Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight

Footnotes

1 Overweight includes obese.
2 Scottish Health Survey, 2008 (see Appendix 1 for more information).
3 Body Mass Index ( BMI) is calculated by dividing an individual's weight in kilograms by their height in metres squared. BMI cannot categorise all individuals accurately eg athletes. Waist circumference can be used as an alternative, with better categorisation of body fat; > 80cm women or > 94cm men = overweight; > 88cm women or > 102cm men = obese.
4 Foresight Tackling Obesities: Future Choices - Project Report Government Office for Science. HMSO, 2007.
5 Sturm R & Wells KB. Does obesity contribute as much to morbidity as poverty or smoking? Public Health 2001; 115:229-235.
6 Prospective Studies Collaboration. Body Mass Index and cause specific mortality in 900,000 adults: collaborative analysis of 57 prospective studies. Lancet 2009;373:1083-96.
7 Organisation for Economic Co-operation and Development.
8 OECD Health Working papers No. 45. OECD, March 2009.
9 The methodology and assumptions used to generate this estimate will be published separately.
10 McCormick B, Stone I & Corporate Analytical Team. Economic costs of obesity and the case for government intervention. Obesity reviews 2007, 8 (Supplement 1), 161-4.
11 A recent FOI request in Scotland identified £4.4 million spend on items such as extra wide beds in 10 of the 14 territorial boards.
12 Sturm R. Increases in morbid obesity in the USA: 2000 - 2005. Public Health 121 (7):492-296 (2007).
13 OECD Health Working papers No. 45. OECD, March 2009.
14 Extrapolated from figures from the FSA on energy balance. The increase in kcals for both the male and female populations have been averaged and extrapolated to a year.
15 Swinburn BA et al. Estimating the change in energy flux that characterize the rise in obesity prevalence. Am J Clin Nutr 2009;89:1723-8.
16 Healy GN et al. Objectively measured sedentary time, physical activity and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2008; 31:369-371.
17 Jackson DM, Djafarian K, Stewart J & Speakman JR. Increased television viewing is associated with elevated body fatness but not with lower total energy expenditure in children. Am J of Clin Nutr 2009; 89: 1031-6.
18 Note that this is twice the amount of activity currently recommended for health gain or maintaining healthy weight. This may change as new evidence emerges.
19 Crombie et al. Targets to tackle the obesity epidemic: a review of twelve developed countries. Public Health Nutrition 2008;12:406-413.
20 During the 'Special Period' of five years in the 1990s levels of per capita daily energy intake fell gradually from 2899 kcal to 1863 kcal and daily energy expenditure increased, so that the proportion of physically active adults increased from 30% to 67%. This resulted in the prevalence of obesity falling from 14% to 7%, the proportion of those with normal weight increasing from 60 to 66% and the rates of death from the consequences of obesity falling significantly in the following years. (France M, Ordunez P, Caballero B & Cooper RS. Obesity reduction and its possible consequences: what can we learn from Cuba's Special Period? CMJ 2008;178:1032-1034).
21 OECD Health Working papers No. 45. OECD, March 2009.
22 The Scottish Retailers' Forum is the Government's leadership group with major retailers and supporting organisations.
23 By reformulation we mean the reduction of salt, saturated fat and sugar levels in food products.
24 Scottish Health Survey 2008
25 Scottish Household Survey 2007
26 For example, Von Kries R et al. Breastfeeding and obesity: cross sectional study. BMJ 1999;319:147-50, Gillman MW et al. Risk of overweight among adolescents who were breastfed as infants. JAMA 2001;285:2461-7, Singhal A, Lanigan J. Breastfeeding, early growth and later obesity. Obesity Reviews 2007;8 (Suppl 1):51-54.
27 Wilson AC, Forsyth JS, Greene SA et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998;316:21-5.
28 Figures from the British Heart Foundation.
29 Effects include higher mental concentration, improved complex decision making, improved reaction time and enhanced full efficiency periods.
30 Annual Population Survey (boosted annual Labour Force Survey). Jan-Dec 2008.
31 High level summary of statistics. Trends for business, enterprise and energy.
32 ScotPHN Report 2007.
33 The National Planning Forum has been established as a high level NHS/ SGHD group to secure greater joint ownership of the national planning agenda. The Forum includes members from all 22 Health Boards, as well as representatives from the Academy of Medical Royal Colleges, the Scottish Association of Medical Directors, NHS Board HR and Finance Directors and now also the Scottish Partnership Forum and Directors of Public Health.
34 Scottish Intercollegiate Guidelines Network. Obesity in adults and children, forthcoming Spring 2010.
35 Haslam D, Sattar N, Lean MEJ. Obesity - time to wake up. ABC of Obesity. BMJ 333:640-642 (2006).
36 The 1995 and 1998 surveys only covered 16-64 and 16-74 respectively.
37 Prospective Studies Collaboration. Body mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;373; 1083-96.
38 NHSScotland cost of obesity. Analytical Services Division, Scottish Government.
39 McCormick B, Stone I & Corporate Analytical Team. Economic costs of obesity and the case for government intervention. Obesity reviews 2007, 8 (Suppl 1), 161-4.
40 Morris S. The Impact of Obesity on employment in England. London Tanaka Business School, 2004.
41 Morris S. Body Mass index and occupational attainment. London, Tanaka Business School, 2005.
42 Fernie JE et al. BMI, obesity and sickness absence in the Whitehall II study. Obesity 2007,15,1554-64.
43 House of Commons Health Select Committee. Obesity: Third report of Session 2003/4. The Stationery Office: London 2004.
44 2007 Annual survey of Hours & Earnings, National Statistics.
45 Prentice AM. Obesity - the inevitable penalty of civilisation? British Medical Bulletin 1997;53:229-237.
46 House of Commons Health Committee. Obesity: Third report of Session 2003-4 Vol 1. HMSO: London, 2004.
47 National Audit office. Tackling obesity in England. HMSO: London, 2001.
48 Finkelstien EA, Ruhm CJ and Kosa KM. Economic causes and consequences of obesity. Annu.Rev. Public Health 2005:26:239-57.
49 These figures are based on 16-64 age group to give the closest match to the USA data which is based on 20-74 year olds.
50 Sturm R. Increases in morbid obesity in the USA 2000-2005. Public Health 2007; 121:492-496.
51 O'Flaherty M et al. Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study. BMJ 2009;339.
52 Wild S et al. Impact Of Deprivation On Cardiovascular Risk Factors in People With Diabetes: An Observational Study Diabetes Medicine. 2008 Feb 25(2):194-9.
53 Better Coronary Heart Disease and Stroke Care. Scottish Government, Edinburgh, 2008.
54 A target for breastfeeding was included but this has been superseded by a HEAT target.
55 http://www.scotland.gov.uk/About/scotPerforms/indicators