Who exactly becomes obese?
Matt James, Senior Fellow and Julia Manning, Chief Executive 2020health
Those of you who read my blog yesterday will have heard of the research 2020health is carrying out in order to address one crucial question: ‘Who exactly becomes obese?’ Our research looks across many factors – from age to gender and ethnicity and crime rates and more so we can so we can undertand why many of England’s residents are becoming obese and develop creative and innovative solutions that together can form part of a much needed national strategy.
The final report will be published in November but to share some initial interesting findings:
Gender is a particularly difficult category to assign to obesity demographics in the UK. Within the UK, the rates of obesity are roughly equal for adult men and women (26.1%), while men are more overweight than women. (NSCIC 2010, 2011, 2012). However, many studies suggest that this figure is somewhat misleading. While country-wide demographics show obesity as an epidemic that is equal among sexes, some research suggests that obesity, correlated with a range of other socio-demographics data, is highly gendered. In other words, for a given socio-economic or demographic factor, gender becomes highly informative in understanding trends in obesity. One of the key messages from this review is that gender needs to be more carefully considered anytime health policy initiatives attempt to address a specific socio-demographic factor.
b. Green Space and the built environment
It is perhaps unsurprising that research indicates that neighbourhood characteristics share correlation towards obesity rates. Research that simply links obesity to deprivation has the potential to overlook complexity in neighbourhood poverty influences. When neighbourhoods are associated with lower socio-economic status, this is often a correlate to obesity, but these neighbourhoods, regardless of individual household income, are often subject to characteristics that affect all residents equally, regardless of personal income or education. One of these characteristics is fast food density in a given area. Some studies have tried to understand this further, and recent literature suggests that, for men especially, it is food options in the vicinity of their employment which have the highest correlations to BMI.
The evidence that links poverty, deprivation, and lower socioeconomic positions to obesity (As well as lower health across nearly all categories) is overwhelming. It continues to be so in Britain, as it is elsewhere in the world, and this report does not question these findings. What has emerged in recent research on obesity, however, is that obesity rates are now rising fairly rapidly among other economic groups. This, too, is gendered. For middle and upper financial classes, men are becoming far more affected by obesity, but this trend is mitigated for women. Specifically, mobility is associated with rising rates of obesity. Previous studies on socio-economic associations for BMI presumed status in economic position, but this is not a reality for many people in the UK. Both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or poor, with the downwardly mobile currently sharing the highest rates and rises of obesity. We argue this is an important avenue for future research to focus on. A much broader discussion could consider obesity in the UK as informed through deep anxiety and uncertainty of economic futures from the beginning of the financial crisis through to the present. Again, these rates are gendered. For the stable poor, obesity is much higher in women, for the stable wealthy, obesity is higher for men, and for the economically mobile, obesity rises for both men and women.
For children, the rates of obesity are more alarming. Childhood obesity is still associated with poverty and parents’ education and habits. However, in many cities and towns, researchers have found ‘hotspots’ of childhood obesity that are not associated with health. These hotspots tend to overlap with both the poorest and wealthiest neighbourhoods.
d. Mental Health
One trend that is apparent from literature in the last 5 years is a rising interest in Mental Health as informative of health seeking behaviours. While we are careful not to argue for ‘causes or causalities’ of mental illness on other health seeking behaviours and maintenance, we argue that it is increasingly important to consider these relationships in future research. Clinical depression and anxiety is positively correlated with higher BMIs, but evidence suggests that, outside the clinic, more subtle ownership of depression and anxiety is deeply linked with obesity. One very large study found that, especially for men, it is the ‘anxious’ middle class that is currently experiencing the largest rise in obesity rates. Depression, uncertainty, and anxiety cannot be understood without context to the wider trends in society, which makes research in the area delicate. Nonetheless, as with specificities in socio-economic factors, we argue that it is worth, in larger research platforms, to examine increasing rates of depression and anxiety in light of the last decade’s complexities in order to better address behaviour changes and personal health maintenance.