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, 348675Adopt 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, 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, 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

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, 348675Adopt 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, 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, 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

The McKinsey Global Institute estimates that the prevalence of obesity could be reduced by 20% within 5–10 years if the UK were to implement the 16 interventions it identifies as amenable to economic analysis.

Citerank: (19) 351042Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 352528Subsidising the production of sugar and fatGovernments are subsidising production of fat and sugar compared with micronutrient-rich foods.555CD992, 352531Overseeing a decline in physical activitySuccessive governments have overseen a decline of physical activity (e.g. due to policies on transport, public spaces, and sports facilities).555CD992, 366559Encourage individuals and families to make healthier choices565CA4D9, 366896WHO's total budget is less than half the marketing budget of McDonaldsMcDonald’s and Coca-Cola’s marketing budgets are each twice the World Health Organization’s full-year budget.1198CE71, 366897Surgical and pharmaceutical solutions don't resolve societal problemsThere is a danger of searching for pharmaceutical or bariatric solutions; as technological solutions are unlikely to resolve societal problems – at best, they are a ‘sticking plaster’.13EF597B, 368179Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 370363Unhealthy foods are cheaper and getting cheaper555CD992, 373987Genetic susceptibility to an obesogenic environmentRoughly 70 percent of obesity risk is genetically inherited; however, this genetic inheritance is best understood as a susceptibility to a fattening environment––i.e. in a healthy environment, genes alone do not usually cause obesity: in an unhealthy environment, genetically susceptible people become obese, while others remain lean because they are not genetically susceptible. [1]555CD992, 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, 399576Encourage individuals and families to make healthier choices565CA4D9, 399702Surgical and pharmaceutical solutions don't resolve societal problemsThere is a danger of searching for pharmaceutical or bariatric solutions; as technological solutions are unlikely to resolve societal problems – at best, they are a ‘sticking plaster’.13EF597B, 399888Strategies of some companies are fuelling the obesity crisisSome companies and industries are fuelling the obesity crisis, through a variety of strategies that prioritise profitability and corporate brand value over public health, and, in the process, externalise significant costs.555CD992, 399893Genetic susceptibility to an obesogenic environmentRoughly 70 percent of obesity risk is genetically inherited; however, this genetic inheritance is best understood as a susceptibility to a fattening environment––i.e. in a healthy environment, genes alone do not usually cause obesity: in an unhealthy environment, genetically susceptible people become obese, while others remain lean because they are not genetically susceptible. [1]555CD992, 399895Production and marketing choices favour profit over diet optimisationDecisions made by many food and beverage companies tend to be shaped more by the immediate corporate financial interests of shareholders (and the associated interests of corporate officers) rather than the social goal of achieving optimal human diets; as reflected in, for example, the production and marketing a high volume of low-cost, highly processed foods that are rich in sugar, salt, and saturated fats.555CD992, 399903Subsidising the production of sugar and fatGovernments are subsidising production of fat and sugar compared with micronutrient-rich foods.555CD992, 399904Overseeing a decline in physical activitySuccessive governments have overseen a decline of physical activity (e.g. due to policies on transport, public spaces, and sports facilities).555CD992, 399918Unhealthy foods are cheaper and getting cheaper555CD992, 399927WHO's total budget is less than half the marketing budget of McDonaldsMcDonald’s and Coca-Cola’s marketing budgets are each twice the World Health Organization’s full-year budget.1198CE71

Citerank: (37) 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, 348677Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 348678Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 348679Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 348680Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 348684Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 348685Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9, 348687More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 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, 348689Encourage physical activity in daily lifeThe Chief Medical Officer’s report (2011) recommends that adults aged 19-64 years undertake 150 minutes of moderate intensity physical activity per week in bouts of 10 minutes or more. [1]565CA4D9, 348695The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 348704GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 348706National Obesity ForumThe National Obesity Forum (NOF) was established in May 2000 to raise awareness of the emerging epidemic of obesity and the effect that it was going to have on both individuals and the NHS.58D3ABAB, 352713Who should improve obesity training for healthcare professionals?Who should improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 366828Shape the physical environment to encourage physical activity565CA4D9, 370326Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 371560British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 371561Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people, with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 396117Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 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, 399553Shape the physical environment to encourage physical activity565CA4D9, 399556Improve obesity training for healthcare professionalsImprove systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.565CA4D9, 399584Incentivise GPs to improve patient outcomesThe Quality and Outcomes Framework should be amended to provide incentives for GPs to proactively offer advice to overweight and obese patients and refer them to weight management services where appropriate, rather than simply keeping a register of these patients. [1]565CA4D9, 399606Who should improve obesity training for healthcare professionals?Improve systems of obesity education and training across all health professional groups to ensure that all professional primary and secondary healthcare groups are appropriately competent to respond to the demands of the obesity crisis.58D3ABAB, 399642Implement hard hitting campaigns, similar to those for anti-smokingHarder hitting campaigns, similar to those for anti-smoking, are required.1198CE71, 399667Better hydrationGovernment initiatives should include a greater focus on the importance of good hydration in weight management and health outcomes.565CA4D9, 399668Encourage physical activity in daily lifeBuild exercise into daily life to promote energy balance. Adults are recommended to take part in 150 minutes of moderate intensity activity every week.565CA4D9, 399695Focus outcomes indicators on action by primary health professionalsThe Quality Outcomes Framework indicators on obesity should include, and focus on, indicators on the action taken by primary healthcare professionals on behalf of overweight or obese patients. [1]565CA4D9, 399734Many health professionals still have inadequate knowledgeMany recently trained health professionals still have an inadequate knowledge of the nutritional aspects of health promotion and disease treatment and the potential benefits of regular physical activity.1198CE71, 399737Improved GP training on obesityGPs should be provided with appropriate support and training to help them have the necessary conversations with patients. Better quality training should be provided both during GP training and for current GPs to help them provide better advice to patients. [1]109FDEF6, 399768More physical activity for kids within and beyond educational settingsThe introduction of compulsory physical education in schools is positive. However, greater promotion of physical activity outside of educational settings is also key to ensure any participation amongst pupils is not limited to school. Similarly, caution is needed to ensure that the promotion of competitive sport does not put off children less disposed to that sport. This could result in children either returning to or increasing their sedentary lifestyle.565CA4D9, 399787The Quality and Outcomes FrameworkThe QOF was introduced in 2004 as a voluntary incentive scheme for GP practices in the UK. It contains groups of indicators against which practices score points according to their level of achievement, with a higher score leading to higher financial rewards. The aim of the QOF is to highlight priorities for improving patient care and provide incentives for GPs to drive up quality in these areas.82AECCD8, 399831Need to make every contact with patients countGPs and other health professionals should be encouraged and required to make every contact with patients count. Very few patients will cite obesity or weight management as the reason for seeing their GP, and will instead present with conditions that are clearly a result of weight issues. GPs should talk with their patients about weight in these instances. [1]109FDEF6, 399832GPs should measure waist circumferenceGPs should measure waist circumference rather than just BMI to help them identify patients who are most at risk and identify the indicators of poor health outcomes. [1]109FDEF6, 399840British Heart Foundation recommends at least 60 minutes every dayThe British Heart Foundation recommends that to maintain their health, children take part in a minimum of 60 minutes of at least moderate intensity physical activity every day. This could include PE lessons, but also swimming, dancing, cycling, most other sports and brisk walking, as well as active play. 1198CE71, 399841Quality and prevalence of physical activity in schools is variableThe Ofsted Physical Education report published in February 2013 found that the physical aspect of physical education was not doing enough to tackle sedentary lifestyles amongst children and young people,with teachers often spending too much time talking and not enough time getting children moving.1198CE71, 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

The aim of the Standard Evaluation Frameworks (SEF) is to support high quality, consistent evaluation of weight management, diet and physical activity interventions in order to increase the evidence base.
The SEFs provide introductory guidance on the principles of evaluation, and list ‘essential’ and ‘desirable’ criteria. Essential criteria are presented as the minimum recommended data for evaluating a weight management intervention. Desirable criteria are additional data that would enhance the evaluation. Supporting guidance describes why particular criteria have been categorised as essential or desirable, and provides further information on collecting data. The SEFs are essential reading to those commissioning, running or evaluating weight management, diet or physical activity interventions.

Citerank: (7) 371533How to regulate the portion sizes of food eaten at home?The average energy intake from eating out accounts for only around 10 per cent of total energy intake (with the total energy intake per person estimated to be an average of 2,192 kcal per person per day versus an approximate energy intake from eating out of 220 kcal per person per day).8FFB597, 371534Encourage the perception that large portion sizes are anti socialEncouraging the perception that large portion sizes are anti social might help to reduce the portion sizes that people prepare and consume at home.959C6EF, 371535Anti-social campaign worked well against smokingThe well-organized and sustained campaign to portray smoking as an anti-social activity appears to have played a significant role in the reduction of smoking (and therefore might play a similarly effective role in reducing the portion sizes and prepared and consumed at home).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, 399689How to regulate the portion sizes of food eaten at home?The average energy intake from eating out accounts for only around 10 per cent of total energy intake (with the total energy intake per person estimated to be an average of 2,192 kcal per person per day versus an approximate energy intake from eating out of 220 kcal per person per day).8FFB597, 399785Encourage the perception that large portion sizes are anti socialEncouraging the perception that large portion sizes are anti social might help to reduce the portion sizes that people prepare and consume at home.959C6EF, 399858Anti-social campaign worked well against smokingThe well-organized and sustained campaign to portray smoking as an anti-social activity appears to have played a significant role in the reduction of smoking (and therefore might play a similarly effective role in reducing the portion sizes and prepared and consumed at home).1198CE71

If the 16 responses that are amenable to economic quantification were to be enacted in the UK, they would expect that this would halt rising obesity and indeed reverse the obesity prevalence by 20% within 5 to 10 years. They rank the impact of each response in a cost effective way using the standard expression of Disability Adjusted Life Years (DALY). The top three are (1) Portion control with a DALY value of 2,126, (2) Reformulation with a DALY value of 1,709 and (3) High calorie food/beverage availability with a DALY value of 1,137. Interestingly, they also examine how these rankings are linked to media coverage using UK data. It makes interesting reading. Portion control with a DALY value of 2,126 had just 182 media coverage while a 10% tax on high sugar high fat products with a DALY value of just 203 had over 930 press citations.

Thus far in the McKinsey obesity journey, the map tells us where we get most bang for our buck but most importantly, it tells us that ALL areas need to be simultaneously acted on to have any benefit.