1. Annalijn Conklin, MSc, MPH
Gates Cambridge Scholar, PhD candidate
Centre for Diet and Activity Research (CEDAR), University of Cambridge
London, 13 May 2013
MEETING THE CHALLENGE OF OBESITY
IN UK’S LOW-INCOME HOUSEHOLDS

2. COMMON PROBLEM RISING FAST – A
CONCERN FOR PREVENTION
• 65% of men and 58% of women in UK were overweight or obese, measured
objectively in 2011
• Higher age-standardised prevalence of obesity (total and central) associated
with lower quintiles of equivalised household income than higher income
quintiles for women and men
• Greater levels of obesity with greater levels of deprivation: 22% of men &
19% of women in least deprived quintile vs. 25% and 30% in most deprived
• Obesity has doubled in UK over 2 decades:
• Adults (≥16): from 13-16% in 1993 to 24-26% in 2011
• Children (2-15): from 11-12% in 1995 to 14% in 2010; peaked at 19% (04/05)
• Serious concern for prevention
• Leading cause of death & disability
• Costs NHS as much as smoking
• Lost labour productivity and costs to cultural capital
Health Survey for England, 2011 (ch.10)

3. MULTIPLE CAUSES – OPPOSING & SYNERGISTIC
Foresight Report (2007)

4. CAUSES DIFFER IN STRENGTH OF IMPACT
Foresight Report (2007)

5. CAUSAL SET DIFFERS ACROSS AFFLUENCE
Foresight Report (2007)
The affluent The less affluent

6. LIMITS TO CURRENT SCIENCE OF OBESITY
• Energy balance (overeating) is an unchallenged hypothesis
• Alternative competing hypothesis: hormonal, regulatory disorder.
Casazza et al. 2013. NEJM 368: 446-54; Taubes 2013. BMJ 346

7. SHIFTING PARADIGMS ACROSS ALL DOMAINS
Physiology • Early-life interventions (breastfeeding, primary appetite control, appropriate child growth)
• Mandatory work-/school-based meditation
Psychology • Reframe safety perceptions and food habit heuristics
Socio-cultural • Improve food literacy
• Rectify aetiological misconceptions (Bust the myths & presumptions of obesity)!
• Penalise parents for unhealthy lifestyles of their children
• Change cultural norms : value of non-processed food & activity; social acceptability of fatness &
activity level; importance of body-size image; depreciation of labour & reliance on automation;
continuous eating event occasions, etc. etc.
Economic • Tax/ Increase price on sugar-sweetened beverages and food high in fat, salt & sugar
• Targeted fiscal measures (balanced): tax big portions or energy-dense food or 2-4-1 offerings but
also subsidise F&V, fibre
• Fiscal levers on all institutions to take some responsibility for employee health
• Reshape oligopolistic global market through tiered pricing of food & activity – GAVI-style
• Penalise food producers engineering products that stimulate affective systems & super-size
Physical • Increase walkability (urban density planning; transportation routes)
• Control food exposure & availability (food outlet density, food production technologies)
Political • Redefine poverty through national commitment to minimum income for healthy living (MIHL)
• Restructure trade agreements & producer subsidies to reduce price of healthy foods
• Embargo highly processed sugary foods
• Global governance of food supply chain & consolidated industry of food product technologies

8. CURRENT ACTION DISJOINTED & MOSTLY
INDIVIDUAL-FOCUSED
• UK / EU regulation (e.g. food labelling, school policies etc)
• National / regional government priorities on diet, PA & obesity
• NHS “make every contact count”
• Local family-based interventions:
• “Mind, exercise, nutrition…do it” (MEND)
• 10 week child obesity programme
• Education of whole family, focus on how to change lifestyles
• Providing information e.g. frequency of behaviour / self-monitoring

9. LEVERAGE POINTS FOR STRUCTURAL
CHANGE
• Education
• budgeting & healthy shopping and cooking skills (home economics)
• make money matter less & cultivate health as the ultimate goal for the
‘good life’ (secular ethics)
• Tendency to graze – limit potential for snacking/ eating on the move
• Stress
• Self-knowledge of ‘right weight’
• Social relationships (Parent-child; citizen-community)
• Purchasing power
• NHS leading by example
• GP training to raise the issue before patient;
• hospital staff & foods need to be healthy