Saturday, 6 January 2018

A report on obesity and physical activity.

Obesity and Physical activity

A report to show how increasing physical activity may give health benefits in relation to lower obesity rates.

Louise Usher

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). (,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 (, 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 (, 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 - 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

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). 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.

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. ( 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:( 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 References

van Baak, M. a (1999) ‘Physical activity and energy balance.’, Public health nutrition, 2(3A), pp. 335–339. doi: DOI: 10.1017/S1368980099000452.

González-Muniesa, P., Mártinez-González, M.-A., Hu, F. B., Després, J.-P., Matsuzawa, Y., Loos, R. J. F., Moreno, L. A., Bray, G. A. and Martinez, J. A. (2017) ‘Obesity’, Nature Reviews Disease Primers, 3, p. 17034. doi: 10.1038/nrdp.2017.34.

Haslam, D. W. and James, W. P. T. (2005) ‘Obesity’, in Lancet, pp. 1197–1209. doi: 10.1016/S0140-6736(05)67483-1.

Kadoglou, N. P. E., Iliadis, F., Angelopoulou, N., Perrea, D., Ampatzidis, G., Liapis, C. D. and Alevizos, M. (2007) ‘The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus.’, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 14(6), pp. 837–43. doi: 10.1097/HJR.0b013e3282efaf50.

Kanneganti, T. D. and Dixit, V. D. (2012) ‘Immunological complications of obesity’, Nature Immunology, pp. 707–712. doi: 10.1038/ni.2343.
Kopelman, P. G. (2000) ‘Obesity as a medical problem’, Nature, 404(6778), pp. 635–643. doi: 10.1038/35007508.

Mary, E. a. (2014) Adult Obesity and Type 2 Diabetes About Public Health England, Public Health England. doi: 2014211.

McPherson, K., Marsh, T. and Brown, M. (2007) Tackling Obesities:Future Choices-Modelling Future Trends in Obesity {&} Their Impact on Health, Foresight.

Available at:,1BM2C,4Q47OG,4H8QX,1.

Miles, L. (2007) ‘Physical activity and health’, Nutrition Bulletin, 32, pp. 314–363. doi: 10.1111/j.1467-3010.2007.00668.x.

Poulain, M., Doucet, M., Major, G. C., Drapeau, V., Sériès, F., Boulet, L.-P., Tremblay, A. and Maltais, F. (2006) ‘The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies.’, CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 174(9), pp. 1293–9. doi: 10.1503/cmaj.051299.

Rennie, K. L. and Jebb, S. a (2005) ‘Prevalence of obesity in Great Britain.’, Obesity reviews : an official journal of the International Association for the Study of Obesity, 6(1), pp. 11–12. doi: 10.1111/j.1467-789X.2005.00164.x.
Rutter, H., Bes-Rastrollo, M., De Henauw, S., Lahti-Koski, M., Lehtinen-Jacks, S., Mullerova, D., Rasmussen, F., Rissanen, A., Visscher, T. L. S. and Lissner, L. (2017) ‘Balancing Upstream and Downstream Measures to Tackle the Obesity Epidemic: A Position Statement from the European Association for the Study of Obesity’, Obesity Facts, 10(1), pp. 61–63. doi: 10.1159/000455960.

Shacter, E. and Weitzman, S. A. (2002) ‘Chronic inflammation and cancer’, Oncology (Williston Park, NY), 16(2), pp. 217–26, 229–2. Available at: papers3://publication/uuid/3F492291-1D16-43CA-9DB3-4EF2578B9A08.
World Health Organization (2014) WHO | Physical activity, WHO.

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