Alcohol misuse: tackling the UK epidemic - London

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The data for 1998 shows a 21 per cent prevalence of overweight and obesity for adolescents aged 13 to
16. 1
The Health Survey for England 1997 found that, in the 16 to 24 year old age range, 23 per cent of
men and 19 per cent of women were overweight, and a further 6 per cent of men and 8 per cent of
women were obese. 23
The prevalence of obesity in adolescents does not differ markedly between England
and Scotland. 24
In childhood, excess weight can cause dyslipidaemia, hyperinsulinaemia and hypertension. Recently, the first
obesity-related cases of type 2 diabetes in white adolescents have been reported in the UK. 28
In children,
as in adults, centralised or upper body fat carries an increased risk for metabolic complications. 27
Overweight
children are more likely to become overweight adults. Adult obesity increases the risk of suffering
significant health consequences. These include hypertension, type 2 diabetes, cardiovascular and
gallbladder disease, dyslipidaemia, insulin resistance, breathlessness, sleep apnoea, asthma, osteoarthritis,
hyperuricaemia and gout, reproductive hormone abnormalities, polycystic ovarian syndrome,
impaired fertility and lower back pain. 25
Obesity has also been linked to the development of certain
cancers. 29
Obesity and overweight can have a significant impact on psychological wellbeing, with many adolescents
developing a negative self image and experiencing low self-esteem. 30
Psychological ill health related to
obesity may be expressed in eating disorders, poor social relations and educational disadvantage. 25
Obese
adolescents show declining degrees of self-esteem associated with sadness, loneliness, nervousness and
high-risk behaviours. 31
Obesity, and the significant health problems associated with it, have serious social, as well as individual,
implications. A report by the UK National Audit Office 32
predicted that social and health sector costs of
adult obesity in England would rise to £3.6 billion annually by 2010. 1
The aetiology of overweight and obesity is complex. Predisposition alone seems to be related to at least
250 obesity-associated genes and perhaps perinatal factors. 14
Twin studies suggest a heritability of fat mass,
and disorders of energy balance that arise from genetic defects. For example, serum leptin
concentrations have been found, in general, to correlate positively with indices of obesity. 33
Unhealthy diets and sedentary lifestyles, as outlined above, both contribute to obesity but expert opinion
is divided on the primary causal factor. While much emphasis is placed on dietary content, there is
evidence, based on the National Food Survey’s annual measures of household food consumption, that
the British are becoming more overweight in spite of consuming less energy than in the 1970s. In recent
decades children and adolescents have engaged in less exercise. Importantly, this decline in exercise has
coincided with an increase in sedentary activities: proxy measures of physical inactivity such as car
ownership, computer use and television viewing seem more closely related to changes in obesity than
household food consumption. 34
Weight gain and obesity is caused by an excess of calories consumed over energy expended. The growing
prevalence of adolescent obesity can therefore probably be attributed to a combination of physical
inactivity and high energy in the diet. 17
The ‘obesogenic’ environment
The term ‘obesogenic’ has been used to describe modern environments which encourage and
promote high energy intake and inactivity. This environmental factor is distinguishable from
genetic causes of obesity. 35
A recent World Health Organisation report concluded that the
obesogenic environment appears to be largely directed at the adolescent market, making healthy
choices more difficult. 17
British Medical Association Adolescent health