1. The HSE & Obesity Research: Past Success & Future Possibilities Dr Louisa Ells Lecturer in Research & Obesity Lead for the North East Public Health Observatory

2. Background 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!

3. Data from national surveys can be used to monitor prevalence and develop appropriate public health interventions

4. HSE: Obesity Prevalence – National Adult Data

5. HSE: Obesity Prevalence – Regional Adult Data Source: HSE 2001-2

6. HSE: Obesity Prevalence – National Child Data (<11yrs) Important indicator for the PSA target to halt year on year rise in childhood obesity!

7. HSE: Obesity Prevalence – Regional Child Data (<11yrs) Source: HSE 2001-2

8. 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 Disease

9. 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 Success

10. 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. Introduction

11. 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:

12. 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: Sample

13. 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: Disability

14. 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: Statistics

15. 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: Descriptives

16. Results: Prevalence of disabling condition

17. Results: AOR for each disability by weight group * * * *** * * * * * * * * * * * * *p<0.05

18. 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:

19. Self reported disability data. Large proportion excluded on grounds of incomplete datasets. Possible Limitations:

20. 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):

21. 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):

22. 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):

23. 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:

24. 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 Possibilities

25. 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: * Wish List (1)*

26. –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: * Wish List (2)*

27. Office of National Statistics, Controller of Her Majestys 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:

28. Discussion / Questions