Abstract
BackgroundObesity is a leading risk for poor health outcomes in England. We examined best- and worst-case scenarios for the future trajectory of the obesity epidemic.MethodsTaking the last 27 years of Health Survey for England data, we determined both position and shape of the adult body mass index (BMI) distribution and projected these parameters 20 years forward in time. For the best-case scenario, we fitted linear models, allowing for a quadratic relationship between the outcome variable and time, to reflect a potential reversal in upwards trends. For the worst-case scenario, we fitted non-linear models that applied an exponential function to reflect a potential flattening of trends over time. Best-fitting models were identified using Monte Carlo cross-validation on 1991–2014 data, and predictions of population prevalence across five BMI categories were then validated using 2015–17 data.ResultsBoth linear and non-linear models showed a close fit to observed data (mean absolute error <2%). In the best-case scenario, the proportion of the population at increased risk (BMI≥25kg/m2) is predicted to fall from 66% in 2017 to 53% (95% confidence interval: 41% to 64%) in 2035. In the worst-case scenario, this proportion is likely to remain relatively stable overall– 64% (37% to 90%) in 2035 –but with an increasing proportion of the population at highest risk (BMI≥35kg/m2).ConclusionsWhile obesity prediction depends on chosen modelling methods, even under optimistic assumptions it is likely that the majority of the English population will still be at increased risk of disease due to their weight until at least 2035, without greater allocation of resources to effective interventions.
Highlights
The last 30 to 40 years has seen a rapid rise in the prevalence of obesity worldwide
In the best-case scenario, the proportion of the population at increased risk (BMI 25kg/m2) is predicted to fall from 66% in 2017 to 53% (95% confidence interval: 41% to 64%) in 2035
While obesity prediction depends on chosen modelling methods, even under optimistic assumptions it is likely that the majority of the English population will still be at increased risk of disease due to their weight until at least 2035, without greater allocation of resources to effective interventions
Summary
The last 30 to 40 years has seen a rapid rise in the prevalence of obesity worldwide. A problem seen only in high income countries, obesity is a leading risk factor for disease in all regions of the world [1]. Recent global modelling suggests that the rapid rises in obesity may be slowing in high-income, English-speaking countries, where epidemics first emerged [2]. Observation of obesity measures in the annual Health Survey for England suggest that this slowdown may be occurring in England [3]. We examine all available Health Survey for England data, from 1991 to 2017, fitting and validating models to simulate the changing distribution of body mass index (BMI) in the English population over time. Obesity is a leading risk for poor health outcomes in England.
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