Tackling the obesity epidemic

15 June 2016

Article by Rebekah James, National Assembly for Wales Research Service

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A person’s feet standing on a weighing scale

Image from Pixabay, licensed under the Creative Commons

In the face of an obesity epidemic in Wales, will the new Welsh Government be equipped to tackle one of the major public health challenges of our time, or will it prove too complex?

Obesity is a leading cause of preventable death in Wales, and along with its associated health conditions, puts significant pressure on health services. It costs NHS Wales £73 million per year, rising to nearly £86 million if overweight people are also included.

Obesity increases the risk of developing heart disease and can contribute to chronic conditions such as type 2 diabetes, some cancers, high blood pressure, muscular-skeletal conditions and depression. Obesity can affect a person’s well-being, quality of life and ability to earn. Obese children can experience health problems and are also more likely to be obese in adulthood.

Although the previous Welsh Government put initiatives in place to tackle the condition, obesity levels are currently not noticeably reducing. Poor diet and sedentary lifestyles are major factors, but there is also a link between obesity and deprivation: obesity levels are higher in deprived areas including Merthyr Tydfil, Rhondda Cynon Taff, Caerphilly, Blaenau Gwent, Torfaen and Neath Port Talbot.

Obesity1

Prevalence of obesity

The Welsh Health Survey 2014 reported that 22% of adults in Wales are classified as obese and 58% of adults are classified as being overweight or obese. This is an increase from the figure of 54% when the survey was first published in 2003/04.

The prevalence of overweight and obese adults rises with increasing deprivation, from 53% in the least deprived areas to 61% in the most deprived areas.

The picture amongst Welsh children remains challenging. Public Health Wales’s Child Measurement Programme for Wales 2013/2014 shows that 27.3% of children were overweight or obese.

This prevalence also rises with increasing deprivation, from 22.2% in the least deprived areas to 28.5% in the most deprived areas. The figure for children in reception year (4-5 year olds) in Wales was 26.5% – higher than any English region where the highest prevalence was 24%.

Obesity2

Addressing the problem

In 2010 the Welsh Government launched the All Wales Obesity Pathway, setting out the approach to preventing and treating obesity in children and adults. The Pathway sets out a four-tier obesity services framework:

Obesity3

The causes of obesity are complex, and can include medical, societal and economic factors. The previous Welsh Government attempted to address the different factors with a variety of policy and legislative levers focussing on good nutrition and physical activity, including: Our Healthy Future; Change4Life; MEND; the Active Travel (Wales) Act 2013; Creating an Active Wales; Appetite for Life and Climbing Higher.

Recent initiatives proposed by politicians and health professionals in Wales to reduce obesity include a tax on sugary drinks and banning advertisements that market food and drink high in fat, salt and sugar. In 2016 Public Health Wales launched a 10-step checklist to tackle childhood obesity.

Concerns over progress

There have been criticisms that the Obesity Pathway has not been fully implemented and there is a lack of Level 3 services, as well as calls for a clearer national direction on tackling obesity.

Fourth Assembly committees undertook inquiries on the availability of bariatric services and childhood obesity. Both inquiries raised concerns about how successfully and consistently the Obesity Pathway is being delivered. A review of progress against the Pathway in 2014 found that all Welsh health boards were providing level 1 and 2 services, but level 3 provision was inconsistent. The Welsh Government acknowledged that more needed to be done and the Fifth Assembly would need to ensure these concerns are addressed.

Some potential areas for action are not fully devolved. For example, Wales’s ability to influence the food and drinks industry is restricted and a co-ordinated approach at UK and EU level may be needed to maximise opportunities in tackling obesity.

Considerations for the Fifth Assembly

Obesity is influenced by a number of factors, including socio-economic deprivation. There are also concerns about the potential cultural ‘normalisation’ of obesity. Suggestions have been made that efforts to tackle the problem need sufficient national leadership and a co-ordinated approach across Welsh Government departments, particularly in promoting healthy eating and exercise.

Some long-standing initiatives aiming to reduce obesity in Wales are still lacking in impact and failing to realise their potential. Members of the Fifth Assembly and the Welsh Government will need to determine why some current initiatives are failing to make sufficient progress, and may need to consider new approaches to create a greater impact on the obesity problem.

Since the above article was released in the ‘Key Issues for the Fifth Assembly’ publication, initial headline results for the Welsh Health Survey 2015 have been published. The 2015 results show that obesity levels in Wales have increased: 24% of adults are classified as obese and 59% of adults are classified as overweight or obese. There has also been an increase in the prevalence of overweight and obese adults in relation to deprivation in Wales, with 54% in the least deprived areas and 63% in the most deprived areas.

Key sources

Obesity in Wales

11 January 2015

Article by Megan Jones and David Millett, National Assembly for Wales Research Service

This week (11-17 January) is National Obesity Awareness Week, the perfect opportunity to take a look at obesity levels in Wales, and what action is being taken to tackle the issue.

Adult obesity

According to the most recent statistics from the Welsh Health Survey 2014, 58 per cent of adults in Wales are classified as being overweight or obese. This is an increase from the 54 per cent of adults who were overweight or obese when the survey was first published in 2003/04.

The prevalence of overweight and obese adults rises with increasing deprivation, from 53 per cent in the least deprived fifth to 61 per cent in the most deprived fifth.

Childhood obesity

Findings from Public Health Wales’ Child Measurement Programme show that in Wales 27.3 per cent of children were classified as being overweight or obese. The prevalence of overweight or obese children in Wales aged 4-5 in reception year at school (26 per cent) was higher than that in England (23 per cent) and higher than any individual English region, where the highest prevalence was 24 per cent.

The prevalence of overweight and obese children rises with increasing deprivation, from 22.2 per cent in the least deprived areas to 28.5 per cent in the most deprived areas of Wales.

Welsh Government action

In 2010, the Welsh Government published the All Wales Obesity Pathway, which sets out the actions that should be taken by Local Health Boards, working jointly with Local Authorities and other stakeholders, to help tackle the issue of obesity in Wales through local policies, services and activities for children and adults. The Pathway sets out a four tier framework for obesity services:

Level 1: Community based prevention and early intervention (self-care).

Level 2: Community and primary care weight management services.

Level 3: Specialist multi-disciplinary team weight management services.

Level 4: Specialist medical and surgical services.

A review of progress against the pathway, published in August 2014, found that all health boards across Wales were providing level one and two services, but the provision of level 3 services remained inconsistent and Welsh Government acknowledged that more needed to be done.

Inquiry into the Availability of Bariatric Services

In May 2014, the National Assembly for Wales’ Health and Social Care Committee published the findings of an inquiry into the Availability of Bariatric Services, focusing on the availability of specialist Level 3 and 4 services. The Committee found that the delivery of these services varied across Wales with only one out of seven Health Boards providing a comprehensive specialist weight management service (Level 3). The Committee also found that individuals seeking to access surgical provision (Level 4) have been subject to more stringent eligibility criteria than recommended by National Institute for Health and Care Excellence guidelines. The report made a number of recommendations, including:

  • the Welsh Government should work with Local Health Boards to provide a clear outline of the actions that will be taken to implement the All Wales Obesity Pathway fully, and provide details of the associated timescales.
  • the Welsh Government should provide assurances that it will require forthcoming Local Health Board plans and the all-Wales Level 3 service specification to include measures to address the lack of multi-disciplinary service provision in Wales within the next 12 months.
  • the Welsh Government should develop and publish a monitoring and evaluation framework for bariatric services in Wales

Inquiry into Childhood Obesity

The conclusions of the Children, Young People and Education Committee’s Inquiry into Childhood Obesity were published in March 2014. The aim of the inquiry was to consider the effectiveness of Welsh Government policies, programmes and schemes aimed at reducing the level of childhood obesity in Wales, and to identify areas where further action is needed. The Committee’s report made a number of recommendations, including:

  • the Welsh Government should review the progress of Local Health Boards in meeting minimum service requirements for each level of the All Wales Obesity Pathway.
  • the Welsh Government should ensure that level 3 services for children are put in place across Wales.
  • the Welsh Government should develop and publish an evaluation framework for its strategies relating to childhood obesity to ensure that the performance of strategies can be monitored against outcomes.

Welsh Government response

In its written response to the report, the Welsh Government accepted the majority of the Committee’s recommendations, and reported on the progress made towards achieving those recommendations. This progress included:

  • changes to the assessment process for the All Wales Obesity Pathway.
  • the development of a draft National Obesity Level Three Service Specification and Clinical Access Policy for adults by Public Health Wales, and a commitment to the development of a similar draft policy for children.
  • the Welsh Government asking Public Health Wales to develop an evaluation framework for strategies relating to childhood obesity as part of its 2014/15 work plan.

Turning the Curve on Childhood Obesity

In February 2015, the Preventing Childhood Obesity Steering Group published their report, Turning the Curve on Childhood Obesity in Wales. The Steering Group had been commissioned by the Effective Services for Vulnerable Groups work programme, one of four national programmes of work led by the Public Service Leadership Group, to explore cross-public service solutions to the problem of childhood obesity.

The report’s focus was to identify practical steps which public services in Wales can take to prevent an upward trend in the levels of childhood obesity. The Steering Group identified six key themes or ‘changes we want to see’:

  1. More children able to walk or cycle to and from school.
  2. Safe environments where children can play in the evenings, weekends and holidays.
  3. More children participating in sport and becoming hooked on sport for life.
  4. All children able to access healthy, nutritionally-balanced meals on a daily basis.
  5. Children and parents are able to distinguish between healthier and less healthy foods, feel confident in trying and preparing healthier foods, and are able to make informed dietary choices.
  6. Healthier choices are easier to access than unhealthy choices.

Additional information

The National Obesity Forum’s State of the Nation’s Waistline report 2015.

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Not so sweet? Debating a Welsh sugar tax

8 December 2015

Article by Megan Jones, National Assembly for Wales Research Service

picture of lumps of sugar

Image from Pixabay. Licensed under the Creative Commons.

In plenary on Wednesday, Assembly Members will take part in a debate on the introduction of a sugar tax. The non-government motion for debate tabled by Elin Jones, proposes that:

The National Assembly for Wales:

Calls on the Welsh Government to bring forward proposals to use new taxation powers under the Wales Act 2014 to allow the next Welsh Government to introduce a levy on sugary drinks.

Sugar Tax

A sugar tax involves increasing the price of sugary foods and/or drinks, such as soft drinks, with the aim of decreasing the consumption of such products.

A number of European countries have already introduced additional taxes on sugary or fatty foods. An additional tax on sweets, chocolate, cocoa-based products, ice cream and ice lollies has been in place in Finland since 2011, as well as a separate additional tax on soft drinks. In the same year, Hungary introduced an additional tax on products such as soft drinks, energy drinks and pre-packed sweetened products, salty snacks and condiments. France introduced a tax on all drinks with added sugar or artificial sweeteners in 2012.

Wales

At present, the National Assembly for Wales does not have the general power to impose new taxes, such as the sugar tax. However, the Wales Act 2014 gives the Welsh Government the power to introduce new devolved taxes, but only with the prior agreement of the UK Government, through an Order in Council. Therefore, the Welsh Government could, with the support of the UK Government, use its new fiscal powers as a means of introducing a sugar tax in Wales.

The idea of a sugar or ‘pop tax’ has attracted some support from stakeholders including the British Medical Association (BMA) in its Food for Thought report, and the Royal College of Paediatrics and Child Health (RCPCH) in its manifesto Child Health Matters, as well as celebrity chef Jamie Oliver.

During a debate on obesity in the National Assembly in May 2015, the First Minister, Carwyn Jones, stated that a sugar tax was ‘an interesting idea’, but ‘not sufficient on its own’, to deal with the problem of childhood obesity.

UK Position

In October 2015 Public Health England (PHE) published a review of the evidence concerning measures to reduce sugar consumption. The review, Sugar reduction: the evidence for action, concludes that a range of factors are contributing to increased sugar consumption, and that a correspondingly broad range of measures is needed in response, such as action to address:

  • price promotions in shops and restaurants
  • the marketing and advertising of high sugar products to children
  • the sugar content in and portion size of everyday food and drink products

Additionally the review considers a tax or a levy, as a means of reducing sugar intake, but suggests that tackling marketing, pricing and food content may be more effective.

In November 2015, the House of Commons Health Select Committee published a report, Childhood Obesity – Brave and Bold Action, which recommended the introduction of a tax on sugary drinks. The chair of the Committee, Dr Sarah Wollaston MP, said:

A full package of bold measures is required and should be implemented as soon as possible. We believe that a sugary drinks tax should be included in these measures with all proceeds clearly directed to improving our children’s health.

Following the organisation of a petition, with over 100,000 signatures, calling on the UK Government to introduce a tax on sugary drinks, the matter was debated by the UK Parliament on 30 November 2015. In response to both the petition and debate, the UK Government confirmed:

The Government has no plans to introduce a tax on sugar-sweetened beverages […]

The causes of obesity are complex, caused by a number of dietary, lifestyle, environmental and genetic factors, and tackling it will require a comprehensive and broad approach. As such, the Government is considering a range of options for tackling childhood obesity, and the contribution that Government, alongside industry, families and communities can make, and will announce its plans for tackling childhood obesity by the end of the year.

Welsh Government

One of the issues the Welsh Government is currently highlighting to tackle obesity is adverts that market food and drink that are high in fat, salt and sugar to children. The Health Minister, Mark Drakeford, has called on the UK Government to ban adverts for fatty and sugary food from being broadcast before 9pm.

According to the Minister:

Adverts marketing soft drinks, chocolate, other confectionery, and sugary cereals are all making significant contributions to children consuming free sugar.

All these food sectors are actively marketed during the advertisement breaks of TV programmes we know our children and young people watch […]

That’s why I have written to the UK Government […] to call for an immediate extension to the Ofcom high in fat, salt and sugar (HFSS) broadcast advertising regulations, which would ban these adverts from appearing on our TV screens until after 9pm.

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A picture of diabetes in Wales

16 November 2015

Article by Philippa Watkins and Helen Jones, National Assembly for Wales Research Service

14 November 2015 is World Diabetes Day. Around 180,000 people in Wales are currently being treated for diabetes (over 5% of the total population and around 7% of the adult population).

It’s estimated that a further 70,000 people in Wales have Type 2 diabetes, but are either unaware they have it or haven’t been diagnosed. Another 540,000 are at high risk of developing the condition.

Type 1 diabetes is an autoimmune condition where the pancreas doesn’t produce any insulin. It’s usually diagnosed in children and young adults.

Type 2 diabetes is far more common than Type 1, accounting for around 90% of adults with diabetes. Type 2 is often linked to lifestyle factors. Obesity is the most significant risk factor, and could amount to 80 – 85% of the risk of developing Type 2 diabetes.

There is growing evidence – and concern – that the rise in childhood obesity has led to an increase in cases of Type 2 diabetes being diagnosed in younger age groups.

Deprivation is strongly associated with higher levels of obesity, physical inactivity, smoking and other factors which are linked to people’s risk of diabetes, and their ability to manage the condition and to avoid serious complications.

Diabetes costs the NHS in Wales around £500 million each year. This equates to approximately 10% of NHS Wales’ budget.

18% of beds in acute hospitals in Wales are occupied by people with diabetes. Over 90% of these patients have Type 2 diabetes.

Further reading:

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