Obesity is a significant public health issue and a key risk factor for a wide range of chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease (including stroke), and some cancers. It also impacts people’s wellbeing, quality of life, and ability to work.
Obesity is complex and can be influenced by a number of factors including economic, commercial, social and environmental determinants, cutting across government departments.
Public Health Wales suggests that obesity should be discussed in a way that avoids assuming it is a result of individual failure or weakness, rather than a product of the environment largely outside the direct control of the individual.
The Health and Social Care Committee’s inquiry report on the prevention of ill health – obesity will be debated in Plenary on 21 January.
This article explores some of the factors that can influence obesity, and the action being taken by the Welsh Government.
Obesity rates in Wales
The most recent figures (2024-25) show that 62 per cent of adults age 16+ in Wales are living with overweight or obesity, based on self-reported weight and height.
In Wales, during the 2023/24 academic year, 13.7 per cent of children aged 4-5 in reception class were overweight and 11.8 per cent were living with obesity.
Rates of overweight and obesity tend to be higher in more deprived areas, which also have lower levels of healthy behaviours such as physical activity and healthy eating.
Stigma and mental health
Much of the evidence received by the Committee addressed the issue of weight-related stigma, including that obesity-related stigma and discrimination are widespread across society and can impact a person’s willingness to engage with healthcare services.
The Cross Wales Psychologists in Weight Management (CWPWM) stated:
“There remain many unhelpful, discriminatory and stigmatising narratives in society about people living with overweightness, including that they lack willpower or self-discipline. These narratives and stigmatizing language lead to blaming individuals and focusing on calories in/calories out, rather than looking at a holistic bio-psycho-social understanding and wider public health policies.”
The group also highlighted the need for a more compassionate approach to weight management in policy, public health campaigns and across healthcare services.
There is a complex, bidirectional relationship between mental health and overweight/obesity. Public Health Wales referred to evidence suggesting that living with overweight or obesity, including exposure to weight stigma, is associated with poorer mental health. At the same time, mental health challenges can affect eating behaviours, as food may be used to manage emotions or mood, increasing the risk of excess energy intake and weight gain.
There is also a link between obesity and eating disorders, with Beat stating that people can have an eating disorder at any weight. It suggested that weight treatment pathways should include screening for eating disorders, established links to eating disorder services, and regular checks on patients’ feelings about food.
The Committee concluded that a trauma informed approach – which considers what has happened to an individual, rather than what is ‘wrong with them’ - is needed within weight management services. Strengthened collaboration across weight management, mental health and eating disorder services could also be beneficial.
Wider determinants
Obesity is shaped by a range of inter‑related factors, including social determinants, the food environment, and levels of physical activity.
Social determinants, such as income, education, housing and time constraints, influence people’s ability to access affordable healthy food and to prepare balanced meals.
The food environment also plays an important role by shaping the choices available to people in their day‑to‑day lives. In Wales, the number of takeaway outlets has increased in recent years, and there is an association between high takeaway density and areas of deprivation.
The Welsh Government has introduced regulations on food promotion and presentation along with healthy eating in schools with the aim of encouraging healthier choices.
Physical activity brings a range of benefits for both physical and mental well-being. However, barriers such as cost, stigma and limited access to facilities can prevent people from being active.
Treatment services for weight management
The provision of weight management services in Wales is developed, funded and provided by local health boards in response to the needs of the local population.
CWPWM told the Committee that weight management services throughout Wales were variable in terms of team make up and resources due to funding, leading to inequity between areas. There were long waiting times for some adult weight management services and there was no dedicated weight management provision for children and young people in some health boards.
The issue of weight loss medication was raised during the inquiry following the recent surge in demand. A Senedd Research article explores its availability in NHS Wales and outlines some of the key concerns.
Welsh Government Strategy
Healthy Weight: Healthy Wales is the Welsh Government’s long term strategy to prevent and reduce obesity, supported by a series of delivery plans.
Whilst the Strategy is generally welcomed by stakeholders, the Committee heard it’s had little impact on the ground, with no clear leadership driving the necessary changes. Similarly, concerns were raised regarding the transparency of previous delivery plans, with calls for regular progress reports to be published.
The Welsh Government’s new Healthy Weight: Healthy Wales delivery plan 2025 to 2027 together with its response to the Committee’s report set out planned actions that aim to prevent and reduce obesity, including measures addressing issues raised during the inquiry.
The Welsh Government states that the new Delivery Plan has “strengthened governance and reporting structures” and that an outcome and measurement framework will be developed to monitor progress.
What will make the difference?
To ensure the Strategy and Delivery Plan achieve their intended impact, stakeholders emphasised the need for:
- strong leadership and clear cross-sector accountability;
- regular progress reporting against outcomes;
- equitable access to person‑centred services across Wales; and
- ongoing action on the wider determinants that shape people’s choices and opportunities.
Welsh Government action in these areas will be important for improving outcomes for people living with overweight and obesity and reducing obesity rates.
Article by Rebekah James, Senedd Research, Welsh Parliament
