Context
Overweight and obesity are chronic, relapsing and progressive conditions characterised by excess body fat. They are associated with an increased risk of morbidity and mortality. The 2021 Health Survey for England estimated the prevalence of obesity in adults in England to be 26%, with overweight affecting a further 38%. The same survey estimated that 10.1% of children aged 4 to 5 were living with obesity, with a further 12.1% living with overweight. At age 10 to 11, 23.4% were living with obesity and 14.3% living with overweight.
Government estimates indicate that the current costs of obesity in the UK are £6.5 billion to the NHS and £27 billion to wider society. It is estimated that obesity is responsible for more than 30,000 deaths each year. On average, obesity reduces lifespan by 9 years, preventing many people from reaching retirement age. It increases the risk of developing many diseases. For example people living with obesity are 3 times more likely to develop colon cancer, more than 2.5 times more likely to develop high blood pressure (a risk factor for heart disease) and 5 times more likely to develop type 2 diabetes. Given the financial implications of overweight and obesity to society and the far worse health and social care outcomes, most interventions that address overweight and obesity are likely to be cost effective or even cost saving from the wider public sector perspective.
Evidence shows that the greatest rates of adult obesity are seen in the most deprived parts of the country. The difference is particularly pronounced for women. In the most deprived areas 39% of women are living with obesity, compared with 22% in the least deprived areas. This disparity highlights the importance of identification, and subsequent uptake of overweight and obesity management services, to reduce health inequalities.
Currently, people who would benefit from overweight and obesity management interventions are identified opportunistically. The lack of active case finding may mean that conditions such as type 2 diabetes are under-diagnosed in people of ethnic minority backgrounds whose risk is increased at a lower BMI and waist circumference.
Standard management of overweight and obesity includes advice on diet and physical activity, behaviour-change strategies. Management may also include medicines and surgery. New evidence identified since this guideline was first published may help to refine interventions that address diet, physical activity and behaviour change, and inform implementation in specific settings.