qualitative dissertation uk

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Abstract

Obesity has been tagged by the World Health Organisation (WHO) as the new crisis

in public health because of increasing evidence that the condition easily leads to a

host of life-threatening diseases like arteriosclerosis, diabetes, cancer, asthma,

arthritis, etc. An enormous amount of scientific research has been done on obesity

but there is as yet no consensus on what constitutes obesity, what are its exact causes

and contributory factors, and how exactly does obesity deteriorate into serious

medical cases. The only point of agreement seems to be that a determined and

concentrated effort needs to be undertaken to arrest the growing number of lives that

have been wasted by obesity, which also causes an enormous drain on a nation’s

health service resources. For such an effort to be effective, however, everyone

involved should have a clear understanding of why it happens so that appropriate

steps can be taken. This dissertation set out to do just that: provide a clearer grasp of

the causes of obesity and the extent to which the problem has degenerated to guide

future activities designed to mitigate the prevalence of obesity.

For the purpose of this paper, UK was made the focus of the study because of

increasing concern that obesity has reached unwieldy proportions in this country,

especially among children. In fact, childhood obesity is now the object of a Public

Service Agreement that the British government usually reserves for problems with

serious national repercussions.



CONTENTS PAGE

1. Introduction 2. Rationale 2.a. Aim 2.b. Objectives 3. Methodology 4. Literature Review 4.a. Obesity-related Diseases 4.b. Public Heath Issue 4.c. Obesity in UK 4.d. PSA Target 4.e. Prevention and Intervention 5. Causes and Effects 6. Influencing Factors 6.a. Diet 6.b. Nutrition 6.c. Physical Activity 6.d. Media advertising 7. Findings & Analysis 8. Conclusion & Recommendation 9. Reference List



1. Introduction

The 2002 Health Survey for England made a disturbing declaration that over half of

the UK population was overweight or obese. In the same year, the National Office of

Statistics (NOS) came up with a more detailed report, blowing up the problem by

saying that obesity was affecting children more than adults. The NOS revealed that

22 percent of all boys and 28 percent of all girls in the 2-15 age bracket were either

overweight or obese. The study raised the same alarm by asserting that about 1

million of all obese persons in UK were less than 16 years old, indicating a steady and

rapid yearly increase in the prevalence rate for childhood obesity in the country. This

is a cause for general concern because obesity in childhood tends to be irreversible

and obese adults are highly vulnerable to a range of ailments that include heart

disease, diabetes, arthritis and certain strains of cancer. Since the future of a nation

lies in the hands of its children, what future awaits a nation with a disease-prone

citizenry?

This upward trend in the prevalence rate of obesity started as early as the 1970s with

the release of a number of government studies, notably the 1974-94 National Study of

Health and Growth and the 1995 Health Survey for England. Between 1984 and

1994, the reports noted a doubling in the prevalence of obesity among British

children, from 0.6 percent to 1.7 percent in boys and from 1.3 percent to 2.6 percent

in girls. Among adults, the prevalence rate rose from 6 percent in 1980 to 17 percent

in 1998 in men and from 8 percent to 21 percent in women. Obesity is determined by

measuring a person’s body mass index (BMI), or the body weight according to height,

rate of growth, sex and age. Among boys, they are obese if 25 percent of body weight



is fat, while it is 32 percent in girls. Based on the BMI measurement of the general

population in the succeeding 10-year period (DoH, 2004; POST, 2003; RCP, 2003;

Comptroller & Auditor General, 2006), there is a steady and worrisome increase in

the number of obese persons in UK. This calls for an organized and concentrated

multi-sector action, which requires a thorough and definitive study beforehand to see

where to plug the holes in the public health system.

2. Rationale

According to the WHO (WHO, 2002) obesity may have assumed the proportions of a

global epidemic but UK presents an interesting case for a country-specific study

because it holds the distinction of being the country where the first obesity-related

case of type-2 diabetes was reported (NHS, 2002). This is an indication that obesity

has become a runaway problem in UK, which is supported by recent public health

bulletins expressing due alarm over the situation. It is necessary then that an

attempt must be made to assess the overall picture so that it can be properly

determined if an organised, resource-intensive and massive intermediation effort is

warranted, and what particular strategies are appropriate. This can only be

accomplished by examining the exact influences of diet, physical inactivity, nutrition

and media on the supposed increase of obesity cases in UK; by seeking to determine

the magnitude and extent of the problem in the UK context; by underscoring the

social and psychological factors that brought about and contributed to the situation;

and by evaluating the effectiveness of the prevention and intermediation measures

that have been tested for government adoption to mitigate the problem. A close



examination of these factors may give stakeholders an idea of where to start attacking

the problem and where to concentrate the effort.

2.a. Aim

The principal aim of this dissertation is to determine how deleterious has been the

effects of media advertising and programming, physical activity and diet and nutrition

on the overall health and fitness of the British population as regards to obesity. In

putting up these trends for closer inspection, the aim of the dissertation is to ascertain

the extent of their influence on public health so that they serve as basis for the

remedial measures that should be undertaken.

2.b. Objectives

1) Give an accurate perspective on the influence of the modern environment on

obesity, focusing on factors suspected as responsible for increasing the

number of obese persons in UK, such as improper diet and nutrition, the

emergence of a sedentary lifestyle and media’s unwitting promotion of these

unhealthy habits.

2) Investigate whether obesity has become so widespread a health problem as to

warrant drastic measures and a concentration of government resources



3) Identify the factors that contributed to the unwieldy increase of obese children

and adults in UK.

4) Evaluate the effectiveness of measures that have been undertaken to combat

obesity and identify the measures that can be undertaken to reverse the upward

trend in the prevalence of obesity in UK.

3. Methodology

3.a. Choice of Research Design

Research for this paper has leaned heavily on the observation method, which used the

quantitative approach to generate what is known as secondary research data. The

quantitative conduct of research was given preference over the qualitative approach,

which employs the direct communication method, because of the universality and

multi-dimensional nature of obesity as a growing social and public health problem.

The study also takes on the characteristics of both the descriptive and causal research

strategies, which were useful in helping meet the varied requirements of this research.

The main requirements included descriptive research of this condition as well as a

discussion of its causes. Descriptive research helps describes the history,

characteristics and scope of the problem, while the causal research determines which

factors or variables are causing a particular behaviour. We believe both methods are

useful to this paper as it focuses on the problem of childhood obesity and the

behaviour relating to the unhealthy eating habits of British children.



In the direct communication method, research is conducted by face-to-face or

telephone interviews with the use of surveys and questionnaires. Its scope of

coverage, however, is narrow and is carried out to reveal only specific data. Therefore

this method would be of little use to this study anyway. On the other hand with the

observation method used for this research, which was carried out with a wide variety

of tools to bear on an equally large range of study related to obesity, the research

panned out to gather data from all possible sources which include books, trade

journals, websites, government studies, papers from seminars and other institutional

publications, to give us the widest choice of perspective on the subject area. Since

obesity is a multi-sided subject, a mass of information is required to make realistic

comparisons between theories and evolving concepts and therefore validate our theory

that the problem encompasses the whole range of human behaviour, food intake,

eating patterns, physical exertions and media advertisement. Secondary data

according to Curwin (1996, p.46) can come from within or outside the organisation.

External secondary data are those collected from research involving textbooks,

journal articles and reports, while internal secondary data comes from organisation-

initiated surveys, annual reports and service feedback. The overall advantage of

secondary data in research is flexibility, since it is often information that an individual

organisation cannot collect on its own. By using the observation method of research

to collect secondary data from what others have written and expressed on obesity, this

writer was able to pin down the theories and findings to fill in the gaps and make

comparisons on what has been done and what still needs to be done to address the

problem of obesity. The theories and findings include: girls are more prone to obesity

than boys; obesity is more prevalent in children than adults; obesity leads to life



threatening diseases; and obesity is influenced by diet, nutrition, media and physical

activity. As research developed with emphasis on secondary data collection, the

researcher also gained valuable insights and understanding of the problem by focusing

attention on its broader implications. In a study that hews as close as possible to the

descriptive and causal type of research, the researcher can pinpoint the specific

techniques used in intervention and prevention programs and specify which of these

elements have a high or low efficiency ratings. It also allows the researcher to

determine which behaviours, habits and activities are contributing to both child and

adult obesity.

There is a more practical reason for choosing the observation method of research in

this project over the direct communication approach. Obesity is a condition that no

one can be proud about, such that no person would ever relish being called ‘fatso’ to

his/her face no matter how overweight he/she is. Experience confirms what the

literature suggests that obesity threatens one’s pride and self-image, which often leads

to self-pity and depression, because society tends to exclude and discriminate against

overweight persons. The 2000 poverty and social exclusion survey in UK, for

example, noted that overweight workers receive less income and occupy lower job

classifications than average normal-weight persons, a clear case of discrimination at

the workplace. RCP (2003) found that obese women especially are often depressed

women who lose interest in studies and are discriminated at work. For this reason, the

probability is high that a study employing the direct communication method of

research would give no useful insight because obese persons are expected to clam up

if personally interviewed about their weight problem. The researcher believes this is



the most suitable research design and method for this paper to achieve its aim and

objectives.

3.b. Construction of the Method

The research method was constructed such that the reference materials selected for

this paper separately address the issues discussed in sections four and six, which

include the main factors, diet and nutrition, physical activity, media and advertising.

One of the more important issues, for example, is whether the measurement for body

mass index is appropriate for both children and adults. The resource materials and

assessment schematic of the research on the reliability of BMI are as follow:

Epstein, et al. (2000) – the authors claim that BMI is the universal standard for

obesity measurement long accepted as accurate for both children and adults. This

contention is supported by both the authors’ use of primary research and outside

references dealing with the same subject, which reached an acceptable number of over

50 works. The authors are psychologists by profession, which indicate that they have

no bias for the blanket acceptance of the BMI measurement since their main interest is

the relationship between behaviour and obesity. They used the primary research

method on obese persons seeking their professional service by measuring the patients’

BMI and then employed the secondary research method by reviewing the works of

health professionals dealing with the subject of obesity.

Royal College of Physicians (2003) – the RCP research team suggests that the BMI

measurements may not be applicable to children because they grow faster during



puberty. Therefore, the RCP calls for the development of a new measurement system

that considers this basic difference between children and adults.

BUPA (2004); Parliamentary Office of Science and Technology (2003); and

Comptroller and Auditor General (2006) – these UK agencies agree that the BMI

measurements of UK children are enough indication that childhood obesity has

reached epidemic proportions in UK. No less than 30 references were used by each of

those three agencies in supporting the argument that childhood obesity is a cause for

alarm in UK. Also most of the references used by these agencies were based on

experiments and hypotheses made by dieticians, nutritionists and other experts on

obesity.

For the research linking obesity to such diseases as hypertension, diabetes, asthma and

cancer, the sources used for this paper include those of the UK- based POST (2003),

Social Issues Research Centre (2005) and Issue Briefs on-line. Separate works were

also scanned to establish the influence of diet and nutrition, physical activity, media

and advertisement on childhood obesity. WHO (2003), Luce (2005) and McLaren

(2006) found strong links between childhood obesity and unhealthy diet, mainly the

high intake of energy-dense food, while BUPA (2004) and WHO (2003) believe the

lack of nutritional value in children’s food intake worsens the problem. For this

reason, the above-named agencies suggest that the nutrition standards in all schools be

examined and that early breastfeeding must be encouraged based on studies that

breastfed babies are less prone to obesity. The main references to support the claim

that lack of physical activity causes obesity were Issue Briefs (2006), DoH (2004) and



RCP (2003). The influence of media and advertising is discussed persuasively by

Bredbenner (2002), McLaren (2006), POST (2003) and Luce (2005).

All these experts and agencies present their views with the suitable clinical and

empirical evidence, such that they may have influenced in to UK authorities into

taking childhood obesity as a serious health problem as to be eventually chosen as a

public service Agreement, which requires a concentration of efforts and resources.

3.c. Sample

To help collect data on the larger perspective of obesity, data was gathered from non-

UK studies that include those of James, et al. (2006); Steinbeck (undated); Luce

(2005); Issue Briefs (2005); Epstein, et al. (2000); and WHO (2003) mainly to see

how other countries are coping with the same problem. These reports are useful to

this research in many ways. For example James, et al., (2006) set global strategies for

preventing childhood obesity, Steinbeck of the University of Australia suggested

treatment for both childhood and adult obesity, Luce (2005) links the fast food culture

with childhood obesity, Issue Briefs of the US-based Henry J. Kaiser Family

Foundation attaches importance to the role of media in childhood obesity, and the

WHO (2003) report blames improper diet and nutrition as the cause of obesity that

leads to chronic diseases. An in-depth study of children’s responses to television

advertisements by Roedder (1981) was considered as another reference but eventually

excluded since there are enough materials on the same subject that are based on the

UK context. Among these are BUPA (2004), Livingstone (2002), Bredbenner (2002),

Lyness (2005), Mclaren (2006), Social Issues Research Centre (2005) and POST



(2003), which are also more recent. Luce, for one argues persuasively that media

advertisements exert a great influence on UK children’s choice and POST (2003) puts

a large part of the blame on advertisers for promoting food high in fat, sugar and salt

content.

Literature Review A literature review is an interpretation and synthesis of published research on a

particular field and should provide the reader with a statement of the major questions

and issues related to the field under study. On that note, this literature review is

preceded by a discussion of the questions and issues surrounding obesity, such as the

applicability to children of the BMI measurements for obesity. The first part of the

review emphasizes that inaccurate data sometimes come from research based on

exaggeration and professional lapses, as may be gleaned from the reports of WHO

and Social Issues Research Centre. The second part examines the medical diseases

related to obesity, through the studies of the Royal College of Physicians (2003),

Parliamentary Office Of Science and Technology (2003), BUPA (2005) and Epstein,

et al. (2000). The third part synthesises the papers of WHO and Issue Briefs (online)

on how obesity became a public health issue in many parts of the world. For the

fourth and fifth subsection, the review focuses on the extent of the problem in UK,

which led to its being set as target of a Public Service Agreement. The last part will

report on the prevention and intervention measures adopted in UK through BUPA

(2004), RCP (2003) and POST (2003).



Literature Review Matrix

Author Year Conducted Experiment

Process Theories

New Theories

Measuring Performance

Used Staff Feedback

Job Satisfaction

Bredbenner C 2002 √ √ √ BUPA 2004 √ √ Caraher, et al 2005 √ √ √ Curwin 1996 Epstein, et al 2000 √ √ √ √ Golan, et al 1998 √ √ √ Graves, et al 1988 √ √ Issues Briefs 2004 √ √ James, et al 2006 √ √ Livingstone S 2002 √ √ √ Luce D 2005 √ √ √ Lyness D 2005 √ √ √ √ McLaren E 2006 √ √ NHS 2002 √ √ POST 2003 √ √ Feilly & Dorosty

1999 √ √

Roedder D 1981 √ √ √ RCP 2003 √ √ √ SIRP 2005 √ Steinbeck K 2002 √ √ WHO 2003 √ √ Wilson, et al 2003 √ √

4a) Questions and Issues

The dissertation examined the available literature on obesity, choosing the materials

that discuss the nature, causes, epidemiology, socio-economic implications and

possible measures to prevent obesity and reduce its prevalence. It also evaluated the

validity of the arguments raised by those who dismiss the problem of obesity as

something similar to making an issue of ugliness in some people. The fact is there is

even some disagreement on the accuracy of the current measurement standards for

obesity, which apply for both children and adults. This is usually done by measuring

the body mass index (BMI), which is arrived at by comparing one’s weight with his



height and dividing the weight in kilograms by the height in metres. According to

Epstein, et al. (2000) if the result of the calculation exceeds certain limits, one is

obese or overweight. This is considered to be fairly accurate for adults whose height

stays put after 18 years of age. In children, however, the BMI measurement is

suspect because their weight-to-height ratio changes in the normal growth process.

RCP (2003) noted that during puberty, children’s weight doubles and their height

increases by 20 percent. Moreover, the BMI method does not distinguish if the body

mass consists of fat or muscular physique.

Partly because of these doubts about the applicability of the BMI measurement to

children, warnings have been aired against rushing into complex and costly measures

to reduce the incidence of obesity, which call for changing the eating habits, lifestyles

and attitudes of people. Some baseline data on obesity, as it were, were set based on

exaggeration and hype. SIRC (2005) observed that in the US, for example, the Centre

for Disease Control (CDC) and Prevention had ran into severe criticism when it set

figures on obesity-related deaths that many found too high. The CDC was later

forced to an embarrassing 10 percent reduction in its estimates.

In a report titled “Childhood Obesity: The New Crisis in Public Health,” the WHO

(2003) came up with findings that set the tone for many of the subsequent studies on

obesity. These findings include:

• The relationship between parent and child fatness may be stronger between

mother and child.



• When both parents are obese, the likelihood of their children being obese is 80

percent, 20-40 percent when only one parent is overweight.

• Intra-uterine exposure to cigarette smoke raises the risk of childhood obesity.

• Babies who are heavier than most become obese in their growing up years.

• In most western countries, the largest number of obese persons comes from

the socio-economically deprived sectors.

• Children from non-white backgrounds living in westernised societies are more

prone to obesity than white children.

4b) Obesity-Related Diseases

One research aspect of obesity where there is little disagreement relates to life

threatening diseases to which obese persons are highly vulnerable. According to RCP

(2003), the greatest risk is posed by coronary artery disease consisting of increased

blood pressure, adverse lipid profiles, change in the left ventricular mass and

hyperinsulinaemia, a pancreatic abnormality similar to diabetes. Obesity is also

known to lead easily to chronic inflammatory conditions, asthma, abnormal foot

structure and function, various types of diabetes, and cancer.

On diabetes as a complication of obesity, there is an increasing agreement that

diabetes is not just a simple childhood disease as previously suspected but is strongly

linked with obesity. In UK, the Parliamentary Office of Science and Technology

(2003) found strong evidence that diabetes is closely associated with obesity, with

women 12 times more prone to it than men. The National Audit Office (NAO) for its



part estimated that 250,000 cases of type-2 diabetes occurred in 1998 as a direct result

of obesity.

The most common of the obesity-related diseases, however, is coronary heart disease.

In 1998, NAO attributed to obesity about 28,000 incidents of stroke and 750,000

cases of hypertension throughout UK. The simple explanation is that cholesterol from

too much consumption of fatty food clings and clogs the coronary vessels to block the

circulation of blood and oxygen. As for the risks of cancer, POST (2003) noted that

the existing literature is less clear but evidence is beginning to trickle in that obesity

increases the risk of colon cancer three times among both men and women.

According to BUPA (2004) another type of cancer associated with obesity is bowel

cancer.

Obesity is also associated with depression, which is as much a psychological as a

physiological disease. Lyness (2005) points out that like obesity, depression is also

linked to diet, particularly to reduced levels of omega-3 fatty acids. Epstein, et al,

(2000) support this view, saying that obese children have increased psychological

problems, which can influence eating or weight control. Obesity causes distress

because of the jokes that their appearance draw from others, such that obese children

lose self-confidence and self-esteem leading to isolation and depression. RCP (2003)

also maintains that since obese persons often suffer from depression, they lose interest

in studies and in improving their lives. Therefore, they need the same medical

attention as those suffering from physiological diseases.

4c) Public Health Issue



When the WHO released its 2003 Global Strategy on Diet, Physical Activity and

Health indicating that obesity was spreading throughout the world because of the

wrong kind of diet and lifestyles, many disputed this view contending that obesity is

solely an issue for advanced western nations experiencing no problem on food

production and supply. In deference to this argument, obesity was yanked out as a

component of the WHO global strategy in 2004. However, evidence continued to

pour in that obesity contributes to the rising diabetes, high cholesterol and high blood

levels in middle and low-income countries (James, et al., 2006), with obesity affecting

as much as 10 percent of all children in the developing world. The growing

consensus is that it is no longer communicable diseases that are bringing on the

disease burden of the world but non-communicable diseases like heart disease, cancer

and mental disorders, all of which are suspected complications of obesity. This is

reflected in the updated WHO Millennium Development Goals, which lists 10

obesity-related factors as determinants of the world’s health problems – high blood

pressure, increased blood cholesterol levels, poor intakes of fruits and vegetables,

physical inactivity, excess weight from too much sugar, fat and salt in the typical diet,

and tobacco consumption. Obesity began to be considered a serious health concern

worldwide, which holds true for low, middle and high-income countries.

A growing number of paediatricians, child development experts and media

researchers around the world agree that the prevalence of obesity is on the upswing.

This represents an “unprecedented burden” on children’s health, the American

Academy of Paediatricians (AAP) warns (Issue Briefs Online). The medical

consequences include hypertension, type-2 diabetes, respiratory ailments, orthopaedic



problems, sleeping difficulties and depression. Two studies, one in the US and one in

UK, agree that there is a strong correlation between childhood obesity and educational

attainment and income levels in women. RCP (2003) acknowledged that obese boys

may sometime grow into normal-weight adults but obese girls almost always become

obese women, and obese women are highly susceptible to depression, which is known

to make people unproductive and even acquire suicidal tendencies.

4d) Obesity in UK

There is still some debate on whether obesity has reached epidemic proportions in

UK. In 2005, international obesity task Force chairman Phillip James told the

European Union Conference on Obesity Strategy that obesity in UK took off in the

1980s and “looks as if it was accelerating in the last 5 to 10 years.” The House of

Commons Committee on Health and the Royal College of Physicians echoed this

view. “If the rapid acceleration in childhood obesity in the last decade is taken into

account,” the RCP predicted, “the prevalence will be in excess of 50 percent.” This

was contradicted by other official surveys. For example, the Health Survey for

England discounted an epidemic in general weight gain among British children since

an epidemic would have raised the average weight to greater levels. This particular

survey pointed to the average weight taken separately of children aged 3-14 and all

15-year-olds. The average weight of boys 3 to 14 years old was 31.0 kilograms in

2003, which actually decreased from 32.0 kilograms in 1995 for the same age group,

while the change in average weight between 1995 and 2003 was from 32.2 kilograms

to 32.4 kilograms such that the change was found insignificant. Among 15-year-old

boys, the average weight was 58.8kg in 1995 and had increased to 60.7 kg in 2003,



while the figure for girls in the same age group was 58.5 kg, which went up slightly to

58.9kg. This data on the average weight gains of children and young adults indicate a

slight change over a 10-year spread, which do not amount to an epidemic (SIRC,

2005). The Social Issues Research Centre also took exception to findings that it is

the children that are most threatened by obesity, pointing out that it is in the older

generation where the problem is more evident. SIRC studies purport to show that

women aged 35 and above dominated the obese groups in many parts of UK and that

there were more obese persons among senior citizens between 65 and 74 years old

than children.

For these reasons, the Health Survey for England cautioned against exaggerating the

numbers, since the educational, medical and financial resources that are channelled

for the purpose may be diverted from where the problem really lies. Despite such

doubts about the real magnitude of the problem, everyone seems to agree that

something needs to be done about obesity. For this reason, the Department of Health

launched the Social Marketing Programme to draw from all the scientific work

already done on the subject and apply the data on effecting a behavioural change

among the citizenry with the use of accepted marketing principles. As its initial

undertaking, a Childhood Obesity Project Team was organised in 2005 with the

assigned task of reviewing the whole body of literature towards providing a better

understanding of the likely causes and effects of obesity, and then developing a cost-

effective framework for an anti-obesity campaign. According to DoH (2004), the

team later came up with a white paper called “Choosing Health: Making Healthier

Choice Easier,” which set forth the government commitment to stem the tide of



obesity prevalence among children below 11 years old on a year-to-year basis by

2010.

The BBC News (2006) reported that obesity levels in UK have more than doubled in

the past 20 years. In the report titled “Child Obesity Doubles in Decade, BBC” noted

that children as young as 2 and 3 years old are being classified as obese or

overweight.

Proportion of Overweight Children in UK

1984-1994

Children

0

5

10

15

20

BoysGirls

(Values in percentage for childhood obesity: boy from 0.6% to 1.7% and girls

from 1.3% to 2.6%)

Adults



0

5

10

15

20

WomenMen

(Values in percentage for adult obesity: women from 6% to 17% and men from 8% to

21%)

(Parliamentary Office of Science & Technology, 2003)

According to Reilly & Dorosty, (1999) the 2003 Health Survey for England

established these interesting facts about childhood and adult obesity in UK:

1) The prevalence of obesity in 2 to 11 year old children has grown from 9.6

percent in 1995 to 13.7 percent in 2003.

2) Of the obese children, 17.1 percent come from semi-routine or routine

households in which the heads of family are wage earners, while 12.4

percent are children of parents holding managerial or professional jobs.

This indicates that more obese children come from low and middle-

income families.

3) The levels of obesity increased by only 11.2 percent among children in

the more affluent fifth of the population, and 16.2 percent in the most

deprived fifth, which is another affirmation of a trend that sees more

obese children coming from rich households.

4) Obese parents beget obese children, and obese children are most likely to

become obese in their adult years.



5) Children from Asian ethnics are four times more likely to become obese

than whites.

6) Obesity reduces life expectancy by an average of 9 years, and by much

more if the obese person is a smoker.

7) Obesity increases the risk of heart disease, cancer, type-2 diabetes and

high blood pressure.

4.e. Public Service Agreement (PSA) Target

Comptroller & Auditor General (2006), POST (2003), Reilly & Dorosty (1999) and

RCP (2003) say there is an epidemic because view that childhood obesity in UK has

reached alarming proportions seems to outnumber the opinion that says it is still

manageable. For this reason, obesity has been identified as the target of a Public

Service Agreement (PSA). This in effect recognizes obesity as a serious public health

issue representing a growing threat to children’s health and a drain on the National

Health Service (NHS) resources. After the anti-obesity PSA was incorporated in the

government’s 2004 Treasury Spending Programme, all the funding and activities

directed at the problem to be expended by participating agencies and partners will be

coordinated at the national, regional and local levels for greater efficiency. The long-

term goal of the PSA on obesity is to bring down the yearly increase in overweight

children below 11-years-old through the Department of Health, Education and Skills

(DES) and Department of Culture, Media and Sports (DMCS). Other departments

are given important roles in the programme, as well as their local offices, health

authorities, the Primary Care Trusts and schools. To be assigned as a PSA in UK,

the government must be assured that the handling and flow of any project or activity



are predictable and manageable so that the resources and efforts do not go to waste.

The main concern of government is that if the arrangements for the delivery of

services are unclear, the resources may get lost. The Comptroller & Auditor General

(2006) noted that since a PSA involves a wider range of organisations of various

disciplines and expertise, there is a need for a better understanding of the issues to

make the programme more organized and efficient. In a joint study, the Comptroller

and Auditor General observed that the PSA on obesity especially requires a more

thorough and careful study because it calls for a multi-faceted approach. In addition,

it was noted that there is a shortage of evidence on what works for obesity and what

initiatives and programmes would be sufficient to achieve its target. Accordingly,

the authorities involved in the PSA against obesity were obliged to familiarize

themselves with the problem by using more reliable data. The goals of the PSA are:

1) increase average fruit and vegetable consumption to at least five portions a day, 2)

reduce the average intake of saturated fat from 14.3 percent to 11 percent, 3) maintain

the current declining trend in total fat intake at 35 percent, 4) reduce the average

intake of added sugar from the current 16-17 percent to 11 percent, 5) increase to 1

percent yearly the number of children meeting the physical activity recommendations

of the Chief Medical Officer, and 6) increase the initiation and duration of

breastfeeding among lactating mothers. Comptroller & Auditor General (2006)

assured that all these will be carried out through such intervention and prevention

programmes as school meals, school sports, children’s play, healthy schools, national

obesity awareness campaigns, simple labelling of packaged food, helping people lose

weight, and healthy food promotion among children.



Under the PSA, teams of experts have been organised to compose the Primary Care

Trusts (PCTs) in the national, regional and local levels, whose first order of business

is to clear the air on obesity measurement. It was acknowledged that the current

measurement method is less accurate for children and so the PCTs were assigned to

devise new weighing and measuring systems with a greater degree of efficiency. This

was deemed essential in guiding decisions on where exactly to place resources and

how the effectiveness of prevention and intervention activities can be monitored. In

support of the PSA, the National Institute for Health and Clinical Excellence is also

drawing up a set of guideline on the assessment, identification, prevention, treatment

and weight management of overweight or obese children and adults.

The two key programmes under the PSA are called Extended Schools and Sure Start.

The first provides a range of services and activities on child and healthcare, social

services and cultural, sporting and play activities, while the second increases the

availability of services on childcare, health and emotional development. Under the

School Meals Programme, for which 220 million pound sterling has been allotted for

2005-2008, schools have been prevailed upon to follow a revised nutritional standard

for school meals. The new nutritional standards were set by legislation passed in

2006, which reduce the fat, salt and sugar contents and increase fruit and vegetables in

the meals consumed by children in school. There is also a School Fruit and Vegetable

Scheme, which provides free pieces of fruit or vegetable each day to children aged 4-

6 in nurseries.

4.f. Prevention and Intervention



Health and nutrition experts advise against withholding food from obese children to

make them lose weight because this can actually harm the normal growth process.

BUPA (2004) advised that if children need to be put on a diet, this should be done

with medical supervision, particularly teenage girls who are vulnerable to such eating

disorders as anorexia nervosa and bulimia if they go without food for prolonged

periods. Unlike adults, there are no drugs considered effective in treating weight

problems in children. The simple solution to child obesity that this research gleaned

from the literature is three-pronged: 1) eat a healthy, balanced diet, 2) make changes

in the fast food-oriented eating habits, and 3) increase physical activity. BUPA

(2004) believes this task relatively easy based on evidence showing that it is much

easier to change a child’s eating habits and physical activity than those of adults.

Although the reasons and causes for obesity have been identified (among them:

genetics, unhealthy diet and nutrition, sedentary lifestyle), there is still a lack of

qualitative evidence on the reliability and effectiveness of intervention and prevention

measures presented by experts. The best that health authorities can do is issue a set

of guidelines for healthy living (Golan, et al., 1998); RCP 2003), which often consists

of the following:

1) Eat at regular hours.

2) Include bread, pasta, cereal, rice and potatoes in every meal.

3) Eat some types of fruit and vegetable at each meal.

4) Limit the consumption of food high in sugar like sweets and chocolate.

5) Reduce consumption of high-fat foods like crisps, chips and pastries.

6) Avoid fried foods.



7) Exercise as often as possible and cut back on TV watching and playing

computer games.

8) Separate eating from TV watching and homework.

9) Eat regular meals and snacks and avoid the habit of “grazing.”

10) Keep out of the house the kind of food that children should

avoid.

11) Walk instead of ride or drive.

12) Use the stairs instead of lifts or escalators.

13) Go for a walk and visit parks and playgrounds.

14) Attend PE lessons and courses on outdoor education

A multi-pronged strategy, the National Health Service (NHS) suggests, may help

prevent obesity among school children, especially girls. This was shown in a

randomised controlled trial (RCT) called Active Programme Promoting Lifestyle in

Schools involving 636 children aged 7-11. The subjects were feed the modified

school meals, taught healthier eating proper habits and told to undergo PE and

playground activities. After one year of this regimen, there were no significant

changes in BMI scores, but there were encouraging changes in eating behaviour,

notably an increase in vegetable consumption among the children. Family-based

programmes that encourage an increase in physical activity, discourage sedentary

behaviour and impart dietary education are also expected to yield beneficial effects.

Another RCT that relied heavily on physical activity and excluded other intervention

measures was called “Dance for Health,” which conducted aerobic classes for 43

overweight children aged 10-13 for 12 weeks at a frequency of three classes weekly.

The result: not much change in BMI and heartbeat rates for both boys and girls. A



long-lasting and more intensified programme of this kind, however, may be useful, as

indicated by another NHS-conducted RCT that consisted of callisthenics, exercise and

aerobics. In the first 12 months of the programme, there were no significant changes

but upon completion of the two-year study, a noticeable reduction in weight was

noted among the subjects.

Prevention and management of obesity on a national level require the coordination of

a range of policies to improve the average diet and levels of physical activity in the

early years, at home, school and the community. The reason is that not all population

studies show consistent links between dietary fat intakes and body weight in children

and young adults (RCP, 2003). In the US, for example, studies noted an increase in

the prevalence of obesity even when the proportion of energy derived by children

from fatty foods had fallen. This shows that the overall amount is less important than

the type of dietary fat that is consumed (POST, 2003).

5. Causes and Effects

Much of the blame for obesity used to be heaped on genetics and medical problems,

but as the number of obese children with normal parents grew and obesity occurs in

children without a history of any particular childhood disease, research turned its

attention to other possible causes. Among the primary causes frequently identified

are the increasing trend towards a lifestyle of unhealthy diet and lack of physical

activity brought on by the “new media” which has children sitting for hours before the

video screen. Livingstone (2002) observed that this phenomenon provided British a

multi-media culture with integrated telecommunications, broadcast, computer and

video access, such that media use has become the major preoccupation of children.



Children are the first and foremost users of new media in the family. BUPA (2004)

suggested that as exercise ceases to be part of people’s daily routine and the national

diet goes high in calorie content, it is so easy to become overweight.

An enquiry of the House of Commons health committee in 2003 established strong

links of obesity with diabetes, coronary heart disease, cancer, osteoarthritis and social

and psychological distress among British adults. On diabetes, the National Audit

Office (NAO) reported that 250,000 cases of type-2 adult diabetes in 1998 were

attributed to obesity, which used to be considered a childhood disease. Majority of

these sufferers were obese women. NAO also cited 28,000 instances of heart attack

and 750,000 cases of hypertension that were traced to obesity. The NAO report was

less clear on the risk of obese persons to cancer but it suggested that obesity increases

the risk of cancer three times among both men and women, especially colon cancer.

On osteoarthritis, no figures were available but it was propounded that because of the

excess weight, arthritis develops quickly on the leg joints of an obese person. As for

social and psychological consequences, obesity has been inextricably linked to low

self-image and depression, with obese persons the frequent objects of discrimination

and prejudice.

The Royal College of Physicians blames obesity on three major factors: decrease in

physical activity, increase in sedentary behaviour, and increase in high-calorie food.

Among the specifics are: 1) transport policies that encourage driving instead of

walking or cycling to school, 2) a food industry that targets children with

advertisements on high-energy food, 3) health promotion policies that fail to focus on

the need for dietary changes or to address issues of health inequality, 4) loss of school



playing fields, 5) less walking because of greater use of cars, escalators and lifts, and

6) increased time spend on TV, computer games, Internet surfing and telephones.

The NAO projection is that by 2010, 1 out of every 4 adults will be obese. This

translates to a cost of some 3.6-billion pound sterling for the National Health Service

and the economy as a whole through direct and indirect costs.

6. Influencing Factors

In the WHO Global Strategy on Diet, Physical Activity and Health, the heaviest

emphasis was placed on the contribution of excess fat, sugar and salt on the world’s

dietary health problems. Tagging obesity as the new crisis in public health, WHO

blamed the advent of an “obesogenic” environment, a condition that encourages the

consumption of more energy food than necessary (WHO, 2003). Other studies place

the excessive use of media higher on the list of causes. These include the surveys of

the US Surgeon General, National Health and Nutrition Examination Surveys,

Framingham Children’s Study and Youth Risk Behaviour Survey.

6.a. Diet

According to POST (2003), the WHO/FAO expert group has turned up with

“convincing” evidence that high intake of energy-dense food accounts for much of the

obesity problem in UK. This came about because of the extensive marketing of fast

foods and high intakes of sugar-sweetened drinks and large-portion meals. POST



(2003) agreed that the average diet in UK is characterized by increased eating

frequency, periodic eating binge and less intake of fibre, which comes mostly from

fruits and vegetables. This finding was contested by a National Food Survey (NFS),

which argued that the average energy intake in UK has actually gone down since the

1970s, indicating that dietary factors have nothing to do with the growing number of

obese Britons. Other health and consumer groups expressed disappointment at the

survey, suggesting that it failed to consider such new consumption patterns as

stocking the home larder with confectionery, alcoholic drinks and TV dinner and the

growing habits of drinking and eating out.

What and when people eat appears to be the deciding factors in child obesity. The

“what” has been identified as high-fat foods like chocolate, biscuits, cakes and crisps,

fried food, fizzy drinks high in sugar, and ice cream and donuts. The “when” includes

eating in-between meals, eating while watching TV or doing homework, eating out of

habit even when not hungry, and eating out as part of a weekly routine.

A healthy balanced diet, BUPA (2004) suggests, will go a long way in combating

obesity but the problem is that most British children are gorging on unhealthy and

fattening foods. For example, starchy foods rich in complex carbohydrates like

potatoes, rice and chapatti are no longer part of the regular diet. So are fresh fruits,

crusty bread and crackers, grilled or baked food, frozen yoghurt, freshly squeezed

juices, bagels and dried or tinned fruits in natural juice. Instead, both children and

adults are stuffing themselves with high-fat foods like chocolate, biscuits, cakes and

crisps, deep-fried food, fizzy drinks, ice cream, and donuts.



To prevent childhood obesity, BUPA (2004) advises British parents to encourage their

children into changing their dietary habits through the following activities: 1) set an

example with their own eating habits, 2) prepare meals and snacks on appointed times

with no in-between eating, 3) don’t let children eat while watching TV or doing

homework, 4) let the children eat when hungry rather than out of habit, 5) teach the

children to chew slowly and savour food, which is more filling and less prone to

overeating, 6) keep high-fat and high-sugar snacks out of the house, 6) don’t make

fast-food outings part of a weekly routine, 7) involve the children in food preparation

so they are aware of what they are eating, 8) don’t use food to comfort a child, which

can reinforce the idea that food is a source of comfort, and 9) instead of a fast-food

outing to reward, let us say, a good report card, buy a gift or bring to child to the

cinema.

6.b. Nutrition

Studies (RCP, 2003; Comptroller & Auditor General, 2006; Reilly & Dorosty, 1999;

POST, 2003) show that the prevalence of obesity is increasing in UK because of the

prevalence of unhealthy and less nutritious food in the average Briton’s diet. RCP

(2003) said the British are consuming less of the foodstuff that makes up a healthy

and balanced diet, which consist of starchy foods like bread, potatoes, pasta, rice and

chapatti that are rich in complex carbohydrates; fresh fruits, crusty bread and

crackers; grilled or baked food; fresh juices with water and sugar substitutes; low-

sugar cereal and milk; dried or tinned fruit in natural juice; frozen yoghurt and bagels.



According to POST (2003), the high glycaemic index (GI) in the diet of the average

Briton is suspected as a prime cause of obesity in the country. Foodstuff with high

GI content includes potatoes, bread, soft drinks, cakes and biscuits. When the body

absorbs high amounts of GI, it causes a sharp increase in blood glucose levels to

stimulate hunger and overeating in teenagers. This has also been linked to flab, heart

disease and type-2 diabetes in adults.

Foods are either high or low in energy density. Fatty and fried foods are energy-

dense, with more than twice as much energy content as that derived from the same

weight of high-protein or high-carbohydrate foods. BUPA (2004) said foods with

high-energy density but low satiety measure encourage snacking and increased energy

intakes, but those with low energy but high satiety reduce overall energy intake. The

food with high density but low satiety measure is the fatty and fried ones, while the

low-density food with high satiety measure are foods like boiled potatoes and fruits.

Satiety is the measure of the extent to which food satisfies hunger.

WHO (2003) pointed to studies suggesting that there are protective effects of early

breastfeeding against obesity and the future risk of type-2 diabetes, but the evidence

remains inconclusive and requires further study. Initial findings show that the

effectiveness of breastfeeding depends on other factors like social class, maternal

weight, smoking while pregnant, etc. Nonetheless, this idea has been incorporated in

the UK prevention and management programme for obesity on the “Healthy Start”

campaign and the National School Fruit Scheme. The first encourages breastfeeding

based on the theory that breast milk gives children a good start towards a healthy life,

while the second activity provides one free piece of fruit a day to 4 and 6-year-old



school children. Studies consistently show that infants breastfed even for a brief

period are less susceptible to obesity when they grow up. On the other hand, an

eating pattern at home that always includes fruits and vegetables is likely to be a habit

that children will later stick to. Both programmes are emphasised in a new nutrition

standard made compulsory for school lunches in the whole of UK (BUPA, 2004).

The 2000 National Diet and Nutrition Survey noted that children’s consumption of

fruits and vegetables has drastically fallen in the last 20 years, such that half of the

subjects covered in the survey had not eaten any fruit or vegetable in a given week.

This was supported by the Poverty and Social Exclusion Survey held in the same

year, which reported that 1 out of 10 children from poor families never include fresh

fruit or vegetable in their daily diet.

6.c. Physical Activity

According to Caraher, et al., (2005), there is a growing trend of the sedentary lifestyle

among a generation that was known as the TV generation in the 1960s, as the video

generation in the 1980s, the Nintendo generation in the 1990s, and lately as the

Internet Age. Issue Briefs (2004) said there is an explosion in the modern world of

children-targeted media that includes TV shows and videos, specialised cable

networks, video games, computer activities and Internet websites. All these kept

children away from sports and other outdoor activities that involve physical exertion.

Consequently, the UK Department of Health reported in 2004 that 17 percent of boys

and 22 percent of girls do less than 30 minutes of physical activity per day.



Separate government surveys show a lifestyle veering away from muscle-stretching

activities that are essential to healthy living. For example, POST (2003) reported that

the number of people playing sports at school declined from 44 percent in 1994 to 33

percent in 1999. That same year, only 2 percent of high school students in UK cycled

their way to school, down from 5 percent in 1989. An Independent Television

Commission survey also estimated that young Britons between age 4 and 15 watch an

average of 2.5 hours of television daily, play computer for the same span of time, and

log on the Internet 10 times a month. The 2000 National Diet and Nutrition Survey,

for its part, revealed that 40 percent of school-age boys and 60 percent of girls fail to

meet the physical activity recommendation of at least 1 hour of moderate intensity per

day. This indicates an increasing sedentary habit among UK children.

RCP (2003) was more specific on the reasons for the diminishing physical activity of

British children. These include: 1) loss of school playgrounds to other real estate

purposes, 2) reduction of road space for walking or cycling to and from school, 3)

lessening amount of PE, school and home sports, and 4) greater use of cars, escalators

and lifts. To address this problem on obesity-causing lifestyle, the UK policy of

obesity prevention and management calls for the promotion of school sports and PE

and the healthy-travel-to-school programme. Since 2004, some 1,000 sports

coordinators have been deployed in schools to promote an active lifestyle among

students. PE was also made a compulsory subject in the national curriculum for

students up to 16 years old. In the travel-to-school programme, local authorities were

assigned the task of encouraging school children to organise cycling clubs and

walking groups.



In the effort to increase children’s physical activity, BUPA (2004) encourages parents

to motivate their children in walking their way to school and stores instead of jumping

in a car. Children must also be taught how to ride a bicycle and swim. Other

recommended steps: involve the whole family in bike riding, swimming and outdoor

activities; encourage trips to the park for a game of cricket, Frisbee, etc.; reduce the

children’s TV watching or computer games to no more than 2 hours daily or an

average of 14 hours per week.

6.e. Advertising

According to BUPA (2004), television advertising has a direct influence on the eating

preferences and habits of British children. For this reason, the Office of

Communications (Ofcom), which serves as media regulator, was directed to

implement a ban on TV commercials that promote junk foods especially on children-

oriented channels and programmes. Among the foodstuff listed as junk were

chocolates, pizza, burgers and crisps. The move gained the support of British parents

who were found in a survey (Luce, 2005, p.281) to be of the unanimous view that TV

adverts are a strong influence over their children’s choice of food. Because of this

influence, children “tend to overeat and to eat quickly without paying attention to

what they are consuming (McLaren, 2006).” However, the advertising and

marketing sector opposed this measure as based on a wrong assumption. The

Advertising Association (AA), umbrella organization of trade bodies representing the

advertising and marketing industries, argued in a position paper that advertising, far



from influencing children to eat unhealthy food, in fact encourages them to choose

one brand over another and that with or without a ban on junk food advertisements,

children will want them anyway. In effect, advertising is just one of many

influencing factors.

POST (2003) acknowledged that the large amount of TV advertisements put out by

the food service industry targets children and promotes processed food that are mostly

high in fat, sugar and salt. Consequently, the consumer and health groups in UK

agitate for regulatory measures, and a group called Food Aware is calling for a ban, as

a good start, on the advertising and marketing of fatty, sugary and salty foods in

places frequented by children, such as schools, websites and children television. To

force the food industry into reducing the fat content of its products, a tax system

called “fat tax” has been proposed on fatty foods. Moreover, a bill has passed first

reading at the House of Commons prohibiting food and drink advertisements during

the TV watching period of pre-school children. The advertising industry, however,

warns that further regulation would harm this particular sector of the economy.

Instead the industry is proposing a new code of practice that would penalise

advertisers that discourage good dietary habits and encourage excessive consumption.

It is believed that information and educational campaigns promoting a healthy diet

and increasing levels of physical activity would be more effective in addressing the

problem of childhood obesity. In this connection, the Food Standards Agency (FSA)

has commissioned a more expansive research to determine exactly how media

advertising influences children’s eating preferences and patterns. The objective is to

develop a framework for the most effective means of engaging children and their

families in the anti-obesity campaign and what sort of programmes, advice and



support are necessary. Up to now, there is no clear consensus on the relationship

between advertising and children obesity. The five areas of debate are: 1) the rights

of children and the place of advertising in a child’s life; 2) the impact of advertising

on the attitudes, behaviour and health of children; 3) the nutritional quality of

advertised foods targeting children; 4) the “pester power” influence of food adverts on

family food choices; and 5) striking a balance between the rights of the advertising

industry to promote products and ideas and the role of the state in protecting the

health of its citizens and vulnerable groups (Caraher, et al., 2005, p. 596-597).

There are three stages involved in the development of advertising literacy among

children based on a theory set by Roedder (1981): limited model, cued model and

strategic model. The limited model applies to children aged 6-8 when they have as

yet no capability to judge the intentions of advertisers. From age 8 to 12, children

enter the cued model stage when they acquire the knowledge to argue with advertising

claims but still unable to use this knowledge for their own good. The strategic model

stage comes after age 12 when children begin to demonstrate an advertising literacy

and use it accordingly.

7. Findings and Analysis

Epstein et, al (2000) postulates that once children get overweight, psychological and

physiological problems develop such that reversing the process becomes difficult.

This happens because children who get used to stuffing themselves to overfilling

begin to feel distressed when they eat less. For this reason, the writer of this paper



agrees with the content of most of the readings that obese children need professional

and medical assistance to help them overcome the problem. The common findings

are that anti-obesity programmes yield better results if they involve not only health

professionals but also the parents of obese children and the schools they are attending.

However, clinical experts are advised to see the parents and children separately on the

theory that children are better at long-term maintenance of ideal weight than parents

(Steinbeck). The twin objectives of health professionals are to encourage obese

persons to eat less processed food and engage in more physical activity. Such a study

involved a clinical dietician with parents serving as agents of change and their obese

children as change agents (Golan, et al., 1998). In the 1-year study, the children aged

6-11 were split into an experimental group, who participated in the experiment under

the guidance of their parents, and a control group in which the children were on their

own. The dietician recorded the family’s eating patterns, activity routines and other

socio-demographic factors, then conducted 14 sessions for children in the

experimental group and 30 sessions for those in the control group. The result was that

weight reduction was higher at 14.6 percent in the experimental group and only 8.1

percent in the other group, which also recorded a 9 percent dropout rate. This gives

obesity the appearance of a psychological problem that the affected children cannot

handle on their own and need the support and guidance of parents.

The trials conducted so far to test the effectiveness of intervention measures are either

family-based, school-based or multi-faceted. All of these were proven to have yielded

positive results. Test programmes in which parents acted as change agents, for

example, were found to have helped primary school children lose weight. One

school-based randomised controlled trial that employed video games and instructional



tapes to effect changes in diet and physical activity found encouraging reduction in

the BMI, skin-fold thickness, waist circumference and waist-to-hip ratio among obese

children after 7 months of the experiment. In the case of a multi-faceted intervention,

one such strategy consisting of instruction, modified meals, PE, tuck shops and

playground activities were used in a trial involving obese in-school children aged 7-

11. After 1 year, no change in eating behaviour was observed among the subjects but

there was a noticeable increase in their vegetable consumption. This was seen as a

good start in the children’s way to healthier living. In effect, what the prevention

and intervention trials achieved was mostly point the obese children to the right

direction, which confirms that there is no magic cure for obesity. Although the

outcomes of these steps are generally uncertain, they are worth taking rather than

leaving the obese children alone, with society doing nothing at all.

8. Conclusion and Recommendations

There is some evidence that child obesity can be reduced by government initiatives

that give schools bigger roles in health improvement and multi-pronged school-based

programmes that promote physical activity and modification of diet and sedentary

behaviours. However, the NHS admits that for the most part, intervention measures

are still unreliable as to effectiveness since they have been conducted with small-size

samples, with high dropout rates, poor reporting and in settings different to UK

conditions. Therefore, this paper proposes that future research be conducted that

intends to generate better procedural quality. These studies must involve a larger

number of participants and held in appropriate settings, at longer duration and with



greater intensity. They also need to address concerns on the cost-effectiveness of

prevention and treatment programmes.

Such future research can work around the initial findings that obesity management has

to concentrate on ways to reduce people’s energy intake through dietary changes,

increase physical activity, decrease sedentary behaviours, and involve families in the

change process.

In UK itself, some sectors of the health community are calling for a closer look at

obesity. The routine claim is that there has been a rapid acceleration of childhood

obesity since the 1990s, but data on official surveys don’t bear this out. The Health

Survey for England 2003 disagrees with the basic findings of the House of Commons

committee on health and the International Obesity Task Force. This emphasises the

need for a better quality research using such tools as mentioned above – larger

number of test participants, longer duration of trials and more intensity.

It may also be worthwhile for future studies to test the effectiveness of weight-loss

drugs such as metformin, serum leptins, serum lipids, orlistat and sibutramine. Initial

studies by the National Institute for Clinical Excellence (NICE) revealed that the BMI

scores of 29 obese young people aged 12 to 19 improved after use of metformin and

serum leptin for six months. Other areas worth looking into are the two curious

phenomena pinpointed by the WHO and other research groups as possible risk factors

of obesity, namely ethnicity and poverty. It was observed that the prevalence of

obesity is greater among people in the poorer sectors of society and the developing,

which is contrary to the popular wisdom that obesity is a sign of abundance and



affluence. It will also be interesting to know why children of ethnic families in UK

are more prone to obesity than whites.

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qualitative dissertation uk

Documents

prevalence of obesity

causes of obesity

childhood obesity

prevalence rate of obesity

obesityrelated diseases

obesityrelated case

percent of body weight

national study of health