Obesity is recognised as one of the most significant public health challenges, both in the UK and internationally. Prevalence is rising in Wales, as elsewhere.
Obesity is a key risk factor for a wide range of chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. It also impacts people’s wellbeing, ability to work, and quality of life.
The Health and Social Care Committee is launching an inquiry on preventing and reducing obesity. This article highlights the complexity of the issue, and why framing obesity solely as a matter of personal responsibility fails to take into account the significant, external factors at play.
Obesity in Wales
At the start of this Senedd, the Health Minister indicated that tackling obesity would be one of her key priorities:
I can give you an absolute commitment that this is an area where I'm going to park my tanks. I think it's absolutely unacceptable that 20% of our children go to school obese or overweight by the age of 5 […] I'm absolutely determined that this is an area that we should focus on.
The most recent figures from the National Survey for Wales show that 62% of adults age 16+ in Wales are overweight or obese (25% reported being obese).
Rates are also increasing among children. In 2023 the Chief Medical Officer (CMO) for Wales reported that nearly one in three children are overweight or obese by the time they start primary school.
Obesity rates are much higher in the most disadvantaged communities. By local authority area, rates of overweight and obesity range from 52% in Powys to 78% in Blaenau Gwent (where 37% of adults reported being obese).
Public Health Wales has previously estimated the cost of obesity to the NHS in Wales as £73 million. By 2050, this is estimated to rise to £465 million. The broader cost to society and the economy in Wales by 2050 is estimated at £2.4 billion.
Why the rise in obesity?
Worldwide, obesity has nearly tripled since 1975. The World Health Organization (WHO) reports that, once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. The WHO points to changes in dietary and physical activity patterns, often the result of environmental and societal changes.
The British Psychological Society (BPS) says that while obesity is ultimately the result of an energy imbalance, the behaviours that create this imbalance are influenced by a “complex interaction of biological, psychological, sociological and environmental factors”.
People have not become greedier or lazier, the Institute for Government (IfG) reports. It describes “huge changes in food systems” making it increasingly difficult for the food industry to sell healthy food and, on a societal level, increasingly difficult for consumers to eat healthily.
CMO Wales’ latest annual report discusses the ways in which the food industry influences people’s choices and behaviour (referred to as ‘commercial determinants of health’). This includes through:
- marketing, which can increase the desirability and acceptability of unhealthy commodities;
- lobbying, e.g. to avoid tighter regulation;
- corporate social responsibility strategies, which can “deflect attention and help whitewash tarnished reputations”, and;
- extensive supply chains, which increase company influence around the globe.
The CMO echoes the WHO’s calls for a “paradigm shift”:
Public health cannot and will not improve without action on the commercial determinants of health, from the local to global level.
A focus on the early years
The BPS highlights that the biological and behavioural systems responsible for appetite and stress develop most in the first few years of a child’s life, making pregnancy and early childhood a critical time for preventing obesity:
There is very strong evidence that the quality of nutrition during pregnancy and immediately after a child is born exerts a powerful influence over their later obesity risk in childhood and adulthood. […] Obesity in early life tracks strongly into later childhood, and on into adolescence and then adulthood, highlighting the importance of intervening during the pre-school years.
Stigma, discrimination, and mental health
Weight stigma and discrimination are widespread and ingrained in society, and can impede prevention efforts and exacerbate poor health. It affects both mental health (e.g. there’s increased risk of anxiety, depression, and self-harming behaviour), and physical health (e.g. through avoidance of, or inability to access, healthcare and exercise).
Psychological factors such as stress, depression, loneliness, and addiction can, in turn, all contribute to unhealthy eating habits and sedentary lifestyles.
Obesity stigma and discrimination may also have a negative impact on employment prospects and career progression.
Communication about obesity (such as through the media) typically frames its causes and solutions as the responsibility of individuals (e.g. obesity is the result of a person’s lack of willpower). Guidelines produced for the UK All-Party Parliamentary Group on Obesity highlight that:
the evidenced complexity of obesity is rarely disseminated to the public and these simplistic and often stigmatising portrayals contribute to the formation and maintenance of stigmatising attitudes and beliefs.
Welsh Government strategy
Healthy Weight: Healthy Wales (published in 2019) is the Welsh Government’s long term strategy to prevent and reduce obesity in Wales. The strategy recognises that there are many factors contributing to obesity, acting at individual, community, societal, and global levels.
The current delivery plan for the strategy runs from 2022-2024. One of its priority areas is shaping the food and drink environment towards sustainable and healthier options.
Following the Welsh Government’s ‘healthy food environment’ consultation in 2022, the Deputy Minister for Mental Health and Wellbeing indicated that regulations to restrict the placement and price promotion of products high in fat, sugar, and salt (including meal deals) will be laid in autumn 2024.
The Healthy Weight Healthy Wales delivery plan recognises the importance of pregnancy and the early years, and includes a focus on supporting families to provide the best start in life. During recent scrutiny of the draft budget 2024-25, the Deputy Minister highlighted the Welsh Government’s continued investment in the Nutrition Skills for Life and Healthy Start programmes, reporting that take-up of Healthy Start vouchers among eligible families is now the best in the UK.
A joined-up, cross-government approach is key however. Evidence received during scrutiny of Peter Fox MS’ Food (Wales) Bill highlighted some areas where Welsh Government policies are misaligned and may actively work against each other. Public Health Wales, for example, pointed to the planning system:
guidance attached to the Town and Country Planning Act in Wales doesn’t enable local authorities to limit fast-food premises, for example, be they around schools or in high density in areas of high levels of obesity.
While government intervention on food and drink often attracts criticism of a ‘nanny state’, the WHO makes the point that supportive environments are fundamental in shaping people’s choices. It emphasises that individual responsibility can only have full effect where the choice of healthier foods and regular physical activity is the easiest choice, i.e. the choice that is the most accessible, available, and affordable.
You can read more about the Health and Social Care Committee’s work on obesity on the inquiry web pages.
Article by Philippa Watkins, Senedd Research, Welsh Parliament
