The HSE & Obesity Research: The HSE & Obesity Research:
Past Success & Future Past Success & Future PossibilitiesPossibilities
Dr Louisa EllsLecturer in Research &
Obesity Lead for the North East Public Health Observatory
BackgroundBackground
• Obesity is a public health priority• Consequences of obesity are serious:
– Pulmonary: eg Sleep apnoea and asthma– Orthopaedic: eg increased fractures– Gastroentrological: eg fatty liver disease– Endocrine: eg type II diabetes, menstrual abnormalities– Cardiovascular: eg hypertension and dyslipidaemia– Inflammatory: eg raised C-reactive protein– Psychological and social: eg stigmatisation and reduced
self-esteem.
Importance of national surveys!
Data from national surveys can be used to monitor prevalence and develop
appropriate public health interventions
HSE: Obesity Prevalence – HSE: Obesity Prevalence – National Adult DataNational Adult Data
0
5
10
15
20
25
30
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
% B
MI>
30
men
women
0
5
10
15
20
25
30
North East North West Yorkshire& the
Humber
EastMidlands
WestMidlands
EastEngland
London South East SouthWest
Per
cent
age
obes
e
men women
England men
England women
HSE: Obesity Prevalence – HSE: Obesity Prevalence – Regional Adult DataRegional Adult Data
Source: HSE 2001-2
0
2
4
6
8
10
12
14
16
18
1995 1996 1997 1998 1999-2000
2001 2002 2003 2004
Est
imat
ed %
ob
ese
HSE: Obesity Prevalence – HSE: Obesity Prevalence – National Child Data (<11yrs)National Child Data (<11yrs)
Important indicator for the PSA target to halt year on year rise in childhood obesity!
0
2
4
6
8
10
12
14
16
18
20
Nor
thE
ast
Nor
thW
est
Yor
kshi
re&
the
Hum
ber
Eas
tM
idla
nds
Wes
tM
idla
nds
Eas
tE
ngla
nd
Lond
on
Sou
thE
ast
Sou
thW
est
Per
cent
age
obes
e
HSE: Obesity Prevalence – HSE: Obesity Prevalence – Regional Child Data (<11yrs)Regional Child Data (<11yrs)
Source: HSE 2001-2
• Factors contributing to obesity:– Energy intake (diet)– Physical activity levels (exercise)– The environment & locality– Social class (poverty)– Disease and disability– Genetics – Ethnic origin– Psychology and behaviour– Birth weight and rate of infant weight gain– Parental obesity
Obesity: A Multi-factorial Obesity: A Multi-factorial DiseaseDisease
Independent associations between weight status &
disability: Results from the Health Survey for
England
J.S.M. Lidstone, L.J.Ells, P.Finn, V.J.Whittaker, J.R.Wilkinson, C.D.Summerbell (2006) Public Health 120(5): 412-417
Past SuccessPast Success
• 2001 HSE found 1 in 20 people to have a severe disability and 22% to be obese.
• Obesity & disability are both important public health issues & any link should present a research priority.
• Much research in this field is limited by a reliance on self-reported height and weight and / or no controlling for confounding variables.
IntroductionIntroduction
• To test for significant associations between overweight/obesity and the presence of a wide range of disabling conditions in adults*
* Controlling for confounders:
sex, age, education, social class, income, smoking status and alcohol consumption
Objective:Objective:
• Data was extracted from the HSE 2001 (disability focus)
• Total sample size: 19,640– 4,429 children– 1,947 no valid BMI– 4,651 incomplete variables= 8,613 included participants for analysis
(56% of the total HSE adult sample, mean age 47.5years SD: 16.9, range: 18-99, 52.8% female)
Methods: SampleMethods: Sample
• Extracted from 3 parts of the survey:– Special module on disability:
Locomotive disability, sight disability, hearing disability, personal care disability, osteoarthritis and allied disorder, arthritis and rheumatism and physical disability (adapted from WHO 1992 long term disability questions)
– Core topic of longstanding illnesses:
Back problems, musculoskeletal illness, respiratory system illness and mental disorders (do you have long standing illness, disability or infirmity?)
– Special module on respiratory problems and allergies:
Asthma (Did a doctor ever tell you that you had asthma?)
Methods: DisabilityMethods: Disability
• Association between weight status and disability was analysed using adjusted odds ratios derived from multivariate logistic regression and represent the increased odds of having a disability in the weight status groups of interest (overweight n=3496, obese n=1415 and morbidly obese n=552) compared to the ideal weight reference group (n=2814)
• All OR were adjusted for: sex, age, education, social class, total household income, smoking status and alcohol consumption
Methods: StatisticsMethods: Statistics
• 3.9% were under weight (BMI <20)
• 32.7% were ideal weight (BMI 20-24.9)
• 40.6% were overweight (BMI 20-29.9)
• 16.4% were obese (BMI 30-34.9)
• 6.4% were morbidly obese (BMI >35)
Results: DescriptivesResults: Descriptives
Results: Prevalence of Results: Prevalence of disabling condition disabling condition
0
10
20
30
40
50
60
70
80
90
100
%
ph
ysic
al d
isa
bility
loco
mo
tive
dis
ab
ility
mu
scu
loske
leta
l
illn
ess
oste
oa
rth
ritis a
nd
allie
d d
iso
rde
rs
art
hri
tis a
nd
rhe
um
atism
ba
ck p
rob
lem
s
asth
ma
resp
ira
tory
syste
m illn
ess
sig
ht d
isa
bility
he
ari
ng
dis
ab
ility
pe
rso
na
l ca
re
dis
ab
ility
me
nta
l d
iso
rde
r
morbidly obese
obese
overweight
ideal weight
Results: AOR for each Results: AOR for each disability by weight groupdisability by weight group
0
2
4
6
8
10
12
14
16
phys
ical
dis
abilit
y
loco
mot
ive
disa
bilit
y
mus
culo
skel
etal
illnes
s
oste
oart
hriti
s an
dal
lied
diso
rder
arth
ritis
and
rheu
mat
ism
back
pro
blem
s
asth
ma
resp
irato
rysy
stem
illn
ess
sigh
t dis
abilit
y
hear
ing
disa
bilit
y
pers
onal
car
edi
sabi
lity
men
tal d
isor
der
morbidly obese BMI>35 (n=552)
obese BMI 30-35 (n=1415)
overweightBMI 25-29 (n=3496)
* * ** * *
** *
**
*
**
* **
*
*p<0.05
• Excess weight is independently associated with an increased risk of many disabling conditions, including physical disability, locomotive disability, musculoskeletal illness, osteoarthritis, arthritis and rheumatism, back problems, asthma, hearing disability and personal care disability.
• No significant effects were found for respiratory illness, sight disability or mental disorders.
Results Summary:Results Summary:
• Self reported disability data.
• Large proportion excluded on grounds of incomplete datasets.
Possible Limitations:Possible Limitations:
• Findings support previous research showing an association between obesity and osteoarthritis, musculoskeletal disorders, locomotive disability and asthma, hearing disability and personal care.
• AOR generally increased with BMI group• Excess weight was not linked to sight disability
(possibly due to small numbers), respiratory and mental illness (possibly due to the breath of these categories within which obesity is linked to a specific disorder eg sleep apnoea in the respiratory group and atypical depression in the mental health group).
Conclusions (1):Conclusions (1):
• Findings warrant further research • PUBLIC HEALTH IMPORTANCE: risks of
musculoskeletal illness, personal care disability and arthritis & rheumatism were significantly elevated even in the overweight category (currently about half of the adult population).
• Obese individuals are at greater risk of disability and individuals with a disability are at greater risk of being obese.
• Is obesity the cause or consequence of disability – the chicken or the egg?
Conclusions (2):Conclusions (2):
• ‘one size fits all’ policies are unlikely to be successful: weight management strategies must be tailored to the needs of individual groups including those with disabilities.
Conclusions (3):Conclusions (3):
• Further research into the association between weight status and disability.
• Investigation into possible causal relationships.
• The need to develop appropriate tailored prevention and intervention programs.
• The need to be inclusive of individuals with disabilities in future data collection events.
Future Research:Future Research:
• Following factors are recorded by the HSE & are used in obesity research:– Energy intake (self reported alcohol, fruit and
vegetable intake)– Physical activity levels (self reported)– Social class – Disease / disability / Medication– Ethnic origin
Future PossibilitiesFuture Possibilities
• Information on the following factors would provide even greater benefit:– Further dietary information (high fat foods e.g.
confectionary consumption, meat consumption).
– Information on vitamin and mineral supplementation.
– Objective assessments of physical activity / fitness levels
– Record stage of pregnancy at BMI measurement
Future Possibilities: Future Possibilities: * * Wish List (1)*Wish List (1)*
– Parental / Familial obesity*.– Birth weight *– Infant feeding e.g. duration and inclusively of
breastfeeding.*– Incidence of maternal obesity & gestational
weight gain.*
– Increased power for further regional analyses.
*Particularly for child data collection
Future Possibilities: Future Possibilities: * * Wish List (2)*Wish List (2)*
Office of National Statistics, Controller of Her
Majesty’s Stationery Office, National Centre for Social Research and UK Data Archive for
providing the HSE dataset.~
Ms Jane Lidstone for her work on this research~
University of Teesside for funding this research
Acknowledgements:Acknowledgements:
Discussion / QuestionsDiscussion / Questions