Related to: Ill Health and Disability, Diet and Malnutrition, Physical and Mobility Impairments. Physical Activity, Children and Young People, Wellbeing, Child Health and Wellbeing Survey , Food Poverty, Active Travel
- Over half of adults (55.7%) in B&NES are estimated to be overweight or obese, although this is significantly lower than regional and national figures.
- Rates of recorded obesity are rising in adults in B&NES, but are lower than national rates.
- 23.2% of Reception aged children (4 to 5 years old) in B&NES are an unhealthy weight, i.e. either overweight or obese. 7.6% of Reception aged children in B&NES are obese.
- 28.4% of Year 6 aged children (10 to 11 years old) in B&NES are an unhealthy weight, i.e. either overweight or obese. 14.0% of Year 6 aged children in B&NES are obese.
- Trends in childhood unhealthy weight - including overweight and obesity - have been relatively static since the national measurement programme began in 2006/07, i.e. there has been no long-term significant upward or downward shift. This accords with national findings that demonstrate prevalence rates of overweight and obesity may have stabilised between 2004 and 2013.
- Age is a significant factor in the levels of obesity among children in B&NES, i.e. increasing with age. Deprivation and ethnicity are significant factors in the level of obesity among Year 6 aged children in B&NES.
- There appears to be a gender gap opening up nationally, especially among Year 6 aged boys, who are more likely to be classified as obese compared to their female peers.
- Parental obesity is a significant risk factor for childhood obesity. Therefore, areas with high levels of childhood unhealthy weight and obesity are also likely to have more adult obesity. 1
Excess weight reduces life expectancy on average by nine years and is implicated in the genesis of many diseases and disorders including diabetes, heart disease, stroke, osteoarthritis, raised blood pressure, gallstones, infertility and depression 2
What does the data say?
Over a third of children in the UK are overweight, yet 79% of parents with an overweight child do not recognise that they are, and of those that do, 41% do not realise that it is a health risk 3 . Furthermore, parents tend to overestimate how active their children are 4 as in England, 79% of boys and 84% of girls aged five to 15 do not meet the current physical activity recommendations of 60 minutes each day 5
Unicef’s 2013 rates of obese children in rich countries comparative overview 6
In Unicef’s 2013 rates of obese children in rich countries in rich countries comparative overview, Unicef compares 29 of the world’s most advanced economies. According to Unicef’s report the UK’s rate of obese children aged 11, 13 and 15 is approximately 12%, and so it has the 10th lowest rate in the table. Childhood obesity levels are more than 10% in all countries except Denmark, the Netherlands and Switzerland. Only Canada, Greece and the United States have childhood obesity levels higher than 20%.
It is important to note that one of the limitations of these league tables is that internationally comparable data on children’s lives is not sufficiently timely. Between the collection of data in a wide variety of different settings and their publication in quality-controlled, internationally comparable form, the time-lag is typically two to three years. This means that most of the statistics on child well-being used in this report, though based on the latest available data, apply to the period 2009–2010.
Perceptions of obesity in the UK
EASO Report - Obesity: An underestimated threat 7
More than 2,000 adults in the UK took part in a public perception survey conducted in seven European countries. It found that People in the UK were the least likely to underestimate their own weight, however men in particular underestimate the dangers of obesity. The UK section of the report presents the following findings;
- 21% of those who think they are a healthy weight are overweight and 36% who think they are overweight are actually obese (compared to 18% in Italy and 49% in Finland)
- 61% of people asked in the UK knew that obesity increases risk of stroke, but only 30% knew that it can increase the risk of cancer
- People in the UK are less likely than in other countries to identify stress and lack of sleep as contributing factors to obesity
- It is estimated that obesity costs the NHS £4.3bn per year, and is estimated to rise to £50bn by 2050
There were 13,446 (2012/13 financial year) people 16 years and over registered as obese in GP practises in Bath and North East Somerset. 8
The prevalence of obesity in those 16 years and over registered as obese in GP practises has been gradually increasing locally and nationally. In B&NES it has increased from 7.5% in 2008/09 to 8.1% in 2012/13 (financial years). The prevalence rate in B&NES is significantly lower than England. The national prevalence of obesity (ages 16+) was 9.9% in 2008/09 and 10.7% in 2012/13 (financial years). 9 However, it is likely that true rates of obesity will be higher than these figures suggest as many obese people will not be on GP obesity registers.
Figure 1: Obesity prevalence (ages 16+) in B&NES and England GP 16 years + registered populations (2008/09 – 2012/13 financial years) 10
*It is important to note that the above prevalence rates are based on the GP registered population of Bath and North East Somerset and so some of these people may not be residents of Bath North East Somerset. Nevertheless, the vast majority of people will be registered with a GP in their county of residence.
For more up to date prevalence figures for obesity recorded as part of the NHS Quality and Outcomes Framework (QOF), see the Ill Health and Disability section.
Survey based data suggests that 55.7% of adults in B&NES are obese or overweight (BMI >25kg/m2). This is significantly lower than rates for both the South West (62.7%) and England (63.8%), but still represents greater than half the adult population (Public Health Outcomes Framework Indicator 2.12: Excess Weight in Adults).11.
Nationally, men and women have a similar prevalence of obesity, but men are more likely to be overweight (41%m compared to 32%f) (2008)12
The modelled obesity prevalence for all people in B&NES from 2006-2008 was 21.9%. This compares favourably to a South West rate of 24.7% and a national rate of 24.2% over the same period. This places B&NES in the lowest 20% nationally. 13
The Health Survey for England in 2011 found that 65% of men were an unhealthy weight (24% obese) and 58% of women were an unhealthy weight (26% obese). 14
It is estimated that £45.8m was spent by the NHS in 2010 on diseases related to overweight and obesity in B&NES, set to rise to £49m by 2015.
B&NES estimated obesity prevalence to 2030 15
Figure 2 - Estimated prevalence of obesity in Bath and North East Somerset
Figure 2 demonstrates the estimated local increase in obesity prevalence up to 2030. If obesity levels continue to rise at the current rate, this would mean an estimated prevalence increase of 27% over the next 16 years from 6.5% (~10,038 persons) to 7.4% (~12,712 persons). If the level is maintained at the 2010 rate, the estimated increase will be smaller, increasing to 6.9% by 2030, an increase of 19% (~9,971 persons to ~11,820 in 2030).
As measured via the National Childhood Measurement Programme (NCMP)16
NCMP is a national programme where children in Reception Year (4-5 year olds) and Year 6 (10-11 year olds) are weighed and measured and the results are used to monitor levels of unhealthy weight in the population. NCMP is now in its 11th year (starting in 2006/07, with latest results for 2015/16 published) and is focused on levels of 'unhealthy weight', which includes all those classified as overweight or obese.
For the purpose of NCMP there are two ways of categorising children - (i) level of clinical concern; and (ii) for population surveillance. Each method uses different BMI percentile cut offs and thus each one will produce different rates of unhealthy weight in children. Letters to parents are sent out on the basis of the clinical cut offs, but for the purpose of the reported NCMP figures (including those on this page), the population monitoring cut offs are used. This means that a child classified as obese will have a BMI above the 95th percentile, and a child that is overweight will have a BMI between the 85th and 95th percentiles of the British 1990 Child Growth Reference. Unhealthy weight refers to all children over the 85th percentile.17
In 2015/16 1,855 Reception Year children were measured in B&NES schools - a participation rate of 96.6% (73rd out of 150 English local authorities, with 1st being the local authority with the highest participation rate). In 2015/16 1,577 Year 6 children were measured in B&NES schools - a participation rate of 93.0% (101st out of 150 English local authorities). The participation rate, particularly among Year 6 pupils, is lower in 2015/16 compared to the previous year (97.2% for Year 6 pupils in 2014/15). It is thought that this was, at least in part, due to national media coverage of a local story.
Reception (aged 4 to 5) [Tables 1, 2 & 3] - in the 2015/16 school year, 23.2% of Reception aged children resident in B&NES had an unhealthy weight (overweight or obese), this is broadly the same as the 2014/15 figure of 23.5%. This reflects an increase in the proportion of overweight Reception aged children resident in B&NES from 13.8% in 2014/15 to 15.6% in 2015/16 - significantly higher compared to England (12.8%) in 2015/16. The proportion of obese Reception aged children in B&NES has decreased from 9.6% in 2014/15 to 7.6% in 2015/16 - significantly lower compared to England (9.3%). The proportion of underweight Reception Year children in B&NES in 2015/16 is suppressed in 2013/14).
Year 6 (aged 10 to 11) [Tables 1, 2 & 3] - in the 2015/16 school year, 28.4% of Year 6 aged children in B&NES had an unhealthy weight (overweight or obese), this represents an increase on the 2014/15 figure of 27.3%. This reflects an increase in the proportion of overweight Year 6 children in B&NES from 13.4% in 2014/15 to 14.0% in 2015/16 - the same copmpared to England (14.3%) in 2015/16. The proportion of obese Year 6 aged children in B&NES has decreased very slightly, from 13.9% in 2014/15 to 13.6% in 2015/16. This is significantly lower compared to England (19.8%) in 2015/16. The proportion of underweight Year 6 children in B&NES increased from 0.8% in 2014/15 to 1.3% in 2015/16.
Tables 1, 2 and 3 details trends in obesity, overweight and unhealthy weight children from both cohorts (Reception and Year 6), from 2006/07 to 2015/16.
|Year||Overweight||Obese||Unhealthy Weight||Overweight||Obese||Unhealthy Weight|
|Year||Overweight||Obese||Unhealthy Weight||Overweight||Obese||Unhealthy Weight|
|Overweight||Obese||Unhealthy Weight||Overweight||Obese||Unhealthy Weight|
Tables: 1-3 - NCMP Statistics for Bath and North East Somerset, England and the South West, 2006/07 to 2015/16 (derived from child's postcode from 2010/11 onward)
Figure 3: Percentage of children of an unhealthy weight in Bath & North East Somerset, England and the South West, 2006/07 to 2015/16 from NCMP data (for consistency, based on B&NES school pupil cohorts)
As shown in Figure 3, the percentage of unhealthy weight children in Reception Year in B&NES's schools between 2006/07 and 2015/16 has been similar compared to England as a whole (and the South West from 2009/10). In contrast, the percentage of unhealthy weight children in Year 6 in B&NES's schools between 2006/07 and 2015/16 has been lower than England as a whole (and the South West from 2009/10).
Tables 1, 2 & 3 and Figures 3 shows that trends in childhood unhealthy weight - including overweight and obesity - have been relatively stable since the national measurement programme began in 2006/07, i.e. there has been no long-term significant upward or downward shift. This accords with national findings that demonstrate prevalence rates of overweight and obesity may have stabalised between 2004 and 2013 (following a rapid increase in prevalence rates between 1994 and 2003).18
Figure 4: Percentage of children classified as obese in Bath & North East Somerset, England and the South West, 2006/07 to 2015/16 from NCMP data (for consistency, based on B&NES school pupil cohorts)
Figure 4 shows a similar static pattern to rates of childhood obesity between 2006/07 and 2015/16. However, it does appear there has been a rise in the proportion of Year 6 pupils classified as obese nationally, particularly in the most recent NCMP year of 2015/16 (but the early years of the NCMP are known to be an underestimate for obesity prevalence for this older year group).
Figure 5: Proportion of Reception Year children of an Excess Weight (including overweight and obese) in Bath & North East Somerset, 2013/14 to 2015/16 from NCMP data by Ward of residence19
Figure 6: Proportion of Year 6 children of an Excess Weight (including overweight and obese) in Bath & North East Somerset, 2013/14 to 2015/16 from NCMP data by Ward of residence20
Figures 5 and 6 illustrate the geographical differences in excess weight (including overweight and obese) of Reception and Year 6 aged children respectively. Among Reception age children the wards with the highest rates of excess weight are Odd Down (28.1%), Keynsham North (27.7%) and Clutton (26.7%). Among Year 6 age children the wards with the highest rates of excess weight are Southdown (44.6%), Radstock (38.4%) and Keynsham North (38.0%).
Further profiling of the B&NES NCMP data is taken from analysis conducted on the data up to 2013/14. Key findings are as follows:
- Age is a significant factor in levels of childhood obesity, i.e. rates of obesity increase with age. For example, in 2013/14 the obesity rate for Reception Year aged children is 8.9%, increasing to 16.0% for Year 6 aged children. There is less variation in the proportion who are overweight.
- Living in a relatively deprived area also appears to be a significant factor in levels of childhood obesity, especially for Year 6 aged children, where rates of obesity are almost twice for the bottom two local quintiles compared to the top local quintile (using the 2010 Income Deprivation Affecting Children Index [IDACI]) - see Figure 7.
Figure 7: Percentage of Year 6 Children in B&NES classified as Obese by Deprivation (using 2010 IDACI), 2012/13 and 2013/14
- Gender does not appear to be a significant factor in explaining the levels of childhood overweight and obesity in B&NES, i.e. the differences between the sexes are not significantly different. However, the analysis of recent national NCMP data does appear to show a particularly high gender difference in rates of Year 6 children classified as obese - 17.9% girls and 21.7% boys in 2015/16.21
- Ethnicity does not appear to be a significant factor in explaining the levels of childhood obesity among Reception aged children in B&NES, i.e. the difference in the level of obesity between White and BME (non-White) Reception aged children is not significantly different - see Figure 8. However, ethnicity does appear to be a significant factor in explaining the level of childhood obesity among Year 6 aged children in B&NES, i.e. the difference in the level of obesity between White and BME (non-White) Year 6 aged children is significantly different - see Figure 8. It is important to note though, that as BME (non-White) families are more likely to be on a low income, it is not possible to tell with this level of analysis whether it is low income, or some other factor related to ethnicity, that is behind this significant difference in the level of obesity among Year 6 aged children.
Figure 8: Percentage of Reception and Year 6 Children in B&NES classified as Obese by Ethnicity, 3 years combined [2011/12, 2012/13 and 2013/14] Note: BME is the definition used by the Institute of Race Relations, i.e. Black and Minority Ethnic or Black, Asian and Minority Ethnic is the terminology normally used in the UK to describe people of non-white descent.
- Rural/Urban Classification does not appear to be a significant factor in explaining the levels of childhood overweight and obesity in B&NES, i.e. whether a child comes from a rural or urban area of B&NES appears to make little difference to their chances of being overweight or obese.
- Distance between school and home does not appear to be a significant factor in explaining the levels of childhood overweight and obesity in B&NES, i.e. how far a child lives from their school appears to make little difference to their chances of being overweight or obese.
- Children and young people with disabilities are more likely to be obese than children without disabilities and this risk increases with age (analysis of HSE 2006-2010 for children aged 2-15 with a LLTI)
- Due to this increased prevalence of obesity, children with disabilities are at greater risk of associated health conditions such as diabetes, asthma, musculoskeletal problems and heart disease.
- This can also increase the risk of secondary conditions such as mobility limitations, fatigue, pain, pressure sores, depression and social isolation.
- Factors linking disability and obesity include diet, physical activity, parental attitudes and behaviour, access to recreational facilities and genetics.
- Overall, children and young people with disabilities are likely to experience health inequalities and this is increased by obesity.
What does the community say?
For the results of the Child Health and Wellbeing Survey see Child Health and Wellbeing Survey section.
A survey carried out by the University of Bath (2011) 24 indicates that parents have a significant effect on young people’s physical activity levels.
Barriers identified included:
- Fears of parenting skills being judged, not knowing other parents or workers attending play sessions
- Lack of awareness of services
- Parents tended to react badly to the receipt of information that their child was overweight. This appeared to stem from the perception that having an overweight child was equated with being a bad parent. From this survey a number of recommendations were made
Are we meeting the needs?
The highest rate of GP referrals for Passport to Health by ward corresponds with the wards with the highest percentages of obese and overweight children, including Midsomer Norton Redfield and Radstock. Keynsham North also has significantly high percentages of obese and overweight children25
Sirona Weight management and SHINE service demographics 2013/14 26
Sirona's Weight Management service combines slimming on referral and Lifestyle Advisors. Anyone aged over 16 can be referred to slimming on referral by thier GP or a health or social care professional. Free vouchers are offered to either slimming world or weight watchers for a 12 week programme with the aim of a 5%-10% weight loss. Lifestyle advisors are offered to clients with a BMI of >25 to support them to lose weight and learn how to maintain a healthier weight.
During the financial year 2013/14, there were 1506 referrals to these services, with 304 seen on a 1-1 face to face basis by lifestyle advisors. 641 slimming world and 282 weight watcher vouchers were issued. 78% of clients were aged 45 and over, 70% were female and 33% came from areas identified as being in the most deprived 40% of LSOAs in B&NES.
SHINE (Self Help Independence Nutrition and Exercise) is a weight management programme for young people aged 10-17. SHINE is a detailed programme incorporating nutritional knowledge, physical activity and behaviour change. Courses run in Bath, Keynsham and Norton Radstock.
In 2013/14, 11 SHINE trainers have been appointed and trained at level 2 and 11 health professionals who refer young people onto SHINE were trained to level 1. There were 35 referrals in the first year of the programme. Specific demographic data for this service is based on NHS database records, which record parents age and gender - this should change once the transition to SystmOne has been completed.
Maternal Gestational weight and interventions
Obesity is a growing threat to women of childbearing age. Half the population is either overweight (body mass index (BMI) 25.0-29.9) or obese (BMI ≥30) 27 In Europe and the United States, 20-40% of women gain more than the recommended weight during pregnancy28. Increased maternal weight or excessive weight gain in pregnancy is associated with adverse pregnancy outcomes29. Half the women who die during pregnancy, childbirth, or puerperium in the United Kingdom are either obese or overweight30 For the offspring, maternal obesity is a major risk factor for childhood obesity, which persists into adulthood independent of other factors.
A 2012 meta-analysis of 44 randomised control trials of gestational weight management interventions (covering diet, physical activity and a mixture of both) concluded that dietary interventions resulted in the greatest improvements in maternal weight and obstetric outcomes31
In April 2013, a pilot was conducted of a modified version of the SHINE (Self Help Independence Nutrition and Exercise) for management of obesity in pregnancy in Bath and North East Somerset. 13 women were recruited to the programme and there were indications of some positive outcomes. However, due to the extremely small sample size no statistically significant conclusions can be drawn as to it's effectiveness at this time and further research is required. 32
Impact of changes in mode of travel to work in body weight 33
A 2015 longitudinal study has used a nationally representative data set – the British Household Panel Survey (BHPS)2 – to examine the impact on Body Mass Index (BMI) of switching between private motor transport and active travel or public transport for the journey to work.3 Thus, this study was able to examine the effect both of a switch to active modes from private motor transport or to private motorised transport from active travel modes.
Switching from private motor transport to active travel or public transport is associated with a significant reduction in weight. In contrast, switching from active travel or public transport to private motor transport is associated with a significant weight increase. This change in BMI can be notable even in a relatively short time period of under 2 years.
It was also found that participants who switched to active travel were, on average, from lower income households, less likely to be educated to degree-level or higher and more likely to work part-time than other participants in the study. This could be indicative of the potential for interventions in the transport and planning sectors to support strategies to reduce health inequalities.
- 1. Brophy et al. 2009; Hawkins et al. 2009b; Conelly 2011 http://www.scotland.gov.uk/Publications/2012/05/5385/3
- 2. National Obesity Observatory (2010) Obesity and Health (downloaded 12/03/2012) http://www.noo.org.uk/NOO_about_obesity/obesity_and_health
- 3. Park MH, Falconer CL, Saxena S, et al. (2013) Perceptions of health risk among parents of overweight Kids: a cross-sectional study within a cohort. Prev Med 57(1): 55–59.
- 4. Centre for Diet and Activity Research (IDH0069) para 3.1
- 5. Health and Social Care Information Centre. Health Survey for England, 2012. Leeds, UK; 2013
- 6. Unicef Research (2013) Child well-being in rich countries: A comparative overview, http://www.unicef.org.uk/Images/Campaigns/FINAL_RC11-ENG-LORES-fnl2.pdf (downloaded 31/01/14)
- 7. European Association for the Study of Obesity – public perceptions of Obesity in Europe May 2015
- 8. HSCIC (Health and Social Care Information Centre) (2013) Quality and Outcome Framwork 2012-2013 Practice level, http://www.hscic.gov.uk/catalogue/PUB12262
- 9. HSCIC (Health and Social Care Information Centre) (2013) Quality and Outcome Framework 2012-2013 Practice level, http://www.hscic.gov.uk/catalogue/PUB12262
- 10. HSCIC (Health and Social Care Information Centre) (2013) Quality and Outcome Framwork 2012-2013 Practice level, http://www.hscic.gov.uk/catalogue/PUB12262
- 11. National Obesity Observatory (2014) Local authority adult excess weight prevalence data (http://www.noo.org.uk/gsf.php5?f=312493) Accessed 05/02/14
- 12. National Obesity Observatory (2010) Data briefing – Adult Weight (downloaded 27/02/2012) http://www.noo.org.uk/uploads/doc/vid_5463_NOO%20Adult%20Weight%20Data%20Briefing%2029%20March%202010.pdf
- 13. National obesity observatory, adult obesity, determinants and associated diseases 2006-2008 http://www.sepho.nhs.uk/NOO/e-Atlas/adult/atlas.html
- 14. Health Survey for England (2011) Adult Trend Tables http://www.hscic.gov.uk/catalogue/PUB09302
- 15. YHPHO Diabetes Prevalence Model
- 16. NHS Digital (2016), National Child Measurement Programme - England, 2015-16 school year [NS], http://content.digital.nhs.uk/searchcatalogue?productid=23381&q=national+child+measurement+programme&sort=Relevance&size=10&page=1#top (viewed 21/11/2016)
- 17. Scientific Advisory Committee on Nutrition (SACN) (2012), Statement defining child underweight, overweight and obesity, available from the following link: https://www.gov.uk/government/publications/sacn-statement-defining-child-underweight-overweight-and-obesity
- 18. van Jaarsveld, C. and Gulliford, M. (2015), Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study, Arch Dis Child doi:10.1136/archdischild-2014-307151, dowloaded from the following link on 6 Feb 2015: http://adc.bmj.com/content/early/2015/01/07/archdischild-2014-307151.full?g=w_ep_open_tab
- 19. Public Health England (2017), Child obesity and excess weight: small area level data, available from the following link: https://www.gov.uk/government/statistics/child-obesity-and-excess-weight-small-area-level-data
- 20. Public Health England (2017), Child obesity and excess weight: small area level data, available from the following link: https://www.gov.uk/government/statistics/child-obesity-and-excess-weight-small-area-level-data
- 21. NHS Digital (2016), National Child Measurement Programme - England, 2015-16 school year [NS], http://content.digital.nhs.uk/searchcatalogue?productid=23381&q=national+child+measurement+programme&sort=Relevance&size=10&page=1#top (viewed 21/11/2016)
- 22. Public Health England - Obesity and Disability, Children and Young People report March 2014 http://www.noo.org.uk/securefiles/140423_1154//obesity%20and%20disability%20-%20child%20and%20young%20people%2019%2002%2014.pdf
- 23. Reilly, J., et. al. (2005), Early life risk factors for obesity in childhood: cohort study, BMJ, 2005;330:1357, available from the following link: http://www.bmj.com/content/330/7504/1357
- 24. Gillison, F. & Whale, K. (2011) “Why don’t families who would benefit use services to promote physical activity and a healthy diet in children?” Report on findings, University of Bath, Bath and North East Somerset Council, NHS B&NES PCT
- 25. Bath and North East Somerset Council (2009-11)Sport and Active Lifestyles, Passport to Health in-house analysis
- 26. Sirona Healthy Lifestyle Service 2013-14 demographic report
- 27. NHS Information Centre. Health survey for England 2006: CVD and risk factors adults, obesity and risk factors children. NHS Information Centre, 2008
- 28. Thangaratinam S, Jolly K. Obesity in pregnancy: a review of reviews on the effectiveness of interventions. BJOG2010
- 29. Ramachendran J, Bradford J, McLean J. Maternal obesity and pregnancy complications: a review. Aust N Z J Obstet Gynaecol2008
- 30. Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer. The seventh report of the confidential enquiries into maternal deaths in the United Kingdom. CEMACH, 2007
- 31. S Thangaratinam, Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta analysis of randomised evidence 2012
- 32. Using SHINE as a psychosocial intervention model to promote maternal health in the management of gestational weight in obese women – December 2013
- 33. Impact of changes in mode of travel to work in body weight http://travelwest.info/project/ee-135-impact-of-changes-in-mode-of-trave...