To tackle obesity we need to know who gets fat and why. Here is the evidence so far

    6 October 2015

    You can hear Julia Manning talk about the obesity crisis with Dr Max Pemberton, Spectator Health editor, Dr Sarah Jarvis, GP and journalist, and Dr Aaron Parkhurst, a medical anthropologist at University College London, on our Spectator Health podcast.

    Jack Nicholson once said: ‘With my sunglasses on, I am Jack Nicholson. Without them I am fat and 60.’ With or without sunglasses, more than half of Britain’s adult population is now overweight or obese. ‘So what?’ cry the libertarians as they lick the icing off their lips from their Krispy Kreme doughnut. ‘It’s my free choice to eat what I like and when I like now my nanny (real or imagined) has her P45.’

    Thus, cowed by taunts of nanny state, oblivious of the tsunami of obstacles shaping our ‘free’ choices which have turned everyday life into an obesogenic environment survival race, and ignorant about the evidence of who gets fat and why, we have trotted out piecemeal solutions over the years with zero impact on our status as the fat man of Europe.

    Last year McKinsey estimated that obesity cost Britain £47 billion a year, more than the cost of war or terrorism. To say, therefore, that obesity represents an economic crisis is not an overstatement, and logically every one of us who becomes obese adds to our nation’s burden.

    Careless Eating Costs Lives, a report by 2020health, highlighted that no individual sector or solution can solve the problem. There are so many actors around us shaping our choices that simply to talk about personal responsibility is naive, although of course our own behaviour is a critical element. We highlighted actions for 13 different agencies, from the Treasury to health, education to Ofcom, schools and industry to local government. Nothing less than a cross-departmental, coordinated, national and local strategy will work. But we still don’t have the whole picture.

    What is still lacking is a detailed analysis of changing trends and factors. If policy is going to be effective, we need to know who exactly gets fat. If it were simply those living in poverty, there would be a natural cap. But numbers of obese people rise year on year. We need to have a more nuanced picture.

    With this challenge in mind, 2020health has been examining and compiling the wealth of current knowledge and statistics on obesity in England to address one crucial question: ‘Who exactly becomes obese?’ By looking at changing trends, the structural and choice architecture of people’s lives, we aim to fill the gaps in research so that individuals, organisations and policy makers in public and private sectors can intelligently and meaningfully begin to address obesity in Britain.

    There are some interesting early findings. Men have caught up with women in the fat league tables, but while countrywide demographics show obesity as an epidemic that is equal among sexes, some research suggests that obesity trends, correlated with a range of other socio-demographics data, are highly informed by gender.

    We know that certain neighbourhood characteristics are linked to obesity rates. One of these characteristics is fast food density in a given area, and recent literature suggests that, for men especially, it is the kind of food options in the vicinity of their employment which has the highest correlation to body mass index (BMI).

    The evidence that links poverty, deprivation, and lower socioeconomic positions to obesity remains overwhelming, but what has emerged in more recent research is that obesity rates are now rising fairly rapidly among other economic groups. This, too, is gendered. For middle and upper financial classes, men are becoming far more affected by obesity, but this trend is mitigated for women.

    Additionally, both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or poor, with the downwardly mobile currently sharing the highest rates and rises of obesity. For the stable poor, obesity is much higher in women, for the stable wealthy, obesity is higher for men, and for the economically mobile, it rises for both men and women.

    For children, the rates of obesity are more alarming. Childhood obesity is still associated with poverty and parents’ education and habits. However, in many cities and towns, researchers have found ‘hotspots’ of childhood obesity. These hotspots tend to overlap with both the poorest and wealthiest neighbourhoods.

    Clinical depression and anxiety are also positively correlated with higher BMIs, but evidence suggests that more subtle forms of depression and anxiety are deeply linked to obesity. One very large study found that, especially for men, it is the ‘anxious’ middle class that is experiencing the largest rise in obesity rates.

    The final report will explore these themes and others in more detail, with the aim of directly informing decisions on how we reverse British obesity trends and our unenviable status as nutritional overachievers. If it was as easy as naming and shaming a particular food ingredient, we would have nailed this problem decades ago.

    Our hope is that this research will give a deeper understanding of this national crisis, and that we will have politicians and agencies bold and wise enough to understand that their duty to protect society from obesogenic harm actually increases, not decreases, our freedoms.

    Julia Manning is chief executive of 2020health