Obesity is a major global public health problem. Recent decades have seen a significant rise in levels of overweight and obesity in many countries around the world. In a number of the major developed countries, including the UK and the USA, the rates of obesity have doubled in the last 25 years and this relentless increase is predicted to continue in the decade ahead. The most recent Health and Social Wellbeing Survey in Northern Ireland in 2005 found that 59% of all adults here were either overweight or obese, with 24% of adults obese. Worryingly, data from the Northern Ireland Child Health System in 2004/05 found that 22% of children are either overweight or obese, with more than 5% already obese.

The 2007 Foresight Report, a report complied by a panel of leading experts and commissioned by the UK Government, warned that if trends in overweight and obesity continue to rise, there is a real prospect that by 2050, ‘Britain could be a mainly obese society’. It predicted that by that date, 60% of men and 50% of women in the UK could be obese. The Department’s Investing for Health Strategy in 2002 had estimated that by 2010 the cost of obesity to the NI Economy could exceed £500m per annum.

Obesity has been variously described to us as a ‘well established epidemic’, a ‘tsunami’, a ‘crisis’ and a ‘population time bomb’. It is a problem that will have an enormous impact, not just on the health of the population, but something that threatens to engulf the entire health service and it will have a very serious impact on society and the economy. For many people obesity is seen primarily as a vanity or aesthetic issue. However, it has very serious and life-threatening health implications through a wide range of conditions, such as heart disease, type 2 diabetes, some forms of cancer, and high blood pressure. We were told that obesity could cause the present generation growing up to have a shorter life span than their parents.

In this report the Committee looked at both the current strategic approach to the prevention of obesity and the availability of weight management or other services to deal with obesity related ill health.

Prevention

To date, no country in the world has been able to develop an overall strategic approach that has significantly reduced obesity prevalence. However, the recent development of the Healthy Weight, Health Lives strategy in England, represents the first national population-wide strategy but it is too early yet to judge its effectiveness. It is clear that obesity levels have increased steadily over many years and it will take a long-term response to reverse this trend.

In Northern Ireland the Department of Health has moved away from the Fit Futures initiative, which focussed on tackling obesity in children and young people, and has begun to develop a whole life course approach, similar to the Healthy Weight, Health Lives strategy in England. While we support the development of the life course approach we have concerns that the Fit Futures initiative has not been formally signed off and implemented.

All Departments and sectors have a crucial role to play in tackling obesity and all need to be involved and committed to the development of the new life course strategy. We recommend that the strategy should be jointly led by the health and education Departments, as has happened in England. There must be single strong effective leadership to drive the strategy forward and, given the potential for significant cost benefits and the consequences of failure to invest, it needs to be provided with significant resources.

Most Departments outlined the action they currently undertake relating to obesity. As identified in the Fit Futures initiative the importance of working with children and young people on nutrition and exercise cannot be over emphasised. The Department of Education has a particularly crucial role in this and, while we welcome the action being taken on nutrition in schools, we call on that Department to make PE in schools compulsory and subject to regular monitoring.

We recognise the potential for the draft 10 year Strategy for Sport and Physical Recreation in Northern Ireland, developed by the Department for Culture, Arts and Leisure in 2007/08, to contribute to a reduction in obesity and we call for it to be resourced and implemented without further delay.

While the cause of obesity can be described in simple terms as an imbalance between the amount we eat and the level of exercise we undertake it cannot be solved by individuals alone. There are many and varied environmental factors, from the accessibility and marketing of food, to transport, planning and other issues that dissuade a healthy diet and physical exercise and these must be tackled. Referred to as the ‘obesogenic environment’, its influence and impact is not widely understood or adequately addressed.

Other issues dealt with in the report include, the role of the new Public Health Agency, the role of local authorities, the potentially positive and negative roles of the media, as well as the need for a community approach and the need to tackle health inequalities. We also identify the need for better co-ordinated research and more representative and reliable data collection.

Weight Management Services

We are very concerned to learn about the current levels of obesity related ill health throughout Northern Ireland and particularly by the number of severely obese patients for whom lifestyle and drugs have failed. These patients now face the prospect of bariatric surgery and the subsequent need for lifelong medical follow-up treatment. We are gravely concerned at the dearth of services at primary and secondary level to deal with those who have serious medical conditions related to severe obesity and the absence of any services to prevent further weight gain in patients with lower degrees of overweight.

We witnessed the frustration of frontline clinicians who told us that services designed to address specific clinical conditions, such as diabetes, cannot adequately address the needs of obese patients. The absence of effective interventions for children with obesity was also highlighted to the Committee.

It is estimated that as many as 50,000 people in Northern Ireland may be eligible for bariatric surgery and this service is currently not provided within Northern Ireland. Last year around 80 people were referred for bariatric surgery to Great Britain. It has been estimated that the cost of treating just 1,000 patients and providing the necessary medical follow-up could be around £10 -£15 million.

On the positive side we recognise that small weight losses do produce health gains and research shows that even a modest reduction in weight of 10% can have a significant impact on a patient’s health. Further delay in providing a comprehensive range of appropriate weight management services will result in greater long term costs. An urgent review to develop such a range of services must be undertaken now.