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What Can We Do About Rising Obesity?

Mar 18, 2024
good evening tonight in this talk in a series on important public health issues I am going to talk about

obesity

obesity

is not new, it has been around for as long as we have records, but it has increased and it is increasing, so we should do it. worry and, if so,

what

should we do about it? This conference will cover the epidemiology of obesity, the health impacts of obesity interventions at the individual level, and interventions at the societal level, and throughout all of this there is a very strong belief that there is absolutely no reason why that people should feel shame or embarrassment about obesity is something that should concern them from a medical point of view and this will require a purely medical approach to this and I have illustrated it with this excellent and proud statue of the great author balzac de roda si We look at obesity in the UK for about two decades, BMI, which is body mass index, is one of the measures of obesity over 30, which is the measure of the type of technical measure of obesity, it increased of around 15 percent. to 26 has been a little more stable in recent years, but it is already a very important issue in terms of impact on social health and for individuals, so in the last year, of which we have four records, more than 11 000 hospital emissions were directly attributable to obesity, but more than 870,000 hospital emissions had obesity as a factor and around 20 6-year-old children are classified as obese and this will be transmitted if we do not act on major health problems throughout life , this change in obesity over time has been gradual. but it has not regressed, the main measure of obesity is, as I said, the body mass index and this is the weight in kilograms divided by the height in meters squared.
what can we do about rising obesity
If people are over 25 years old, they are classified as overweight and over 30 are classified as overweight. classifies as obesity and these are associated As I will talk later with health outcomes, this is not a relative judgment, it is a judgment of

what

the body mass is at the rate at which health problems start to appear. This is particularly surp

rising

in terms of the constant increase. in obesity in older children and especially in the most disadvantaged areas, then if we compare a decade between 2007 8 and 2018-19 and in this data what we have are those who live in the most disadvantaged areas in the orange bars and in the blue bars those in the least deprived and darkest areas are the later periods on the left, we have four to five year olds and you can already see that there is a significant difference where people who live in more deprived areas will have higher levels of obesity and As we move towards the sixth year, this difference is greater, but surp

rising

ly during that time the amount of obesity has not increased, it has actually decreased in those who are least disadvantaged, but it has increased in those who live in areas of higher deprivation. and this finding of a link between childhood obesity and deprivation is consistent in many high-income countries, we have actually created an environment in which people who are in more deprived areas, if they have a genetic tendency in that direction, There will probably continue to be the health effects of acquiring obesity at a young age and this difference is actually quite profound and if we look over time, the difference between the most and least deprived areas in terms of children both in the year of reception like even more in year six it's been steadily increasing So the difference if we go back to 2006 was about 8.5 uh the difference most recently is about 15 so this problem is increasing not decreasing and if we look the map of England, what we see is the index of multiple deprivation.
what can we do about rising obesity

More Interesting Facts About,

what can we do about rising obesity...

On the left, dark colors mean greater deprivation and the map of childhood obesity in the sixth year is very closely correlated; There is no absolute correlation, but the level of deprivation largely predicts where in the country large amounts of childhood obesity will be found. in that area and this is particularly striking if you start looking at a smaller scale level, these are maps of blackpool. Blackpool is an absolutely fantastic place that many people will enjoy, as well as those who live there, but it also has some of the biggest health challenges in the country and on the far left, what we have is a map of the proportion of children younger four to five years old with obesity and that is in different parts of the city, but by the time they reach 10 or 11 years old, this amount of obesity in children is largely concentrated in particular parts of Blackpool and if then you look at a map of male life expectancy at birth, which has a huge variation across the city, what you see are the areas with very low life expectancy, so 66 to 73 in red in adults correlate very strongly with childhood obesity in children aged 10 to 11 years.
what can we do about rising obesity
Therefore, this sets children up for a lifetime of poor health. Obesity, of course, does not end in childhood, it tends to increase. until middle age and this is just data showing the proportion with obesity and overweight by age, men on the left and women on the right and there is a slight decrease once people reach middle age too late, this is not only a UK problem if we look globally, the prevalence of obesity has increased markedly on all continents and if what we have on the left are women, on the right are men and what has happened since 1975 and as you can see , a constant increase in obesity everywhere if you then look at a map of the world and compare 1975 with 2016.
what can we do about rising obesity
On the left we have the previous period and this shows the proportion of people who are overweight, a BMI of more than 25 kilograms per square meter and very large parts of the world had very low BMI. Overweight rates If you go to the right, which is the most recent period, the proportion has increased substantially in almost all parts of the world and in many areas there are now very high rates of overweight, particularly in North America and Latin America, parts of Europe. from North Africa and the Middle East, but increasingly in other areas, including parts of East Asia and Africa, and the same is true if we look at people who have a higher BMI and have obesity and again really low rates in relation to where we are now.
If we go back to 1975, the world seemed like a very different place at that time in many countries compared to now, where there were actually quite substantial amounts in the darker colors of obesity in many parts of the world. It's important to also remember that, um, there is also overnutrition. Too many calories, through sugars and fats in particular, are the main driver of this, but we still have caloric malnutrition where people have too few calories. It has always been a problem, historically it has been the consequence of poverty everywhere, so I have illustrated it with history. by oliver twist asking for more food, but now there are many countries that have a double problem: undernutrition in some in terms of calories and overnutrition in terms of calories in others and in higher income countries you can often have a situation where People who have obesity also have poor diets, meaning they are actually lacking certain critical parts of the diet, so it is possible to be overnourished in terms of calories but undernourished in terms of other parts of the diet that are essential. .
Obesity causes health problems in people. that they have obesity through multiple mechanisms and I think when people think about this, they just think to some extent about the mechanical fact that people are heavier and also when people remember lipids when they look at them under a microscope in the school, for example, looks pretty inert, actually the mechanical issues are important, but adipose tissue, which is where lipids are stored, is a very active metabolically active tissue and does a lot of different things that change the shape in which the body responds to many different parts of the metabolism, this includes insulin. resistance, so it changes the way the body responds to insulin, which is the main driver of how glucose and other sugars are handled.
It changes several hormones, some of which are hormones that are very important for appetite control, so it can become a Detect a circular problem, but also important hormones such as estrogen, which is an important sex hormone in the metabolism of women, and discover the reasons why this has major implications for health. Higher amounts can cause inflammation, so systems like interleukin-6 tnf alpha, these are signs of inflammation, they can be affected by having more adipose tissue, they can affect clotting and increase the risk of clotting and of course they can infer that they affect lipid metabolism, the way fats are handled, so having obesity leads to a large number of changes in the way the body handles not only lipids and fats themselves, but a variety of different things that can have implications for people's health, so the easiest thing to explain is the direct physical effects and now I'm going to go over those. several of the health impacts of obesity so you can see why it is such a major health problem.
There is a very strong association between obesity and osteoarthritis, which is a major inflammation, erosion of the joints. The knee joints are the most frequently affected because they are very strong, they support the weight of most of the body and for every five unit increase in body mass index, there is an association with a 35 percent increase in risk of knee osteoarthritis and 11 of hip osteoarthritis in a United Kingdom. In one study, for example, 69 knee and 27 hip replacements were linked to obesity, but there is also an increase in osteoarthritis and non-load-bearing joints, suggesting there are additional mechanisms.
It's not just about physical weight, the next major problem associated with obesity. Now within diabetes there are two types: type 1 diabetes, which is much less associated, but type 2 diabetes, which makes up around 90 per cent of diabetes in the UK and the prevalence of how common it is has increased very rapidly since the 1960s and 1960s. The reason for this is that the rising tide of obesity and diabetes has many consequences. Increased blood sugar can be very dangerous in itself in obesity, but it also has indirect effects if not treated or prevented, including heart disease, stroke, kidney disease, and eye disease.
This strong push from increasing obesity towards more diabetes is a very important public health problem. The biggest risk of type 2 diabetes is being overweight and this probably accounts for 80 to 85 per cent of type 2 diabetes in the UK and, unsurprisingly, increases with deprivation, unlike type 1 diabetes it is important, where people who have obesity and type 2 diabetes lose weight the diabetes can often go into remission so diabetes comes on with weight gain which can decrease if the weight goes down and if we look around the world there is a correlation very strong among areas of the world where there is a high prevalence of obesity.
I have illustrated it here with 18-year-old women, but the same will happen with men and at different ages and high blood sugar, which is the main one. marker of obesity, so these are very closely related around the world, then there are very important impacts in terms of heart disease in general, for every unit of BMI the risk of heart disease or coronary heart disease increases by about 8 percent and this is associated with a number of different factors, fat, particularly fat around the organs, is associated with increased cholesterol, increased blood pressure and of course the effects of type 2 diabetes In the case of coronary heart disease, the place where the fat is located on the lips is important, as well as the fact there is fat and the increase in weight circumference, waist circumference, which is associated with flat visceral fat around the abdomen area, is as important a predictor of heart disease as actual BMI, so if people have their fat distributed primarily centrally, that is a greater risk than if it is more peripheral and this is a particularly risk. high for certain ethnic groups, for example people of South Asian descent, also in the cardiovascular system there is a strong association between obesity and strokes, especially strokes in younger people and this again is strongly associated with increased of weight on the waist-hip ratio, so central obesity, but also BMI, for example, a study conducted in the USA that looked at the waist-hip ratio showed that for those under 65 years of age, the probability of suffering a stroke was 4.4, which is areally substantial increase for among those over 65 there was an increase, but much smaller, other factors tend to become more dominant, so obesity is associated with several major cancers.
I've illustrated it with cancers in women, but there are cancers in both women and men that are Obesity is linked, so here's a meta-analysis that looks at the risks of obesity with a whole host of major cancers and some of them don't have no association with obesity, but some have a fairly significant one including endometrial cancer and uterine cancer. and postmenopausal breast cancer. I put them together because they are largely driven by hormones and it is the effect of obesity on hormonal balance that is probably why these cancers are more common and then esophageal cancer, which is a form very dangerous. of cancer with a much worse outcome than many others and kidney cancer are also associated with obesity, some of them the effect is quite small, for example in postmenopausal breast cancer it is a relatively small effect, but because it is a very common effect cancer this can still have a big impact on public health move on to the next body system liver disease nonalcoholic fatty liver disease is very common with obesity so liver disease in the uk is It is very often associated with alcohol and globally it is associated with infections, particularly hepatitis, but obesity is another very important factor in liver disease.
The most dangerous form is something called non-alcoholic steeto nash hepatitis. It can progress to cirrhosis and liver cancer and here it is in this country. It is the second most common reason why people may need a liver transplant, which is a very important operation in pregnant women, obesity can also be a significant risk for pregnancy outcomes in general, the likelihood of miscarriage before 12 weeks is about one in five, there are relatively common miscarriages, but if you have a significantly elevated BMI, the chance is one in four so the race the risk increases there is also an increased risk of gestational diabetes is the diabetes that appears only during pregnancy blood clots which are a risk in pregnancy for high blood pressure and preeclampsia and can also cause difficulties during childbirth So obviously it is something that you would prefer that people not start pregnancy with obesity, although once during pregnancy you should definitely not try to lose weight suddenly.
That would not be good practice and unfortunately it has been vividly demonstrated in the last year that there are no infections. all infections, but some infections can become more common or more dangerous due to obesity and the one where we have seen this really clearly is with covid19. There is a very clear association here in the United Kingdom and in other countries between obesity and admission to hospital with covid19 if they enter hospitalization in ICU with 19 covert and die from covid19 and the higher the degree of obesity the stronger this association is. and it is also clear that countries with more obesity have more deaths from covid although this relationship is relatively indirect so if we look at all causes of mortality or mortality from communicable diseases, that is, infections or non-communicable diseases, such as heart attacks, strokes and cancers.
In all of them there is a very clear association between obesity and early mortality. I just illustrated this is a study of almost two million people who never smoked in a gp database here in the UK on the left all causes of mortality in the communicable and on the right non-communicable and what you have is the BMI and if people are very underweight, which is a relatively much rarer problem here in the UK, then there is a higher risk, the lowest risk is when people are what in medical terms would be considered normal weight and Once people become overweight, obese, and then really severely obese, then the risk of dying prematurely increases substantially and this association between obesity and increased mortality is independent of age, sex, smoking, and a variety of other risk factors, so as obesity increases, the risk of premature mortality increases for people who would otherwise have died much later. is steadily increasing and therefore this represents a major future problem for individuals, families, society and the NHS, so I hope that has made clear the fact that obesity is clearly increasing in the UK, clearly It is increasing globally and has multiple negative health outcomes, making it a very important problem.
A public health problem: Recognizing now that obesity is a major health problem is obviously easier than addressing it, but we must do it, and what I want to talk about in the second half of this talk is to say that there is a way to overcome This, but it is important that we start from the principle that it is very difficult for people to lose weight and maintain that loss and they need support, and this is made more difficult because people who are overweight and obese often feel very stigmatized and, at times, Often from a very young age many people especially those who live in areas of deprivation live in highly obesogenic environments these are environments that in some sense make it much more likely that someone will end up obese there is a tendency in much of the narrative to blaming people for being relatively overweight or obese, which does not help them, but it is also scientifically incorrect and I think we would all accept that individual society, health services and industry have a role to play in this now, before to analyze how it can be treated.
I think it's just important to have a very brief overview of why obesity is not universal and why it has increased over time. Obesity is, obviously, calories ingested and absorbed. That is very important compared to the calories expended in normal life. We have a calorie base that we have to Now we have to maintain normal activity along with this, most people probably almost everyone, not absolutely everyone, enjoys eating control of how much we want to eat seitai tea, as it is sometimes called in medical literature, medical literature is highly regulated biologically and has a very strong genetic component.
So with an infinite amount of food in front of you, different people, largely for genetic reasons, will have different points at which their body will tell them that you have actually had the right demand and this is a very complicated area because of course , we are I don't think about this but we need to have enough food to be able to operate normally physically and mentally and not too much so as not to end up with obesity and this is a very very delicate balance and if it is slightly unbalanced in one direction then obesity is likely to follow because It's not an individual occasion, but it changes it, it's an effect that affects people's intake, day after day, year after year, and the key to how much we want to eat is the brain and especially, but no.
It's entirely an area called the hypothalamus, but there are multiple biological systems operating on this and the hypothalamus and the rest of the brain receive enormous amounts of information and signals with gut hormones of various types, other forms of hormones of different types, also neurotransmitters. as visual and other cues, all of which are driving the need to eat more, some of which are driving the need to say enough, and many of which are changing the way the body handles food, so This is a very, very complicated system, but at the end of the day they operate in the brain and therefore the desire to eat if food is available now has a very strong genetic component.
In the extreme, you have something like the very rare part of the part. of the illegal syndrome where a single chromosome, which in this case chromosome 15, changes can cause people to feel constantly hungry and end up with very substantial obesity, but for most people the primary control controls their preference for how much they eat. In terms of satiety, the point at which the body says it is the right amount, it is affected by multiple genes and this is called polygenic control over many different genes and it is a spectrum, there is no one or the other as a spectrum, so Individual variation in obesity can largely be explained genetically, if people have almost infinite amounts of food potentially available, and multiple gut hormones and other food circuits are also targets for pharmacological treatments and, as I have advanced, we are beginning to have to the point where we can actually do something to affect this physiological mechanism along with several medical conditions, such as hypothyroidism, having low thyroid control can also cause weight gain, so it's not just about how much they are people are genetically programmed to eat.
There are also a number of other physiological factors that can cause them to be higher or lower weight and the weight to change at various times in their lives and due to this genetic factor, but also other social problems, if a mother or a father in a family are overweight or have obesity, then children are also more likely to have it in that family and this is true whether it is the mother or the father and whether they are girls or boys, but there are many exceptions both ways, this does not it's something that doesn't follow, uh, completely inevitably and This is both genetic and social in terms of its drivers.
Weight gain is largely driven by physiology and genetics, but when people want to lose weight or are trying to lose weight or lose weight, the body tries to maintain the weight it needs. had previously gained, so through lifestyle changes it is possible to lose quite significant amounts of weight, largely by reducing the number of calories consumed, but the body responds to weight loss by trying to return to its previous maximum weight and there are some studies that, for example, suggest that someone who has lost a significant amount of weight may have a prolonged physiological response, like a thinner person who is relatively hungry, so the body tells them that they have to come back, that You have to eat more and This can lead to yo-yoing among obese people who lose weight through a great effort of will and actions, but then the body essentially pressures them to eat more again and return to the previous weight.
This is a process called yo-yo. This explains, to a large extent, why different people have different levels of obesity, but why this has changed over time and the answer is actually social and has to do with the foods that are available now, the total calories available socially it has increased constantly. So on the left we have relatively long records, slightly uncertain but relatively long, in England for example, this goes back to when this university knew when it was founded around 1600 and as you can constantly see, in the graph of the La left shows for several countries the increase in the amount of calories available to people and then more recently some data showing the constant increase in the supply of fat over time in people's diets, so with Over time the amount of calories and the amount of calories from fat have increased. over time in all societies and this has happened as countries have become richer and there are more things available to them and what you can see here on this graph is that on the left, the left axis, the proportion of people. who are overweight or obese and on the right axis the available daily caloric supply and these are several countries put on a graph and what you can see is that there is a strong correlation between the amount of calories available and the proportion of obesity, so If you get people together who have a genetic propensity for obesity and increasing amounts of available calories, of course, that's one of the ways that there's an upward push in terms of people's obesity levels in general. , but not all foods are equally likely to cause obesity for the same number of calories, an ultra-processed food leads to greater weight gain per calorie ingested, it is possible to feel full with the same number of calories, but if you eat less Processed foods, in a sense, simple foods that you can make from scratch.
You will feel full sooner in terms of the number of calories you will absorb than with ultra-processed foods that have a very high calorie density and the various ways that foods are presented are broken down in a way that is more easily absorbed and, so highly unprocessed foods, in common sense, common foods, fewer calories, they just pass right through you, ultra-processed foods, a lot of them will be absorbed, it's not just the amount ofcalories but also the way in which calories are presented and this is important in explaining why some parts of society are exposed to very large amounts of processed foods and if we compare these two maps in the UK, one of them , for example, the one on the left, is the density of fast food establishments. of fast food establishments and the one on the right is childhood obesity.
There is no absolute cause and effect, but you can see that there is a very strong correlation, so people have a significant genetic tendency towards obesity. Available calorie amounts have been steadily increasing and ultra-processing of foods, which is highly concentrated in areas of deprivation in terms of available foods, all of this may help explain why rates have increased over time, so how Do we get out of that hole? a role for people and their families as a role for the medical profession and then there is a role for society, let's just consider doctors and the people who work with their patients, their clients, and this is a slide of two of my The first lecture in this series, which is art, asked what is the role of the individual, medical practice, the medical profession and the state in terms of preventing disease and preventing things that lead to disease, including obesity, doctors of primary care, gps and specialists have a central role in secondary prevention when someone already has some evidence of obesity we can try and help people reverse it, stabilize it, reverse it, but also prevent some of the medical problems that can occur like result of that and also the treatment.
This is based on a one-to-one conversation between a doctor and a nurse or other professional and their patient or client and is based on individual consent. It may involve appropriate advice on how to not gain weight and then hopefully lose weight and may also involve the prescription of medications and in severe cases surgery prevention what stops is what starts from the position before people have obesity uh falls mainly on the state and the role of the state in obesity is a disputed area and I'm going to deal with that uh Lastly, if you survey people about how much responsibility, if any, they thought each of the following has in ensuring that people in general stay healthier and obesity is just one element of this, which You will see over time that there has been a slight increase. actually over time in the proportion who think the state has an important role the national government the local government but there is a substantial proportion of people who think there is an important role for the nhs for the national government for the local government for the individual and for the food and alcoholic beverage industry when it comes to obesity, so this is a problem that in a sense we should all have and we should all try to improve now.
The first thing, the most obvious in a way is to help people lose weight and that is through Diet to lose weight in a sustainable way it is possible. with substantial benefits and I gave the example of people whose diabetes appears because they become obese and Then, when they lose weight, they can go into remission, the key is to have a lower calorie or fat intake than necessary to maintain the current weight, around 600 kilocalories per day. The difference between the daily deficit between expenditure and intake is ideal, but it must be nutritionally balanced if people simply go down without maintaining the correct balance, that is obviously potentially bad for health for different reasons and of course it should be pleasant , otherwise it will not be sustainable.
This is actually usually better than ultra-low-calorie diets, which can sometimes be helpful, but in general, this type of sustainable weight loss is what people should aim for, with help. Exercise is also important, but I think it's often considered more important than it really is. It plays a very important role, but it is very difficult to lose weight once a person has developed obesity without reducing calories, and to prevent obesity, most people may need to do 45 to 60 minutes of moderate-intensity activity each day. day and, in modern life, a long time. For people this can be quite difficult, but exercise is essential not only because it is part of an overall approach to weight, but it is also essential for wider health benefits, as well as helping to keep weight down, so exercise is really important, but you can't see it.
As the only thing people need to maintain a healthy weight and lose weight and it's easier to exercise more in more affluent areas, that's just a practical reality and if you look at the amount of physical activity compared to wealth or deprivation, depending on which way. If you look at it, there is a reasonably strong correlation and if you go through environments where there is more deprivation, you will see why it is more difficult to exercise in many of these environments, so those are things that people can do with support, but remembering this. fact that losing weight is difficult maintaining the weight once you have lost it is also very difficult, then you get to things where medications can be used and drug treatment to help lose weight has until recently been relatively disappointing, but I think that is changing and I think that people who work in this field believe that it is going to change substantially in the coming years.
Pharmacological treatments already exist. Many of the current ones have limited effectiveness or unacceptable side effects, and an example of a drug that is currently recommended is something called autostat. stops about a third of the fat being absorbed but can have quite significant side effects for many people, not everyone, it is so helpful for some people but this can be problematic for many others but it is becoming more likely that The medications will be based more on hormonal weight control and these are particular gut hormones that are part of this cycle where the body tells the brain that actually this person has probably eaten enough or that this person needs , you know you need to eat more and the most recent one, I think it's a very exciting development, is actually a dog called cemuglutide, which is a glucagon-like peptide, this is one of the gut hormones, it's like one of those that They have been used in type 2 diabetes, but recently it has been shown to have benefits in terms of helping to lose weight and then maintain it and it does this by reducing appetite, it basically tells the brain that this person has eaten enough, now you might worry that once people start taking it, the weight will continue to fall and fall, in fact, other mechanisms are activated, so what we have seen in this and this is a trial that actually came out this year in the England Journal, what you can see is a significant change from the beginning in terms of the percentage of weight and then it stabilizes, so here is an example and hopefully there will be many more drugs that mimic part of the natural process by which controls appetite, which can help you lose weight and then maintain it, but I think we are very far from its widespread use.
These are largely for people who have significant degrees of obesity and the potential for very serious health problems. The most invasive treatment that doctors can provide is bariatric surgery and there are several forms. From this, broadly speaking, there are three types of gastric bands, which are a band around the stomach that helps people bite because it essentially means they can't eat as much to feel full, but there are two other gastric bypasses where the upper part of the stomach. to the small intestine or what's called a sleeve gastrectomy where part of the stomach is removed and then reconnected and this is actually the main way it works is by changing the way the signals from the intestine, the hormones from the intestine, regulate the appetite. and people with glucose start to lose weight sustainably and quite quickly with these, but as with all operations, there are risks and side effects, so this is not the way you would want to treat people who have obesity unless they really have a point where other things have proven to be ineffective and the effects of gastric surgery are that people with severe obesity can lose quite significant amounts of weight, often very quickly and then it stabilizes and if, for For example, they have type 2 diabetes, this can often be resolved and blood sugar reduction maintained, so this can have really significant long-term positive health effects, as you would expect, given that environments that tend to to promote obesity are found in areas of greater deprivation, there is a very strong correlation between the need for bariatric surgery and areas of deprivation or three times more likely in more deprived areas and this is an operation that tends to be necessary for people of medium age, so those are things that individuals can do, families can do, individual doctors can do for people with significant obesity.
The last thing to consider is state intervention and the other slide from the first talk I gave in this series was the idea of ​​the ladder of possible state intervention starting from very uncontroversial areas where things like supporting science to test possibilities, test, for example, where various medications for people with significant obesity are effective to inform the public or information to engage industry and say, look, could you try to work with us to help? These are a relatively limited use of state powers. Mass voluntary programs are the least relevant for obesity, but then. you get into areas where state powers are used quite a bit more and those include stimulus taxes or interventions where you put in a relatively small tax or intervention to try to change the regulation of behavior, higher taxes that are actually designed to change the behavior quite profoundly. such as, for example, taxes on cigarettes and higher alcohol, which prohibit or subject people to civil or criminal law, and I think there will be a general opinion in society that the upper end of the scale of State intervention would not be appropriate for these areas, but the question is what things should the state do to help people and society reduce the amount of obesity, a number of people who are overweight and this inevitably has to be decided by the politicians as representatives of society, this is not a medical decision, ultimately it is a political decision, but I think there are some things that can help us find the best way to approach this.
The first thing is to be absolutely simple: hospital admissions directly attributable to obesity. or when it is a factor, it is a very important part of the work of the NHS, it increases substantially due to deprivation and has increased over time, so this is a problem for all of society, as well as for people suffering the effects obesity doctors. I think the second general principle is that if someone has a propensity to be obese or overweight, we, the pub, we, the public, should recognize that they are constantly bombarded not only with their own body telling them that they want to eat a little more, but also with huge marketing and advertising and foods being advertised that have an incredibly high calorie value and this is just a picture of my local supermarket and these are all rows of shells that are essentially just sweet or fatty products and we need to get involved with the food industry in this. as a society as a whole because the pleasure that people get from eating, the benefits for business and health are not mutually incompatible, but currently there seems to be an intention and we need a different approach if we want to get back to where we were before, where the obesity.
It's a much smaller problem and you know, just give some examples of the kinds of things that really, if you're trying to address obesity, wouldn't really be what you would want. Listen to our sponsorship in UK sports and many of the companies that In this, all the companies that sell foods that people want, but they are very high calorie foods, often calorie dense, and they associate them with sport, which isn't really helpful, especially for younger people. The goal should not be to reduce enjoyment or even gains, but to reduce unnecessary energy, particularly sugars and fats, but also remember that ultra-processed foods can increase weight for the same calories and this is perfectly possible.
I have illustrated two things here. enjoy between many Greek yogurts and colas, there is a big difference in terms of energy in the two yogurts here, one has zero grams of fat, the other has quite substantial amounts of fat, they taste slightly different and, right, different tail shapes. with the amount ofsugar and sugar cubes that they have in them, so if you're drinking a cola full of sugar, you're drinking a very large amount of sugar, um, in fact, so if we're going to try to deal with these we're going to have to use multiple interventions, each with a modest incremental impact and we still don't know the optimal combination and I think there is no country in the world that has this absolutely enlightened, this is a serious problem that everyone in the country is fighting and due to the fact that The way we all interact with food varies enormously across different cultural environments, solutions will be different in different places, but examples of possible state interventions include things like traffic light labeling of high-calorie foods that restrict direct advertising. to children restrict sports advertising of nutritious foods with high calorie content restrict fast food establishments near schools taxes on sugar on soft drinks with higher caloric content reduce taxes on lower calorie ones that in a sense is putting the incentive on the Upside down all this would require some use of state powers And this has to be a political issue and I think the best way to do it in the way that is least difficult for individuals is to have a small intervention in a very broad scope instead of waiting May an intervention simply resolve this.
The problem is that there is often a feeling that we can't really change things, but I will end with an example where that is clearly not true, which is why in recent years there have been voluntary agreements in the UK between the government and the food industry. They have had some effects, but generally in areas where there is voluntary interaction in many areas, the amount of sugar, for example, has barely changed, in fact in some cases it has increased, there are some particular areas where things have improved, such as breakfast cereals, yogurts and spreads. We've seen significant drops, but in many other areas there hasn't really been any change, but there was one example of a very small tax over the same time on high sugar drinks, i.e. fizzy drinks, and this is just to show. that these next two slides are just to show what the impact of that was and there were a lot of people who said, well, this will lead to people not wanting to drink them, actually which led to the beverage companies reformulating them to a large extent. to reduce the amount of sugar in their drinks so they were below the sugar tax threshold and the result of that was that sales stayed the same or increased in terms of the number of colas that were consumed and you can see that here on the right that's the total sales of these using public health data from England and this is across all socioeconomic groups, but the amount of sugar actually consumed was substantially reduced by 35, so it was reduced from over 135,000 tonnes to just over 87,000 tonnes during this relatively short period. for a really quite small incentive for the sugar tax and therefore if we look at the weighted average sales of total sugar through soft drinks or colas of different types, what we see is a really substantial difference between 2015 and 2019 during the period in which this had such an effect.
Here is an example with a very small state intervention that did not actually affect the market, did not infect people's ability to consume sugary drinks, but did significantly reduce the number of calories By itself, that will have a modest effect, but if you do a lot of things. With effect sizes like this, then we will end up being able to go back down the curve where obesity has been rising, we can go back to a situation where obesity levels off and then falls, so, in short, the obesity has increased and in many parts of the world they are increasing this conference has covered the epidemiology of obesity showing that it is really increasing globally the health impacts that are multiple in many body systems interventions at the individual level where we are going, we are already looking at new interventions new medications for example, but I think we are going to see a significant improvement in these over the next few years and interventions at a societal level that show that it is possible to have an effect that can actually lead to a reduction in the calorie intake of the people and at the same time they can continue consuming the foods and drinks they want.
It's a problem. It is a growing problem. We need to address it, but there is a way to fix it on both an individual and societal level. thank you so much

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