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Obesity is a global epidemic. Currently, more than half a billion adults worldwide are estimated to be overweight or obese yet this problem is entirely preventable. Excess weight costs the NHS over £5 billion each year and is associated with an increased risk of obesity-related disease (e.g. type 2 diabetes and heart disease). University of Glasgow researchers defined two `Action Levels' for waist circumference to indicate the point when an individual needs to initiate weight loss to reduce their risk of disease. These Action Levels have been incorporated into national and international clinical guidelines for the diagnoses and management of obesity-related disease, and have provided the foundation for public-health campaigns and policies worldwide, designed to reduce the burdens of chronic ill-health that follow obesity.
Childhood obesity is a national problem but it is a problem even more keenly felt in the West Midlands where statistics show the percentage of children classified as obese is higher than the national average. Research demonstrating that simple measures such as waist circumference and body mass index (BMI) are every bit as effective as complex and expensive measuring processes such as magnetic resonance imaging (MRI) scans in identifying high risk obese children has fed into the evaluation and subsequent improvement of child weight management programmes in the region and more widely in the UK. It also informed the development of an obesity strategy and action plan for Worcestershire for the period 2008-11.
Professors O'Rahilly and Farooqi were the first to identify monogenic causes of severe childhood obesity, leading the way for identification of additional genetic causes by their group and others. Their research led to the development of diagnostic tests for these conditions, which are now an accepted element of clinical guidelines around the world. This work led to the understanding that inherited disorders of appetitive drive can underlie human obesity which has altered attitudes to obesity and had an impact on the management of families with these conditions. Their research also led directly to a highly effective therapy for congenital leptin deficiency which reverses the severe obesity associated with this condition and associated endocrine and immunological deficiencies. This treatment is now available throughout the UK and in specialist centres worldwide.
Obesity in the UK is a growing problem for individuals and for NHS resources.a,f There is evidence to suggest that the Government's healthy living messages are failing to get through, as figures show obesity levels have almost doubled in 14 years.a,f More than half the adult population are now overweight or obese.b The report led by Waumsley that reviews the evidence base for psychological approaches to obesity and provides guidelines for practitioners forms the basis for this impact case. This influential research on secondary data was commissioned by the British Psychological Society (BPS) and remains their position statement on obesity, and features in advice to the general public on obesity in adults. As lead, Waumsley participated in a House of Lords cross-party seminar on behaviour change and obesity, has been an expert discussant on obesity at the BPS Annual Conference, and will lead the BPS's response to the National Institute for Health and Care Excellence (NICE) consultation on Overweight and obese adults: lifestyle weight management.
Clinical research conducted at the UCL Institute of Child Health between 1998 and 2011 under the direction of Professors Alan Lucas and Atul Singhal showed that a slower rate of infant weight gain had long-term benefits to reduce the risk of obesity and cardiovascular disease. This contradicted the accepted view, which favoured the promotion of rapid weight gain in infancy. This work has had a significant influence on public health policies and initiatives in the UK and elsewhere. It has changed the way infant formulas are made and used. Two new interventions for overweight children have been developed and are helping families around the world.
Research at the UCL Institute of Child Health underpinned the update in 2009 of children's growth charts, which allow for more accurate determination of a child's growth pattern and provide better tools for assessing possible weight problems in children. The new charts are now in universal use in the UK for children from birth to 18 years of age, including preterm babies. Having been quickly adopted, they now account for 90% of all growth chart sales. Modified versions of the charts are in use in Ireland and New Zealand. In the UK they are provided to all new parents as part of the Personal Child Health Record (PCHR) — known as the "red book". They are used in general practice, community paediatrics, general paediatrics and paediatric endocrinology. The most recent charts are for use in children with growth or nutritional problems.
Our sustained impact in obesity treatment began in 1999 with Europe's first residential camp programme for overweight and obese children. Our impact on treatment grew sufficiently to warrant the formation of a dedicated spin out company, MoreLife. Underpinned by our research, MoreLife is an award winning, Department of Health accredited provider, delivering specialist weight management services, both nationally and internationally. Through NHS and other contracts we are delivering high quality, evidence based services to over 3,500 adults and 3000 young people per year. Our impact on the policy and practice of obesity treatment and public understanding continues in the UK and has been extended internationally.
Research in the area of childhood obesity has focussed on the development, implementation and evaluation of interventions. The APPLES Study (1996-99), the first UK school-based RCT was key in contributing to the evidence-base through wide dissemination including 3 BMJ (2001) publications, cited in NICE (2006) and WHO guidance (2004). Collaborations with academics, practitioners and the RCPCH led to the development of further community-based obesity treatment and prevention interventions including WATCH IT; early programmes e.g. EMPOWER, HELP and HAPPY and more recently innovative school-based initiatives involving school gardening. There is evidence of results being disseminated and influencing research, practice and policy.
Every child born in the UK receives a set of growth charts with their Personal Child Health Record. These charts have been developed and designed by Professor Charlotte Wright, University of Glasgow. Growth monitoring is fundamental for the assessment of health and the identification of growth abnormalities in children, and growth charts are used to interpret these measurements. The design of child growth charts and the instructions for their use influences perceptions of normality and drives screening activity for conditions such as failure to thrive or obesity. The newly developed UK child growth charts more accurately reflect healthy growth patterns than previous versions, and feature a range of design improvements and evidence-based, straightforward instructions for use. They have been endorsed by the key professional societies for child health and nutrition in the UK, and are being used by health professionals and parents throughout the UK, Ireland and New Zealand.
The Counterweight Programme (CW) is a structured model for obesity management in primary care settings. CW has made substantial changes to clinical and public health guidelines and to practice nationally and internationally: the Programme has since been adopted in Primary Care Galway, Ireland and for a government funded trial in Ontario, Canada. The creation of a spin out company, Counterweight Ltd, in 2011 resulted in concomitant job creation and significant commercial activity, with CW now being used in private healthcare, pharmacies, fitness clubs, and by freelance healthcare professionals. Moreover, the programme has significantly benefited the health and welfare of obese patients and improved care practice by increasing quality, accessibility and cost effectiveness of weight management services in the UK.