In order to tackle obesity we need to understand what causes it.

1. The main suspects

Many causes of obesity have been suggested. The most popular is eating too much and moving too little.

Other suggested causes include our genes, some medical conditions (like an underactive thyroid gland), some medications (like some anti depressants), emotional factors, age, alcohol and lack of sleep.

2. The test of time

One useful check for any suggested cause is the test of time. What has changed significantly since the early 1980’s, when obesity rates first began their rapid rise in the UK, which might potentially explain that rise?

For example:

• Human genes are unlikely to have changed significantly since the 1980’s.

There may be some people with a pre-existing genetic predisposition to excess weight when food is plentifully available – but if so, it is likely to be the unprecedented availability of calories which is the trigger.

• The fact that humans age and grow old isn’t new. It has been true throughout human history.
• Levels of unhappiness, stress and depression among adults probably haven't risen dramatically (despite media suggestions to the contrary). For example suicide rates have fallen.
• Research suggests that it is obesity which triggers thyroid problems rather than the other way round.  
• Overall levels of physical activity are lower than in the 1960's but have remained about the same since the 1980's..
• International sleep surveys show no obvious correlation between length of sleep and obesity levels in the different countries.
• The most rapid increase in anti-depressant prescriptions occurred when levels of obesity were levelling off, suggesting this may be a factor for some individuals but is not a significant factor overall. 

3. The test of time – is alcohol a possible factor?

• Alcohol consumption rose during the 1980’s and 1990’s but has since fallen back over the last ten years or so. This roughly correlates with obesity levels which rose during the 80’s and 90’s but have since begun to level off (but not fall).

Alcoholics are rarely overweight, as they tend to neglect eating and the alcohol affects the way their liver digests food. However, regular alcohol consumption alongside food tends to add ‘hidden calories’ so is a possible contributory factor.

4. The test of time – What has changed significantly?

• What we eat and drink, when, where and how have all seen significant changes since the early 1980’s, so could be a potential cause.

Examples include significant increases in:

-      The availability and consumption of carbonated drinks and snacks (often consumed in addition to the main meals of the day - for example with 2 litre bottles of Coca Cola first introduced in 1978)

-      Ready meals (following the introduction of the microwave in 1984)

-      Takeaways and meals in fast food outlets (now a £30 billion a year market in the UK). 

What these trends have in common is a rise in food which is calorie rich but nutritionally poor (and often relatively cheap and widely available) - potentially leading to people becoming overweight but undernourished.

• The way we experience the early months and years of life has also changed - for instance fewer natural births, less breastfeeding and more babies born to obese parents. This could also be a potential cause, as the early years of life are increasingly being seen as a critical period. 
  

5. Research findings

Research is increasingly confirming that, although exercise has many health benefits and has a part to play in helping manage weight, it is what people eat and how much that is primarily causing obesity – with factors in the early months and years of life also important.

The key points here are that:  

Food high in sugar, salt, fat and refined carbohydrates is particularly likely to lead to weight gain.

This appears to be because:

• They are calorie rich (so you consume more calories for a given volume of food)
• They don’t make you feel full for long (increasing the risk of overeating)
• Where sugar is concerned this may be ‘hidden’ (so people don’t realise how much they are consuming)
• They don’t contain much fibre (which could help control weight) and they reduce the diversity of our gut microbiota (which is now being suggested as another factor influencing weight).
• Where such food is relatively cheap and readily available this is likely to be a further factor leading to overconsumption.
• Salt contributes to weight gain in a different way. It increases thirst, leading to increased fluid consumption – and where the fluid is sugar sweetened beverages this contributes to weight gain as described earlier.

Conversely vegetables, fruit and whole grains are particularly likely to help control weight.

This appears to be because they are pretty much opposite in the way they work i.e. they

• Are not so calorie dense
• Make you feel fuller longer
• Don’t containing hidden ingredients likely to increase weight
• Contain fibre and encourage more diverse gut microbiota.

As regards the early months and years of life a range of interventions were proposed by Professor Mary Rudolf, in order to help tackle obesity, based on her review of the research i.e.

• Encourage responsive feeding.
• Encourage positive family mealtimes
• Find alternatives to food for comfort and to encourage good behaviour
• Encourage exclusive breast feeding for 6 months
• Ensure portion sizes are appropriate for age
• Increase acceptance of healthy foods – including fruit and vegetables
• Reduce availability and accessibility of energy dense foods in the home
• Reduce consumption of sweet drinks and increase consumption of water

These again focus on the importance of food but shift the focus to the earliest months of life, when food tastes, habits and preferences are being established. 

Some researchers would start the process even earlier. They argue that what mothers eat when they are pregnant and how much and whether or not they themselves are obese has significant influence on how their baby will develop.   

Conclusions

Research findings and the test of time agree on the key points:

• A diet high in sugar, salt, fat and refined carbohydrates increases the risk of obesity.
• A diet rich in vegetables, fruit and whole grains reduces the risk of obesity.
• Exercise has many health benefits and can help manage our weight - but what we eat and how much we eat is even more important.
• The first thousand days of life (from conception onwards) are particularly important in establishing food tastes, habits and preferences – meaning parents have a particularly important role to play.

Tackling Childhood Obesity - The Next Steps

In April 2018 we submitted our recommendations to the House of Commons Health and Social Care Committee.

You can see our recommendations here. 

In its May 2018 report the Committee referred to some of the evidence we provided, about initiatives that have successfully reduced childhood obesity levels in parts of France, Holland and Denmark (see paragraph 13). In fact the Committee agreed with our analysis on three important points: 

1. To tackle obesity in the UK we need a 'whole system' approach, along the lines employed in parts of France, Holland and Denmark. 

2. Early years intervention is important, including the value of breastfeeding. 

3. What people eat is the main issue. Exercise is good for health and should be encouraged but if we want to tackle obesity we need policies to reduce the consumption of products high in sugar, salt and fat - and to increase the consumption of vegetables, fruit and wholegrains.    

We will continue to campaign to reduce levels of childhood obesity, both in our own right and as a member of the national Obesity Health Alliance. In particular we will continue to campaign for the mass production of healthier food, to seek to tackle the issue at source. As we identified in our 2015 report Healthy and Wealthy?we believe this is a Win Win approach. Reports from consumer research companies suggest this in the long term commercial interests of food companies - and it is clearly in the best interests of public health.