Monday, 12 September 2011

A new first for British obesity

A few papers here in the UK ran with a story about obesity and an interesting, if slightly disturbing finding related to levels in the UK. A summary of the story in the Daily Mail is shown here, with the news that a recent survey from the Department of Health found that 4 English boroughs now have levels of obesity exceeding 30% of the population of that area. Why is 30% an important figure? Well, because that was the nationwide average predicted for 2025-2030 not so long ago (although it might get even worse).

Unfortunately Gateshead here in the good 'ole North East of England comes joint top with Tamworth, followed by Swale and Medway. A link to the NHS Choices website provides some background on what is obesity and how it is measured but the simple definition is a body mass index (BMI) greater than 30. The data by the way, is derived from the Department of Health, Health Profiles data.

There are a couple of interesting points to take from this news. First is the break with the commonly-used North-South divide. For my non-UK readers, there has for many years been an assumption that various health, social and economic differences exists in the UK (mainland UK) based on your geographical position - the 'North-South divide'. So, the more traditionally industrial North classically associated with heavy industry, manufacturing, the Industrial Revolution and working men's clubs is viewed differently to the more affluent, service and finance industries directed South. The difference between regional areas is never more stark than in research like this recent article from Hacking and colleagues published in the BMJ which ran with the headlines about the widest mortality gap for 40 years. The current top 4 obesity figures suggest at least that being a 'Northerner' or a 'Southerner' does not seem to protect/enhance your chances of becoming obese given the demographic data, although does not rule out socio-economic factors as being somehow involved.

Second are the various explanations reported on to account for the figures. I was struck by the use of the term 'obesogenic environments' attributed to Prof. Danny Dorling of Sheffield University (hopefully not misquoted). By that he means, a large density of fast-food outlets and few open spaces for exercise and recreation. If one is to believe this explanation accounting for the survey results, one accepts that obesity is purely a disease of lifestyle, or indeed culture (where other evidence suggests that it might not be that simple). Having visited Gateshead several times during my residency in this part of England, I would perhaps question whether it has a greater obesogenic environment than other parts of England. Fast-food for example is everywhere and as for open spaces, well I wouldn't single out Gateshead as being any more 'built-up' than any other part of the country, having green spaces such as the People's park and for all those hours of shopping on foot because of the ahem, parking issues, Newcastle Upon Tyne only a bridge away. The current Mayor of Gateshead offers another explanation for the Gateshead results and obesity in general: deprivation. He is also quoted (hopefully again not misquoted) as saying "We're bringing healthy food into schools. The children are happy to do without chips but it's the parents who make the decisions about what they eat for tea". His words not mine ('chips' by the way is the English term for a fried potato or french fries); although there's nothing like a sweeping generalisation. Pity the poor fried chip introduced into English culture in the 1860s-1870s as part of our national dish (fish and chips), perhaps a little time before our current obesity problems.

The survey figures are indeed a cause for concern in terms of the potential health implications to those people who are overweight or obese. I however would perhaps question whether the simplistic explanations and soundbites afforded to the data do it justice. In the end, obesity like many things, is very much more complicated than we think.