Citerank: (28) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348693Stakeholders – Groups & ActionsExplore the map via the different stakeholder groups and the measures each group can take to help tackle the obesity crisis.58D3ABAB, 348767A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 348775Modelling suggests the majority of UK population may be obese by 2050The prevalence of obesity in the UK more than doubled in the 25 years to 2007. In England, nearly a quarter of adults and about 10% of children were obese in 2007, with a further 20–25% of children overweight. The Foresight report extrapolated that 40% of Britons might be being obese by 2025, with Britain being a mainly obese society by 2050.1198CE71, 348776A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 348779Involve all stakeholders in the process of changeReversing the rising trend and addressing the prospect of the rising health burden and societal costs will be demanding and will necessitate major changes in behaviour – not only in individuals, but also in families, communities, organisations and economic markets.565CA4D9, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 351674Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179, 352390Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 352390Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 365986Foresight – Obesity System MapObesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period, resulting in the accumulation of excess body fat. However there are many complex behavioural and societal factors that combine to contribute to the causes of obesity.7F1CEB7, 366467Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 366990What costs should be included in the financial analysis?What cost factors should be included in the assessment of the overall financial impact of obesity on the UK economy?8FFB597, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399557Involve all stakeholders in the process of changeReversing the rising trend and addressing the prospect of the rising health burden and societal costs will be demanding and will necessitate major changes in behaviour – not only in individuals, but also in families, communities, organisations and economic markets.565CA4D9, 399599Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399889Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 399889Industrial way of life is obesogenicRapid societal changes—for example, in food production, motorised transport and work/home lifestyle patterns—have placed human physiology (which has evolved to cope with an under-supply of food and high energy expenditure) under new stresses, and revealed an underlying genetic tendency to accumulate and conserve energy (i.e. gain weight) in a high proportion of the population. In this sense, obesity can be construed as a normal physiological response to an abnormal environment.555CD992, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 399973A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 399974A profound impact on the health of the populationObesity is responsible for more than 9,000 premature deaths each year in England, reduces life expectancy on average by nine years, and is a major risk factor in wide range of serious health problems including Type 2 diabetes (5 x), cancer (3 x the risk of colon cancer), and heart disease (2.5 x).57DE7179, 399978Modelling suggests the majority of UK population may be obese by 2050The prevalence of obesity in the UK more than doubled in the 25 years to 2007. In England, nearly a quarter of adults and about 10% of children were obese in 2007, with a further 20–25% of children overweight. The Foresight report extrapolated that 40% of Britons might be being obese by 2025, with Britain being a mainly obese society by 2050.1198CE71, 399980What costs should be included in the financial analysis?What cost factors should be included in the assessment of the overall financial impact of obesity on the UK economy?8FFB597, 399984Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179

The rapid increase in the number of obese people in the UK is a major challenge. This analysis by the government’s Foresight programme shows that over half of the UK adult population could be obese by 2050.1 The economic implications are substantial. The NHS costs attributable to overweight and obesity are projected to double to £10 billion per year by 2050. The wider costs to society and business are estimated to reach £49.9 billion per year (at today’s prices).

Citerank: (21) 348693Stakeholders – Groups & ActionsExplore the map via the different stakeholder groups and the measures each group can take to help tackle the obesity crisis.58D3ABAB, 348702Individuals and FamiliesThe actions and choices of individuals and families are fundamental to the challenge of tackling obesity. 84E4A378, 348703Actions – Industry2794CAE1, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 352281Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 352314Actions – Central Government2794CAE1, 352387Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992, 352388Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 352389Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 352391Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 352399Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 352400Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399558Changes required across many different policy areasObesity has to be seen as not just a technical, food, physical activity or healthcare problem but a challenge for what sort of society is being built. Small, incremental, publicity-driven (i.e. social market-based) changes might suit the existing balance of policy interests, but a more extensive, co-ordinated, cross-sectoral action would be more effective.1198CE71, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399890Successive governments have made counterproductive policy choicesThe growing prevalence of obesity in the UK is partly the result of well-intentioned but counterproductive policy choices made by successive governments over several decades.555CD992, 399891Many individuals are consuming more energy than they are expendingPublic Health England estimates that the average man in England is consuming around 300 calories a day more than they would need were they a healthy body weight.555CD992, 399896Industrial development changes what and how people eatEconomic and industrial development has tended to be accompanied by a historic shift in patterns of food consumption from diets high in cereal and fibre to diets high in sugars, fat, animal-source food and highly-processed foods – creating a socio-cultural environment in which obesity is more likely to emerge in the population.555CD992, 399907Reluctance to talk about and address implications of own weightThe weight of the population continues to rise despite media imagery of thin models encouraging a slim ideal that is far out of reach for most of the public. In this context, “Fat” remains an emotive and stigmatic subject – and often perceived as an insult – which makes it harder for people to acknowledge, confront and address their own obesity (and harder for others including health professionals to encourage them to do so too).555CD992, 399917Advertising and marketing reinforce new eating patterns Marketing and advertising instil and reinforce new cultural norms about what (e.g. fast food) and how to eat (e.g. snacking), and how much (e.g. larger portions) to eat.555CD992, 399923Previous physical activities replaced by industrially generated energyIndustrial development allows many different aspects of life that previously involved daily physical activity to be accomplished through industrially generated energy instead; for example, the substitution of motorised transport for walking and cycling, a shift from manual and agricultural work towards office work, and a multitude of labour saving devices at work and in the home.555CD992

There are many competing diagnoses of what ‘really’ matters in obesity generation. Different analyses and policy solutions have been developed and proffered, each clamouring for support, funding and adoption. The increasing sophistication of different positions actually adds to the complexity of the policy challenge. For policymakers, now worried about the cost of obesity (and the spectrum of ailments linked to it, such as diabetes), there is a situation we describe as policy cacophony – noise drowning out symphony of effort. This cacophony is not helpful because policymakers need coherent directions on which they feel they can deliver. Obesity policy is already weighed down by complexity, accentuated by the multi-level (global, European, national, regional and local) nature of modern systems of governance. It is also shrouded by ideological fears such as interventions being interpreted as ‘nanny-ish’ or restricting ‘personal’ choices in food and lifestyle.

Compounding this policy cacophony are two other difficulties which this review sets out to address. The first is time frame. Obesity is a problem that has taken decades to develop. Bar sudden external shocks to society, such as a massive oil shortage or price rises that make walking a necessity, it is likely to take many years to bring it under control. Yet, the political timetable demands quick results. Second, there is a difficulty about evidence. No country has managed to reverse obesity trends, or at least not so far. To some extent, part of the obesity policy problem is the evidence, or lack of it. Yet, the rise of obesity is literally visible and the explanation and ways forward are hard to pinpoint. This does not mean we favour disregarding evidence, but rather that we see obesity as a test case for policy changes in advance of perfect evidence. Faint hearts privately muse that obesity is too complex. But we see obesity as akin to that of climate change – complex, yes – and demanding firm action, however hard that might be.

This briefing explains how responsibility for measures to tackle obesity is changing and it reviews what the Department of Health has done, and is now doing, to address the main areas of concern highlighted by the Committee of Public Accounts.

Citerank: (60) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348767A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 352311Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 352311Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 352373Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 352710Develop better pharmaceutical obesity therapiesObesity drug sales are forecast to $3.8bn globally in 2018 [2]—in comparison to $57bn for Diabetes drug sales[2]—with evidence suggesting that the modest average weight losses achieved with current anti-obesity agents may be of some clinical benefit [5]. However, the current generation of drugs, which act on the central nervous system to suppress appetite, have raised significant health concerns—including psychiatric disorders, such as suicidal behaviour, depression, and cardiovascular problems.565CA4D9, 352718Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 366161McKinsey Global InstituteThe MGI discussion paper, Overcoming obesity: An initial economic analysis studied studied 74 interventions (in 18 areas) that are being discussed or piloted somewhere around the world to address obesity, including subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising high-calorie food and drinks, and public-health campaigns – with sufficient data found on 44 of the interventions in 16 areas. 58D3ABAB, 366169Obesity Interventions identified by MGI74 interventions – across 18 groups – to reduce obesity.565CA4D9, 366449Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 366450Understand how to align incentives and build cooperation109FDEF6, 366452No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 366453Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 366454Education and personal responsibility are necessary but not sufficientEducation and encouraging personal responsibility are necessary but not sufficient.1198CE71, 366456Co-ordinated multi-party actions are required to tackle obesityCapturing the full potential impact is likely to require commitment from government, employers, educators, retailers, restaurants, and food and beverage manufacturers, and a combination of top-down corporate and government interventions and bottom-up community-based ones. 1198CE71, 366457Government obesity efforts are too fragmented to be effectiveGovernment efforts to tackle the obesity issue seem too fragmented to be effective. In the United Kingdom, 15 central government departments; all local authorities with responsibility for health, education, and local planning; 16 EU directorates-general; and a wide range of nongovernmental organizations all have a significant impact on the major intervention areas. [1]118FF4888, 366458Current incentives are mis-aligned118FF4888, 366460Desire to prioritise options becomes a barrier to actionA search for the “best” interventions or a single solution could delay action and displace responsibility. Given the seriousness of the obesity issue, the aim should be to do as much as possible as soon as possible. [1]118FF4888, 366462Experiment with multiple interventionsSociety should be prepared to experiment with possible interventions. In many intervention areas, impact data from high-quality, randomized control trials are not possible to gather. So, rather than waiting for such data, the relevant sectors of society should be pragmatic with a bias toward action, especially where the risks of intervening are low, using trial and error to flesh out their understanding of potential solutions. 565CA4D9, 366463Paucity of investment in intervention measuresThe UK invests less than $1 billion a year in prevention activities such as weight-management programs and public health campaigns – i.e. around 1% of the social cost of obesity in the UK. More investment is required.555CD992, 366467Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 366479Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 366479Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 366481Improve surgical interventions for obesity565CA4D9, 366483Types of weight-management services565CA4D9, 366555Employers offer team challenge incentive schemes in the workplaceEmployers provide team challenge activities to encourage physical activity and improved key health indicators in the workplace.565CA4D9, 366557Employers give employees financial incentives to improve healthEmployers provide material incentives to individuals for improved key health indicators (e.g., discounts on insurance premiums, gym membership, prizes).565CA4D9, 366827Develop a coherent fiscal, regulatory and governance frameworkTake every opportunity, iteratively over time, to bring the public fiscal, regulatory and governance framework into alignment with public health goals on obesity. Use taxes, subsidies, targets and pricing signals to incentivise change in behaviour, supply and consumption by aligning measures with the health properties of food and drink and behaviour—and seek, wherever practical, to amplify positive patterns that are aligned with the policy goals and damp those that pull against.565CA4D9, 371556Many obesity policy measures appear to be cost-effective for societyThe recent MGI study [1] reported that almost all of the obesity policy interventions included in its economic analysis appeared to be highly cost-effective at the societal level—i.e. the health-care costs and productivity savings that accrue from reducing obesity through a specific intervention outweighed the direct investment required to deliver that intervention when assessed over the full lifetime of the target population.1198CE71, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399548Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 399552Develop a coherent fiscal, regulatory and governance frameworkTake every opportunity, iteratively over time, to bring the public fiscal, regulatory and governance framework into alignment with public health goals on obesity. Use taxes, subsidies, targets and pricing signals to incentivise change in behaviour, supply and consumption by aligning measures with the health properties of food and drink and behaviour—and seek, wherever practical, to amplify positive patterns that are aligned with the policy goals and damp those that pull against.565CA4D9, 399555Many obesity policy measures appear to be cost-effective for societyThe recent MGI study [1] reported that almost all of the obesity policy interventions included in its economic analysis appeared to be highly cost-effective at the societal level—i.e. the health-care costs and productivity savings that accrue from reducing obesity through a specific intervention outweighed the direct investment required to deliver that intervention when assessed over the full lifetime of the target population.1198CE71, 399561Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 399567Employers offer team challenge incentive schemes in the workplaceEmployers provide team challenge activities to encourage physical activity and improved key health indicators in the workplace.565CA4D9, 399568Employers give employees financial incentives to improve healthEmployers provide material incentives to individuals for improved key health indicators (e.g., discounts on insurance premiums, gym membership, prizes).565CA4D9, 399575Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 399575Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 399586Develop better pharmaceutical obesity therapiesObesity drug sales are forecast to $3.8bn globally in 2018 [2]—in comparison to $57bn for Diabetes drug sales[2]—with evidence suggesting that the modest average weight losses achieved with current anti-obesity agents may be of some clinical benefit [5]. However, the current generation of drugs, which act on the central nervous system to suppress appetite, have raised significant health concerns—including psychiatric disorders, such as suicidal behaviour, depression, and cardiovascular problems.565CA4D9, 399588Improve surgical interventions for obesity565CA4D9, 399592Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 399599Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 399611Understand how to align incentives and build cooperation109FDEF6, 399612Co-ordinated multi-party actions are required to tackle obesityCapturing the full potential impact is likely to require commitment from government, employers, educators, retailers, restaurants, and food and beverage manufacturers, and a combination of top-down corporate and government interventions and bottom-up community-based ones. 1198CE71, 399613No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 399614Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 399615Education and personal responsibility are necessary but not sufficientEducation and encouraging personal responsibility are necessary but not sufficient.1198CE71, 399617Experiment with multiple interventionsSociety should be prepared to experiment with possible interventions. In many intervention areas, impact data from high-quality, randomized control trials are not possible to gather. So, rather than waiting for such data, the relevant sectors of society should be pragmatic with a bias toward action, especially where the risks of intervening are low, using trial and error to flesh out their understanding of potential solutions. 565CA4D9, 399715Types of weight-management services565CA4D9, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399932Paucity of investment in intervention measuresThe UK invests less than $1 billion a year in prevention activities such as weight-management programs and public health campaigns – i.e. around 1% of the social cost of obesity in the UK. More investment is required.555CD992, 399973A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 400018Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 400018Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 400061Current incentives are mis-aligned118FF4888, 400083Government obesity efforts are too fragmented to be effectiveGovernment efforts to tackle the obesity issue seem too fragmented to be effective. In the United Kingdom, 15 central government departments; all local authorities with responsibility for health, education, and local planning; 16 EU directorates-general; and a wide range of nongovernmental organizations all have a significant impact on the major intervention areas.118FF4888, 400084Desire to priortise options becomes a barrier to actionA search for the “best” interventions or a single solution could delay action and displace responsibility. Given the seriousness of the obesity issue, the aim should be to do as much as possible as soon as possible.118FF4888

A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden. Almost all the identified interventions are cost-effective for society—savings on health-care costs and higher productivity could outweigh the direct investment required to deliver the intervention when assessed over the full lifetime of target population. In the United Kingdom, such a program could reverse rising obesity, saving about $1.2 billion a year for the National Health Service (NHS).

Citerank: (11) 348688Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 24.9% of adults in England are obese—with a body mass index of over 30—62% of adults are either overweight or obese (with a BMI of over 25), and 32% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK is estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 348767A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 351674Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179, 351678Key questions for a whole systems approachA set of key questions for a whole systems approach identified by the National Institute for Health and Care Excellence.8FFB597, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399746Key questions for a whole systems approachA set of key questions for a whole systems approach identified by the National Institute for Health and Care Excellence.8FFB597, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399972Impacts of obesityObesity presents a significant threat to the health of the UK population and a significant drain on the nation's financial resources. 23% of adults are obese—with a body mass index of over 30—61% of adults are either overweight or obese (with a BMI of over 25), and 33% of 10–11-year-olds are overweight or obese. The annual cost of obesity to the UK economy has been estimated to be £27bn–£46bn [1], [2]; although international comparisons suggest that the true cost could be significantly higher.57DE7179, 399973A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 399984Inequality of impactAlthough obesity occurs across all population groups, it impacts disproportionately on the socially and economically disadvantaged and some ethnic minorities. [8]57DE7179

Established in 2014 by the Institute of Medicine (IOM), the Roundtable on Obesity Solutions engages leadership from multiple sectors to solve the obesity crisis. More than one third of adults and 17 percent of children and adolescents are obese. Cautious estimates suggest that obesity now accounts for almost 10 percent of the national health care budget. Until the epidemic is reversed, obesity will continue to drive rates of chronic diseases and their associated medical costs. Through meetings, public workshops, background papers, and innovation collaboratives, the Roundtable fosters an ongoing dialogue on critical and emerging issues in obesity prevention, treatment, and weight maintenance. The Roundtable provides a trusted venue for enhancing and accelerating discussion, development, and implementation of multi-sector collaborations, and policy, environmental, and behavioral initiatives that will increase physical activity; reduce sedentary behavior; and improve the healthfulness of foods and beverages consumed to reduce the prevalence and adverse consequences of obesity and eliminate obesity-related health disparities.

Citerank: (10) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 372559Improve collaboration across organisational boundariesEffective collaboration across organisational boundaries is vital to achieving and sustaining constructive progress in the face of complex, systemic problems—and to leveraging the energy, insight and resources distributed across the network of organisations to maximum effect.565CA4D9, 374621Obesity harms children and young people648CC79C, 374634Glasgow Health WalksIn 2011–12 the Glasgow Health Walks project led to a return on investment of £8 for every £1 spent.62C78C9A, 374635Birmingham's Be Active ProgrammeBirmingham's Be Active Programme returned on average £21.3, and up to £23 in benefits for every £1 spent in terms of improved quality of life, reduced NHS use, productivity and other gains to the local authority.62C78C9A, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399563Improve collaboration across organisational boundariesEffective collaboration across organisational boundaries is vital to achieving and sustaining constructive progress in the face of complex, systemic problems—and to leveraging the energy, insight and resources distributed across the network of organisations to maximum effect.565CA4D9, 399603Glasgow Health WalksIn 2011–12 the Glasgow Health Walks project led to a return on investment of £8 for every £1 spent.62C78C9A, 399604Birmingham's Be Active ProgrammeBirmingham's Be Active Programme returned on average £21.3, and up to £23 in benefits for every £1 spent in terms of improved quality of life, reduced NHS use, productivity and other gains to the local authority.62C78C9A, 399996Obesity harms children and young people648CC79C