Obesity
and Physical activity
A
report to show how increasing physical activity may give health benefits in
relation to lower obesity rates.
Louise Usher
Contents
1.0 Introduction……………………………………………..2
1.1 Obesity…………………………………………..2
1.2 Physical Activity and obesity…………..2
1.3 Chronic disease………………………………2
1.4 Prevalence of obesity……………………...3
2.0 Method…………………………………………………….4
2.1 Search strategy………………………………4
3.0 Results……………………………………………………..5
3.1 Physical Activity and obesity…………..5
4.0 Physical activity guidelines………………………7
4.1 Government initiatives………………….7
4.2 Local initiatives……………………………..8
4.3 Results of interventions…………………9
5.0 Summary…………………………………………………11
6.0 References………………………………………………12
1.0 Introduction
1.1 Obesity
Obesity is defined by body mass index. This
does not highlight the prevalence of morbidity and mortality associated with
those who are overweight nor carry excess abdominal fat. (Kopelman, 2000).
63% of adults in 2015 were classed as being
overweight (a BMI of over 25) or obese (a BMI of over 30). (https://www.gov.uk/government/publications/adult-obesity-applying-all-our-health/adult-obesity-applying-all-our-health,2017)
According to Public health England (PHE),
obesity related ill health cost the NHS £6.1 billion in 2014-2015. (Mary, 2014)
A myriad of reasons driving obesity rates
higher, the majority of people know that eating a healthy diet and being
physically active will help prevent weight gain but the act of beginning these
steps is not always easy. (Haslam and James, 2005)
1.2 Physical
Activity and obesity
The obesity epidemic is impacted by genetics as well as energy imbalance
through high energy foods and as lives are currently more sedentary, the
physical activity has decreased, (Kopelman, 2000). Hence, less energy used through physical
activity. Individuals increasing physical activity may see an energy deficit (van Baak, 1999) and begin to facilitate weight loss.
While the UK government has used various approaches for the
treatment of a healthier lifestyle (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541233/Physical_activity_infographic.PDF),
the obesity epidemic continues to rise (Rutter et al., 2017). Chronic disease caused by an association of
inflammation (diabetes type 2, cardiovascular disease, cancer) (Shacter and Weitzman, 2002) give threat to health such that improved understanding of
immunological processes to regulate obesity may assist with lowering
obesity-associated disorders. (Kanneganti and Dixit, 2012)
1.3 Chronic
disease.
An ageing population is an
unpreventable cause of chronic disease (Ons.gov.uk, 2015).
The ageing population is predicted to continue to grow as the figure
1 demonstrates below,
Fig 1 – Ageing
population in developed countries.
As the cornerstones of obesity treatment, (diet, exercise and
physical activity) the government aims to promote theses methods as a forefront
to medical and bariatric treatment, (González-Muniesa et al., 2017).
1.4 Prevalence
of obesity
In 2002, 23% of men and 25% of women were
reported to be obese, (Rennie and Jebb, 2005). Some evidence shows that higher rates of obesity are reported in
those of a lower socio-economic status. Figure
2 shows a predicted figure for the future which is much debated. However, as previously discussed physical activity is
beneficial to health, (Miles, 2007).
Fig 2 - http://www.bbc.co.uk/news/magazine-15108966
predicted trend for obesity.
Obesity demonstrates a risk factor for
chronic ‘lifestyle’ diseases. Weight
loss is associated with improvement of symptoms, (Poulain et al., 2006). Etiology
of a multifactorial nature includes genetics, metabolism, lifestyle and
environment. The health risks of obesity
carried around the abdomen area show strong association with comorbidities such
as type 2 diabetes, dyslipidemia, coronary heart disease and hypertension,
(Poulain et al, 2006).
2.0 Method
2.1 Search
strategy
Peer reviewed paper of systematic review
were found by searching Google Scholar, NHS Uk, The Lancet, Pubmed, DoH, PHE,
Nutrition journal.com.
Many government websites were targeted to
find past statistical evidence in relation to actions taken for a positive
direction into better health using physical exercise. During these searches, the NHS website of a
critical review was enlightening reading.
The Daily mail article questioning the 1980s fat guidelines on saturated
fat published in 1983 in the UK. When
the researchers used available evidence at the time the results of randomized
control trials supported the recommendations made. Observational studies would have been a
positive way to confirm or deny any findings.
The NHS website points out the reporting gives a potentially dangerous
report. The NHS website still states
that a diet high in saturated fat could lead to obesity while also advising
that current guidelines are that a small amount of saturated fat should be
incorporated as part of a balanced Mediterranean style diet, (www.NHS.UK, 2015).
Gov.uk hosts a blog named Public Health
Matters. In March 2017, Kevin Fenton
wrote an interesting article in relation to obesity and the food environment.
He quotes PHE estimated in 2014 that there are over 50,000 fast food and
takeaway outlets in England and how this may impact health.
The Foresight paper gave great information
on tackling obesities and predicting by 2050, 50% of women, 60% of men and 25%
of children would be obese. Within this
paper the author highlights the issues once again with chronic disease. Particularly type 2 diabetes, stoke and
coronary heart disease as well as cancer and arthritis.
Likening tackling obesity with tackling
climate change, the Foresight paper feels a whole society change is needed with
commitment. (McPherson, Marsh and Brown, 2007).
3.0 Results
3.1 Physical
activity and obesity
A sedentary lifestyle, physical
inactivity and over consuming energy balance are a fact of human behavior
currently. The World Health Organisation
(WHO) identifies inactivity as the fourth leading risk factor for global
mortality. Globally, causing 3.2 million
deaths, (World Health Organization, 2014). While previously demonstrated
the issues with obesity can be multi factorial, regular moderate intensity
activity has significant benefits for health (World Health Organization, 2014). The WHO also boldly state physical activity can reduce the risk of
cardiovascular diseases, diabetes, colon and breast cancer and depression.
As well as helping to control weight.
The BMJ reported a research based finding
in figure 3.
REF: BMJ 2009;338:b688
Figure 3 – BMJ cohort study on the results of physical
activity and mortality.
A population based cohort study was
carried out on 2205 men aged 50 in the years 1970-1973. At ages 60, 70, 77 and 82 years old they were
reexamined to see total mortality. The
objective of this study was to examine how a change in physical activity
influences mortality in comparison with smoking cessation.
They concluded increased physical
activity in middle age is followed by a reduction in mortality to the same
level as seen in men with high physical activity of a more constant level. Results show a comparable result with smoking
cessation.
(Kadoglou et al., 2007)
carried out an interventional study to the anti-inflammatory effects of
exercise training in patients with type 2 diabetes mellitus (DM).
Stating that chronic inflammation along
with DM is strongly associated with increased cardiovascular health
compromises, Kadoglou et al hoped the
study would evaluate aerobic training may have an effect on inflammatory
markers on patients with DM.
Encouraging results were found as the
exercise treated patients showed improved glucose control, lipid profile and
Vo2 peak as well as decreased insulin resistance and systolic blood pressure.
The 60 subjects did not undertake
significant weight loss yet purely with physical activity saw improvements in
metabolic profile.
4.0 Physical
Activity guidelines
4.1 Government
initiatives
Previously detailed here, the government
website hold many claims to the benefits of activity within this info graphic
below set as figure 4,5 and 6.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/541233/Physical_activity_infographic.PDF
Figure 4 – The
government state a health benefit of multi factorial nature by aiming for more
physical activity. Better sleep, healthy
weight, stress management and all together improvement in quality of life is
documented. Claiming type 2 diabetes may
be lowered by 40%, cardiovascular disease lowered by 35% and falls, dementia
and depression by 30%. Back pain may be alleviated
as well as pain in joints by 25% and the risk of colon and breast cancer may be
reduced by 20%.
Figure 5 – To
achieve the aims stated above, the guidelines suggest 4 main ways in which to
change for the health benefits to be achieved.
Being more active helps heart and mind and ways to be more active
suggest running, walking, playing sport, cycling. Sitting down is heavily documented at the
present time. Less TV and sofa sitting
is suggested. Coupled with building
strength by going to the gym, doing weight bearing exercise such as yoga will
help keep muscles bones and joints strong.
Reducing a chance of falls can be achieved by improving balance.
Undertaking dancing or tai chi are great suggestions for this.
Figure 6 - While the government initiative suggests
starting somewhere is better than not starting at all, 2 days per week is
recommended for the strength training and movement. While sitting down for long periods, it is
suggested taking breaks to move around. 75 minutes of high impact exercise of
vigorous intensity is recommended where the participant gets out of
breath. Less vigorous is considered
moderate intensity and this should be at least 150 minutes per week.
4.2 Local
initiatives
2014 saw Medway council “supporting healthy
weight” team (SHW) host an Obesity Summit.
This was well attended by voluntary, private and public sector
partners. Aiming to develop a framework
for obesity, the SHW team was working
with children and adults to help achieve a healthy weight.
The national child measurement programme
saw 23.3% of 4-5 year olds and 32.7% of 10-11 year olds in Medway either overweight
or obese.
The aim was to support obesity prevention
in the Medway local plan.
A meeting was held in February 2013 by Nick
Bundle the Speciality registrar for Public Health NHS Medway. Entitled “The scope for tackling obesity in
Medway through the built environment”.
Recognising that adult obesity levels in Medway
are estimated to be 30 percent (worse than the national average), the meeting discussed the more recent
research showing the matter of obesity not being simple matter of poor decisions of food and lack of
physical activity. Available food and affordability are issues that face Medway
residents. This public health matter saw
the local professionals deciding to work closely with teams in the council to
reshape the local environment.
National planning policies now highlight
the promotion of healthy communities.
Medway has a joint health and wellbeing
strategy to run from 2012 to 2017. This
tackles obesity as a priority and works with councils to plan to achieve this.
Links to transport and green spaces are
promoted for physical activity. Even though the health outcomes do not
currently reflect this. This new policy
also restricted the opening of hot food takeaways. Allotments were funded more than previously with
revenue channeled from planning contributions.
However, these plans can only be influenced when there is an application
for change of use or new build. They
cannot be revoked as a public health matter.
During this meeting, public health realized
a lack of evidence cannot be a reason for inaction. Yet shaping the environment into less
obesogenic is a step in the right direction.
The Department of Health and NICE
guidelines began to recognize the importance of shaping the community to enable
easier ways to focus on a less obesogenic environment.
4.3 Results
of intervention
Public health England published a report on
July 4th 2017 detailing the
health profile of the Medway towns. There
is a definite concern within Medway. (http://fingertipsreports.phe.org.uk/health-profiles/2017/e06000035.pdf)
With a lower life expectancy than the national average (8.2 years lower for men
and 5.8 years lower for women) and a statistic that 21% of children live in low
income families, the figures are suggestive that more needs to be done. In year 6 within the local area, 20.9% of
children in 2017 were measured within the obese range.
Figure 7 from
Public health England Ref:(http://fingertipsreports.phe.org.uk/health-profiles/2017/e06000035.pdf)
Showing the estimation of Medway age profiles between 2015 and the estimate in
2018.
The aging population within Medway shows
signs that death will be higher than the national expected average for those
ages 75 and over.
5.0 Summary
While
much evidence is proven within this report that initiatives are taking place
both nationally and locally, the long term outlook shows more may need to be
done.
The
local Medway area is showing that research has proven some issues may be those
from lower socioeconomic classes either having issues with affordability or
education. There is far more to this
issue as we can see from the evidence within this report. However, even
globally with changes being made to the bigger picture, we are showing more and
more need for a different approach.
Without
doubt, physical activity will benefit
obese patients, therefore lowering the prevalence of chronic disease. Diseases such as type 2 diabetes mellitus,
coronary heart disease, cardio vascular health, mental health, dementia and
cancer can all become less prevalent with healthy lifestyle changes such as
diet and physical activity. This is clear.
However, even with steps in place
for obese and overweight patients to undertake more physical activity, this may
not be being carried out.
A
wider approach of a more conclusive change is needed which within the evidence
of this report is being likened to the changes made to approach the issues
raised within climate change.
The
aging population outlined in the figures above show not only increases in age
throughout the future years yet also the risks of chronic disease
increasing. To tackle the obesity epidemic
strongly would help this population to age well and healthy. While there is no doubt diet plays a huge part
in obesity, the evidence presented here has proven clearly that while diet can
help lower and prevent obesity, an
increase in physical activity even without weight loss will lower the
prevalence and incidence of chronic disease and improve the health and
lifestyle of those affected. Living well
will benefit those previously at risk of chronic disease and this can be
achieved with an increase in physical activity.
Local
and national initiatives need a more vigorous approach to change the course of
the evidence and predictions shown within this report.
6.0
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Email to book: lusherlifenutrition@gmail.com
Word count (excluding ref – 2277)