Public Health Policy and Obesity - Stephen and Ariana

Public Health Policy Surrounding Obesity in the UK

Health problems related to obesity in the United Kingdom (UK) cost the National Health Service (NHS) more than £5 Billion a year. In England alone more than 61.9% adults and 28% of children are classified as overweight or obese (DoH 2015) increasing their risk of type 2 diabetes, heart disease and certain types of cancer. The UK Government are taking a multifaceted approach to empowering people to make healthier choices encouraging people to be more active and to eat and drink more healthily (DoH 2015).

The Foresight Report (2007) identified worrying figures and predication's about obesity rates in the UK suggesting that by 2050 60% of men and 50% of women could be clinically obese and has the potential to cripple the NHS with a staggering £45.5 billion a year. They recommended approaching this from multiple levels including personal, family, community and nationally.

The Government produced a white paper called Healthy Lives Healthy People (DoH 2010) which sets out to tackle the issues surrounding obesity from a whole society perspective, encouraging individuals, communities and industry to work together to improve the health of the nation. In response to this white paper a number of actions were undertaken to address the issues raised (DoH 2010).

Change4Life is a public health campaign seeking to tackle obesity by encouraging people to ‘eat well, move more, live longer’ (DoH 2009). There overall aim is to help inspire a wide group of people including the NHS, government bodies, charities, schools and community leader to make the health and wellbeing of individuals and families top of their priority list. Originally aimed at parents with children the campaign now targets adults with campaigns about physical activity and reducing alcohol intake. It recognisable branding with cartoon figures and bright yellow background mean it is easily identifiable when advertising both in print and on television (DoH 2009). The Change4life website has many resources available from the following link Change4Life Resources.

The Public Health Responsibility Deal (PHRD) is a strategy published in March 2011, following the release of the White Paper. The PHRD recognises that the cost of ill health is ever increasing and that in order to achieve positive results a more complex approach to public health is needed (DoH 2011). It suggests that as a nation we aspire to achieve good health and that although we are aware that eating and drinking more healthily, increasing physical activity and having access to adequate health support at work will increase our quality of life, we persist in behaviours that undermine this (DoH 2011).

The Deal encourages businesses to voluntarily ‘sign up’ to the Deal and outline pledges to help achieve the overall core commitments. This voluntary approach echoes the points raised in the White Paper suggesting that the Government aims to use a less intrusive approach in order to achieve the desired effect without resorting to government legislation

Despite these strategies and campaigns the levels of obesity remain the same. In order to tackle the issue and to reduce the estimated 2050 statistics a more holistic approach to obesity need to be undertaken one that uses behaviour change techniques and multidisplinary teams. 

Public health policy surrounding obesity in Malta

Ever since the obesity epidemic became a worldwide problem, Malta has suffered along with the rest of the world. In fact, Malta has some of the highest rates of overweight and obesity in Europe.

Figure 1: Age-standardized prevalence estimates for overweight and obesity in adults aged 18 years and over, 2014

Source: The European Health Report, WHO, 2015

As can be seen from the above figure (Figure 1), Maltese adults were the third most overweight and obese of all European countries in 2014, after Andorra and Turkey (WHO, 2015). A study published in 2014 by Decelis et al., showed that 20.4% of 10 to 11-year-old Maltese children were overweight and another 14.2% were obese in 2012 (Decelis et al., 2014).

The Healthy Weight for Life Strategy was developed in 2012 and has an eight-year time frame (2012-2020). Its overall aim is to curb and reverse the growing proportion of overweight and obese children and adults in the population in order to reduce the health, social and economic consequences of excess body weight. This requires an inter-ministerial and multi-sectorial approach, so that changes are made to the living environment, which shift it from one that promotes weight gain (obesogenic) to one that promotes healthy choices and a healthy weight for all. In order to promote healthy eating, several priority areas for action were identified, highlighting the importance of involving stakeholders, educating consumers, promoting breastfeeding, supporting pregnant women and new mothers, supporting families of school-age children to provide the younger generation with healthier food, regulating advertising of unhealthy foods directed at children and supporting schools to implement healthy eating, among many others. 

A Food and Nutrition Policy and Action Plan for Malta was also developed in 2015. Its aims are to be reached by 2020 so it spans 5 years in total. It encompasses several areas for action including five priority action areas which are; to increase the information about the food and nutrition action plan to all stakeholders, to improve the availability and accessibility of drinking water in schools, to increase the number of mothers who exclusively breastfeed up to six months, to reduce the availability and intake of foods high in fat,  sugar, and salt in schools and to develop a comprehensive surveillance and monitoring system on food consumption.  

New draft guidelines have been issued by the Health Promotion and Disease Prevention Directorate (Figure 2 below). They will be consolidated when the first nationwide dietary survey is planned to be completed sometime in 2016 (Food-based dietary guidelines Malta, FAO).

Figure 2: The Healthy Plate as endorsed by the Health Promotion and Disease Prevention Department in 2015 Source: Health Promotion and Disease Prevention Directorate, Malta

A National Food Consumption Survey, which is taking place right now, is expected to be finished by the end of 2016. It covers a larger proportion of the Maltese population in order to be representative, and asks detailed questions to each interviewee. It includes weight, height and waist circumference measurement, a detailed 24-hour recall with portion sizes and a food frequency questionnaire. This survey is expected to show a clearer picture of what the Maltese typical diet consists of.

Apart from this survey, other initiatives are being taken by the Ministry of Energy and Health to collect enough information about Maltese health in order to form proper dietary guidance at all age groups. For example; The Body-Mass Index (BMI), Bags and Backs study will measure the weight and height of all Maltese school children to determine the rate of childhood overweight and obesity. 

References

Department of Health (2009) Change4life marketing strategy [online] available from < http://www.nhs.uk/change4life/supporter-resources/downloads/change4life_marketing%20strategy_april09.pdf> [March 2016

Department of Health (2010) Healthy Lives, Healthy People [white paper] London: Stationary Office (Cm7985)

Department of Health (2011) The Public Health Responsibility Deal [online] available at <https://responsibilitydeal.dh.gov.uk/wp-content/uploads/2012/03/The-Public-Health-Responsibility-Deal-March-20111.pdf> [1 March 2016].

Department of Health (2015) Policy Paper 2010 to 2015 government policy: Obesity and Healthy eating [online] available from < https://www.gov.uk/government/publications/2010-to-2015-government-policy-obesity-and-healthy-eating/2010-to-2015-government-policy-obesity-and-healthy-eating> [March 2016]

King, D. (2007) Foresight report on obesity. The Lancet, 370(9601), 1754

Health Promotion and Disease Prevention Directorate. (2012). A Healthy Weight for Life: A National Strategy for Malta 2012-2020. Superintendence of Public Health, Valletta, Malta

Health Promotion and Disease Prevention Directorate. (2015). Food and Nutrition Policy and Action Plan for Malta 2015–2020. Superintendence of Public Health, Valletta, Malta

FAO. Food-based dietary guidelines - Malta. Retrieved from            http://www.fao.org/nutrition/education/food-based-dietary-guidelines/regions/countries/malta/en/

World Health Organization. (2015). The European health report - Targets and beyond, reaching new frontiers in evidence.