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

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re&

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Hum

ber

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idla

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idla

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on

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ast

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est

Per

cent

age

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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

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%

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

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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

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hear

ing

disa

bilit

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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