noo National Obesity Observatory

Overweight and obesity: where are we and where are we heading?

Harry Rutter National Obesity Observatory

harry.rutter@lshtm.ac.uk

noo National Obesity Observatory Prevalence of excess weight among adults aged 16+ years

Health Survey for England 1993-2010

Excess weight (overweight and obesity) has risen amongst adults over the last two decades.

Adult excess weight: BMI ≥ 25kg/m2

0

10

20

30

40

50

60

70

93-95 94-96 95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10

Prev

alen

ce o

f exc

ess

wei

ght (

%)

Survey year (3-year average)

Males Females

noo National Obesity Observatory Prevalence of excess weight among children aged 2-15 years

Health Survey for England 1995-2010

Overall, excess weight has levelled off amongst children, but at a very high level.

Child excess weight: BMI ≥ 85th centile of the UK90 growth reference

0

5

10

15

20

25

30

35

40

95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10

Prev

alen

ce o

f exc

ess

wei

ght (

%)

Survey year (3-year average)

Boys Girls All children

noo National Obesity Observatory

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Prev

alen

ce o

f mor

bid

obes

ity

Year of measurement

Males Females

Trend in morbid obesity prevalence for adults (16+) by sex Health Survey for England 1993-2010

Morbid obesity (BMI ≥ 40) has also been rising sharply over this time. These figures may well be an underestimate.

noo National Obesity Observatory Implications for local areas

Example LA population 100,000 250,000 750,000 1,000,000

Numbers of people who are:

Overweight 37,000 92,000 275,000 367,000

Obese 26,000 65,000 196,000 261,000

Morbidly obese 3,000 7,000 20,000 27,000

The national figures have huge implications for local areas.

noo National Obesity Observatory Trend in obesity prevalence for adult males by age group

Health Survey for England 1993-2010

Adult obesity: BMI ≥ 30kg/m2

0

5

10

15

20

25

30

35

40

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Obes

ity p

reva

lenc

e (%

)

Year of measurement

75+

65-74

55-64

45-54

35-44

25-34

16-24

Men over 35 years old

Levels of obesity in men differ by age group, as do the trends we are seeing for each group.

noo National Obesity Observatory Trend in obesity prevalence for adult females by age group

Health Survey for England 1993-2010

Adult obesity: BMI ≥ 30kg/m2

0

5

10

15

20

25

30

35

40

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Obe

sity

prev

alen

ce (%

)

Year of measurement

75+

65-74

55-64

45-54

35-44

25-34

16-24

Women over 35 years old

This is true for women as well.

noo National Obesity Observatory

8.8%

16.8%

25.0%

33.1%34.2%

30.2%

23.8%

13.9%

18.8%

25.2%

28.5%

30.6%

33.6%

26.3%

16-24 25-34 35-44 45-54 55-64 65-74 75+

Males Females

Adult obesity: BMI ≥ 30kg/m2

Prevalence of obesity among adults by age and sex Health Survey for England 2008-2010

Obesity rises steadily through to middle age and then stays broadly constant.

noo National Obesity Observatory

10.7%

9.1%

19.0%

15.8%

10.4%

8.8%

20.0%

16.6%

10.3%

8.9%

20.0%

16.5%

10.5%

9.2%

20.4%

17.0%

10.1%

8.8%

20.6%

17.4%

Reception boys Reception girls Year 6 boys Year 6 girls

Year of measurement

2006/07 2007/08 2008/09 2009/10 2010/11

Prevalence of obesity among children by school year and sex National Child Measurement Programme 2006/07 – 2010/11

Child obesity: BMI ≥ 95th centile of the UK90 growth reference

Obesity rates nearly double over the course of primary school. We are seeing opposing trends, with a slight decrease in Reception Year but increases in Year 6 prevalence.

noo National Obesity Observatory

12 18.5 25 30 40 50BMI (kg/m2) Males 1991-93 Females 1991-93 Males 2007-09 Females 2007-09

Underweight<18.5kg/m2

Males1991-93: 0.7%2007-09: 0.8%

Females1991-93: 1.3%2007-09: 1.3%

Healthy weight18.5 to <25kg/m2

Males1991-93: 37.8%2007-09: 28.0%

Females1991-93: 47.6%2007-09: 37.2%

Overweight25 to <30 kg/m2

Males1991-93: 46.7%2007-09: 44.5%

Females1991-93: 33.3%2007-09: 34.7%

Obese30 to <40kg/m2

Males1991-93: 14.6%2007-09: 25.4%

Females1991-93: 16.4%2007-09: 23.8%

Morbidly obese≥40kg/m2

Males1991-93: 0.3% Females2007-09: 1.4% 1991-93: 1.4%

2007-09: 3.0%

Change in the adult BMI distribution HSE 1991-93 to 2007-09 (population weighted)

Adults are aged 18+ years

There is a very complicated picture within overall obesity rates, which has changed over time. Broadly speaking, the entire population is getting heavier – there is not only an increase in the numbers of obese people.

noo National Obesity Observatory Prevalence of obesity by deprivation decile

National Child Measurement Programme 2009/10

Child obesity: BMI ≥ 95th centile of the UK90 growth reference

23.6%22.9%

21.7%20.5%

18.9%17.9%

16.6%15.7%

14.6%

12.6%12.6%12.0%

11.4%10.7%

9.7%9.0%

8.3% 7.9% 7.5%6.8%

Mostdeprived

Leastdeprived

Reception Year 6

There is a very strong correlation between obesity rates and level of deprivation amongst children, with prevalence in the most deprived areas around double that of the least deprived areas.

noo National Obesity Observatory

Adult obesity prevalence by ethnic group Health Survey for England 2004

Adult (aged 16+) obesity: BMI ≥ 30kg/m2

25%

17%

25%

15% 14%

6% 6%

23%

32%

38%

21%

28%

20%

17%

8%

23%

BlackCaribbean

BlackAfrican Irish Pakistani Indian Bangladeshi Chinese

Generalpopulation

Males

Females

Male Female

Prevalence of obesity also varies widely between ethnic groups and between sexes within ethnic groups.

noo National Obesity Observatory The cost of overweight and obesity to the NHS

estimated to be £5.1bn per year

Hypertensivedisease41.2%

Osteoarthritis16.6%

Diabetes mellitus16.2%

Ischaemic heart disease15.6%

Ischaemicstroke6.5%

Corpus uteri(womb) cancer

1.6%

Colon/rectumcancer1.3%

Breast cancer1.1%

The total cost to the NHS can be broken down by disease category

Overweight and obesity are responsible for a range of diseases

Percentage of disease attributable to overweight and obesity

Diabetes mellitus 79%

Hypertensive disease 58%

Corpus uteri cancer 49%

Ischaemic heart disease 34%

Ischaemic stroke 34%

Osteoarthritis 21%

Colon/ rectum cancer 16%

Breast cancer 12%

Total cost to society estimated at up to £16bn

It is difficult to estimate the costs of obesity accurately. We can look at the costs of diseases caused by obesity to estimate that obesity costs the NHS £5.1bn/year. It is more difficult to put a figure on costs to other areas (e.g. local authorities or business) but the total cost to society is estimated at up to £16bn.

noo National Obesity Observatory Where are we heading…?

• Increasing prevalence with age • Rise in morbid obesity • Population demographics – baby boomers • Increasing life expectancy • Increasing ‘obesity years’

Need to consider absolute numbers, not

just proportion of population