Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLANDAppendix 5 Thehuman costs of obesity1 Obese people are more likely to suffer from a number ofserious chronic diseases, many of which are lifelimiting.Besides the physical effects, the psychologicaland social burdens of obesity can also be debilitating.Diseases associated with obesityCoronary heart disease2 The most common cause of premature mortality amongobese people is coronary heart disease. Our work onthe costs of obesity in 1998 (the latest year for whichdata were available) suggests that approximately28,000 people in England suffered a heart attackin that year that was directly attributable to obesity(Appendix 6).3 In women, obesity is the third most powerful predictorof cardiovascular disease (after age and blood pressure).This is in part because it is strongly associated with otherimportant risk factors for heart disease such as highblood pressure and high cholesterol. The risk of heartattack for an obese woman is approximately three timesthat of a lean woman of the same age 44 .Osteoarthritis6 Osteoarthritis, or degenerative disease of the weightbearingjoints such as the knee, is a very commoncomplication of obesity, which causes a great deal ofdisability 47 . Pain in the lower back is also frequentlysuffered by obese people, and may be one of the majorcontributors to obesity-related absences from work. It islikely that the excess weight alone, rather than anymetabolic affect, is the cause of these problems.Respiratory disease7 Many respiratory disorders are related to obesity, themost serious of which is obstructive sleep apnoea.Sufferers experience the intermittent cessation ofbreathing during sleep, which causes broken sleeppatterns and may contribute to high blood pressure andheart disease 48 .Reproductive disorders8 Obese people of both sexes are more likely to sufferreproductive disorders, and for obese women there is anincreased risk of complications during pregnancy. 49Type 2 diabetes4 Of all serious diseases, Type 2 diabetes has the strongestassociation with obesity 10 . The metabolic problemswhich give rise to this type of diabetes most commonlyoccur as a result of excess weight. Indeed, the risk ofdeveloping Type 2 diabetes rises with increasing bodymass index well below the threshold of clinical obesity.Women who are obese are 12 times more likely todevelop non-insulin dependent diabetes than women ofa healthy weight. Diabetes itself predisposes people tohigh blood pressure and heart disease 45 .Cancer5 The link between obesity and cancer is less welldefined.Research suggests that the risk of a number ofcancers is increased by obesity, including: breast cancerand cancer of the endometrium, uterus, cervix, ovaryand gall-bladder in women; and cancer of the rectumand prostate in men 46 . The clearest association is withcancer of the colon, for which obesity increases the riskby nearly three times in both men and women.Social and psychological penaltiesStigmatisation9 In studies that have examined the reactions ofschoolchildren to various forms of physical disabilityand obesity, obese children were consistently rated theleast attractive by their peers. In one study of obeseschoolgirls, obesity was rated a social stigma by78 per cent of girls in the healthy weight range, and62 per cent of overweight girls 50 . Obese girls wereperceived by their peers to be less active, less attractive,less healthy, weak-willed and having inferior physicalabilities and poor self-control regarding dietary habits.10 Another study noted that in affluent societies, obesepeople are subject to intense prejudice anddiscrimination, and that children as young as sixdescribe obese children as "lazy, dirty, stupid, ugly,cheats and liars" 51 . Thus, the stigma of overweightappears to have two aspects: stigmatisation of theappearance of the body and stigmatisation of thecharacter of the person for the perceived moral failure ofnot controlling one's weight.appendix five55