Adult Excess Weight
This section discusses Adult Excess
Weight. A chapter on Childhood Excess Weight is also
available Childhood Excess
Facts, Figures, Trends
England is one of the most overweight nations in the world; the
majority of adults are either overweight or obese. Excess Weight is
influenced by genetics, gender, ethnicity, and socioeconomic
deprivation. It is therefore important that services are targeted
in areas with a high concentration of black and minority ethnic
(BME) groups and in wards with high levels of socioeconomic
In England, the prevalence of obesity among adults rose from
14.9% to 24.9% between 1993 and 2013. The rate of increase has
slowed down since 2001, although the trend is still upwards. The
prevalence of overweight has remained broadly stable during this
period at 37–39%2. In 2013, 62% of adults had excess weight3. By
2050 obesity is predicted to affect 60% of adult men, 50% of adult
women and 25% of children4.
About half of women of childbearing age (16 to
44 years) in England are either overweight or obese. The prevalence
of obesity in women of this age has increased over time from around
12% in 1993 to over 19% in 20132. Around 1 in 6 pregnant
women are obese5
In Bedford Borough the latest data modelling suggests an adult
excess weight prevalence of 63.5% (6). This equates to
approximately 27,000 obese adults and 45,000 overweight adults, a
total of 72,000 adults with excess weight in Bedford Borough. As a
comparison, the East of England average for excess weight is 65.6%
and the England average is 64.6%. Comparative data for England can
be viewed at the National Obesity Observatory website http://www.noo.org.uk or http://www.phoutcomes.info/
Ward level data is available for ‘obesity’ only, based on
modelled estimates. The seven wards in Bedford Borough with the
highest prevalence are below:
Ward of residence
Kempston Central and East
How does obesity affect
Excess weight is linked to poor health, and poor social
outcomes, including hypertension, Coronary Heart Disease, stroke,
type 2 diabetes, premature death, osteoarthritis, depression,
cancers, infertility, asthma, sleep apnoea, and unhealthy blood
cholesterol levels(1,2,4,7, 8)
Overweight and obese individuals are more likely to be subject
to social discrimination, including lower earning power, and there
are adverse consequences for the wider economy from lost working
days and increased benefits payments(16).
Figure 1. Increasing risk of
mortality (death) with rising BMI
Calle et al.(1999). Image retrieved from
When compared to healthy weight
An obese man is:
An obese woman is:
5 times more likely to develop type 2
Almost 13 times more likely to develop type
3 times more likely to develop cancer of
More than 4 times more likely to develop
high blood pressure
> 2.5 times more likely to develop high
blood pressure, a major risk factor for stroke and heart
More than 3 times more likely to have a
It is possible to estimate the disease
specific attributable proportion of obesity, that is, that
proportion of a population with a given disease who would not have
that disease if they were not obese:
Disease Specific attributable proportion
Bedford Borough attributable population
a. QMAS 2011 data
b. QMAS 2011 data including CHD, atrial
fibrillation, stroke, heart failure.
The proportion of chronic disease that is
attributable to obesity will increase substantially if current
levels are not halted or reversed; this will in turn lead to high
levels of sickness absenteeism and increased levels of poor mental
Maternal obesity is associated with increased morbidity and
mortality for both the woman and her unborn child (11). Pregnant
women who are obese are at increased risk of:
- Developing gestational diabetes
- Having a raised blood pressure and pre-eclampsia
- Having a blood clot in the legs (DVT)
- Having a large or ill baby needing increased monitoring which
can lead to complications in labour
- Having a Caesarean section
- Difficulty in sitting for an epidural or an anaesthetic
- Having a wound infection, leading to a longer hospital
- (Rarely) having complications following surgery and delivery
requiring intensive hospital care.
- Having a still-birth or intra-uterine death.
There is evidence that children born to overweight or obese
mothers, tend to have higher birth weights, and become overweight
children, and subsequently overweight adults(12). There is also
evidence that infants exposed to an obesogenic environment during
uteri use on average an extra £1,138 in NHS resources throughout
the first year of life, in comparison to infants born to mothers
with a healthy BMI, likely due to the above mentioned
17% of pregnant women booked into Bedford Hospital in their
first trimester are obese (BMI ≥ 30) and 3% morbidly obese (BMI
 Bedford hospital data
What does obesity cost?
In 2008 obesity cost NHS Bedfordshire £98.8 million, this figure
was projected to rise to £136 million by 2015 without concerted
action (14). Estimated social care costs are difficult to quantify.
However nationally, 70% of total health and social care spend is on
long-term conditions attributable to excess weight and poor
lifestyles (diabetes, cardiovascular disease, muscular skeletal
disease, some cancers and mental health problems). The wider cost
to the economy is estimated at closer to £20billion a year once
factors such as lost productivity and sick days are taken into
The management of long term conditions often requires social
care support. Severely obese people are over 3 times more likely to
need social care than those who are a healthy weight (15). Some of
the social care costs for obesity related conditions such as
stroke, diabetes, hypertension are likely to consist of:
- the provision of ongoing support including re-enablement
- the provision of personal non-clinical care (washing, dressing,
cleaning, meals etc.)
- developing a Personal Independence Plan (PIP)
- Disability living allowance
- the blue badge scheme (disability mobility badge)
- lost income due to lost working days due to illness and
- the lack of ability to provide meaningful contribution to local
- the carer becoming a recipient of care – care still required
for person cared for plus themselves in addition
- Disabled Facilities Grants (DFG – walk in showers, stair-lifts
The cost of obesity to the wider economy (including costs to
Local Government and the NHS in primary and secondary care) is
around £27 billion a year. However, for every participant on a 12
week weight management programme, the NHS stands to save £230 over
a lifetime. Physical activity programmes also produce a return on
investment between £8-£23 for every £1 spent(16) This therefore
justifies the costs associated with the prevention and management
What are the key
Whilst everyone is susceptible to obesity, levels are
disproportionally higher in the lower socio-demographic/socially
disadvantaged groups, and some ethnic groups. The South Asian
population in particular are at risk of chronic diseases and
mortality at lower BMI levels than the European population (17).
Women from Black African groups appear to have the highest
prevalence of obesity and men from Chinese and Bangladeshi groups
have the lowest (3).
Men have a higher prevalence of obesity than women (26% compared
to 24%), and are more likely to be overweight (41% compared to 33%)
What are the challenges in
With the exception of gender and ethnicity, many of the risk
factors for obesity are modifiable and centre upon healthy
lifestyle changes towards a healthier diet and more physical
activity in everyday life. This requires more than information
alone; the three key elements that must converge at the same time
in order for behaviour change to take place are:
- A trigger
The challenge is to create an environment in which these three
elements are present and this should be a starting point for all
commissioning of services to help prevent weight gain or manage
weight. Although overweight and obesity are clinical terms, they
have taken socially derogative connotations to a point where
stating a person is obese is typically considered offensive.
There is a common misconception regarding the genetic element of
obesity and this can affect the response toward taking action (as
described above). Although genes contribute to the way that the
body reacts to diet and exercise, in the vast majority of cases,
making lifestyle changes are effective tools in managing
What are we doing and
Obesity management and prevention is separated into 4 tiers.
Tier 1 services are universal and preventative in nature, and
include health promotion and population level communication (i.e.
Change 4 Life). Tier 2 services are targeted lifestyle
interventions through primary care, commercial, or bespoke weight
management programmes (sometimes with medication (i.e. Orlistat)).
Tier 3 is a specialist multi-disciplinary weight management
programme delivered within a hospital setting. Finally, tier 4 is
Current overweight and obesity
Prevention and management of overweight and obesity are complex
issues. The Excess Weight Partnership Strategy 2015-2019 for
Bedford Borough identifies actions for delivering this agenda
county wide (click here to open document). There are a number of
services that have been commissioned to prevent and manage issues
pertaining to weight in Bedford Borough.
The Excess Weight Management Pathway is currently being revised
to include newly commissioned services. Please click
here for the pathway.
When excess weight services are commissioned or developed, it is
done so in accordance with the guidance developed by the Medical
Research Council (2006)19. This ensures that an appropriate
evidence base is used to justify its effectiveness and value for
money when developing and evaluating complex interventions. Where
there is inadequate evidence to commission a service, or no service
currently exists, services are developed and evaluated in order to
ensure that action is being taken in the areas necessary whilst
evidence is being collected4.
BeeZee Bodies CIC is the excess weight management services
provider in Bedford Borough. The following services and products
have been commissioned by Public Health:
BZ Bumps: Maternal Obesity programme -
delivering healthy living information and support to pregnant women
with a BMI > 30. The programme provides information on nutrition
as well as safe physical activity sessions, ante and post-natal.
The programme recruits from midwifery at Bedford Hospital and the
Luton and Dunstable hospital. This service is commissioned
“I think more about healthier options. I
think about portion control. I eat more brown bread as opposed to
white. I drink more milk and orange juice instead of fizzy. I am
more aware of habits I have that I don't want my children to have”
(Participant Maternity Programme)
Weight Watchers: Commercial Weight Management Referral
Scheme – 12 weeks free of charge for patients who are
eligible but are unable to afford the cost. A third of all patients
who started a 12 session course achieved ≥5% weight loss, which is
associated with clinical benefits. Losing 5%+ of body weight has
been associated with reduced blood pressure and a reduced risk of
Type 2 Diabetes and Cardiovascular Disease20.
Slimming World: Commercial Weight Management Referral
Scheme - 12 weeks free of charge for patients who are
eligible but are unable to afford the cost. A total of 54.7% of
completers lost at least 5% initial body weight.
“It has changed my life. I feel so much
better in myself and it wasn't as scary or hard as I thought!”
(Adult who took part in a commercial weight management
The below services have been commissioned as part of a 2-year
Gutless: Weight Management for Men - a
programme designed specifically for men. Upon enrolling, men will
have a health and fitness assessment, and are able to choose what
services they access. Options include nutrition sessions, web-based
1:1 support, gaol setting and motivational support, free or reduced
rates for existing BB exercise groups and games or gym based
Believe: Weight management for Faith-based
Groups- Approximately 70% of Bedford Borough residents
belong to a faith-based group. This programme is delivered by a
member of BZ Bodies CIC and a member of the faith organisation.
This programme aims to engage with hard to reach groups and to
Web-Based Video Chat: Weight Management Support
Online - This pilot service is a new way of being able to
reach those who would otherwise struggle to access services (e.g
those with disabilities, single parents with small children, those
in very rural locations where transport is difficult). It consists
of a 10 week programme, offering weekly 1:1 sessions with a
qualified nutritionist and personalised support including goal
setting, over a live web-based chat.
Further services commissioned by Public
Exercise Referral Gym / Physical Activity Programme – A 10 week
gym based or physical activity based programme delivered by
qualified instructors to improve the health of patients with a
range of conditions that may benefit from increase physical
activity levels. Regular physical activity can reduce the risk of
many chronic conditions including coronary heart disease, stroke,
type 2 diabetes, cancer, obesity, mental health problems and
musculoskeletal conditions. Even relatively small increases in
physical activity are associated with some protection against
chronic diseases and an improved quality of life (21). These
benefits can deliver cost savings for health and social care
services and are recommended by NICE (2006)(22), even in the
absence of weight loss due to the associated health benefits. In
Bedford Borough there is a newly redesigned service with better
accountability, more efficient booking and follow up, and more
effective reporting procedures has been recently implemented to
improve the quality of referrals.
In the latest GP Referral Patient Survey (2014):
- 97% of GP Referral patients said that the Activity for Health
Scheme has encouraged them to lead a more physically active
- 78% of GP Referral patients have either joined or intend to
sign up to the reduced rate memberships at their gym or have you
taken part in one of the Sports Development Re-Active 8
Lifestyle Hub (GP Referral Support) – A programme which uses
motivational interviewing to establish the most effective referral
programme for clients based on their individual circumstances. It
is likely that this will improve the quality of referrals into the
above programmes by facilitating 20 – 30 minute discussions
regarding lifestyle and assessing the programme that is most likely
to have the greatest effect. The addition of the Let’s Get Moving
(LGM) programme for patients who suit this method most adds a
further dimension to the services available to Bedford Borough
patients. According to the NICE guidance, Let’s Get Moving provides
a robust vehicle to implement brief interventions for physical
activity while harnessing the health benefits of this clinically
effective and cost-effective methodology (23).
[N.B. Motivational interviewing is a directive, patient-centred
counselling approach focused on exploring and resolving ambivalence
enhance intrinsic motivation and promote confidence in a person's
ability to make behaviour changes (employed by the Lifestyle
Advisors). There is much evidence reporting the efficacy of
motivational interviewing in modifying behaviours and this is a
central component of the Let’s Get Moving programme, mentioned
Bedford Borough Sports Development Team provide a range of
subsidised programmes of sport and activity programming designed to
re-engage people with previous enjoyment of sport:
- Just Turn Up (14-30 years)
- Sportivate (17-25 year olds): 2012 legacy programme
- Pre-activate8 (entry level programme)
- ReActive8 (30-55 years)
- ReActive8 Gold (50+ years)
- Over 70’s Gentle Exercise Classes
- She-Activate8 (For mothers/carers and daughters)
- No Limits (for those with a disability)
In an independent review in 2011:
- 86% of adults reported that taking part in Sports Development
activities had increased their participation in sport or physical
- 33% of adults said that they had improved health as a result of
- 12% that it had aided weight loss.
More detail on Active8 at:
Physical activity is highly cost effective with Quality Adjusted
Life Year (QALY) costs between £20 - £500 (values below £30,000 are
considered cost effective)(25).
Let’s Get Moving Back Into – In 2013, £430,000 was secured for
Bedfordshire to deliver a brand new initiative to tie into the
Lifestyle Hub. It is designed as a package to increase sporting
activity in people who currently do no sport, by targeting at risk
patients, providing them with the Let’s Get Moving programme and
signposting them into local activities, either bespoke or
What are the unmet needs/ service gaps?
The principal unmet needs include universal access to high
quality affordable food, and accessibility to open play areas and
opportunities to use active transport to the whole population.
Referrals to excess weight services are not as high as they
should be, bearing in mind the levels of excess weight in Bedford
Borough. This is due to a lack of confidence in health
professionals to discuss excess weight, and also a lack of
awareness of the services available.
Recommendations for consideration by organisations i.e. BCCG,
General Practices, Local Authority, Public Health and other
providers e.g. SEPT, Bedford hospital Obesity prevention and
intervention services are vital, as well as creating an environment
that ensures healthy choices are easy choices.
It is important to work collaboratively to:
- Tackle the obesogenic environment, by creating strong links
with other partners/directorates such as Environmental Health and
Planning, to implement projects that tackle the environment (for
example looking at the opening times of takeaways near schools and
encouraging food businesses to sign up to a Responsibility Deal26).
Plans are being formalised to tackle the obesogenic environment
through the Excess Weight Partnership Strategy 2015-2019.
- Ensure Bedford Borough workplaces are exemplars of healthy
- Be mutually accountable for obesity prevention from Health
&Well Being (HWB) Board level downwards.
- Deliver training to enable school staff and health visitors to
discuss overweight and obesity confidently as brief intervention
advice and signpost to services.
- Deliver social marketing to enable parents to recognise
childhood obesity and, thereafter, have the confidence and
knowledge to act appropriately.
- Deliver social marketing interventions to influence positive
health behaviour in target geographical locations.
- Support active travel and physical activity schemes.
There should be continued focus on areas of deprivation and in
high BME wards in order to reduce the inequalities gap that
presently exists, by ensuring that culturally appropriate social
marketing is taking place, alongside the targeted interventions
commissioned. In addition, we should look to explore other high
risk groups, for example, those with learning difficulties.
Obesity is a complex condition with wide ranging and mixed
antecedents. It is essential to continue to develop and commission
services and projects that have an influence on the whole
community, and also on individual behaviours, in order to reverse
the current Bedford Borough adult obesity trends.
More detail on Active8 at
Physical activity is highly cost
effective with Quality Adjusted Life Year (QALY) costs between £20
- £500 (values below £30,000 are considered cost effective – NICE
2006) (Lewis et al, 2010).
This section links to the following
sections in the JSNA:
1. Department of Health (2011). Healthy Lives, Healthy People: A
call to action on obesity in England.
2. Health and Social Care Information centre (2014). Health
Survey for England 2013. http://www.hscic.gov.uk/catalogue/PUB16076
3. Public Health England (2015). Adult weight data
4. Government Office for Science (2007). Foresight - Tackling
Obesities - Future Choices.
5. Public Health England (2015). Maternal Obesity. http://www.noo.org.uk/NOO_about_obesity/maternal_obesity_2015
6. PHE (2015). Public Health Outcomes Framework.
7. Department of Health (2013). Reducing obesity and improving
8. Loveman, E., Frampton, G.K., Shepherd, J., Cooper, K.,
Bryant, J., Welch, K. and Clegg, A. (2011). The clinical
effectiveness and cost-effectiveness of long-term weight management
schemes for adults: a systematic review. Health Technology
Assessment. 15 (2), 1–182.
9. Calle E.E., Thun M.J., Petrelli J.M., Rodriguez, C., Heath
and C.W Jr. (1999). Body-mass index and mortality in a prospective
cohort of U.S. adults. N Engl J Med. 341(15), 1097-105.
10. McPherson, K., Marsh, T. and Brown, M. (2007). Future
Choices-Modelling Future Trends in Obesity and the Impact on
Health. Foresight Tackling Obesities.
11. Centre for Maternal and Child Enquiries (CEMACH) (2007).
Saving Mothers Lives 2003-2005. London.
12. National Obesity Observatory (PHE) (2015). Maternal obesity
and child outcomes.
13. Morgan, K., Rahman, M., Hill, R., Khanom., R. Lyons, R. and
Brophy, S. (2015). Obesity in Pregnancy: infant health service
utilisation and costs on the NHS. BMJ Open. 5 (11).
14. National Heart Forum (2010). Healthy Weight, Healthy Lives
Toolkit for Developing Local Strategies.
15. Local Government Association &Public Health England
(2013). Social Care and Obesity: A discussion Paper. London.
16. National Obesity Observatory (PHE) (2015). Why invest in
17. National Obesity Observatory (2011). Obesity and Ethnicity.
18. Taylor, D. et al (2006). A Review of the use of the Health
Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory
of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM) to
study and predict health related behaviour change.
19. Medical Research Council (2006). Developing and evaluating
complex interventions: new guidance. University of Cambridge.
20. Blackburn, G. (1995). Effect of Degree of Weight Loss on
Health Benefits. Obesity Research. 3 (2), 211s-216s.
21. Department of Health (2011). Start Active Stay Active: A
report on physical activity for health from the four home
countries’ Chief Medical Officers.
22. Department of Health (2006). NICE CG43 - Obesity Guidance on
the prevention, identification, assessment and management of
overweight and obesity in adults and children.
23. Department of Health (2012). Lets Get Moving: Commissioning
24. R. and Rollnick, S. (2006) Motivational Interviewing for
Pediatric Obesity: Conceptual Issues and Evidence Review. J Am
Dietetic Assoc. 106(12), 2024-2033.
25. Lewis, C. Ubido, J. Holford R and Scott-Samuel A. (2010).
Prevention Programmes Cost-Effectiveness Review: Physical activity.
Liverpool Public Health Observatory.
26. Department of Health. Public Health Responsibility Deal.
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