Deciphering the distinctive geographies of obesity in

England Health Surveys Users Meeting

Royal Statistical Society

Graham Moon July 2008

Why obesity ?• Equivalent to an extra 30 years.

• Premature mortality – 9 years of life lost

• Diabetes mellitus,

• Cerebrovascular disease,

• Coronary heart disease,

• Hypertension,

• Respiratory disease,

• £0.5b cost to NHS; c £2b to wider economy

• Implications for health promotion

What about the geography?

Richard Elmhirst's mission to "Fat Town" was going well yesterday, as he tempted cautious Bradfordians to nibble scraps of venison on cocktail sticks instead of lunchtime fast food or stodge.

"That's a nice strong taste," said Betty Gill, who has watched local school meals swing to and fro between chips and salad during 29 years as a classroom assistant in the city. "I think I'll get some. How long do you fry it for?"

SHA areaCounty Durham and Tees Valley 27.3North and East Yorkshire and Northern Lincolnshire 26.1Trent 25.1Birmingham and the Black Country 24.9South West London 24.3

HSfE Data

Proportion of Obese Adults: averaged 2000-2002

Suggested Obesity Prevalence (%) by Strategic Health Authority. Source: Data from DH (2005)

Summary• Emotive, contested geographies

• Survey data limited at sub-regional level

• Experian – one size fits all. Area types plus BMI

• Men’s Fitness – obesogenic environments

Aim• To examine the complexities inherent in the

geography of obesity in England

– Obesity and over-weight

– By age-sex-ethnicity

– By scale of analysis

• "The socio-economic state of a large city which suffered industrial decline is an important context," said Mr Hughes. "It's not surprising that the likes of Manchester and Glasgow were up there with us in Men's Health's top 10."

Our Work• Team: Steve Barnard, Gemma Quarendon, Liz Twigg, Bill Blyth;

Universities of Southampton and Portsmouth

• Sponsor: TNS

• Available: Social Science & Medicine, 65, 20-31, 2007

• ML Synthetic Estimation

• HSfE 1998 onwards (+ other parts of UK) & TNS data

• Established BMI definitions

• Part of wider body of work on MLSE and health needs

Level N

Available N for modelling

Observations at each level Mean (SD)

1 - Individuals 18,526 2 - Primary Sampling Units (Wards)

7969 (wards)

1,212 (PSUs)

15 (8.98)

3 - Primary Care Trusts 303 289 64 (48.95)

4 - Regions 8 8 2316 (543.63)

Variable Level Coefficient

(Standard Error)Obesity Overweight

Intercept -1.517 (0.054) -0.145 (0.040)

Male Individual -0.110 (0.073) 0.600 (0.040)

Black 0.361 (0.098) 0.429 (0.115)

Asian 0.344 (0.094) 0.352 (0.109)

Aged 20-29 -0.308 (0.080) -0.331 (0.060)

Aged 40-49 0.123 (0.065) 0.363 (0.040)

Aged 50-59 0.284 (0.068) 0.357 (0.047)

Aged 60-69 0.308 (0.066) 0.385 (0.059)

Aged 70-79 -0.222 (0.100) -0.300 (0.060)

% Low Social Grade (NSEC 5,6,7)

PSU 0.005 (0.002) NA

% households with dependent children

0.003 (0.001) 0.003 (0.001)

% households renting from local authority

0.005 (0.001) 0.002 (0.001)

% married 0.004 (0.001) 0.003 (0.001)

% high social grade

(NSEC 1, 2)

NA -0.007 (0.002)

Obesity - PCTsHighest

• Rowley Regis and Tipton

• Doncaster West

• Eastern Wakefield

• Wednesbury and West Bromwich

• Burntwood, Lichfield and Tamworth

• Hull 12th

Overweight - PCTs• Highest

• East Lincolnshire

• North Devon

• East Devon

• North Norfolk

• Yorkshire Wolds and Coast

Obesity by SexMen

• Burntwood, Lichfield and Tamworth

• West Cumbria

• North Warwickshire

• Cannock Chase

• Dudley Beacon and Castle

Women

• Central Birmingham

• Doncaster West

• Rowley Regis and Tipton

• Wednesbury and West Bromwich

• Walsall

Excess female obesity in areas with high ethnic populations

Obesity by Age

Age Group

70-7960-6950-5940-4930-3920-29

Pe

rce

nta

ge

Ob

ese

30

20

10

0

Overall

Scale I

720168N =

PCT

Row ley

Wandsw orth

Hammersmith

Doncaster

Ob

esi

ty (

%)

24

22

20

18

16

14

12

10

Scale II• 25 PCTs feature in the 100 wards with the highest

prevalence of obesity

• Of these the most featured are from:

– East Lincolnshire

– Rowley Regis and Tipton

– West Cumbria

– Walsall

Obesity Wards

Quartiles 1 (Top) 2 3 4 (Bottom)

PCTs 1 (Top) 72.52% 19.34% 6.49% 1.65%

2 25.22% 46.15% 23.63% 5.00%

3 7.99% 24.29% 43.21% 24.51%

4 (Bottom) 1.66% 6.15% 20.93% 71.26%

Conclusions• Obesity and overweight are not (completely) in the same

places

• Geographies are consistent by age and sex

• The evidence points to a high prevalence of obesity in the post-industrial West Midlands

• Small-area evidence supports this concentration but also points to more rural locations