Smokers and obese patients face more curbs on NHS surgery

NHS bosses are planning a massive expansion of the controversial rationing that forces smokers and obese patients to wait months in pain before they can have surgery, a leaked letter reveals.

The move will see local NHS bodies across England implement restrictions on access to treatment that will hit what doctors’ leaders believe will be tens of thousands of patients.

The plan is disclosed in a letter sent on 15 March by Dr David Black, NHS England’s medical director for Yorkshire and the Humber, to Rotherham Clinical Commissioning Group (CCG). In it, he praises the GP-led group that controls the NHS budget for treating the town’s residents for introducing what critics call “lifestyle rationing”, which compels dangerously overweight patients or those who smoke to wait for hip or knee surgery. “We are very supportive of your work to best manage resources for the benefit of all patients and understand that this may mean that difficult decisions need to be made,” Black wrote.

And he added: “We expect that many CCGs will be in the process of developing similar schemes and initiatives to deliver plans for 2017-19. This is something we would encourage, where plans are well developed and clinically validated.” He then told the CCG to give him four weeks’ warning of any further plans “to change access thresholds” so that NHS England can prepare for the fallout.

The move has triggered a storm of protest, with ex-health minister Norman Lamb warning that condemning patients to long, painful delays for care is destroying the NHS’s fundamental principles and obliging those affected to pay for private treatment.

“This is yet more evidence of the creeping advance of rationing. Guidance based purely on medical judgment on weight loss is fine, but what is happening around the country goes well beyond that in practice. It will inevitably result in those people with money paying for speedy treatment, while everyone else is left waiting,” said Lamb, who is the Liberal Democrats’ health spokesman.

“We are seeing, bit by bit, the destruction of the solidarity that this country has been so proud of with the NHS – the idea that whatever your income or wealth, you get access to the care you need, in your hour of need,” he added.

Labour claimed that underfunding of the NHS lay behind the extension of rationing. “This secret memo from NHS chiefs reveals the truth of what’s happening to the NHS under the Tories – more and more rationing of treatments. People will be waiting longer and longer in pain and discomfort for surgery such as hip and knee replacements,” said Jonathan Ashworth, the shadow health secretary. “There is now a very clear choice in this election. Cuts, longer waiting times and restrictions on treatment under the Tories, or Labour, who will return our NHS to its founding principle of universal provision, free at the point of need, with best quality of care for all,” he added.

As many as one in five patients awaiting a hip or knee operation ends up being denied surgery for months after such schemes are introduced, it emerged last week. Seventy-nine out of 408 patients needing a knee replacement in Scarborough and Ryedale, and also in Yorkshire, have not been referred to hospital for the procedure since the CCG brought in that policy last November. The 79 have been told to lose weight or stop smoking during the delay – which the CCG calls “a six-month period of health optimisation” – before they have their surgery.

The figures, uncovered by the Yorkshire Post, led the Royal College of Surgeons to claim that “it is disgraceful that one in five patients is having … surgery delayed for at least six months based on what are, frankly, arbitrary criteria.”

Ian Eardley, the college’s vice-president, told the Observer: “It is deeply concerning that one in five patients are now being denied immediate surgery because they smoke or are deemed obese. There is no medical evidence to justify restricting referrals for entire groups of patients; it is effectively a form of discrimination. These figures are just the tip of the iceberg as we know that over a third of commissioning bodies are pursuing similar policies, meaning tens of thousands of patients across the country are facing restrictions on their surgery.”

Patients denied hip or knee surgery can end up in severe pain or have trouble walking, “making it near impossible for them to lose the required weight to allow them to access surgery in the future. Patients need all of the support they can get to lose weight or to stop smoking, but removing their rights to timely NHS surgical care will obviously not achieve this,” he added. Eardley called on all political parties to make it clear during the election campaign that they do not think the NHS should impose such restrictions on those who are obese or who smoke.

Smokers and obese patients face more curbs on NHS surgery

Three genes could explain why some people are obese but healthy, say scientists

Scientists have offered a genetic explanation for why some people are obese and healthy while others develop diabetes and heart disease as a result of their weight.

The study identified three genes, which appear to influence whether fat is compartmentalised and stored around the outside of the body or whether it spills into the circulatory system. Higher levels of fat in the blood supply increase the risk of type 2 diabetes and can lead to fatty deposits around the heart and liver.

Professor Haja Kadarmideen, a geneticist who led the work at the University of Copenhagen, said: “People who have the ability to store large amounts of fat are able to be fat, but not unhealthy.”

Previous studies have found that while being overweight or obese is a risk factor for diabetes, liver disease and heart disease, about 15-20% of those who are obese appear to suffer no health consequences.

Other research, involving more than 100,000 adults in Denmark, found that those with an “overweight” body mass index (or BMI) were more likely to live longer than those in the “healthy”, “underweight”, and “obese” categories, suggesting that the relationship between weight, health and lifespan is not straightforward.

“We wanted to ask what is it that allows some people to be overweight and remain healthy,” said Kadarmideen.

The findings suggest that an individual’s genetic makeup influences the weight threshold at which health problems begin to emerge – and for some people this will fall outside a “healthy” body mass index (BMI), as defined by public health guidelines. Conversely, a small proportion of people within the healthy BMI range are so-called TOFIs (thin on the outside, fat on the inside) and develop metabolic problems normally associated with obesity.

The study involved 60 men and women, all of whom were morbidly obese (average BMI of over 45), half of whom had metabolic disease and half of whom were healthy. The participants were all undergoing elective bariatric surgery.

The scientists scanned tens of thousands of genes for variations between the two groups. They identified three genes that showed very different profiles between the two groups, both in terms of the gene activity and the underlying genetic sequence. When the activity of the genes was examined more closely in fat and tissue samples, the scientists concluded that the genes played a significant role in regulating how fat is transported and stored in cells. The team are now hoping to replicate the findings in a larger population study.

In the future, it may be possible to give personalised estimates for a healthy BMI based on a person’s genetic profile and other biomarkers, the scientists said. “This paves the way for being able to diagnose, develop drugs and target treatment at the specific genes,” said Kadarmideen.

He added that the findings should not be interpreted as an excuse for abandoning guidelines for a balanced diet or forgoing exercise, because these lifestyle factors have an impact on health, regardless of a person’s weight.

The findings are published in the journal PLOS One.

Three genes could explain why some people are obese but healthy, say scientists

GPs should not worry about offending obese patients, finds study

GPs who raise the issue of their patients’ obesity in the surgery will not offend them and are likely to help them reach a healthy weight, a new study has shown.

Doctors are notoriously nervous of telling people they are overweight and worry that initiating any discussion will lead to a long, fruitless conversation about failed diets and eating habits that will go on long beyond a 10-minute consultation.

But a trial of a 30-second intervention in which the GP suggests the patient’s weight may be affecting their health and offers them a place on a weigh-loss programme reveals advice can make a major difference, according to research published in the Lancet medical journal.

More than 130 GPs who took part in the trial, involving more than 1,800 patients, were asked to start a conversation that might go like this:

GP: While you’re here, I just wanted to talk about your weight. You know the best way to lose weight is to go to [a weigh-management programme such as Slimming World or Rosemary Conley] and that’s available free on the NHS?

Patient: Oh?

GP: Yes, and I can refer you now if you are willing to give that a try?

The patients were randomly assigned to be offered either an NHS-funded place on a 12-week weight-management programme or advice to lose weight. The researchers found that 77% of those offered a weight-management programme said yes, and 40% went to all the sessions. At the end of a year, those people had lost 2.43kg (0.38 stone) on average, while those given advice by the GP had also lost weight, but less, at an average of 1.04kg.

Prof Paul Aveyard from the University of Oxford, who is a practising GP, said GPs do not talk to patients about their weight unless that is the reason they have come to the surgery. “We weigh people and that’s it. Whereas with smoking, every time we see them, once a year, we have to tell them effective ways to stop smoking,” he said.

Trials from the 1970s had shown that if GPs tackled people about smoking, they were more likely to quit. But this is the first study to see whether it works in obesity too, he said.

“GPs worry a lot about offending people. It is a very personal thing. Secondly, they do worry that the conversation will go on a long time and not actually lead anywhere,” he said.

There was also the wish not to take on one more of society’s ills, Aveyard said. “The GP might easily say this is more than my job is about,” he added.

Although weight management programmes can be prescribed for free for those who need them on the NHS, patients are usually left to make their own arrangements. In the trial, patients left with a voucher and an appointment for the first of their 12 free sessions. More than half went to practically all of them, said Aveyard.

The average BMI of those in the trial was 35 – a BMI of over 35 is considered severely obese – which meant that people needed to lose 20 to 30 kilos to get down to a healthy weight. Obesity can lead to type 2 diabetes, heart problems, stroke and cancer.

Even losing a few kilos can make a difference to people’s health. Slow and steady progress in bringing weight down is the goal of programmes which aim to change people’s attitudes to food as well as what they eat. The rapid weight-loss from most conventional diets is short-lived and people tend to put it on again once the diet ends.

Dr Iain Turnbull, a GP in Swindon who took part in the trial, said one of the main reasons they do not mention weight when somebody arrives with a cough or a chest infection is constraint on time. “We don’t really have the opportunity to talk to them about weight management on top of everything else,” he said. “The reality of modern GP practice is that it is a terrifically high-pressured and time-intensive specialty.”

But the study enabled him to keep the discussion brief and his patients were not offended. “I didn’t have any negative feedback from patients. They seemed quite pleased that I’d brought up the issue.”

Paul Cooper from Northampton weighed 96 kg when his GP brought up the issue as part of the trial. “I couldn’t see my feet,” he said. In his case it was easier, as he was diagnosed with type 2 diabetes at the consultation. He chose not to go on a weight-management programme, but tackled his diet using a fitness app instead and is now 84 kg and continuing to lose weight in what he hopes is a sustainable manner.

He was not angered by the GP telling him his weight was a problem. “Personally I think the doctor is the only person you would accept it from,” he said.

Boyd Swinburne and Bruce Arroll from the University of Auckland in Australia have said the study calls for a rethink of how obesity is tackled in primary care everywhere. “It is surprising that this is the first study in primary care to investigate a brief intervention for obesity, perhaps reflecting the nihilism about weight loss that pervades medical care,” they write.

Tam Fry, spokesman for the National Obesity Forum, said: “The paper effectively runs a coach and horses through the excuses that GPs in general have trotted out when challenged to talk to their patients about losing weight. Their principal argument has been that it’s pointless since no good weight-loss programmes exist. Nonsense. They do and have done so for years.

“Now that the evidence is out in the open, family doctors should take action to prevent obesity and weight-related health problems that clog up their waiting rooms.”

Dr Alison Tedstone, the chief nutritionist at Public Health England, said: “It’s important that GPs talk to their overweight and obese patients about losing weight and help them to find further support, as many do already. An extra 30 seconds could make all the difference; it doesn’t take long and can be raised in a supportive and sensitive manner.”

GPs should not worry about offending obese patients, finds study

More babies face health risks due to obese parents, experts warn

A growing number of babies worldwide are at risk of brain damage or having a stroke, heart attack or asthma in adulthood because their mother was obese, health experts have warned.

Leading doctors said dangerously overweight mothers were passing on obesity to their children as the result of “a vicious cycle” in which excess weight can seriously affect the health of parents and their offspring.

Four studies published in the Lancet Diabetes and Endocrinology make clear that the risks of maternal obesity include stillbirth, dangerously high blood pressure in pregnant women, diabetes in the mother or child, and complications during childbirth.

The scale of obesity in women of childbearing age and the consequent dangers to health were so great that urgent action was needed to ensure women were a normal weight before they conceived, the authors say.

Mothers being very heavily overweight could lead to their children having autism or attention deficit hyperactivity disorder or developing cancer in later life, the researchers say.

British women have the highest rates of obesity in Europe. One in five women in the UK who became pregnant were already obese, while in England, 26% of 35- to 44-year-old women were obese in 2013, as were 18% of those aged 24-35.

UK obesity rates

Rates are even higher elsewhere. In the United States, 32% of women of peak childbearing age, between 20 and 39, were obese in 2011-12, and 60% of American women were either overweight or obese when they conceived, according to one study.

Prof Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, which represents 14,000 doctors working in Britain and worldwide who specialise in childbirth and women’s health, said: “Obesity has reached pandemic proportions globally and its origins start in the womb. In the UK, the prevalence of obesity is over 25% in both women and men. Around one in five pregnant women are obese, increasing their risk of miscarriage, stillbirth and neonatal death as well as gestational diabetes, blood clots, pre-eclampsia, more complicated labours and severe bleeding after the birth.”

The international team of experts behind the studies said they feared that the problem, which is worst in developed countries, would escalate further because one in five (21%) women in the world are projected to be dangerously overweight by 2025.

One of the research papers, which have reviewed hundreds of previous obesity studies, warned: “The long-term effects of maternal obesity could have profound public health implications.” Another concluded that maternal obesity was spreading so fast, especially in western countries, that governments should start treating it as a global public health priority.

One of the research reviews, led by Prof Keith Godfrey of Southampton University, detailed the range of serious health problems that excess maternal weight could have on a child and pointed out that fathers’ weight could also increase the risks.

“Increasing evidence implicates maternal obesity as a major determinant of offspring health during childhood and later adult life,” the review states, adding that it heightened the child’s risk of obesity, coronary heart disease, stroke, type 2 diabetes and asthma. Maternal obesity could also lead to poorer cognitive performance and increased risk of neurodevelopmental disorders, including cerebral palsy.

An unborn child’s brain could be damaged because “obesity in pregnancy is associated with complex neuroendocrine, metabolic, immune and inflammatory changes, which probably affect foetal hormonal exposure and nutrient supply,” Godfrey’s paper explains.

The key lies in “eipgenetic processes by which aspects of parental (both mother’s and father’s) lifestyle can affect the way the baby’s genes operate during development. These can change the person’s responses to the challenges of, for example, living in an ‘obesogenic’ environment,” it adds.

The National Institute for Health and Care Excellence advises women who may become pregnant to eat healthily, exercise for at least 30 minutes a day and try to maintain a healthy weight.

Each obese woman who gave birth in Britain cost the NHS £500 to £1,000 more than a mother of a normal weight, said Prof Rebecca Reynolds, of Edinburgh University.

However, the authors drew few firm conclusions in their search for ways to address and prevent maternal obesity and found limited evidence that specific interventions were effective.

“We know that there are going to be more and more obese people in years to come, so there will be passage of obesity from one generation to the next, even though no parent who is obese wants their child to suffer from it too,” said Prof Mark Hanson, of Southampton University, another co-author.

He recommended that overweight women be given more information and guidance from health professionals before they conceived or after they had given birth to help them lose weight, especially before they had any more children.

Bariatric surgery undertaken before an obese woman conceived could benefit both her and her baby’s health, the authors found, though anyone who has the operation should wait for up to 18 months afterwards before giving birth.

“Women who are overweight when entering pregnancy or who gain excess weight during pregnancy may well establish an inter-generational amplification of the obesity epidemic,” said Dr Tim Lobstein, director of policy at the World Obesity Federation.

“There is international agreement at United Nations level to halt the rising prevalence of obesity and diabetes across the globe. However, turning an ambitious target into practical action is proving elusive.

“There are well-recognised but well-embedded systemic problems to resolve, such as the increasingly commercialised food supply, the dominance of motorised transport, the development of dense and hazardous urban environments, or the enticements of sedentary screen-watching,” he said.

More babies face health risks due to obese parents, experts warn

Plans to deny surgery to obese patients and smokers put on hold

A health authority that suggested it would deny non-life-threatening surgery to the obese and smokers has said it will put its proposals on hold.

The plans by Vale of York clinical commissioning group (CCG) could have meant that patients who exceed a body mass index (BMI) of 30 would face delays in receiving some NHS surgery for up to a year.

Leading medics have warned that it could become part of a growing trend in hospitals that could result in overweight patients being denied elective medical procedures in a bid to cut costs.

The restrictions were described as the “most severe” policy the modern NHS has seen by the Royal College of Surgeons (RCS).

But the North Yorkshire authority said it had been asked to review the plans by NHS England. It said in a statement: “NHS England has today asked us to review the draft approach, which we will now do, and will hold off implementing anything until we have an agreed way forward.

“We will ensure any plans are implemented in line with national guidance, are in the best interests of our patients and are clinically robust.”

A spokesman for NHS England said denying operations to a particular group – such as smokers – was “inconsistent” with the NHS constitution.

“Major surgery poses much higher risks for severely overweight patients who smoke. So local GP-led clinical commissioning groups are entirely right to ensure these patients first get support to lose weight and try and stop smoking before their hip or knee operation.

“Reducing obesity and cutting smoking not only benefits patients, but saves the NHS and taxpayers millions of pounds.

“This does not and cannot mean blanket bans on particular patients such as smokers getting operations, which would be inconsistent with the NHS constitution.

“Vale of York CCG is currently under special measures legal direction, and NHS England is today asking it to review its proposed approach before it takes effect to ensure it is proportionate, clinically reasonable and consistent with applicable national clinical guidelines.”

The report by the CCG said obese patients may secure a referral in less than a year if they shed 10% of their weight. Similarly, if smokers refuse to quit they faced having procedures delayed for up to six months, which can be accelerated if they quit their habit for eight weeks.

News of the proposed rationing sparked criticism from the former health minister Norman Lamb, who said it was “outrageous”.

NHS Providers, which represents NHS leaders, said similar proposals were likely to follow in future.

A spokesman said a number of considerations are taken by health services outside of costs when considering the decision to operate, but added: “However, given that we are in the middle of the longest and deepest financial squeeze in the NHS’s history, we are likely to see more decisions like this in future.”

In April, the RCS found almost a third of CCGs have one or more mandatory policies on BMI level, stopping overweight or obese patients being referred for routine surgery. Cancer patients are not included within the scope of such policies.

Body mass index, which relates to a person’s weight and height, is used by experts to define overweight and obese limits.

Those with a BMI of 30 to 35 and above are said to be moderately obese, while someone whose BMI is higher than 40 is classified as severely obese.

The president of the RCS, Clare Marx, said: “The policies being introduced by Vale of York CCG are some of the most severe the modern NHS has ever seen.

“We would support any attempts by Vale of York to expand its weight-loss and smoking-cessation programmes, but introducing blanket bans that delay patients’ access to what can be life-changing surgery for up to a year is wrong.”

Lamb, a Liberal Democrat who served as minister for state care and support in the Department of Health between 2012 and 2015, said: “Any rationing not based on clinical need is outrageous. But it is caused by the Conservative government persisting with plans to reduce the share of our national income spent on the NHS.”

Plans to deny surgery to obese patients and smokers put on hold

Hospitals to cut costs by denying surgery to smokers and the obese

Smokers and obese people will increasingly be denied surgery on the NHS as hospital managers cut costs to deal with financial restraints, prominent health service figures have warned.

The prediction came as one health authority said it would make people wait up to a year for elective surgery for conditions that are not life-threatening if their body mass index (BMI) – which measures weight in relation to height – was 30 or greater.

To score a BMI of 30, a man of average height in Britain – 5ft 10in – would have to weigh 15 stone. A woman of average height (5ft 5in) would have to weigh 12 stone 12lb.

Vale of York clinical commissioning group (CCG) said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”.

But the Royal College of Surgeons (RCS) warned that it was a dangerous move that ranked among the “most severe the modern NHS has ever seen”.

Its president, Clare Marx, said that while the RCS supports helping people to lose weight and stop smoking, “introducing blanket bans that delay patients’ access to what can be life-changing surgery for up to a year is wrong”.

She added: “As the true scale of financial pressure on NHS trusts has become clear over the summer, we are fast finding ourselves in a situation where CCGs are introducing draconian commissioning policies, often flouting Nice [National Institute for Health and Care Excellence] or other clinical guidance, in order to balance the books.

“An honest national debate on exactly what the NHS can afford, and what we are willing to pay, is urgently needed.”

Chris Hopson, the head of NHS Providers – which represents acute care, ambulance and community services – told the Daily Telegraph: “I think we are going to see more and more decisions like this.

“It’s the only way providers are going to be able to balance their books, and in a way you have to applaud their honesty. You can see why they’re doing this – the service is bursting at the seams.”

In a statement released on Friday, Vale of York CCG said: “The local system is under severe pressure. This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it.”

Policy documents produced by bosses in the North Yorkshire authority make clear that adult smokers will have elective surgery postponed “for six months or until they’ve stopped smoking for eight weeks”.

And, for people whose BMI is 30 or more – who are defined as obese – such treatment will be put back a year “or until 10% of weight loss is achieved, whichever is the sooner”.

The CCG added that, in either case, “patients undergoing surgery for cancer will not be affected” and its clinicians would “identify other groups of patients who should be exceptions to the policy”.

In March last year, it was reported that the vast majority of NHS authorities were placing restrictions on access to surgery for overweight people, including one CCG that was refusing all routine surgery to people whose BMI was 35 or greater – those defined as morbidly obese.

The investigation by GP magazine also found that most of England’s CCGs were denying some treatments to smokers.

Hospitals to cut costs by denying surgery to smokers and the obese

Minimal-calorie diet plans ought to be scrapped for the obese, health watchdog warns

Extremely low-calorie diet plans must be scrapped for the obese, the well being watchdog has explained, as it warned diet plans this kind of as the 5:2 really do not operate.

The National Institute for Well being and Care Excellence (Great) said obese individuals on restrictive diet plans should be warned they are most likely to regain excess weight and are at chance of developing an consuming disorder.

Any obese particular person needing to swiftly drop fat (for example for joint replacement surgical treatment) ought to be presented counselling and comply with a reduced-calorie diet program for a highest of ten weeks, in accordance to new draft guidance.

The quantity of people following really minimal-calorie diets, consuming significantly less than 800 kcal a day, has grown in recent years. Diet programs such as the 5:two program, which involves restrictions for two non-consecutive days a week and unconstrained eating the other 5 days, have also elevated in recognition.

The advisable consumption is two,000 kcal for women and 2,500 kcal for guys day-to-day.

Prof Mark Baker mentioned: “Very reduced-calorie diets have grown in reputation in current years, so we now have far more evidence to consider how properly they operate, if the fat reduction can be sustained and the security worries, than we did in 2006.

“The new draft guidance now suggests that they must not be employed routinely for individuals who are obese, only people who have who have a clinical need to drop weight swiftly, such as before joint substitute surgical procedure.”

Minimal-calorie diet plans ought to be scrapped for the obese, health watchdog warns

Soldiers discharged from the Army for being obese

Tam Fry, a board member of the National Obesity Forum, described the findings as “deeply worrying” and warned British troops were now facing the same problems as the US military.

In America, nearly half of all soldiers on active duty are overweight, with 19 per cent obese, according to an official report published last year.

Mr Fry said: “It should be as concerning to the taxpayer as to the military that British personnel are being discharged because of obesity.

“The forces have every opportunity to keep their men and women in shape – that’s what boot camps are for – but they appear no better than civilian governments in maintaining their population’s fitness.

“It should be no comfort to us either that, from figures released this month, the same problem confronts the US military.

“In Washington generals are dubbing the crisis a national emergency.”

The latest figures have been released just months after it was revealed the Royal Regiment of Scotland is blighted by unfit soldiers.

Troops serving within the prestigious regiment have failed fitness tests 630 times in the past three years.

The Royal Highland Fusiliers were the worst hit, with soldiers failing tests involving timed runs, press-ups and sit-ups, 170 times.

The Black Watch were the next worst affected, with soldiers failing the two-minute tests 120 times.

The MoD said troops who fail are told to take more physical training. Only in extreme cases does failure result in discharge from the army.

A spokeswoman for the MoD said it is a condition of service that all solders are healthy and fitter than the general public.

She said: “Overall obesity levels within the army are consistently lower than in civilian life. All individuals are assessed on their ability to carry out military activities rather than on their weight.”

She added that information of soldiers released on medical grounds would be published next month.

Soldiers discharged from the Army for being obese

United kingdom amid worst in western Europe for degree of overweight and obese folks

67% of males and 57% of girls in the United kingdom are both obese or obese, the Global Burden of Disease review identified. Photograph: Choose and Mix Pictures/Alamy

The United kingdom has increased amounts of weight problems and overweight individuals than anyplace in western Europe except for Iceland and Malta, according to an authoritative global study that raises fresh concerns about the probably health consequences.

In the United kingdom, 67% of guys and 57% of girls are both obese or obese, according to the Global Burden of Condition review, published in the Lancet medical journal. Far more than a quarter of youngsters are also overweight or obese – 26% of boys and 29% of ladies.

The study, which makes use of data from 1980 to 2013, found that the variety of overweight and obese people in the planet had surged in the past 3 decades. About two.1 billion folks – practically 30% of the population of the planet – are obese or obese, raising the risk of diabetes, heart disease and cancers. Though the rise in obesity rates would seem to be slowing in some nations, it has but to be reversed in any.

“Weight problems is an problem affecting folks of all ages and incomes, everywhere,” mentioned Dr Christopher Murray, director of the Institute of Wellness Metrics and Evaluation (IHME) in Seattle and a co-founder of the International Burden of Illness review.

“In the last three decades, not one particular country has attained success in decreasing obesity prices, and we assume obesity to rise steadily as incomes rise in minimal- and middle-revenue nations in certain, unless of course urgent measures are taken to tackle this public overall health crisis.”

In western Europe, the Uk lags behind only Iceland, with 74% of men and 61% of women obese or obese, and Malta, on 74% and 58% respectively.

Weight problems alone – defined as a physique mass index (BMI) of 30 or far more, whilst obese is BMI of above 25 – improved by 10% in the United kingdom in excess of the past 3 decades, the review finds. There was a slight drop in the numbers of obese people among 1980 and 1986, prior to it began to rise steadily. About a quarter of the United kingdom population is now obese. The peak age for young children is among ages 5 and 9, when about 10% are obese. Amongst adults, it is at 60-64, when a third of males and ladies are obese. “In spite of the important advancements that the United Kingdom has produced in public health more than the final 30 many years, we have not been immune to this global trend,” mentioned Dr Ivy Shiue, assistant professor at Heriot-Watt University, Edinburgh, and an author of the study. “The rapid boost in youngster weight problems is notably disturbing, as becoming overweight at a youthful age can set children up for a lifetime of poor health.”

There is concern about the rising amounts of weight problems between kids in the establishing globe too, in which under-nutrition is occasionally replaced by the wrong sort of nutrition – the arrival of the substantial-fat, higher-sugar diet eaten in affluent countries. Practically 13% of the two boys and girls across the building planet are now overweight or obese, with especially high charges amongst ladies in north Africa and the Middle East.

“The rise in weight problems amid youngsters is specifically troubling in so a lot of low- and middle-revenue countries,” stated Marie Ng, assistant professor of international wellness at IHME and the paper’s lead author. “We know that there are extreme downstream well being results from childhood obesity, including cardiovascular ailment, diabetes, and a lot of cancers. We want to be thinking now about how to turn this trend around.”

Far more than half of the world’s 671 million obese men and women (as opposed to obese and obese) live in 10 populous nations. Ranked from the biggest numbers to the least, they are the United States, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia.

There are numerous countries, including Kuwait, Libya, Qatar and Samoa, the place much more than half the female population is obese. In Tonga, half the male and half the female population is obese. In South Africa, 42% of girls are obese.

“No nations had considerable decreases in obesity in the previous 33 years,” the authors publish. “This raises the question as to whether many or most countries are on a trajectory to attain the substantial charges of weight problems observed in countries this kind of as Tonga or Kuwait.”

There is evidence of a slowdown in some created nations, foremost to hope that the epidemic may possibly have peaked there, but, mentioned Murray, that is no cause for complacency. “Levelling off is just not very good sufficient,” he informed the Guardian.

“That would be like us saying it’s Ok if we end the boost in smoking. Plainly we need to bring down obesity if we want to assist individuals have healthier, much more active lives.”The paper calls for a lot more action. “Urgent worldwide leadership is essential to support nations to a lot more properly intervene against main determinants such as extreme caloric consumption, physical inactivity, and lively promotion of foods consumption by business, all of which exacerbate an already problematic obesogenic atmosphere,” the authors compose.

United kingdom amid worst in western Europe for degree of overweight and obese folks

How obese is the United kingdom? and how does it evaluate to other countries?

Virtually two-thirds of males and women in the Uk are obese or obese, according to new evaluation of obese and weight problems information carried out by Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The examine which appears at information from 1980 to 2013, claims that far more folks in the United kingdom are either obese or obese than at any other time in the past three decades. The United kingdom, it says, has the third-highest charge of extra weight in western Europe behind Iceland and Malta.

67% of guys and 57% of girls in the Uk are overweight or obese in accordance to the examine which employs a Entire body Mass Index (BMI) of above 25 to define ‘overweight’ and a BMI of thirty or much more to define ‘obese’.

Researchers identified that overweight and weight problems among youngsters and adolescents is also a growing issue in the Uk. The study identified 26% of boys and 29% of girls were obese or obese, compared to 17.5% and 21% in 1980.

The analysis of trend information from 188 nations, discovered that worldwide, the proportion of male grownups with a BMI of 25 or far more, elevated from 29% in 1980 to 37% in 2013 even though the proportion of female adults with the BMI stated over, increased from 30% to 38% in excess of the same period.

Researchers also highlighted a considerable enhance in the prevalence of extra bodyweight in youngsters and adolescents in designed countries – 24% of boys and 23% of ladies around the world had been obese or obese in 2013.

The table at the finish of this post shows obese and weight problems costs by country and gender. You can discover the total data in the downloadable spreadsheet.

Click right here to investigate the IHME’s instrument which shows information on prevalence of obese and obesity by nation and more than time. Photograph: /IHME

What is BMI? and why is it used to measure obesity?

BMI is calculated by dividing a person’s excess weight in kilograms by the square of their height in meters (kg/m2). It is generally employed to classify obese and weight problems in adults.

BMI as a measure of weight problems has prolonged been a sizzling subject of debate, with critics arguing that it does not distinguish between unwanted fat and muscle and questioning its validity as a useful way to measure whether or not a man or woman is obese or not.

Nick Trefethen, professor of numerical analysis at the University of Oxford even proposed a ‘new BMI formula’ in 2013.

The Globe Well being Organisation provide a helpful explanation of why BMI is a well-known approach to measure extra excess weight but also why caution ought to be expressed:

BMI provides the most useful population-degree measure of obese and weight problems as it is the exact same for each sexes and for all ages of adults. However, it need to be regarded as a rough guidebook because it could not correspond to the identical degree of fatness in various people.

The National Health Observatory (NHO) identify BMI as an “eye-catching measure since it is an easy, inexpensive and non-invasive indicates of assessing extra body fat” whilst “true measures of physique excess fat are impractical or high-priced to use at population degree”. The NHO do note the draw breaks of it even though:

It is only a proxy indicator of entire body fatness elements such as fitness (muscle mass), ethnic origin and puberty can alter the relationship between BMI and body fatness. Consequently, BMI might not be an exact device for assessing weight status at an personal level, and other ways of measuring physique composition could be much more useful and precise.

BMI does not supply any indication of the distribution of body excess fat and does not fully alter for the results of height or physique form, which might be notably critical when comparing figures across ethnic groups.

However it argues that:

The widespread use of BMI and the resulting supporting literature indicate that extremely convincing arguments would be essential to move to program use of any other index of fatness…investigation has shown that people whose BMI falls into the overweight or obese categories are a lot more probably to knowledge well being issues associated with excess weight.

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How obese is the United kingdom? and how does it evaluate to other countries?

Must GPs send obese patients to slimming clubs?

The Nationwide Institute for Wellness and Care Excellence (Great) has advisable that the NHS give totally free slimming clubs for individuals looking to shed excess weight. They say programmes such as Fat Watchers could be utilised by the NHS as component of the drive to help the public slim down. Should slimming clubs be incorporated in NHS remedy?

Must GPs send obese patients to slimming clubs?

Staying slim for the duration of pregnancy "risks obese children"

Ladies who really do not put on adequate weight whilst they are pregnant could boost their odds of raising an obese child, a review has recommended.

The US examine identified that a child whose mother’s fat in pregnancy was either above or below the advisable degree was at biggest chance of weight problems.

Researchers who examined the health-related information of mothers and young children in California identified that amid all ladies who gained more than the suggested excess weight throughout pregnancy, twenty.4 per cent of their kids were obese or obese, compared with 19.5 per cent among ladies who gained less than recommended excess weight.

For females who acquired weight within the suggestions, the figure was 14.five per cent in in accordance to the findings published in the American Journal of Obstetrics and Gynecology.

In Britain, there is no officially advisable bodyweight gain, but the NHS says a mom can expect to put on 22lb-26lb.

Senior investigator Medical doctor Monique Hedderson, of Kaiser Permanente Division of Study in California, mentioned: “The association we found amongst typical weight females who acquired too considerably or too minor bodyweight for the duration of pregnancy suggests that this may possibly have an influence on the youngster independent of genetic elements.”

The study’s lead writer Sneha Sridhar, said: “Gaining both too small or as well significantly excess weight in pregnancy may completely impact mechanisms that control vitality stability and metabolism.

“This could have extended-term effects on the child’s growth and fat.”

Staying slim for the duration of pregnancy "risks obese children"

People who dwell or perform near takeaways "are almost twice as very likely to be obese"

Those who dwell or function close to takeaways eat an extra 40g of high-calorie meals a week on average. Photograph: Alamy

Individuals who reside or work close to takeaways consume far more junk meals and are practically twice as likely to be obese as people who have none on their doorstep, a examine has found.

Shoppers who are the most tempted by takeaways and quick foods eat an additional 40g of large-calorie foods – the identical as half a little serving of McDonald’s fries – each and every week in contrast with people who remain away.

Operating close to a rapidly meals spot or takeaway triggered the largest problems, closely followed by having them close to residence.

The investigation, published on the internet in the British Health-related Journal (BMJ), is the very first United kingdom examine to combine information from property, perform and commuting and concerned 5,442 grownups from Cambridgeshire aged 29 to 62.

On typical, folks had been exposed to 32 takeaway retailers – nine each and every in their nearby neighbourhood and on their commute, and 14 within a mile of perform. There had been about 48% much more takeaway shops and fast foods joints near perform in contrast with residence, the review identified.

Researchers examined how a lot takeaway foods men and women ate making use of questionnaires for meals such as pizza, burgers, fried food (this kind of as fried chicken) and chips. They also measured people’s entire body mass index (BMI) as a measure of their fat.

The final results showed that men and women exposed to the highest variety of takeaways have been 80% far more likely to be obese and 20% much more probably to have a greater BMI than those with the lowest number of encounters. They also ate more of these sorts of foods.

The researchers stated: “Compared with folks least exposed to takeaway meals outlets, we estimate these most exposed consumed an additional five.7g per day of takeaway food, which would constitute a 15% larger consumption than those least exposed.

“In a week, this translates into an additional 39.9g of takeaway foods. This weekly sum constitutes more than half a small serving of McDonald’s french fries (usually 71g per serving).”

Dr Thomas Burgoine, lead writer of the examine from the UK’s centre for diet program and exercise study, based mostly in the Healthcare Study Council’s epidemiology unit at the University of Cambridge, explained: “The foods we eat away from residence tend to be much less healthful than the meals we put together ourselves, so it is critical to consider how publicity to meals retailers selling these high-calorie meals in our day-to-day environments may well be influencing consumption.

“Our examine supplies new proof that there is some type of relationship between the amount of takeaway food shops we encounter, our consumption of these foods, and how considerably we weigh.

“Of course, this is most likely to be just a single of a number of elements that contribute to a person’s danger of establishing weight problems. Nevertheless, our findings do recommend that taking actions to restrict takeaway outlets in our towns and cities, specifically close to workplaces, could be one way of positively influencing our diet program and wellness.”

Prof Jill Pell, chairwoman of the Health-related Research Council’s population health sciences group, stated: “To date, research examining the link between the neighbourhood foods setting and diet program and physique fat have provided mixed outcomes, which is why it is crucial that we continue to research these relationships.

“In potential this sort of investigation will provide the robust proof required to create effective approaches to tackle obesity and encourage a healthier life style.”

More than the past decade, consumption of foods outdoors the residence has improved by 29%, although at the exact same time, the variety of takeaway food shops has improved dramatically, the researchers explained. This, they argued, could be contributing to increasing levels of obese and obesity.

People who dwell or perform near takeaways "are almost twice as very likely to be obese"

Teenage girls who are obese do a grade worse at college, research finds

In English, maths and science, obese women acquired benefits that have been decrease by an amount equivalent to a D instead of a C, which was the regular in the sample.

Josie Booth, from Dundee University’s college of psychology, said: ”There is a clear pattern which shows that ladies who are in the obese range are performing far more poorly than their counterparts in the wholesome bodyweight variety all through their teenage years.”

Professor John Reilly, the lead investigator from Strathclyde University, said: ”Further work is essential to understand why obesity is negatively relevant to academic attainment, but it is clear that youngsters, dad and mom and policy-makers in education and public wellness should be conscious of the lifelong educational and financial effect of obesity.”

The researchers mentioned they took into account potentially distorting factors, such as poorer background, IQ and the age the women started menstruating, but found they did not affect the general outcomes.

The review published in the Global Journal Of Obesity was funded by a Bupa Foundation grant to Strathclyde University.

Teenage girls who are obese do a grade worse at college, research finds

Obese youngsters eliminated from households

Utilizing Freedom of Information laws, the newspaper approached the 206 local authorities in Britain with duty for child safety.

Of the 128 councils that supplied usable responses it was found that in between 26 and 46 morbidly obese kids were taken by social companies when taking the potential figure from the remaining councils, the figure could be as numerous as 74, the Mirror said.

Social services removed the young children from their families for their protection simply because their extreme excess weight brought on significant overall health issues.

Nottinghamshire County Council had seven young children taken into care, the highest variety of individuals councils that responded. Oxfordshire saw 3 kids under sixteen removed from their dad and mom by social providers, Cornwall and Monmouthshire councils two each and every, and a single little one in Havering, Hounslow, Portsmouth, Salford and South Ayrshire.

The two heaviest primary college pupils in England – a boy of 23st 2lb and a woman of 22st 11lb – lived in the North West.

London had 21 of the fattest one hundred youngsters in England, followed by the West Midlands with 16 and the South East with 14.

NHS data showed that 1 in 10 children is obese by the time they commence major school, the Mirror said, placing them at threat of building well being difficulties such as heart condition, type-two diabetes and cancer.

Obese youngsters eliminated from households

Obese kids could turn into new norm in Europe, says WHO

Boys working. In 23 out of 36 European countries, much more than 30% of boys and ladies aged 15 or above are not receiving adequate physical exercise, Photograph: Mike Egerton/PA

Being obese is in danger of turning out to be the new norm for kids as properly as grownups in Europe, the Globe Well being Organisation warns, issuing figures displaying that up to a third of eleven-12 months-olds across the area are as well heavy.

In accordance to the EU figures, Greece has the highest proportion of obese eleven-yr-olds (33%), followed by Portugal (32%), Ireland and Spain (the two thirty%).

Whilst the UK’s figures are not directly comparable, information from the childhood measurement programme in 2011/12 suggests England has as significant a issue as any country, with 35.4% of ten- to eleven-yr-old boys and 32.four% of girls overweight. Amongst people, twenty.7% of boys and 17.seven% of girls had been obese.

The school-based mostly measurements also display that 23.5% of 4- to 5-year-outdated boys and 21.six% of ladies are overweight.

The WHO mentioned the figures for young children have been alarming. “Our perception of what is regular has shifted being overweight is now far more common than unusual. We must not let one more generation expand up with weight problems as the new norm,” mentioned the WHO regional director for Europe, Zsuzsanna Jakab. “Bodily inactivity – coupled with a culture that promotes inexpensive, practical foods large in fats, salt and sugars – is deadly.”

The WHO’s European regional workplace issued a series of country profiles at the opening event in Athens of the Greek presidency of the EU. The United kingdom profile based on WHO information shows that 64.two% of the grownup population have been obese in 2008, between whom 26.9% had been obese.

By 2030, it is forecast that much more than a third of the population – 36% of men and 33% of women – will be obese. Only the Czech Republic and Malta currently have a increased proportion of obese adults, according to the WHO information.

Young children in Europe are not physically energetic ample, the WHO says. In 23 out of 36 countries, a lot more than thirty% of boys and girls aged 15 or over are not acquiring ample exercising and eating the wrong kinds of meals.

“We need to have to produce environments exactly where physical exercise is encouraged and the healthier food choice is the default decision, regardless of social group,” mentioned João Breda, programme manager for nutrition, bodily action and weight problems at the European regional workplace. “Physical activity and healthful meals alternatives must be taken extremely critically in all environments – schools, hospitals, cities, towns and workplaces. As nicely as the meals market, the urban organizing sector can make a difference.”

Uk information demonstrates that saturated body fat can make up twelve.seven% of the calories in an regular adult diet plan, which is greater than the WHO suggested limit of ten%. The fruit and vegetable intake was only just under the recommended 600 grams per day, at 588g.

The United kingdom does extremely poorly by comparison with the rest of Europe on breastfeeding. Only 1% of babies have been breastfed by the age of 6 months as the WHO recommends, in 2010.

WHO Europe condemned the marketing of junk food to kids final 12 months in a difficult-hitting report. It mentioned youngsters had been currently being surrounded by adverts for food items higher in salt, sugar and saturated body fat, even in schools and sports activities centres. The report expressed concern about the use by foods marketers of personal computer games and smartphone apps that kids readily entry.

Some nations have managed to contain the epidemic, says the WHO, though they have not succeeded in turning it close to. In France and some Scandinavian nations, the figures seem to display a plateau impact. The WHO says they have implemented the policies it advises, such as promoting the eating of fruit and veggies in colleges, improving the nutritional good quality of college lunches, controlling advertising and imposing taxes on some foods, alongside initiatives to inspire more physical exercise in kids.

Obese kids could turn into new norm in Europe, says WHO

Obese folks breathe in a lot more air pollutants, say scientists

The examine of one,900 participants was carried out by Dr Pierre Brochu, a professor at the Universite de Montreal’s School of Public Well being in Canada.

Following his findings, Dr Brochu says obese and overweight folks are now much more vulnerable to the effects of air pollution.

Atmospheric respiratory irritants this kind of as ammonia, sulphur dioxide, ozone and nitrogen oxide can set off a quantity of severe wellness effects, such as asthma.

In the United kingdom alone, a report by the Environmental Audit Committee in 2011 recommended tens of thousands of early deaths that year were linked to air pollution.

Dr Brochu said: “Obese class two folks have the highest average air inhalation, or 24.six m3 per day.

“That is eight.two m3 much more than the 16.4 m3 an regular grownup with normal weight breathes everyday, or 50 per cent much more air and pollutants.”

Dr Brochu also located obese people need far more oxygen than best athletes.

In a separate review, he found that a man or woman who climbs Mount Everest wants an average of 19.8 m3 of air per day.

Meanwhile, a cross-country skier in a competitors can breathe up to 41.two m3 per day and a Tour de France cyclist breathes an average of 45.9 m3 per day over the 21-day race.

Even so, this is peak inhalation which can not be maintained every day above an entire yr.

Dr Brochu mentioned: “We observed that half of the sort two obese cohort breathed 24.6-fifty five m3 of air each and every day, 12 months following year.

“As a result, it is clear the sum of air they inhale every single day exposes them to more contaminants than some best athletes.

“But it remains to be observed if substantial inhalation prices are a issue in the advancement of asthma and other lung illnesses in adults as well as young children.”

Obese folks breathe in a lot more air pollutants, say scientists

Which are the most obese regions in England?

Practically two-thirds of adults in England are obese or obese in accordance to new information released by Public Overall health England. The statistics by district local authorities demonstrate that Copeland, Cumbria has the most obese people in England followed by Doncaster, South Yorkshire.

The interactive map beneath exhibits the prevalence of extra excess weight (overweight like obesity, BMI ≥25kg/m2) in grownups aged 16 and over at nearby authority degree in 2012. Click on an location to see the information

• Mapped utilizing Google Fusion

• Get the data behind the map

Which are the most obese regions in England?

MPs should measure themselves to check if they are obese a Lord and major surgeon has said

He stated that there had been rather too a lot of portly bellies observed all around the halls of Westminster and that measuring thier waistline and towards their height was a basic way to check no matter whether they were a healthier dimension.

“At the end of the day you are not able to be obese unless of course you are consuming too significantly – and it seems to be negative if MPs are telling men and women what to do and are obese themselves.

“It is an essential issue and we notice fairly a bit of weight problems in the ranks and, they are eating too a lot of the gross nationwide merchandise. .

“It is killing hundreds of thousands of people, its costing billions and the price is cost-free – consume less and consume more healthily. I hereby empower folks – all they have to do is place significantly less meals in their mouths.”

This week the Nationwide Weight problems Forum warned that Britain’s obesity crisis could be worse that feared with a report suggesting that predictions that half the British population will be obese by 2050 ”underestimate” the scale of the crisis.

In the same debate Lord Tebbit blamed people’s “personal stupid actions” in eating “rubbish” food items for the rise in weight problems. The former Conservative Cabinet minister lashed out at those who “stuff themselves silly” at question time in the Lords.

He advised peers: “Individuals ought to know that if they stuff themselves silly with high calorie rubbish foods they will get body fat.”

“It is their accountability and all the forums and other nonsenses are just making an attempt to divorce men and women from the consequences of their very own stupid actions.”

MPs should measure themselves to check if they are obese a Lord and major surgeon has said