Thursday, 17 January 2013

Lard of my fathers - A Welsh obesity crisis?

Obesity levels in Wales are increasing. Why, and how, has it
become such a "problem"? Do we need to rethink how obesity is approached?
(Pic : BBC)
Continuing the health theme this week - as a nation, we're all getting fatter apparently. There've been several stories over the last few months about obesity in Wales, which will have a knock on effect on health services and general well being in the future if it isn't tackled.

How is obesity defined?

It's worth pointing out that obesity isn't – in the strictest definitions - a "disease", though it's usually treated as such. It's a term for a person with an abnormal amount of body fat.

Obesity is measured by the Body Mass Index (BMI) where height and weight are used to determine how "dense" someone is. So, a short but large person would have a higher BMI than someone who is tall but thin - even if they weighed the same.

If you have a BMI below 18, you're underweight. 18-25 is the average range. Above 25 is overweight and above 30 obese. Those with a BMI above 40 are considered "morbidly obese".

Care should be taken in using Body Mass Index
alone to determine obesity.
(Pic :

It's usually the primary, simplest measure. However, BMI is imperfect as it doesn't take into account muscular build (muscle is denser than fat) or even body shape or weight of bones and organs. Most athletes in the prime of their fitness would count as obese by BMI alone. Try telling the Welsh rugby team that to their faces.

To be absolutely certain, "proper obesity" is probably a combination of high (30+) BMI, a high body fat percentage and a waist measurement of more than 40 inches for men or 35 inches for women (because women's bodies distribute fat around the chest and hips more than the abdomen).

Even then it's still imperfect, especially for women who – to put it mildly – carry significantly more weight around the chest or hips than elsewhere through no fault of their own.

Why is obesity a problem?

In the latest National Health Survey (September 2012), 57% of Welsh adults were said to be overweight, and 22% obese. This is similar to the UK average. Taking that alone, Wales would be pushing towards the top in terms of "fattest countries in the world".

Obesity increases the risk of developing several long-term and chronic illnesses :
  • Heart/cardiovascular disease
  • Respiratory diseases
  • Strokes
  • Osteoarthritis
  • Diabetes
  • Skin conditions
  • Some mental health problems
  • Certain types of cancer

As you might expect, these diseases are expensive to treat and some are amongst the leading causes of premature death. Obesity itself is estimated to cost the Welsh NHS around £73million per year. Though the cost of treating diseases associated with obesity is likely to take up a significant chunk of the NHS budget.

There's also a specific issue with childhood obesity. In the same survey, 35% of children are said to be either overweight or obese. It looks as though obesity rates are levelling off, but an obese child is more likely to develop those conditions at a much younger age, probably reducing life expectancy and quality of life with it.

However, there is evidence that it's possible to be "fat and healthy" - as long as you exercise and abide by a reasonable diet. Where you carry body fat is as important as how much of it there is. That may well come down to genetics.

How has obesity become such a problem?

Firstly, we eat a lot more processed food, high in things like salt, sugar and fats. As the old saying goes – "you are what you eat" - but I don't think it's as simple as that. Everything is fine in moderation. Wales is, traditionally, an agrarian society with a "meat and two veg" diet. I don't think that's changed much, just how we eat and how that food's prepared.

Is it any wonder we're getting fatter if we don't know what's
in the food we cook? Like horse, rat or chimp.

For example, if people wanted to avoid horse meat in their burgers, or want to watch salt and fat intake, wouldn't it be better if they made them from scratch instead of buying processed burgers out of the freezer section? In some (but not all) cases, it might work out cheaper.

One overlooked area is alcohol. A pint of beer contains as many calories as a burger. Also, you're more likely to eat something starchy while/after drinking alcohol. Moderate amounts of alcohol might not do much to increase body weight due to how it's metabolised, but those post-pub snacks will.

We're not really – as a whole – consuming more calories than we did 50-60 years ago. In fact, there's evidence that average calorie intakes have fallen since the mid-1970s. The only difference is we're more sedentary. We've shifted from an industrial economy, where manual labour was commonplace (burning more calories over the course of a day) to an office-based service economy where you're more likely to sit at a desk and perhaps work irregular hours.

So although the amount and quality of food we eat is going to be a factor, it's just as likely to come down to lack of exercise. Humans are evolutionary preconditioned to conserve energy, and the easiest way to do that is not to do anything physically straining at all - and certainly not seek it out if you can help it.

We're also raising a generation of children who are as happy to play the latest FIFA game than play football, and whose parents are scared of their own shadows because of paranoid tabloid newspapers. Then, just when you think the Olympics might boost sport participation and get kids running around outside again unsupervised – April Jones disappears.

What are the Welsh Government doing?

The Welsh Government has an "All Wales Obesity Pathway" as part of its strategic approach to health over the next 20 years. That's above the head of most people, and it's mainly for the Local Health Boards anyway.

The public face of the Welsh Government's obesity drive is the Change4Life campaign - a pan-UK initiative that aims to inform the public about healthier food and drink choices, as well as encouraging people to exercise. It's not as blunt as public information campaigns for tobacco or alcohol, and wants to try and get whole households acting together.

The Welsh Government are under no obligation
to make you exercise, eat healthier or take up the
latest stupid infomercial fad.

Indirectly related to this are previous Welsh Government legislation to protect playing fields, as well as statutory play assessments announced late last year.

You might expect me to harangue the Welsh Government for "not doing enough", but really they're doing everything they can and shouldn't be criticised for something that's beyond their control.

They can do more for the things around obesity – specialist obesity clinics, increase sport opportunities etc. but it's not as if they can go around forcing people to eat healthier or take more exercise.

The problem's complicated in Wales by having an above average number of people with limiting disabilities, who might not exercise because of discomfort or lack of appropriate facilities.

I think Welsh politicians and health professionals can set an example. For instance, it's hard to take advice on heathy eating seriously from doctors and nurses who look like they're on the brink of a heart attack themselves.I don't mean go hold a sports day in front of the Senedd – just give the impression they're taking care of their own physical health and that it isn't "above them" like many professional people might believe.

Rhodri Morgan did after his heart scare back in 2007. Some current AMs noticeably are or have done for some time, so good on them. I don't think it's fair to name names either way, but it's probably obvious who I'm referring to.

So, is Wales facing an obesity crisis?

There's a clear problem, but I'm concerned it's turning into a moral panic. Let's not get too carried away, shall we?

Firstly, we need to think about what message a "clamp down on obesity" is going to send out about physical appearance, especially to girls and women who are already under the cosh. We still have really stupid photoshops in glossy magazines. We still place skin-deep values above personal worth and skills. Sometime that's fine, or part of an act – I don't have a problem with it in those circumstances – but I'd like to think people are worth more than a nice photograph.

Things might improve if, instead of anonymous bums waddling down high streets, we had images of obese people – you know – being completely normal. Some might be considered attractive. Some of them might even – brace yourselves – enjoy exercise or play sport regularly. Just pop along to your local Division 5 SWALEC League game or golf club if you don't believe me.

Health campaigns need to focus on the selfish emotional and physical down sides of being obese rather than the  "freak show" side of it : limited movement, excess sweating/heat, low self esteem and body consciousness, unable to play with your own children (in some cases) and shortened life expectency.

Shift the focus in school PE lessons to doing exercise for its own sake, and because it can be fun, not necessarily for performance. There's a chronic problem in getting girls (and some boys) to play sport in particular, so alternative forms of exercise in schools – like zumba and dancing – shouldn't be written off as "PC nonsense".

Should alternative forms of exercise be as
valid as traditional sports in schools?

Most importantly of all, get the public to set realistic targets. Gastric bands are an extreme "get slim quick" measure. I'm not a fan of the NHS using them unless someone is so obese their life is in danger. You can still eat "bad food" with a gastric band. You can still avoid exercise. Those are the two things health professionals should want the obese to avoid. It is very much a lifestyle switch similar to giving up smoking.

Before I'm accused of hyprocrisy or lack of empathy, unlike many people I can say that I've been there myself. I've endured all the worst things about being obese whilst young. And I'm not talking about being a little bit tubby either, my BMI was over 40.

I didn't lose the weight because of a medical procedure or a fad diet. It was exercising more, eating less and setting realistic targets for myself. I'm not kidding. It took two years to lose the weight, though fortunately I haven't rebounded.

Despite all that, the only reason I believe it worked was because I wanted to do it, I found exercises I actually enjoyed (walking, moaning and weight training) and not because I was told to or was nudged.

Food for thought – excuse the pun – for policy makers and health professionals.


  1. Congrats on the weight loss Owen, you mentioned it before. It's something alot of people have fallen into because of how society is shaped these days. I believe people should take personal responsibility for themselves, but I don't believe that in a cold or Conservative way. I think seeing as we all pay taxes to the Government (kind of), Government policy should be designed to assist people to improve their health and weight.

    To be fair, parts of the private sector are also doing their bit, with so many workplaces providing gyms now. But at the moment the whole free market in food is a big problem, as is reliance on the car.

  2. Thanks, Anon.

    There are certainly things government can do, but as you said it can only "assist" really and there are limits. Take free swimming in Wales for instance - it would only improve health and wellbeing if people actually take it up. I think governments are (perhaps rightly) scared of throwing money on flagship projects that won't work, however well intended. I fear that's going to happen in the proposed Active Travel Bill.

    Big public and private sector employers should consider investing in their employee's health (gyms, subsidising/sponsoring sports activities, cycling facilities) as a productivity booster as much as a public service. It could hopefully boost mental health too in some cases. Healthy workers are happy workers.

    As you said it comes down to personal responsibility. But if more healthy activities were on offer or organised I think more people would take them up.

    I wish I could say I pay closer attention to precisely what I'm eating myself, but I guess the vast, vast bulk of us are hypocrites in that respect. There are some good schemes at a local level, like food co-ops, but convenience has trumped thoughfulness. I wish I had more and better cooking/home economics classes in school personally.

  3. I have to ask, what is that thing the blonde woman is shaking?

    I broadly agree with you, but there are things that the Government could do (albeit only after a meaningful transfer of pwers from Westminster). They could regulate the amount of fat in processed foods, they could subsidise to cost of fresh foods relative to those of processed foods, they could even subsidise gym memberships (as they currently do for people on benefits).

    But of course that won't help the people who won't help themselves. You're right that people need to start taking more responsibility for themselves and their lives.

  4. Anon 15:42 - I think it's called a "Shake weight"/"Shaker weight". I believe it's supposed to tone arms, but I'm not sure if it actually works or not.

    Regulating things like fat, sugar and salt in food is absolutely essential and I'm surprised it hasn't already happened. I guess we'll both know the reasons why. The amount of salt in some foods is quite concerning in particular and a hidden danger. Food manufacturers could just turn around and say it's an essential ingredient in some foods or whatever. Then again, we need to remember that fruits have quite high levels of sugar too.

    Fresh foods - especially vegetables and fruits - could be made cheaper by simply being produced closer to markets or on community-owned allotments and farms. I think that's one idea in the "Greenprint", but obviously it would need to be scaled up a little bit.

    I'm not against subsidised gym membership, or people being "prescribed" gym activities by GPs. The only problem is, as you said, people actually taking it up.