SERIES: Part 5 – Conclusions on Causes and Consequences of Rising Obesity Levels in the UK

I’m back!

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!

SERIES: Part 4 – Consequences of Rising Incidence of Obesity in the United Kingdom

In my opinion, the consequences of increasing incidence of obesity fall into four key dimensions: individual, societal, structural and economic.


This is Part 4 of my Obesity in the UK series. If you missed Parts 1, 2, or 3 – mainly dealing with the causal factors of obesity – you can find them by following the links. 🙂 This part addresses consequences of rising obesity in the UK. And it is the penultimate article in this series.

I try to keep this blog relatively positive (despite the subject matter). Thus, the final article will deal with ‘solutions’ and a bit of a discussion about the previous articles. So, here goes.


  1. Individual Consequences of Rising obesity

The consequences of obesity as they affect individuals in the UK are primarily health related. In the United Kingdom, the National Health Service (NHS) means that government funded free healthcare is available to all – alongside a far smaller private sector. The consequences I discuss here are largely those that affect the quality of life of obese individuals.

Of particular concern is the number of disability adjusted life years (DALYs) that obese individuals face as opposed to normal weight individuals.

Obese individuals with a co-morbid condition also incur a greater cost both to health services and the individual in terms of time. Furthermore, T2DM, for example can reduce life expectancy by up to 10 years.


Amongst other major risk factors are an array of Cardiovascular diseases including stroke, arthritis, gallbladder disease, OSAS (Obstructive Sleep Apnoea) and infertility.

Despite lower levels of overall obesity, women were found to have significantly higher levels of “very high waist circumference”; 44% compared with 34% in men, suggesting a risk that members of this group may progress towards obesity or the development of a comorbid condition.

Encouragingly, even modest weight loss, has been shown to have an effect on improving other co-morbid conditions associated with obesity, including diabetes.


Nonetheless, some of these conditions are fatal. Thus, many obese patients face the risk of a shorter, lower quality life than the general population as a result of their obese status.

Moreover, childhood obesity is of particular concern as it has been shown to have immediate and long-term detrimental effects to health.

A societal effect of increased incidence of obesity is the potential for further increased incidence of obesity. People evaluate themselves compared to those around them. One study found that even having obese friends increases an individual’s likelihood of progression to obesity. This causes a shift in societal perception of normal: thus a vicious cycle of increased obesity.


2. Structural Factors – Industry and marketing

A consequence of rising obesity is the potential for more stringent measures on the food and beverage industry. In 2014, New York mayor, Bill De Blasio proposed a portion cap on sugary beverages. In the UK, lawmakers have proposed various reforms and restrictions on the food industry, such as taxes on certain foods.

Some argue that introducing a tax on typically unhealthy foods, may cause some groups, particularly teenagers, to reduce their consumption. Nonetheless, it may also have an unintended detrimental effect on the lowest income individuals, making food too expensive.


3. Economic Cost to Health Services


The economic burden of disease of overweight and obesity is huge. It is estimated that the direct cost to the National Health Service (NHS) in 2007 was £3.2 billion. This is an almost three-fold increase from £1.1bn in 2004, which was already more than twice the £480 million in 1998.

Unsurprisingly, if the growing proportion of healthcare spending on obesity follows this trend it may soon be unaffordable, resulting in an insurmountable burden on national health services.


4. Cost to Society

More easily overlooked is the cost of productivity lost by individuals who can no longer work due to their obese status and associated conditions.

This could have a massive impact on the economic climate in the UK as it can severely augment the number of tax payers in years to come whilst incurring greater cost to health and social services.

The consequences on the British economy could be profound, particularly due to the nation’s ageing, and comparatively older population. Furthermore, fiscal interventions to increase government spending on health and social services by increasing taxes could lead to a slowdown in consumer spending and a ripple effect on the broader economy.


In my opinion, the burden and cost of the consequences of obesity justify the need for the United Kingdom to aspire to meet its own targets and those set by the World Health Assembly. But further investigation may aid a better understanding – from a behavioural economics and behavioural medicine perspective of the kind of interventions that might prove beneficial. 


SERIES: Part 3 – Even more causes of rising obesity incidence in the United Kingdom

This is Part 3 of my Obesity in the UK series. If you missed Part 1, or Part 2, you can find them by following the links. 🙂 Like part two, this part addresses causal factors but with a greater emphasis on some indirect causes.

Beliefs, Perceptions and Stigmatisation

There is evidence to support that a potential driver of obesity is the failure of obese persons, or parents of obese children, to recognize themselves or their child as obese. In short, weight perceptions among obese adults in Britain do not match clinical definitions of obesity. Most obese adults do not describe themselves as obese. Another study of 2976 English children found that a third of parents underestimate their child’s BMI.

As more people in the community grow into the category of obesity, perceptions of “normal” for everyday Britons may be increasingly swayed. Even teenagers, were not immune to this warped self-perception in terms of weight: 39% of overweight teenagers described themselves as “normal”.

At first glance, these findings seem almost counterintuitive. However, in a society that stigmatizes obesity, it is no surprise that many do not wish to recognize themselves as “obese”.

Moreover, overweight and obese individuals who reported experiencing fat stigmatization gained 0.95kg over a year. In an image-obsessed world, many people are experiencing stigmatization due to their weight. Thus, paradoxically, this cruel, “skinny-culture” may be a factor driving more overweight individuals towards obesity.



Socioeconomic status

At first glance, higher levels of obesity among low-income groups may too seem counter-intuitive. However, in the UK, as in many other high and middle-income countries, this is the case.

There is an existing or emerging inverse relationship between income and obesity. Attempts to explain these trends follow the assumption that in high and middle- income nations, the vast majority of the population is able to afford to be adequately fed. Thus, a very negligible proportion of the population will be underweight due to an economic inability to access food. What may be significant in understanding this is how socioeconomic factors drive the types of food that individuals and families consume on a regular basis.

Whilst the prevalence of childhood obesity and overweight in the UK has stabilized in recent years, children from the lowest socioeconomic groups have continued to exhibit increased levels of overweight and obesity in comparison to their counterparts from other socioeconomic strata. The outlook is similarly bleak for low-income adults. This points to the importance of appropriate education on diet. According to the HSE, lower income women exhibited a higher proportion of obesity: 26% – 31%, as opposed to 15% – 18% in the highest income quintiles. Men in the lowest income groups were also more likely to be obese: 29% – 30% were classified as obese, versus 23% –

Urbanization is shown to have an effect on diet. In a study examining obesogenic environments, it was found that individuals in the most deprived areas consumed significantly fewer portions of fruit daily; as did those living in densely populated environments. According to the World Bank, in 1985, 78% of people in the UK lived in urban areas, versus 82% today, a percentage that is expected to increase.

Furthermore, energy-rich, processed foods are cheaper to produce and thus cheaper to purchase. Many are increasingly marketed towards children from a young age. These subtle lifestyle changes may be driving many Britons transition into overweight and obesity, resulting in continued increased incidence.

Slightly distinct from the factor of income is that of income inequality. Studies show that national income inequality is associated with higher BMIs within obese populations, lower life expectancy and other negative health and psychosocial outcomes. It is theorized that life near the bottom of more hierarchical societies, such as the USA, results in higher levels of psychosocial stress than in more equal nations, such as Sweden.

Compared to many other high-income countries, the United Kingdom has a very high level of income and wealth inequality. Moreover, the gap growing: between 1985 and 2010 inequality rose by almost 25%, making the UK the most unequal country in Europe.

Thus, growing inequality may be one of the primary factors driving growing waistbands.

SERIES: Part 2 – Causes of Rising Incidence of Obesity in the United Kingdom

This is Part 2 of my Obesity in the UK series. If you missed Part 1, you can find it here.

So back to Causes.

Among other factors, rising incidence of obesity in the UK can be explained by behavioral theories relating to changes in physical activity and eating behavior.

Basic weight gain is most commonly caused by excess energy consumption for expenditure. Rising incidence of overweight and obesity on a population level, however, is more complex. Whilst there are individual physiological and genetic factors resulting in obesity, one may infer that obesity trends are a result of multiple direct and indirect factors including social, political and economic factors affecting our behaviour. Some of them are introduced here.

Environmental Obesogenicity

Environmental factors of societal and market forces driving eating behavior within the population are an area of increasing interest. An obesogenic environment is one where the food and activity environment may drive individuals towards obesity progression. Plenty can be said about obseogenic environments and I will write about this particular aspect more pointedly in future.

Physical Activity and Inactivity

Similarly, It is well understood that appropriate physical activity is a means of effective weight management. It has been argued that the cause of weight gain pertaining to physical exercise is not only low levels of physical activity, but also by high levels of physical inactivity. Sedentary behaviour in itself is linked to co-morbidities.

One theory for increased incidence of obesity considers decreased levels of energy expenditure. An example of this is a change in shopping behavior. Greater accessibility and affordability of services such as online grocery shopping and delivery positively impact the lives of many people, e.g. disabled and elderly, but many modern conveniences have come at a social cost to health.

A greater proportion of the working population in the UK is employed in occupations conducive to levels of relative inactivity. Improved transport services, urbanization, affordability of vehicles and even mobile internet access have made life more convenient, de-necessitating much of our passive physical activity. As early as 1984, a US telephone company estimated that an additional phone extension in the household saves approximately 1.6km of walking annually.

It has been found that children were more likely to be obese for each additional hour of sedentary time. Low levels of activity have been shown to be the most prominent risk factor for weight gain. This trend of increased sedentary behavior may form part of the forces driving obesity incidence in the UK.

Eating Behaviour

Genetics & Physiology

A number of studies have explored the genetic bases of obesity. In particular, twin studies and Genome-wide association studies (GWAS). Results of the Twins Early Development Study (TEDS) show a strong heritability of adiposity and waist circumference as do GWAS. However, these explain less than 3% of BMI variation in children and adults.

Furthermore, it is unlikely that genetic factors are central to rising obesity incidence, as these have not changed substantially, relative to the short time frame of rising prevalence discussed earlier.



There is no doubt that the causes of rising obesity are complex, multiple and multifactorial. Thus, this article has a Part 2: More Causes of Rising Incidence of Obesity in the United Kingdom

SERIES: Rising incidence of obesity in the United Kingdom – Introduction

In the past three decades obesity in the United Kingdom has increased three-fold, emerging as one of the UK’s most prominent public health challenges. Obesity is largely a lifestyle and behavior associated condition, although there are also some genetic factors.

Obesity is measured by a standard anthropometric measurement of known as Body Mass Index (BMI). The terms overweight and obese are usually classified as increased weight-for-height. The figure below classifies the BMI ranges used to define BMI status. (Do you know your BMI?) BMI is calculated by dividing the weight in kilograms by the square of the height in meters. (Or googled)


An individual whose weight is two or more times the ideal weight is classified as morbidly obese.

Recent studies show steady increases in obesity incidence both nationally and internationally. Indeed, today we live in a world where more people are clinically obese than those suffering morbidity or mortality due to starvation.

Globally, the percentage of people classified as overweight or obese increased in both men and women from 28.8% and 29.8% in 1980 to 36.9% and 38.0% respectively. Child overweight and obesity also increased. In 2013, World Health Organization adopted a target of halting the rise in child obesity by 2025.

The primary reason obesity is a public health concern is because it is a risk factor for other non-communicable diseases (NCDs) such as Type II Diabetes Mellitus (T2DM), hypertension and coronary heart disease (CHD). Morbid obesity, considered the most serious stage of obesity, can leave patients at the highest risk of mortality related to their obese status.


Throughout this series I will outline the causes and consequences of rising obesity incidence as identified in empirical studies and literature. All sources are available upon request.

Likely due to methodological challenges, much of the available data on obesity in the UK and elsewhere discuss prevalence and not necessarily incidence. However, understanding disease prevalence and its nuances is useful in interpreting both causal and consequential factors of incidence.

 According to Health Survey for England (HSE), in 2013, 26% of men and 24% of women were classified as obese; 41% of men and 33% of women were classified as overweight. Scotland and Wales had similar findings.

The UK has seen increases in obesity in children for several years. In 1995, 11% of boys and 12% of girls were classified as obese. By 2005, these numbers were 18% and 19% respectively. These increases have since leveled off: to 16% of boys and 15% of girls in 2013.

The prevalence of obesity is significantly higher in some groups. Children were more likely to be obese if they lived in an urban area. Whilst 22% of boys and 21% of girls from the lowest-income families were already obese.

Rising incidence of obesity is a problem

The major problem presented is the co-morbidities with which obesity is associated. Obesity is a major risk factor for many NCDs, thus causing and contributing to a high proportion of morbidity and mortality.

Type 2 Diabetes Mellitus (T2DM) is strongly correlated with obesity. The detrimental effects on an individual living with obesity and T2DM are multiple-fold. Rising incidence of obesity in children is well correlated with incidence of childhood T2DM. Expectedly, in terms of reducing the risk of cardiovascular diseases, particularly coronary heart disease, greater reduction in adiposity results in greater risk reduction. With the exception of LDL cholesterol, fat loss in obese patients improves blood pressure, glycemic control and lipids.

T2DM is simply hyperglycemia resulting primarily from a resistance to insulin but also from impaired insulin secretion. Clinical studies have shown the metabolic effects of high sugar, particularly fructose. These sugars mediate fatty liver and insulin resistance in humans. In a typical Western diet, the majority of fructose comes from sugary, soft and fruit drinks, often resulting in significantly elevated levels of fasting glucose and thus, high levels of insulin, leading to resistance.

Obesity also has a role in worsening nocturnal hypoxia in obstructive sleep apnea syndrome (OSAS). It has been theorized that oxidative stress and inflammation caused by OSAS is a major factor causing cardiovascular morbidity and mortality in obese patients.

This series will explore the causes, consequences and some potential solutions to rising obesity incidence in the UK. The significant contribution of behavioural factors to the rising prevalence and incidence of obesity suggests an important role for well-defined interventions to manage and reduce obesity levels. It is clear, however, that the burden and cost of the consequences of obesity justify the need for the United Kingdom to aspire to meet its own targets and those set by the World Health Assembly.