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Government initiatives to tackle the obesity epidemic

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Obesity is the most common nutritional disorder in the world (WHO, 1998), caused when an individual’s energy intake exceeds her or his expenditure for a prolonged period of time. For example, consuming an extra 100 kilocalories per day on top of an individual’s energy requirements will cause a 5kg weight gain per year (SIGN, 1996).


VOL: 101, ISSUE: 39, PAGE NO: 23

Karen Fisher, BSc, is chief dietitian, Whiteabbey Hospital, Newtonabbey, Northern Ireland

Download a print-friendly PDF file of this article here

Obesity is the most common nutritional disorder in the world (WHO, 1998), caused when an individual’s energy intake exceeds her or his expenditure for a prolonged period of time. For example, consuming an extra 100 kilocalories per day on top of an individual’s energy requirements will cause a 5kg weight gain per year (SIGN, 1996).

Yet despite the apparently simple cure of reducing calorie intake or increasing physical activity, the incidence of obesity is on the increase (Table 1). In 2003 almost 60 per cent of women and 68 per cent of men were overweight or obese in the UK.

The picture is similar for children. One recent report found 33 per cent of Scottish 12-year-olds were overweight, 18 per cent were obese and 10-11 per cent were severely obese. The expected figures were 15 per cent, 5 per cent and 2 per cent respectively (NHS Quality Improvement Scotland, 2003).

Along with this rise in obesity has come an increase in diseases such as diabetes, coronary heart disease, cerebrovascular disease and certain cancers.

The National Diet and Nutrition Survey (Office for National Statistics and MRC, 2004) found that only 36 per cent of men and 26 per cent of women met the target of 30 minutes of physical activity, five days a week as recommended by the Department of Health (Joint Health Surveys Unit, 2004).

The document Securing Good Health for the Whole Population (DoH, 2004a) highlighted the lack of cohesion between the different departments within government. While the DoH is recommending a lower fat, sugar and salt diet, schools are making money from vending machines, reducing the number of hours given to physical exercise and selling off their playing fields. On the back of this report, the government published its white paper Choosing Health: Making Healthy Choices Easier in November 2004 (DoH, 2004b).

The ethos of this document is for collaboration between different government bodies (for example the Food Standards Agency, DoH, Department for Education and Skills, Department of Culture, Media and Sport) as well as with the media, food industry and communities to achieve the common goal of better public health.

Encouraging healthy choices

Choosing Health aims to help people make healthier choices by developing a more user-friendly system for food labelling.

The Food Standards Agency (FSA) is consulting on options such as the traffic light system to allow consumers to see at a glance how a particular product fits into a healthy diet.

It also aims to improve the image of healthy foods by increasing public awareness of how food affects health, hence increasing demand for new product lines (for example the five-a-day campaign).

The FSA is also working with the food industry to develop healthier products. Many manufacturers undertook to voluntarily reduce the salt content of their products by 10 per cent by 2005-2006. They are also reducing the sugar and fat content.

Preventing obesity in children

Choosing Health recommends involving the Department for Education and Skills in making healthy eating a whole-school approach that is supported by school policy and the curriculum, rather than something that just happens in the canteen.

One study found that an overweight young person has a 50 per cent chance of becoming an overweight adult, and children of overweight parents have twice the risk compared with those of healthy weight parents, so targeting schools is imperative (Whitaker, 1997).

Pilot projects that have shown positive outcomes in primary, secondary and special schools in England include healthy breakfast clubs, healthier tuck shops, water provision, healthier vending machines, improving the dining room environment, healthy cooking clubs, healthier lunchboxes and growing clubs.

Voluntary codes to limit promotion of unhealthy products to children are also to be strengthened.

The aim of increasing a child’s physical activity level to 60 minutes a day is more likely to be met if the government’s environment and education departments work together to develop sporting facilities, prevent the selling of school playing fields, and encourage children to walk or cycle to school through the Travelling to School initiative, which promotes walking and cycle lanes.

Nationally the DoH is working to improve the number of mothers who breastfeed their babies, as there is evidence to suggest this reduces the risk of obesity (Armstrong et al, 2002).

Physical activity levels

Another aim is to encourage adults to take 30 minutes of moderate physical activity five days a week.

Choosing Health endorses the use of pedometers, both in clinical practice and also in public awareness campaigns. Ideally each individual would achieve 10,000 steps per day or 15,000 for weight loss.

The DoH would also work alongside the Department for Culture, Media and Sport and sports organisations to increase awareness of the benefits to health as well as investing in more initiatives to promote activity, for example cycle lanes.

Prevention and treatment guidelines

Choosing Health recommends producing guidance for best practice for preventing and treating obesity, and incorporating these into everyday practice. The SIGN guidelines were produced in Scotland for this purpose in 1996 (SIGN, 1996). CREST guidelines for managing obesity in secondary care have just been published for use in Northern Ireland (CREST, 2005), and the NICE guidelines for England are due for publication in 2007.

Which strategies work?

For a weight management programme to be successful it has to involve alterations in activity level, dietary modification and cognitive behavioural therapy (CBT) (SIGN, 1996; RCP, 1997; WHO, 1998).

A medically recognised goal of weight reduction would be to lose 10 per cent of starting weight and follow this up with weight maintenance.

Dietary modification requires awareness of eating habits. The CBT model encourages using a food diary to give the individual and the health professional an idea of how, when and why food is eaten. This encourages ownership of issues and goals, and provides a basis for self-monitoring. It also identifies triggers for binge eating. Success of strategies will be measured against:

- Halting increasing obesity in under-11s by 2010;

- Reducing mortality from CHD and related disease by 40 per cent and cancer by 20 per cent in those under 75 by 2010;

- Increasing the number of people who are taking regular exercise.


The white paper does go some way towards recognising the difficulty society has in achieving goals set by the DoH for diet and physical activity, when the environment we live in actively promotes unhealthy behaviour. It has put many initiatives in place to prevent and treat obesity, but only time will tell if this epidemic has reached its peak.

This article has been double-blind peer-reviewed.

For related articles on this subject and links to relevant websites see

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