Tackling the weight problem in England: A Multifaceted Approach

On the 19th of June we wrote about the weight problem in England, presenting in the article some validated data from Public Health England. The headline statistics were that roughly six in 10 women and seven in ten men are overweight or obese in England, which, we argued, meant that we have a public health problem.

What we mean by a public health problem is that the nature of the beast goes beyond an individual or family. It is also not localised to a specific community but stretches across the nation. The solutions must therefore take account of the different levels at which the problem exists and not just be targetted at individuals, which we identified as a potential weakness in the interpretation of the solutions proposed by the NHS website entry on obesity. These solutions relate to the steps that individuals can take in relation to lifestyle modification, mainly centred on weight reduction and improved activity levels. Good as these solutions are, current thinking on dealing with public health challenges of this nature is reflected in the famous Dahlgren and Whitehead model shown below:

If you want a fuller discussion of this, we recommend the articles by the Office of Disease Prevention and Health Promotion (US) or Public Health England addressing this topic at some length.

And so we can turn to some potential solutions that span the different levels of the problem.

• At the most intimate level, we recognise that people have different body types, with some more genetically predisposed to weight gain and high cholesterol. There is scope for medical practitioners, geneticists and individuals to address the challenges through tailored interventions. For instance, current medical practice is generally agreed on the reduction of the risks from high cholesterol through the use of statins for individuals at greater cardiovascular risk. Further research in this area could identity therapeutic solutions for genetic factors that predispose to obesity.
• As we consider individual lifestyle factors, we note that the NHS website entry on obesity, referred to above, offers a sweeping view of solutions at this level. It highlights the need for weight loss, the importance of social support and the role of increased activity levels, giving as an example the popular Couch to 5K running plan. We shall, over the next several weeks, look at the options at this level from different perspectives.
• The third level relates to social and community networks. This recognises that communities with a shared identity, lifestyle or genetics will likely experience identical health problems. An example of this is the current lockdown that has been placed on Leicester when the restrictions on the rest of England are being relaxed. From an obesity viewpoint, it is known that the poorer people are, the more likely they are to have poor dietary choices. This could be tackled through a number of approaches, from better education about the cooking of simple healthy meals to making it easier for people to get cheap but healthy food alternatives. Tailored approaches for different sections of a city can recognise the need for solutions that reflect the challenges in those parts. Other options include making it easier for people to have access to exercise facilities. The legal responsibilities of municipal and county councils to recognise and take action on such health challenges has led to the establishment of public exercise facilities in parks in England.
• The highest level, from an obesity perspective, relates to those factors that impact the country as a whole. You will have noticed that as the scale of the problem expands, so too does the need for a higher level of political involvement. Problems at the national scale require central government intervention. It is up to central government to determine the rules that govern the environment in which businesses can sell beverages, food and advertising for products that influence obesity.

The fact that we have a national problem with obesity suggests that perhaps not enough is being done across the various levels at which health is determined. Could it be that we need to review the legal framework within which such popular chains as MacDonalds, KFC, Nandos or local takeaway shops trade? How about advertising? What about alcohol and the advertising related to it?

This also raises important questions about our cultural attitudes towards food, cooking and alcohol consumption. There is only so much that can be achieved through information campaigns. We also need cultural changes that influence the way we relate to obesity and the factors behind it. This will require us to find ways of addressing the harms of obesity in sensitive ways that appeal both to the head and the heart. No doubt this is a discussion that will continue for years to come.