Obesity in Scotland: A Public Health Burden

Obesity is the excessive accumulation of fat that is detrimental to one’s health. The World Health Organization defines obesity as body mass index (BMI) which is equal to 30 or greater. Obesity is one of the leading causes of death worldwide. In addition, such diseases as diabetes, some types of cancer and ischemic heart disease are largely attributed to obesity. It is estimated that approximately 10 % of the world’s adult population are obese.

The prevalence rates of obesity have been on the rise in the last twenty years; it has doubled since the 1980s. However, in some countries like the UK, particularly Scotland, the rate has increased three to four times in the same span of time. Obesity is associated with chronic conditions such as coronary heart disease, type II diabetes and some cancers. It also has social (bias and discrimination), psychosocial (anxiety, depression and low self-esteem) and economic (direct healthcare and other associated costs) consequences. This paper analyses the factors contributing to the prevalence of obesity, its consequences and policies aimed at tackling obesity in Scotland (Crawford 2010).

The prevalence rate of obesity varies as a function of employment; that is social economic class and income, with men as well as women in managerial or professional households least prone to obesity. Men in households with a high income stand a much higher risk of obesity than those in the lowest income households.

Another significant factor is gender differences. The data from Scottish Health Survey done in 2003 indicated that more men than women are obese. However, the number of women who are obese is considerably higher. In addition, there is only slight difference in prevalence of obesity by income among women, but large differences by income in the prevalence of morbid obesity among women in the lowest income households than in the highest income households, which is approximately three times).

Age was found to be the strongest factor associated with being obese concerning both men and women. Obesity was the highest among people at the age of 55-64, particularly it was 80 percent before decreasing. When a group of people at the age of 16-24 was used as reference, the chances of men being obese increased, while steadily reaching a maximum of 5.68 times higher than those aged 55-64. Among those who were aged 75 and over, the chances were still high at 2.33 times higher. The pattern was still the same for women, although the relative sizes of the chances were smaller for each group than it was for men, with the highest chances of being obese equal 3.77 for women aged 65-74.

Obesity prevalence rates for boys and girls aged 2-15 indicate that more boys, 34.6 percent in particular, are being overweight and obese than girls whose rate is 30 percent. Furthermore, the number of boys who are obese is higher than the number of girls, which differs from the pattern observed in adults, where more women are obese as compared to men.

Obesity is a main risk factor for non-contagious diseases, such as musculoskeletal disorders (mostly osteoarthritis), cardiovascular diseases (stroke and heart disease), diabetes and some types of cancer (breast, endometrial, colon) (Murray 2006).

Obesity in children may result in a disability or even early death in adulthood. Furthermore, children suffering from obesity are prone to cardiovascular diseases and breathing difficulties; they often develop insulin resistance and hypertension.

Obesity is associated with social consequences, such as discrimination and bias, and psychological consequences such as depression and anxiety, low self-esteem and emotional distress. It also has economical consequences for health care sector as well as the wider economy. Direct (treatment, diagnostic, and preventive services related to obesity and indirect costs (income lost from absenteeism, restricted activity, low productivity) are both involved in the economic consequences (Chambers, Wakley & Staffordshire University 2002).

In formulating the different policies in Scotland aimed at controlling obesity, the following two approaches were considered: targets and interventions.Health targets express a commitment to achieving specified goals in a defined period of time, while enabling to monitor the progress of achieving broader goals and objectives. Currently Scotland does not have obesity targets. The reason is that targets that were previously set have not been met. Population diet and nutrition needs to be improved by decreasing the intake of salt and non-milk sugars and increasing the consumption of fruits and vegetables. Specific mention is made in order to increase the intake of complex carbohydrates and oil rich fish. Adults are recommended to participate in at least 30 minutes of moderate physical activity 5 days a week, while children and young people, those who are aged 5-18, should participate in at least one hour a day of moderate physical activity (Bouchard 2008).

Interventions include population education and communication strategies. A key role for governments that has been identified by WHO in the Global Strategy on Physical Activity, Diet and Health (2004) is that they provide ‘accurate and balanced information’ to the general population regarding diet and nutrition, as well as physical activity. The primary objective of Mass Media Campaigns was changing attitudes, providing knowledge and raising people’s awareness, aiming at potential change in behavior (Ewles 2005). Improving the health literacy skills of individuals as well as improving cooking skills can lead to the consumption of healthier diets. Marketing, advertising, sponsorship and promotion conducted by food and beverage industries should be highly responsible on a mandatory basis, especially in terms of marketing their products to children, and should be an integral part of food policy implemented by government. Food Labeling Governments may require product manufacturers to provide information about a product on its packaging and regulate the quantity of a product sold in a package.

The communities in which individuals live and work exert a strong influence on their health and health-related behaviours. Therefore, programs and interventions in schools, workplaces and other community-based settings are critical in a comprehensive strategy aimed at combating obesity.
The principle objectives of the health school schemes are to provide healthy environments for students which include not only diet and physical activity, but also mental health issues. There have been significant efforts to improve the nutritional quality and standards of school meals (Whitacre 2009). In addition to providing nutritious school meals, there have been efforts to remove junk food in schools, particularly in vending machines. Increasing levels of physical education in schools have been highlighted in policy documents from all devolved regions, and there has also been a focus on imposing minimum hours of physical activity per week in schools. In addition, there is a program designed to measure the height and weights of students in school (Dalton 1997).

Employers can provide support for their employees in terms of maintaining healthy lifestyles in a variety of ways. The Health Sector drug therapy and surgery can make essential contributions towards tackling obesity (Goodrick & Foryet 1995). There is an objective to develop and maintain high-quality environments that are long-lasting for the purposes of providing support for inactive people.

In conclusion, the primary cause of obesity is disproportion between the amount of calories consumed and that of calories used. Taking of energy rich foods which are high in sugars, fat and salts but low in minerals and vitamins has been on the increase; and a decline in physical activity caused by changing modes of transportation, urbanization and increasingly many forms of work of which are sedentary by nature. Societal and environmental changes result in a change in physical activity patterns and dietary changes. Other changes are caused by the lack of supportive policies in various sectors such as agriculture, health, urban planning, transport and environment.

In tackling this obesity menace, some amendments need to be implemented in the existing policies. Therefore, since obesity related targets are crucial in terms of solving this problem, they need to be set. Monitoring and evaluating of the comparisons of obesity prevalence within the given region need to be conducted on a constant basis. Treatment and prevention of obesity should be approached as a life course in all generations. Thus, there should be a UK-wide strategic framework for tackling obesity.