Home > Living and Working Well > Healthy Lifestyles > Adult obesity

Adult obesity

Last Modified 09/05/2022 12:56:34 Share this page


Obesity is "one of the greatest long-term health challenges this country faces"1: a significant public health concern which results in long-term negative social, psychological and physical consequences. 

In 2019 almost two-thirds (64%) of adults were above a healthy weight, with 28% of the adult population living with obesity. Obesity is associated with reduced life expectancy and is a risk factor for a range of chronic diseases, including cardiovascular disease, type 2 diabetes, at least 12 kinds of cancer, liver and respiratory disease, and obesity can negatively impact mental health1. Excess weight is also a risk factor in relation to COVID-19 health outcomes, with those who are overweight or living with obesity more likely to be admitted to hospital, to an intensive care unit, or to die2.

Higher levels of deprivation are associated with an increased likelihood of obesity in both adults and children1. Obesity is a notoriously difficult condition to reverse once established; four out of five children who are obese go on to become obese adults3 and many adults struggle to lose excess weight, often regaining any weight lost through dieting4. Prevention therefore seems the best approach.

Obesity is not just detrimental at the individual level; it affects overall society and can have economic impacts, by for example, affecting a person's ability to work. Obese people are less likely to be employed, have more difficulty re-entering the labour market, and when in work earn on average about 10% less than non-obese people5. Overall, it has been estimated that the indirect costs of obesity to the UK economy are £27 billion6. It is estimated that overweight and obesity related conditions across the UK cost the NHS £6.1 billion each year, with 900,000 obesity related hospital admissions in 2018/191.

Tackling obesity can help to reduce pressure on doctors and nurses in the NHS. It is estimated that if those who were overweight or living with obesity in the UK population lost 2.5kg (a third of a stone) it could save the NHS £105 Million over the next 5 years1,7.

Obesity develops from an accumulation of excess body fat, which occurs when energy intake from food and drink consumption is greater than energy expenditure through the body's metabolism and physical activity. A commonly used objective measure for the severity of obesity is Body Mass Index (BMI). Figure 1 shows the definitions for the BMI classifications and the proportion of males and females in each across England.

Figure 1: Body Mass Index (BMI) classification and weight status of England population, 2019
 Definition (BMI score) Males Females 
 Underweight  <18.5  1.9% 1.4% 
 Healthy weight  18.5 - 24.9  32.7% 40.4% 
 Overweight  25.0 - 29.9  41.0% 31.4% 
 Obese (exc. morbidly obese)  30.0 - 39.9  22.6% 23.2% 
 Morbidly obese  => 40  1.8% 3.6% 
Source: NHS Digital, Health Survey for England, 2019: Overweight and obesity in adults and children

The National Institute for Health and Clinical Excellence (NICE) guidance on overweight and obesity8 recognises that BMI needs to be interpreted with caution as it is not a direct measure of fat distribution and recommends the use of waist circumference alongside BMI as a more accurate method of measuring overweight and obesity and for assessing the associated health risks for adults.

Figure 2: Waist circumference classification

Figure 2: Waist circumference classification
Source: NICE guidelines [CG43] Obesity prevention, December 2006

The impact of obesity is also discussed in the sections on childhood obesity, healthy eating, diabetes and physical activity.

Facts, figures and trends

There are no definitive data for obesity in adults. In the absence of definitive data, numbers of adults in Blackpool who may be overweight or obese have been estimated using data from the Health Survey for England (HSE). Obesity by age group has been approximated by applying the percentages in each weight category from the 2019 HSE data to the Blackpool population giving the numbers in figure 3.

Figure 3: Estimated number of overweight and obese adults in Blackpool by age group and gender, 2019
 16-24 25-34 35-44 45-54 55-64 65-74 75+Total 
 Overweight 1,769 2,467 2,054  3,208 3,125 2,653 2,327 17,467
 Obese (exc. morbidly obese) 702 1,700 1,983 2,736 2,736 2,313 1,465 13,742
 Morbidly obese 132 542 421 469 469 245 106  2,459 
 Excess weight (overweight and obese) 2,603 4,709 4,457 6,331 6,331 5,212 3,898  33,668
  Overweight  1,705 2,420 2,105  3,219  3,032 2,729 3,159  18,012
  Obese (exc. morbidly obese) 677 1,668 2,033  2,955 2,654 2,380  1,988  14,170
 Morbidly obese 127 531 431 516 455 252 144 2,532 
  Excess weight (overweight and obese) 2,510 4,620  4,570 6,690 6,141 5,361 5,290 34,717 

Source: NHS Digital, Health Survey for England, 2019 and ONS mid-year population estimates, 2019

As figure 3 shows, the numbers of overweight and obese men and women are similar in many age groups. This is a change fom previous years, where there were higher numbers of obese women, and higher numbers of overweight men, reflecting an overall increasing trend in obesity among men. The estimated total number of people classed as overweight in Blackpool is 35,479. The estimated total number obese is 32,906. These extrapolated figures (from HSE), when applied to Blackpool mean that over 65,000 people in Blackpool are likely to be overweight or obese and this is probably an underestimation as Blackpool generally has poorer outcomes when compared to England. The information in figure 3 is shown visually in figure 4.

Figure 4: Estimated number of overweight and obese adults in Blackpool by age group and gender, 2019

OW and obese by age
 Source: NHS Digital, Health Survey for England, 2019 and ONS mid-year population estimates, 2019

As figure 4 shows, the number of overweight and obese in both men and women is highest in the 45-54 and 55-64 age bands, though this is due to the higher population within that age group. It is important to note that these are just raw numbers, so the larger number of women overweight and obese in the older age groups merely reflects that women live longer than men. Proportionally, the percentage of individuals estimated to be obese peaks at 38% for men in 65-74 year age group. For women the proportion of the population who are obese is 33-35% between the ages of 35 and 74, with a peak of 35% between 45-54 years.

Sport England Active Lives Survey

The Sport England Active Lives Survey is the indicator for measuring the population levels of overweight and obesity (excess weight) used by the Public Health Outcomes Framework. Whilst estimates for the periods 2016/17 to 2018/19 were only slightly above national and regional levels, the most recent published data for Blackpool (2019/20) estimates that 71.6% of adults were overweight or obese; this is higher than the HSE data estimates and significantly higher than the estimated national average of 62.8% (Figure 5). This is particularly concerning because, in addition to the long-term impact of obesity and excess weight on life expectancy and other chronic diseases, evidence shows that people who are overweight or obese are more likely to be negatively affected by COVID-191,2. Whilst excess weight data for 2020/21 is not yet available, we know from the Active Lives Survey that levels of physical inactivity in Blackpool rose during the COVID-19 period9, potentially exacerbating already high levels of excess weight.

Figure 5: Estimated percent of overweight and obese adults in Blackpool compared to England and the North West, 2015/16 to 2019/20

 Active Lives OW OB Trend
 Source: PHE Public Health Profiles / Active Lives Survey 2019/20, Sport England

Figure 6 shows the national trends in overweight and obesity from 1993 to 2019. Rates of overweight were similar in 2019 to recent years and rates for men and women have remained fairly stable over the last twenty years. Conversely, obesity prevalence increased steeply between 1993 and around 2000, fluctuating between 24% and 26% between 2006 and 2014 before beginning to rise more sharply again. Severe (morbid) obesity has also increased between 1993-95 and 2017-19, with almost 2.2% of men and 4.5% of women severely obese in 2017-19, from 0.3% of men and 1.5% of women in 1993-9510,11.

Figure 6: Trend in obesity and overweight by gender, England, 1993-2019

Nat trend 93to19
 Source: NHS Digital, Health Survey for England 2019: Adult and child overweight and obesity

Prediction of future trends for obesity from 2011 are worrying for England and of course, Blackpool: By 2030, 41-48% of males and 35-43% of females could be obese12. The research tells us that over the next twenty years, the obesity attributable diabetes risk in the UK is projected to add an excess 544,000 - 668,000 cases of diabetes, 331,000 - 461,000 of coronary heart disease and stroke along with 87,000 - 130,000 cancers. Modelling of morbid obesity predicts that by 2035, 8% of people in England will be morbidly obese, and potentially as high as 13% among English males aged 55-6413. There is no evidence to suggest Blackpool will avoid any such impact from these predictions and this could be exacerbated with the higher number of more deprived parts of the borough.

Socio-economic factors

Nationally, research indicates that obesity is associated with deprivation (greater deprivation equalling higher levels of obesity), especially for women. PHE summarises the data on the relationship between obesity prevalence in adults and socioeconomic status in the English population:

    • Adults living in the most deprived areas are the most likely to be living with obesity. This is most pronounced for women, where 39% of women in the most deprived areas were obese in 2019, compared to 22% in the least deprived areas. For men, 30% of those in the most deprived areas were living with obesity, compared to 22% in the least deprived10.
    • Obesity is highest amongst women in lower income groups, with 33.6% of women in lower supervisory and technical occupations, 31.7% in semi-routine occupations, and 33.2% in routine occupations living with obesity. This compares to 18.4% in higher managerial and professional occupations.
    • For men, the relationship between obesity and socioeconomic status is less strong, and trends are less clear cut. The lowest prevalence, however, remains amongst those in higher managerial and professional occupations (21.9% compared to 30.7% in small employers and 29.6% in routine workers14.

National and local guidance

With renenwed impetus following the impact of COVID-19, the UK Government's 2020 strategy 'Tackling obesity: empowering adults and children to live healthier lives' aims to reduce the numbers of adults living with obesity, halve childhood obesity by 2030 and reduce inequalities. The approach includes:

    •  A new campaign as part of 'Better Health', supported by tools and apps with advice on how to lose weight and keep it off
    • Working to expand weight management services available through the NHS
    • Publishing a UK-wide consultation on food labelling and how people can be supported to make healthy food choices
    • Introducing legislation requiring large food businesses to add calorie labels to the food they sell
    • Consulting on intentions to make companies providing alcohol to include calorie labelling
    • Legislating to end the promotion of foods high in fat, sugar or salt (HFSS) by restricting volume promotions (e.g. buy one get one free)
    • Banning the advertising of HFSS products being shown on TV and online before 9pm and consulting on wider advertising restrictions

The most established piece of clinical guidance relating to adult obesity is the NICE Clinical Guideline CG189 Obesity: identification, assessment and management. It offers evidence-based advice on the care and treatment of obesity and recommendations about low-calorie and very low-calorie diets, bariatric surgery and follow-up care.

This is supported by a range of NICE public health guidance and briefing papers including:

    • CG43 - Obesity prevention (updated March 2015) - guidelines on preventing children, young people and adults becoming overweight or obese across a range of settings.
    • NG7 - Preventing excess weight gain (March 2015) makes recommendations on behaviours that may help people maintain a healthy weight or prevent excess weight gain.
    • PH42 - Obesity: working with local communities (updated June 2017) aims to support effective, sustainable and community-wide action to prevent obesity. It sets out how local communities, with support from local organisations and networks, can achieve this.
    • PH53 - Weight management: lifestyle services for overweight or obese adults (May 2014) makes recommendations on the provision of effective multi-component lifestyle weight management services for adults who are overweight or obese (aged 18 and over). It covers weight management programmes, courses, clubs or groups that aim to change someone's behaviour to reduce their energy intake and encourage them to be physically active.
    • PH27 - Weight management before, during and after pregnancy (July 2010) is for NHS and other commissioners, managers and professionals who have a direct or indirect role in, and responsibility for: women who are pregnant or who are planning a pregnancy and mothers who have had a baby in the last 2 years.
    • LGB9 - Preventing obesity and helping people to manage their weight (May 2013) summarises NICE's recommendations for local authorities and partner organisations on preventing people becoming overweight and obese and helping them to manage their weight. It is particularly relevant to health and wellbeing boards.

[1] Department of Health and Social Care, Tackling obesity: empowering adults and children to live healthier lives (policy paper), July 2020.

[2] Public Health England (2020) Excess Weight and COVID-19: Insights from new evidence.

[3] Nader P et al (2006) Identifying Risk for Obesity in Early Childhood. Paediatrics, 2006 Sep: 118(3): e594-601

[4] Fildes A., #charlotin, J., Rudisill, C., Littlejohns, P., Prevost, A.T. & Gulliford, M.C. (2015)  Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. American Journal of Public Health, 2015 Sep;105(9):e54-9. doi: 10.2105/AJPH.2015.302773.

[5] Organisation for Economic Co-operation and Development (OECD). Obesity Update 2017

[6] Public Health England (2017) Health Matters: obesity and the food enviornment.

 [7] Kent, S., Aveyard, P., Astbury, N., Mihaylova, B. and Jebb, S.A. (2019) Is Doctor Referral to a Low‐Energy Total Diet Replacement Program Cost‐Effective for the Routine Treatment of Obesity?. Obesity, 27: 391-398. https://doi.org/10.1002/oby.22407. 

[8] NICE guidelines [CG43] Obesity prevention, December 2006, Updated March 2015.

[9] Sport England. Active Lives Survey 2020-21.

[10] NHS Digital, Health Survey for England 2019, 15th December 2020.

[11] UK Health Security Agency. Patterns and trends in excess weight among adults in England. March 2021.

[12] Wang, Y.C., McPherson, K., Marsh, T., Gortmaker, S.L. and Brown, M. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011 Aug 27;378(9793):815-25. doi: 10.1016/S0140-6736(11)60814-3.

[13] Keaver, L., Benshuai, X., Jaccard, A., & Webber, L. (2020) Morbid obesity in the UK: A modelling projection study to 2035. Scandanavian Journal of Public Health, 2020 Jun;48(4):422-427. doi: 10.1177/1403494818794814.

[14] Public Health England, Health Survey for England: Adult obesity prevalence by National Statistics Socio-economic classification (2013-2017), September 2020.