity per week. Women were less likely to be active (65%) compared with men (70%) (NHS, 2020). Multiple lockdowns and the closure of the leisure and fitness sector is likely to have exacerbated this gender inequality.
While all bio-psycho-socio-cultural factors linked to obesity are important, physical activity plays a central role in health optimisation. The role of physical activity in weight management has been placed into question in recent years, with a variety of studies suggesting a limited efficacy for exercise alone in weight reduction. However, what is beyond doubt, is the central importance of physical activity in physical, mental, emotional and social health.
Furthermore, the importance of physical activity at either end of the life-cycle, from pregnancy to older age, is well established and fundamental to enhanced health and wellbeing.
The starting point in our search for a solution to the obesity epidemic is to recognise that there is no magic wand. Searching for a single solution to eradicate obesity is misguided. Furthermore, we must recognise that the disease of obesity is not one of aesthetic, simply defined as body size, shape or weight.
It is crucial that we look under the bonnet to understand and treat the plethora of physical, mental, emotional and social issues linked to the prevention and treatment of obesity. We must act in a collaborative, coordinated, multi-agency approach to simultaneously address the complex interaction of factors associated with obesity if we are to create a successful and sustainable solution, now and long into the future.
Physical activity plays a central role in the prevention and treatment of obesity beyond weight management, and highlights the importance of recognising the fitness and leisure sector as an ‘essential service’ in the enhancement of public health across the lifespan, from womb to tomb.
*In England, in 2020, 9.7% of reception aged children and 20.2% of year 6 aged children suffered from being overweight or obese. Boys were more likely to suffer from obesity in both age groups. For children living in the most deprived areas, obesity prevalence was more than double that of those living in the least deprived areas. 53% of children fail meet the guidelines for physical activity for health (60 mins/day) (NHS, 2020).
NHS Digital. Statistics on obesity, physical activity and diet, England, 2020.
Centers for Disease Control and Prevention. Strategies to prevent obesity. 2020