Obesity Obesity can reduce people's overall quality of life. It - - PowerPoint PPT Presentation

Obesity

Obesity can reduce people's overall quality of life. It creates a strain on health services and leads to premature death due to its association with serious chronic conditions such as type 2 diabetes, hypertension, and hyperlipidaemia, which are all major risk factors for cardiovascular disease. The two major lifestyle factors associated with the growth of obesity are physical inactivity and poor diet. BMI is a relatively straightforward and convenient way of assessing someone's weight even if it has some limitation such as:

• It can tell if the individual is carrying too much weight but can't tell the difference between excess fat,

muscle, or bone.

• The adult BMI doesn't take into account age, gender or muscle mass, which means that very muscular

adults and athletes may be classed "overweight" or "obese" even though their body fat is low and adults who lose muscle as they get older may fall into the "healthy weight" range even though they may be carrying excess fat Weight categories for adults are determined through the calculation of a BMI (Body Mass Index)

• 18.5 to 24.9 - a healthy weight
• 25 to 29.9 me - overweight
• 30 to 39.9 - obese
• 40 or above - severely obese

Scotland’s Adult Population

Obesity and Pregnancy

NICE: Weight management before, during and after pregnancy (2010) If a pregnant woman is obese this will have a greater influence on her health and the health of her unborn child than the amount of weight she may gain during pregnancy. That is why it is important, when necessary, to help women lose weight before they become pregnant. Dieting during pregnancy is not recommended as it may harm the health of the unborn child. Many pregnant women ask health professionals for advice on what constitutes appropriate weight gain during pregnancy. However, there are no evidence-based UK guidelines on recommended weight-gain ranges during pregnancy. The amount of weight a woman may gain in pregnancy can vary a great deal. Only some of it is due to increased body fat – the unborn child, placenta, amniotic fluid and increases in maternal blood and fluid volume all contribute. Specific recommendations for pregnant women will not be provided here.

Overweight/obese (BMI 25 plus) Obese (BMI 30 plus) BMI 25 plus and

• nwards

16 to 24 25170 12081 37251 25 to 34 41239 15992 57231 35 to 44 56421 24185 80606 Total 122830 52258 95088

When considering the BMI of women of child bearing age within NHSGGC approximately 28% overweight, 20% obese and severely obese.

Estimated Numbers of NHSGGC Residents by BMI Classification, Age and Females Source SAPE 2010

BMI categories All maternity Hospitals % BMI Not Recorded 314 2.4% Underweight BMI<18.5 403 3% Normal 18.5<=BMI<25 5,832 43.9% Overweight 25<=BMI<30 3,700 27.9% Obese 30<=BMI<30 1,861 14% Severely Obese 35<=BMI<40 787 5.9% Severely Obese 40<=BMI<45 272 2% Severely Obese BMI>=45 109 0.8% Total 13,278 Overweight and all obese categories 6,729 50.7% Obese 1,861 14.0% Obese and severely obese 3,029 22.7% All severely obese categories 1,168 8.8%

Women at First Antenatal Appointments by Body Mass Index (1 April 2016 to 31 March 2017) Source: PNB

Obesity and Children

Calculating a child’s BMI is not enough to establish the weight category for a child, it needs to be plotted against the UK Growth chart

For all the Scottish/GGC data used in this presentation, the UK ‘clinical’ thresholds which correspond to the UK growth charts (RCPCH2 2015) has been used and follows:

Category Definition % above this threshold in a healthy population Overweight Above 91st BMI centile 9% Obese Above 98th centile 2% Severely obese Above 99.6th centile 0.4%

Scotland’s Children Population age 2-15

Prevalence of overweight and obesity among children with BMI recorded at 27-30 months in NHSGGC and Scotland as a whole (annual average for period Oct 2013-Sept 2016)

Source: CHSS-PS EMIS, ISD

HSCP Children with BMI recorded Overweight 91st-97th centile Obese 98-99.5th centile Severely obese ≥99.6th centile Total (all children) n (%) n (%) n (%) n (%) n Glasgow NE 999 (55.3) 173 (17.3) 83 (8.3) 63 (6.3) 1,808 Glasgow NW 969 (59.8) 138 (14.2) 66 (6.8) 41 (4.3) 1,621 Glasgow S 1,196 (52.3) 166 (13.9) 81 (6.8) 57 (4.7) 2,287 Glasgow City Total 3,163 (55.5) 477 (15.1) 230 (7.3) 161 (5.1) 5,716 West Dunbartonshire 348 (38.9) 59 (16.9) 29 (8.2) 22 (6.3) 895 East Dunbartonshire 750 (71.4) 143 (19.0) 53 (7.1) 27 (3.6) 1,051 East Renfrewshire 705 (66.3) 110 (15.6) 40 (5.7) 18 (2.6) 1,063 Inverclyde 507 (71.9) 84 (16.6) 39 (7.8) 21 (4.1) 704 Renfrewshire 1,013 (60.5) 183 (18.0) 80 (7.9) 42 (4.1) 1,674 NHSGGC Total 6487 (58.4) 1,055 (16.3) 472 (7.3) 290 (4.5) 11,103 Scotland Total 36,387 (70.8%) 6,482 (17.8%) 2,870 (7.9%) 1,510 (4.1%) 51,364

It cannot be assumed that preschool children who are overweight and obese will all continue with an unhealthy weight as they grow older. The evidence from studies tracking children’s weight over time suggests that children who are overweight in the early years are more likely to revert to a healthy weight than school aged children (Johansson et al, 2006), while other children who are normal weight as toddlers can progress to obesity later in childhood. However many studies have shown that that children born to one or two obese parents are much more likely to be obese so it is possible in the preschool years to identify families at increased risk. (e.g. Wright et al, 2010; Growing Up in Scotland Report Overweight Obesity and Activity, 2012; and Reilly J, 2005)

More evidence is beginning to emerge and Growing Up in Scotland; Overweight and obesity at age 10 (2018) tracked a sample of 2,800 children in Scotland 2010/11 and found:

• Notable increase in rates of overweight/obesity between ages 6 and 10 and an average increase in

BMI score for all children.

• Inequality in levels of overweight/obesity from different social backgrounds – which already

exist at age 6 – have widened by age 10

• Overweight/obesity at age 6 strongly associated with overweight/obesity at age 10.
• Many children of healthy weight at age 6 moved into overweight/obesity
• Prevention in early childhood alone would not be sufficient in reducing later levels of
• verweight/obesity
• Aspects of children’s family environment and experiences were associated with overweight/obesity

at age 10 and with movement between BMI categories e.g. maternal overweight/obesity and frequency of unhealthy snacks related at both time points

• A home environment which facilitates higher levels of inactivity - play a more important role when

children are slightly older.

• Poor parental recognition of child overweight/obesity may also be problematic. The findings suggest

that many parents are ill-informed or find overweight hard to recognize.

In addition, The New England Journal of Medicine published an article by Mandy Geserick et.al. Acceleration of BMI in Early Childhood and Risk of Sustained Obesity (2018). They studied a sample of 51,505 from birth to adolescence and in some cases to adulthood. They concluded that among obese adolescents, the most rapid weight gain had occurred between 2 and 6 years of age; most children who were obese at that age were obese in adolescence (90%).

HSCP Children with BMI recorded Healthy weight (BMI>0.4th and <91st centile Overweight 91st-97th centile Obese 98-99.5th centile Severely

• bese

≥99.6th centile Total children

• verweight/obe

se/severly

• bese

n (%) n (%) n (%) n (%) n (%) n (%) Glasgow NE 1765 1478 (83.7%) 150 (8.5%) 72 (4.1%) 61 (3.5%) 283 (16.1%) Glasgow NW 1792 1520 (84.8%) 150 (8.4%) 66 (3.7%) 53 (3.0%) 269 (15.1%) Glasgow S 2292 1986 (86.6%) 170 (7.4%) 70 (3.0%) 52 (2.3%) 292 (12.7%) Glasgow City Total 5849 (95.7%) 4983 (85.2%) 470 (8.0%) 206 (3.5%) 167 (2.9%) 843 (14.4%) West Dunbartonshire 958 (92.5) 795 (82.7%) 106 (11.1%) 33 (3.4%) 22 (2.3%) 161 (16.8%) East Dunbartonshire 1031 (93.3%) 925 (89.7%) 62 (6.0%) 27 (2.6%) 13 (1.3%) 102 (9.9%) East Renfrewshire 904 (95.6%) 813 (89.7) 66 (7.3%) 17 (1.9%) 6 (0.7%) 89 (9.8%) Inverclyde 813 (96.5%) 667 (82.0%) 81 (10.0%) 34 (4.2%) 21 (2.6%) 136 (16.8%) Renfrewshire 1764 (93.8%) 1548 (87.8) 155 (8.8%) 58 (3.3%) 38 (2.2%) 250 (14.3%) NHSGGC Total 11313 (94.9% 9690 (85.7) 939 (8.3%) 376 (3.3%) 266 (2.4%) 1582 (14.0%) Scotland Total 93.3% 84.6% 9.0% 3.7% 2.5% 15.2%

Primary School Aged Children and the Prevalence in NHSGGC

Prevalence of BMI centile categories among children at P1 in NHSGGC and Scotland as a whole (annual average for period 2012/13-2014/15) Source: ISD

It is important to remember that most children at this age have a healthy weight.

Percentage children at P1 healthy weight NHSGGC (annual average 2012/13-2014/15)

Source: ISD

Rates of combined overweight, obese and severely obese P1 trend data from 2011/12 – 2016/17

Obesity and Inequalities

An inequalities gap exists for obesity and diet in both children and adults with the most deprived areas consuming a poorer diet and recording higher levels of overweight and obesity compared to the least

• deprived. As the children grow, the disparity becomes even more visible between areas of deprivation in

regards of the BMI categories. Prevalence of overweight and obesity among children with BMI recorded at 27-30 months in NHSGGC by SIMD (annual average for period Oct 2013-Sept 2016) Of those with BMI recorded SIMD quintile Children with BMI recorded Overweight 91st-97th centile Obese 98-99.5th centile Severely obese ≥99.6th centile Total (all children) n (%) n (%) n (%) n (%) n 1 (most deprived) 2348 (51.9) 393 (16.7) 185 (7.8) 140 (5.9) 4522 2 1062 (56.2) 174 (16.3) 80 (7.5) 49 (4.6) 1889 3 849 (60.2) 132 (15.5) 61 (7.1) 30 (3.6) 1411 4 782 (63.1) 130 (16.5) 60 (7.6) 32 (4.1) 1240 5 (least deprived) 1415 (69.3) 226 (15.9) 87 (6.1) 38 (2.7) 2041 Total 6457 (58.2) 1055 (16.3) 472 (7.3) 290 (4.5) 11103

Source: ISD SIMD Quintile Healthy weight (BMI>0.4th and <91st centile Overweight 91st-97th centile Obese 98-99.5th centile Severely obese ≥99.6th centile Overweight/obe se/severely

• bese

Obese and severely

• bese

1 (Most Deprived) 83.0% 9.1% 4.2% 3.3% 16.6% 7.5% 2 84.6% 9.2% 3.2% 2.5% 14.9% 5.7% 3 86.2% 7.9% 3.3% 2.1% 13.4% 5.5% 4 88.4% 7.1% 2.5% 1.6% 11.2% 4.1% 5 (Least Deprived) 90.2% 6.8% 2.0% 0.8% 9.5% 2.8% Total 85.7% 8.3% 3.3% 2.4% 14.0% 5.7%

Percentage of BMI centiles per SIMD category recorded at P1 in NHSGGC (annual average for period 2012-Sept 2015)