OBESITY IN SCOTLAND - Obesity Action Scotland
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OBESITY in SCOTLAND
OBESITY IN SCOTLAND
July 2016
Briefing
Facts
}} Obesity is defined as Body Mass Index over 30 kg/m2, which records weight
adjusted for height
}} Obesity is a serious public health threat in Scotland: affecting one in every four
adults and almost one in five children
}} Two in every three adults in Scotland (65%) are overweight; people of normal
weight in Scotland are now in the minority
}} Obesity rates in Scotland are amongst the highest in the world, even higher than in
England
}} The current obesity crisis results from living in obesogenic environments: where
relative inactivity and overconsumption of energy dense foods is too available,
affordable and accepted
}} Although personal choices are important, obesogenic environments create
dangerously high levels of obesity in the population
}} Obesity harms many aspects of health; it interferes with sexual function, breathing,
mood and social interactions
}} Obesity also shortens life, increasing deaths from type 2 diabetes, heart disease
and common cancers
}} In Scotland, obesity reduces productivity and physical activity; it increases
sickness absence, and demand for health and social care services
}} The cost of obesity to the NHS in Scotland is huge, estimated between £360
million and £600 million annually
Definition
On a population level, overweight and obesity are usually defined using Body Mass Index
(BMI). BMI is a measure of whether a person is a healthy weight for their height. For most
adults a BMI of 25 – 29.9 kg/m2 is overweight and BMI over 30 kg/m2 is obese.
BMI, calculated from a person’s height and weight, is the most effective population measure
available as it is relatively accurate, simple and cheap for large population groups. However,
there will always be exceptions to the rule; for example, people who are very muscular and
pregnant women will be quite heavy for their height with a high BMI, but will not have the
health risks of carrying extra fat mass. In such individual circumstances other measures can be
used to provide a more accurate assessment of healthy weight.
Calculate your BMI ( your weight in kg
your height in metres ) Divide your answer
again by your
height in metres
232 - 242 St Vincent Street 0141 221 6072
Glasgow G2 5RJ @obesityactionsc
www.obesityactionscotland.org info@obesityactionscotland.orgMonitoring Obesity in Scotland Rates are higher in areas of greater
deprivation, particularly among women1,
Carried out annually, children2, older age groups, black and minority
the Scottish Health ethnic groups, and people with disabilities4.
Survey1 provides a
detailed picture of the
health of the Scottish Childhood Obesity in Scotland
population. Each year
the survey provides }} In 2014, 31% of children in Scotland (aged 2
BMI data for adults and to 15) were at risk of overweight or obesity; of
children. which 17% were at risk of obesity and 14% at
risk of overweight1
Routine Child Health
Reviews2 which include }} In 2014/15, almost 22% of Primary 1 children
height and weight are (aged 4 to 6) were at risk of overweight or
undertaken in Primary obesity; of which 10% were at risk of obesity
1 (age 4 to 6) covering 92% and 12% were at risk of overweight; this was
of that population group. slightly less than in 2005/6 (10.5% and 12.8%
The resulting statistics respectively), however these high rates have
report BMI annually. persisted relatively unchanged over the last
decade2
In England the National
Child Measurement }} The proportion of healthy weight Primary 1
Programme3 measures height and weight at children has not improved in the last 10 years
reception (age 4 to 6) and year 6 (age 10 to 11). (in 2007/8 and 2014/15 it was 77%)2
}} Children in Scotland living in two most
Overweight and Obesity in Scotland deprived quintiles, are least likely to have
healthy weight1
}} Two in three (65%)
adults aged 16-64 Overweight }} In 2014/15 in the least deprived areas 17% of
are overweight or Primary 1 children were classified as at risk of
obese (had BMI overweight and obesity compared to 25% in
Obese
over 25)1 Normal the most deprived areas2
Weight
}} More than one in
4 adults are obese
(28% had BMI over Underweight Obesity in Pregnant Women
30)1
Provisional 2015 data indicates that 21% of
}} Between 1995 and 2014, the proportion pregnant women in Scotland are obese at
of adults categorised as obese (BMI 30+), their first antenatal booking, with a further 28%
increased by half, from 17.2% to 28%1 classified as overweight7.
}} Since 1995, the proportion of the population
which was overweight or obese (BMI 25+)
increased from 52.4% to 65%1
}} Women have higher obesity rates than men
(29% compared with 26%)1
}} Obesity increases with age, with almost 35%
of men and 37% of women in the 65-74 age
group being obese1
}} Obesity does not affect everyone equally.
www.obesityactionscotland.orgImpact of Obesity
Obesity can have a negative impact on health as well as other aspects of life for adults and children
reducing their overall quality of life. Obesity increases the risk of:
Type 2 Diabetes: Fat cells in the body, Complications during pregnancy and
especially from fat tissue around waist, birth: miscarriage, gestational diabetes,
produce hormones and proteins that high blood pressure and pre-eclampsia,
interfere with body’s cardiovascular blood clots, baby’s shoulders becoming
and metabolic systems, increasing risk “stuck” during labour, heavier than
of type 2 diabetes. Obese women are normal bleeding after birth4,20
13 times more likely to develop type 2
diabetes than normal-weight women14. Musculoskeletal problems: gout,
47% of type 2 diabetes is attributable to osteoarthritis, and lower back pain
obesity15 are caused by the mechanical and/
or metabolic strain of excess fat mass
11 Common Cancers: breast, womb on the bones. 47% of gout and 12% of
(endometrial), bowel, pancreas, osteoarthritis are attributable to obesity
oesophageal, kidney, ovarian, prostate,
gallbladder, liver and stomach. Hormones Mental health problems: depression,
and proteins produced by bipolar disorder and anxiety are
fat cells are released into the associated with obesity21. Mechanisms
bloodstream and carried around the body are still being investigated and could
to many organs increasing the cancer include higher inflammation levels, insulin
risk16. 29% of colon cancers, 14% of resistance, hormonal changes and social
endometrial, 13% ovarian, 3% and cultural factors22
prostate and 1% rectal cancers are
attributable to obesity15 Respiratory disorders: asthma,
chronic obstructive pulmonary disease,
Cardiovascular disease: hypertension, obstructive sleep apnoea are caused
atherosclerosis, heart failure, ischaemic by mechanical factors and metabolic
heart disease, ischaemic stroke. Obesity pathways related to obesity
increases the risk of cardiovascular
disease through causing high blood
pressure and type 2 diabetes. 36% of Kidney disease23
hypertension, 18% myocardial infarction,
15% angina pectoris, and 6% of strokes
are attributable to obesity15 Premature death: obesity reduces life
expectancy by an average of 3 years;
severe obesity (BMI > 40) reduces it by
Alzheimer’s disease26 and dementia 8-10 years24
Gastrointestinal disorders: gallstones, Unemployment4
pancreatitis, liver disease, gastro-
oesophageal reflux disease, irritable
bowel syndrome. Gastrointestinal
disorders are 2 to 3 Discrimination and stigmatisation4
times more common in obese individuals
than in people of normal weight17. 15%
of gallstone cases are attributable to Increased risk of hospitalisation
obesity15 Severely obese people (BMI > 40) have
been found to be 3 times more likely than
Infertility in women and impotency in those of healthy weight to need social
men18. Losing weight improves women’s care4
chance of getting pregnant and in men
improves hormone imbalance and
erectile dysfunction19}} Food Production – drivers of the food
Additional Risks for Obese Children industry e.g. the pressure for profitability,
the price of food, effort to increase efficiency
Emotional and behavioural impacts: of production; variables reflecting the wider
stigmatisation, bullying, low self-esteem, social and economic situation in the UK e.g.
and school absence4 purchasing power and societal pressure to
consume
Breathing difficulties, increased risk of
fractures, hypertension, early markers of }} Individual Psychology – psychological
cardiovascular disease, insulin resistance attributes e.g. self-esteem, stress, ‘demand
and psychological effects27 for indulgence’, level of food ‘literacy’;
variables related to the level of parental
Risk becoming obese adults4 control and level of children’s control of diet
Higher risk of morbidity, disability and }} Social Psychology – factors that have
premature mortality in adulthood21. influence at the societal level e.g. education,
media availability and consumption, TV
watching; variables related to social norms
around weight and body image
Causes of Obesity
}} Physiology – biological variables e.g. genetic
Obesity, understood as the accumulation of predisposition to obesity, level of satiety and
excess body fat, occurs when energy intake from resting metabolic rate
food and drink is greater than the body’s energy
requirements over a prolonged period. }} Individual Activity – individual’s or group’s
level of recreational, domestic, occupational
An obesogenic environment promotes weight and transport activity, parental modelling of
gain, acts on individual biology and psychology activity and learned activity patterns
influencing individual lifestyles. Although personal
responsibility plays an important role in weight }} Physical Activity Environment – factors that
gain, in obesogenic environments inactivity and may facilitate or obstruct physical activity e.g.
overconsumption of energy dense foods are cost of physical exercise, perceived danger
easy, affordable and widely accepted, making an in the environment and the ‘walkability’ of
unhealthy lifestyle the default option. the living environment; variables that reflect
cultural values associated with activity
The Foresight Report13 for the UK Government patterns
identified 7 clusters of factors / behaviours that
are contributing to obesity
(termed a systems map): These clusters are interconnected. For example,
some individuals may exhibit compensatory
}} Food Consumption behaviour such as allowing themselves an
– characteristics of the energy-dense snack as a ‘reward’ after
food market in which exercising.
consumers operate
e.g. the level of food This connectivity is important when designing/
abundance and variety, delivering interventions, as it may help to explain
the nutritional quality unexpected impacts or losses of impact due to
of food and drink, the mitigating effects of different factors/behaviours.
energy density of food,
and portion size
www.obesityactionscotland.orgScotland vs the World Cost of Obesity in Scotland
}} Obesity rates in The annual cost to the NHS in Scotland of
Scotland are higher overweight and obesity is estimated to be
than in England: 65% vs 60% are overweight between £360 million and £600 million28.
and obese, and 28% vs 24% are obese9
Average NHS costs for people with a body mass
}} Obesity rates in Scotland are the highest in the index of 40 (severe obesity) are estimated to be
United Kingdom9 twice those for people with a BMI of 20 (within
normal weight range). The costs to the health
}} Obesity rates in Scotland are among the service of obesity and its comorbidities may be
highest in the developed world10, with current comparable to those attributable to smoking.
projections suggesting that by 2030 rates
could exceed 40%11 Treating smoking-related illness costs NHS
Scotland around £400 million per year29. ASH
}} A global analysis indicated that prevalence Scotland estimated that societal costs of tobacco
of obesity and overweight in children and use in Scotland were nearly £1.1 billion30.
adolescents in developed countries was 23%5.
The rate in Scotland is 31% Healthcare expenditure is only part of the issue;
there are also the indirect economic costs of
}} Scotland had the highest prevalence of obesity overweight and obesity. The McKinsey Institute
in pregnant women when compared to 11 estimates that the cost to the UK is equivalent to
other European countries (where BMI data is
3% of gross domestic product ($73billion).
available)8. In 2010, a European comparison8
indicated that 21% of pregnant women in
This analysis takes into account of the loss
Scotland were obese. The next closest rate
of productivity attributable to loss of life or
was Germany at 14% which has a similar age
impaired life quality, direct health care costs and
distribution for pregnant women as Scotland8
investment to mitigate the impact of obesity.
}} If worldwide obesity trends continue, the
probability of meeting the World Health
Organisation’s global obesity target which
aims for no rise in obesity above 2010 levels
by 2025 will be close to zero12
REFERENCES
1. Brown L, Christie S, Gill V, et al. The Scottish health 6. World Health Organisation. Report of the
survey. 2014 edition. Volume 1. Main report. 2015. commission on ending childhood obesity. 2016.
2. Information Services Division Scotland. Primary 1 7. Information Services Division Scotland. Births in
body mass index (BMI) statistics Scotland - school Scottish hospitals - year ending 31st March 2015.
year 2014/15. 2016. SMR02 data. Updated 2015. Accessed 10/06,
3. Health & Social Care Information Centre. National 2016.
child measurement programme: England 2014/15 8. EURO-PERISTAT Project. European perinatal
school year. 2015. health report. Health and care of pregnant women
4. Public Health England. Making the case for tackling and babies in Europe in 2010. www.europeristat.
obesity. Why invest? Updated 2015. Accessed com. Accessed 10/06, 2016.
09/05, 2016. 9. Baker C, Bate A. Obesity statistics. Briefing paper.
5. European Association for the Study of Obesity. 2016; 3336.
Facts & statistics. Updated 2016. Accessed 08/06, 10. OECD. Obesity update 2014. 2014.
2016.REFERENCES
11. RR Donnelley B62286 02/10. Preventing 21. Simon GE, Von Korff M, Saunders K, et al.
overweight and obesity in Scotland. A route map Obesity and psychiatric disorders in the US adult
towards healthy weight. 2010. population. Arch Gen Psychiatry. 2016; 63(7):824-
12. NCD Risk Factor Collaboration (NCD-RisC). 830.
Trends in adult body-mass index in 200 countries 22. Harvard TH Chan School of Public Health.
from 1975 to 2014: A pooled analysis of 1698 Weight problem take a heft toll on body and mind.
population-based measurement studies with 19.2 Accessed 13/05, 2016.
million participants. The Lancet. 2016; 387:1377- 23. Kopple JD. Obesity and chronic kidney disease.
1396. Journal of Renal Nutrition. 2010; 20:S2930.
13. Butland B, Jebb S, Kopelman P, et al. Foresight. 24. Dent M, Swanston D. Briefing note: Obesity and
Tackling obesities: Future choices - project report. life expectancy. 2010.
2nd edition. 2007. 25. Scarborough P, Cowburn G, Cobiac L, et
14. NHS Information Centre Lifestyle Statistics. al. Translating the world health organisation
Statistics on obesity, physical activity and diet, 25x25 goals into a united kingdom context: The
England 2012. 2012. PROMISE study. 2016.
15. McGuire A, Morris S, Raikou M. Appendix 6 26. Christensen A, Pike CJ. Menopause, obesity
estimating the cost of obesity in England in the and inflammation: Interactive risk factors
national audit office tackling obesity in England. for Alzheimer’s disease. Frontiers in Aging
2001. Neuroscience. 2015; 7(7):130.
16. Cancer Research UK. How being overweight 27. World Health Organisation. Obesity and
causes cancer. Updated 2015. Accessed 12/05, overweight. Factsheet no 311. Updated 2015.
2016. Accessed 05/13, 2016.
17. American College of Gastroenterology. Obesity. 28. Castle A. SPICe briefing: Obesity in Scotland.
Updated 2016. Accessed 13/05, 2016. 2015; 15/01.
18. Public Health England. Health risks of adult 29. Scottish Government. Publication of Scottish
obesity. Accessed 10/05, 2016. government tobacco control strategy. Updated
19. Pasquali R, Patton L, Gambineri A. Obesity 2013. Accessed 10/06, 2016.
and infertility. Current Opinion in Endocrinology, 30. Action on Smoking and Health Scotland. Up in
Diabetes and Obesity. 2007; 14(6):482-487. smoke. The economic cost of tobacco in Scotland.
20. NHS Choices. Risk of being overweight in 2010.
pregnancy. Updated 2015. Accessed 13/05, 2016.
Obesity Action Scotland
Obesity Action Scotland was established mid-2015 to provide clinical
leadership and independent advocacy on preventing and reducing overweight
and obesity in Scotland.
Our main aims:
• To raise awareness and understanding of what drives obesity and the
health problems associated with obesity and overweight with health Royal College of
practitioners, policy makers and the public Physicians and Surgeons
• To evaluate current research and identify strategies to prevent obesity and 232 - 242 St Vincent Street
overweight based on the best available evidence Glasgow G2 5RJ
• To work with key organisations in Scotland, the rest of the UK and 0141 221 6072
worldwide, to promote healthy weight and wellbeing info@obesityactionscotland.org
@obesityactionsc
Overseeing our work is the Steering Group whose membership spans various www.obesityactionscotland.org
disciplines involved in preventing and tackling obesity and its consequences:
clinicians, public health experts, epidemiologists, nutritionists and dieticians, Further copies can be
GPs and weight management experts. downloaded from our
There are four members of staff. websiteYou can also read
