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Dr Michael Thomas is chair of the Welsh Committee for Public Health Medicine
Obesity is one of the biggest public health issues facing us in Wales, and is indeed a problem facing the world.
The National Survey for Wales 2017 revealed that 59% of adults in Wales are overweight or obese. When I wrote a blog on public health in Wales in 2016 the rate was 57%. Placing aside the pressure that this will continue to place onto an already struggling NHS – the fact that over half of the adult population in Wales is classed as overweight or obese means urgent action needs to be taken to address this epidemic.
There is unfortunately, no clear answer. The increasing number of overweight and obese adults in Wales clearly illustrates that focussing on personal responsibility doesn’t work. Instead of looking at what an individual alone should do we need to look at what society as a whole can deliver.
The link between poverty and health inequality is well known. That this is continuing to be an issue is borne out further by the National Survey which shows that the highest proportion of obese or overweight individuals are from the most deprived areas. These are areas that often have high unemployment rates and a range of social problems. Cuts to funding for Local Government in Wales has meant that leisure services are one of the areas impacted by the drop in funding, further compounding the issue. We know that obesity is caused by a deficit between the number of calories consumed and the number used. We also know the impact of being overweight or obese has on a person’s self-confidence, and that this improves with exercise.
There has been a focus by the Welsh Government in recent years on reducing health inequalities more generally but with a specific focus on reducing the number of people who are classified as overweight or obese. The NERS (National Exercise Referral Scheme), is an evidence-based health intervention that aims to increase the long term adherence of clients to physical activity as well as improve their physical and mental health. In some of the most deprived areas of Wales the local NERS teams work with local businesses to improve the amount of fresh fruit and vegetables that are eaten by offering discounts to NERS clients. I hope that in time this will help to reduce the number of overweight and obese individuals in Wales.
It is often said that a barrier to healthy eating is the cost of healthier food in comparison to less expensive food that will make you feel “fuller” and is faster to make. By encouraging people to “buy fresh” and shop more locally we are able to both instil a sense of community, which can help combat obesity and ensure people eat more healthily and contribute to their local economy. The best way to do this is via discounts, such as those received by NERS participants in Blaenau Gwent to promote buying fresh with the hope that this will drive down costs as time goes on.
The Welsh Government has also introduced other measures to help reduce the rate, some that are based on improving the situation now – such as the Public Health (Wales) Act, the Active Travel (Wales) Act, and of course the Well-being of Future Generations (Wales) Act which places a duty on public bodies to help create a healthier Wales for the future. There is also the Daily Mile – which sees primary school children running a mile each day – embedding a healthy lifestyle at a young age.
In our report Food for thought: promoting healthy diets among children and young people the BMA has put forward a range of further measures for consideration by governments, including a tax on sugary drinks and a UK-wide target for all manufacturers, caterers and retailers to reduce the amount of calories, fat, saturated fat and added sugar levels for certain items such as chocolate and confectionery; pies and pastries; savoury snacks and chips. Whilst there is more that urgently needs to be done, society working together as a whole to tackle this epidemic would be a step in the right direction.
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