Public Health Mini-Guides: Obesity

Nick Townsend, Nick Townsend, Angela Scriven, Angela Scriven

• Publisher: Churchill Livingstone
• Year: 2014
• eBook ISBN: 9780702047206
• Topic: Medicine
• Subtopic: Nursing

Obesity and its linked morbidity and mortality is a significant public health challenge on a global scale and places a burden not only on the individual but also on society as a whole. This Mini-Guide presents key themes relating to this challenge, including the means of measuring obesity, the most recent prevalence and trends, the health consequences and causes of obesity along with approaches to counter obesity both at an individual and a population level.Understanding is facilitated through: - Case Studies- Boxed examples- Thinking Points- Summary Points at ends of chapters.- Links to webpages, resources and further reading.

1

Defining the obesity problem

What is obesity?

Obesity is a medical condition characterised by an excess of adipose tissue (fat) in the body that may have adverse effect on the health of an individual^1–4 (see Chapter 3 for detailed coverage of the health risks of obesity). The World Health Organization (WHO) similarly defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health.⁵ This is an important definition, as it indicates what to measure when investigating obesity.

Measuring obesity

Screening programmes

These are large-scale programmes that identify those who are at risk from obesity-related ill health. They should be accompanied by an explicit intention to prevent and also reduce the prevalence of obesity in the population.^6–9 For example, if a General Practice (GP) surgery is routinely measuring patients visiting their practice in order to identify those who are overweight or obese, it is important that when individuals are classified within high-risk weight status thresholds, they receive suitable treatment to enable them to reduce their weight in a healthy manner.

Surveillance programmes

The aim here is to monitor the levels of obesity in a population rather than to identify those who require treatment.^9–11 Within surveillance programmes, data are usually anonymised, meaning that no routine feedback of individualised results is provided, nor is any formal link to treatment maintained. Data collected from these programmes enable the identification and monitoring of trends over time and assist in the targeting of interventions. Additionally, information from surveillance programmes may be used to analyse different causal and contributory factors for overweight and obesity, supporting the development of effective interventions and public health approaches to tackle obesity^12,13 (see Chapter 6 for an overview of public health obesity interventions).

On occasions programmes may straddle the line between screening and surveillance, such as the National Child Measurement Programme (NCMP) in England (see the NCMP Case Study in Box 1.1).

Box 1.1 Case study: National Child Measurement Programme

The National Child Measurement Programme (NCMP) for England was established in 2005/06. The NCMP collects population-level surveillance data for children through taking annual measurements of height and weight for Reception year (typically aged 4–5 years) and Year 6 (typically aged 10–11 years) primary school pupils.¹⁴ The measurement exercise was coordinated locally by Primary Care Trusts (PCTs) with the support and cooperation of schools.¹⁵ PCTs were freestanding statutory bodies of the National Health Service (NHS) that had the responsibility for securing the provision of a full range of primary care services for the local populations. There were 152 PCTs covering all of England within which the collection of NCMP data was coordinated. However, changes to the structure of the NHS under the Health and Social Care Bill 2011 announced the abolishment of PCTs by 2013, with the public health aspects of the PCTs taken on by local councils.¹⁶ With the abolition of the PCTs, responsibility for NCMP measurement was taken on by Local Authorities with central collation of the data conducted by the Health and Social Care Information Centre (HSCIC) which was formally known as the NHS Information Centre. With the abolition of the PCTs in 2013 this measurement became the responsibility of Local Authorities. Authorities can undertake measurements at any time during the school year.¹⁷ Height and weight measurements are taken by health professionals, usually school nurses, in a room or screened area. Measurements are taken with children in ‘normal light indoor clothing’ without shoes or coats. The weight is recorded in kilograms (kg) to the first decimal place (the nearest 100 g) and height is recorded in cm to the first decimal place (the nearest mm).¹⁷ Some differences between PCTs in the collection and recording of data had been found to influence prevalence estimates at the PCT level.¹⁸

The NCMP data are key to improving understanding of overweight and obesity in children. They are used at a national level to inform policy and locally to inform the planning and commissioning of services. The NCMP also provides local areas with an opportunity to raise public awareness of child obesity as well as informing parents of a child's result, sent through a letter.^14,19 In addition, the Public Health England Obesity Knowledge and Intelligence team (formerly the National Obesity Observatory) presents NCMP data in an e-Atlas – an interactive mapping tool that enables the user to compare a range of indicators, examine correlations and allows regional and national comparisons: www.noo.org.uk/visualisation/eatlas

Further details on the NCMP can be found at the Obesity Knowledge and Intelligence team website (www.noo.org.uk/NCMP) and through the Health and Social Care Information Service (http://www.hscic.gov.uk/ncmp).

Thinking points

1. Some people object to the collection of measurements related to obesity, although screening for other health conditions is welcomed; why is there this disparity?

2. What unintended harms can arise from running obesity measuring programmes?

3. Is it ethically sound to run a surveillance programme in which those identified as at risk of ill health are not informed?

4. With changes to the NHS in England, the running of the NCMP may have to change; should it be retained, and what should be saved in order to link future obesity measurement findings to earlier data?

Measurement of obesity

There is a lot of evidence to suggest that self-reported height and weight data are unreliable^20–22 with indications that overweight or obese adults tend to underestimate their weight^20,22–24 or overestimate their height,^20,23 with the degree to which this is done varying by age;^21,23,25 sex;^20–22 and ethnicity.^26,27 Similar results have also been found with adolescents^28–32 and with parents reporting on the weight of their children.^33–35 It is imperative, therefore, in collecting data on obesity, or in assessing an individual's risk of obesity-related ill health, that objective accurate measures are taken.

There are a number of measures which can be taken to identify those at ris...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Series info
• Series preface
• Preface
• Chapter 1: Defining the obesity problem
• Chapter 2: Obesity prevalence and trends
• Chapter 3: The health consequences of obesity
• Chapter 4: Causes of obesity
• Chapter 5: Individual interventions to treat obesity
• Chapter 6: Population approaches to preventing obesity
• References
• Index
• References